Full Text Available ED Toffanello,1 EM Inelmen,1 A Imoscopi,1 E Perissinotto,2 A Coin,1 F Miotto,1 LM Donini,3 D Cucinotta,4 M Barbagallo,5 E Manzato,1 G Sergi11Department of Medical and Surgical Sciences, Geriatrics Division and University of Padova, Padova, 2Department of Environmental Medicine and Public Health, University of Padua, Padua, Italy; 3Department of Medical Physiopathology (Food Science Section, University of Roma, La Sapienza, Roma, 4S Orsola Malpighi Hospital, Bologna, 5Geriatric Unit, Department of Internal Medicine and Emerging Diseases, University of Palermo, Palermo, ItalyBackground: Loss of the sense of taste is common among older people. Morbidities and polypharmacy may contribute to the age-related decline in gustatory function. The aims of the present study were to investigate taste perception in elderly hospitalized patients by comparing their taste recognition thresholds with those of healthy, free-living elderly individuals and to identify potential determinants of taste loss.Methods: The participants in this observational study were 55 elderly patients hospitalized in the acute geriatric section of the Department of Medical and Surgical Sciences at Padova University and 41 free-living individuals aged older than 65 years, randomly recruited from elderly people attending mild fitness programs at public gymnasiums in Padova. Data were collected on nutrition, health, cognitive, and functional status for all participants. Gustatory capabilities were assessed using aqueous solutions of sucrose, sodium chloride, citric acid, and quinine hydrochloride (representing sweet, salty, sour, and bitter stimuli, respectively, and taste recognition thresholds were measured in both groups.Results: In comparison with the free-living elderly subjects, those in hospital were significantly less able to recognize the taste of citric acid (P < 0.05. Low citric acid sensitivity was independently associated with advanced age (≥75 years; odds ratio [OR] 3
Jun 1, 2015 ... and Infectious Diseases Hospital. HIV infection was confirmed using indirect ... HIV infection affects the serum levels of iron, vitamin A and β-carotene by reducing their levels; hence, dietary supplementation with ... include vitamins such as vitamin A, D, E, K, B and C and minerals such as Iron, iodine, zinc, ...
Abstract. Book Title: Review Manual for Massachusetts General Hospital Handbook of. General Hospital Psychiatry. 5th ed. Book Author: Theodore A. Stern. Pp 121. Philadelphia: Elsevier Mosby. 2004. ISBN 0-323-02768-7.
Full Text Available In Italy a specific surveillance system for zoster does not exist, and thus updated and complete epidemiological data are lacking. The objective of this study was to retrospectively review the national hospital discharge forms database for the period 1999-2005 using the code ICD9-CM053. In the period 1999-2005, 35,328 hospital admissions have been registered with annual means of 4,503 hospitalizations and 543 day-hospital admissions. The great part of hospitalizations (61.9% involved subjects older than 65 years; the mean duration of stay was 8 days. These data, even if restricted to hospitalizations registered at national level, confirm the epidemiological impact of shingles and of its complications.
Müller, Matthias J; Olschinski, Christiane; Kundermann, Bernd; Cabanel, Nicole
Sleep complaints and sleep disturbances are highly prevalent in patients with psychiatric disorders. During hospitalization the patients? condition may be even worse but little is known about the subjective sleep quality in psychiatric hospitals. Thus, we have investigated subjective sleep quality and mean sleep duration in patients with different psychiatric disorders at the end of hospitalization. For a period of one year, inpatients of a psychiatric hospital with diagnosis of substance use...
A hospital's institutional review board is charged with the responsibility of fully protecting the rights of research subjects. In doing so, the board establishes that research protocols are based on sound scientific principles, that benefits to research subjects outweigh the risks, and that the subject's consent is informed and not coerced. Although it has been argued that risk management has no role in the activities of such boards, the literature indicates that risk management and quality assurance principles apply to all areas of the institution, including the activities of the board. The institution must ensure that its researchers and board members are as fully protected as possible from civil and criminal liability and that the integrity of those conducting the research is established and maintained. The institution must also provide sufficient support for the board to conduct its reviews and educate the research community and board members on current and evolving laws and regulations governing human research. Risk prevention and quality assurance strategies should recognize the rights of the research subject as paramount while protecting the institution, its researchers, and the community served.
María Nélida Conejo Pérez
Full Text Available Recent studies have demonstrated therapeutic mild hypothermia improves neurological outcome of patients after suffering an out-of-hospital cardiac arrest.Other studies in animals suggest that the sooner hypothermia is started after return of spontaneous circulation, the lower neurological symptoms are suffered by patients.The aim of this work is to know the efficiency of the therapeutic moderated hipotermia after the cardiopulmonar resuscitation realized extra hospitable.Methods: We made a literature search in Medline (Pubmed, Cinahl, Cuiden, Cochrane Library and the Joanna Briggs Institute, combining mesh and free terms; and searched in the journals Circulation, Resuscitation and Emergency Medicine Journal manually last year. We selected systematic reviews and randomized and nonrandomized clinical trials which had contrasted in-hospital and out-of-hospital TMH with over 18 years patients.Results: Only 5 articles met the inclusion criteria of the 35 selected: four randomized clinical trials and one nonrandomized. They were then subjected to a critical methodological evaluation (CASPe and statistic evaluation (IDIPaz.Conclusions: Pre hospital TMH is an effective and safe technique in comatose patients after being resuscitated from cardiac arrest, improving the neurological status at hospital discharge.
Xu, Huan; Liu, Yuxiu; Su, Yi; Zhou, Linming; Yang, Guobin; Yi, Xueming
This is a study that describes the prevalence and patterns of constructing virtual subject in hospital in China. It is a high risk for hospital to invest greatly for innovation of hospital disciplines, so we want to establish some new comprehensive platforms which based on some informational systems that involve diseases treatment, medical research, diseases recoveries, prevent diseases and medicine developments. But the virtual subject platform could afford a superior chance for cooperation between interior and exterior medical organizations. This article discusses the subject's structure, the construction's principles, cooperation advantages and clarifies that the platform could boost the efficiency of hospital to do some medical research.
Moriana, Miriam; Civera, Miguel; Artero, Ana; Real, Jose T; Caro, Juan; Ascaso, Juan F; Martinez-Valls, Jose F
Hospital malnutrition is a highly prevalent problem that affects patient morbidity and mortality resulting in longer hospital stays and increased healthcare costs. Although there is no single nutritional screening method, subjective global assessment (SGA) may be a useful, inexpensive, and easily reproducible tool. A cross-sectional, observational, randomized study was conducted in 197 patients in a tertiary hospital. SGA, anthropometric data, and biochemical parameters were used to assess the nutritional status of study patients. Fifty percent of subjects were malnourished according to SGA. A higher prevalence of malnutrition was found in medical (53%) as compared to surgical departments (47%). Half the subjects (50%) had malnutrition by SGA, but only 37.8% received nutritional treatment during their hospital stay. Mean hospital stay was longer for patients malnourished (13.5 days) or at risk of malnutrition (12.1 days) as compared to well nourished subjects (6.97 days). SGA significantly correlated (Pmalnutrition parameters. Prevalence of hospital malnutrition is very high in both medical and surgical departments and is inadequately treated. SGA is a useful tool for screening hospital malnutrition because of its high degree of correlation with anthropometric and biochemical parameters. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.
Andrews, Jeff; Sathe, Nila A; Krishnaswami, Shanthi; McPheeters, Melissa L
Nonpharmacologic airway clearance techniques are used to reduce the sequelae of obstructive secretions. We systematically reviewed comparative studies of nonpharmacologic interventions that health professionals can employ to achieve mucus clearance in hospitalized or postoperative patients without cystic fibrosis, over the age of 12 months. We searched MEDLINE and other databases from 1990 to 2012 to identify relevant literature. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers also independently extracted data regarding subject and intervention characteristics and outcomes, and assigned overall quality ratings. The 32 studies meeting the review criteria included 24 randomized controlled trials, 7 crossover randomized controlled trials, and one prospective cohort study. Studies were typically small and together included a total of 2,453 subjects (mean 76/study). Studies generally examined chest physical therapy/physiotherapy modalities in postoperative or critically ill subjects or those with COPD. Interventions, comparators, and populations varied considerably across studies, hampering our ability to draw firm conclusions. Interventions, including conventional chest physical therapy/physiotherapy, intrapulmonary percussive ventilation, and positive expiratory pressure, typically provided small benefits in pulmonary function, gas exchange, oxygenation, and need for/duration of ventilation, among other outcomes, but differences between groups were generally small and not significant. Harms of the techniques were not consistently reported, though airway clearance techniques were generally considered safe in studies that did comment on adverse effects. Further research with clearly characterized populations and interventions is needed to understand the potential benefits and harms of these techniques.
Skinner, Elizabeth H; Haines, Kimberley J; Berney, Sue; Warrillow, Stephen; Harrold, Meg; Denehy, Linda
Physiotherapists play an important role in the provision of multidisciplinary team-based care in the ICU. No studies have reported usual care respiratory management or usual care on the wards following ICU discharge by these providers. This study aimed to investigate usual care physiotherapy for ICU subjects during acute hospitalization. One hundred subjects were recruited for an observational study from a tertiary Australian ICU. The frequency and type of documented physiotherapist assessment and treatment were extracted retrospectively from medical records. The sample had median (interquartile range) APACHE II score of 17 (13-21) and was mostly male with a median (interquartile range) age of 61 (49-73) y. Physiotherapists reviewed 94% of subjects in the ICU (median of 5 [3-9] occasions, median stay of 4.3 [3-7] d) and 89% of subjects in acute wards (median of 6 [2-12] occasions, median stay of 13.3 [6-28] d). Positioning, ventilator lung hyperinflation, and suctioning were the most frequently performed respiratory care activities in the ICU. The time from ICU admission until ambulation from the bed with a physiotherapist had a median of 5 (3-8) d. The average ambulation distance per treatment had a median of 0 (0-60) m in the ICU and 44 (8-78) m in the acute wards. Adverse event rates were 3.5% in the ICU and 1.8% on the wards. Subjects received a higher frequency of physiotherapy in the ICU than on acute wards. Consensus is required to ensure consistency in data collection internationally to facilitate comparison of outcomes. Copyright © 2015 by Daedalus Enterprises.
Yvon, Marianne; Festa, Carole; Hanen, Sylvie; Mercuel, Alain; Monteiro, Michel
A social experiment and pilot project funded by the French Directorate General of Social Cohesion aimed at providing legal aid services ("legal empowerment and mental health") has been conducted since 2009 in three healthcare institutions in Paris (France): the Centre Hospitalier Sainte-Anne, the Groupe Public de Santé Perray-Vaucluse, and the Hôpital Tenon (psychotraumatology unit). Lasting until 2012 and piloted by the NGO Droits d'Urgence, the initiative aims to promote the legal empowerment of socially excluded people suffering from psychiatric or mental disorders and to facilitate access to care. The initiative operates on two levels, providing legal support to vulnerable people and offering legal expertise and advice to medical and social staff. An ad-hoc intervention approach was designed to ensure the implementation of the initiative based on several combined tools: legal aid, technical committees, awareness-raising activities, and pooling of legal resources and information. Developed across the three institutions, this integrated and subsidiary initiative improves our understanding of the complex circumstances of disempowered people ? who are often faced with overlapping social, medical, administrative and legal difficulties ? and helps to take into account their vulnerabilities. The cross-professional and cross-boundary system promoted by this initiative involves medical staff, social workers and lawyers around patients viewed as both actors and legal subjects.
Buttigieg, Sandra C; Pace, Adriana; Rathert, Cheryl
Purpose The purpose of this paper is to give a comprehensive and updated analysis of the available literature on hospital dashboards. Design/methodology/approach A search of the current literature was performed by searching electronic databases, including Google Scholar, EBSCO and Medline, as well as books. Findings In all, 48 manuscripts consisting of peer reviewed articles, conference proceedings, case reports and text books were included in this review. Practical implications Despite the numerous advantages of performance dashboards, several authors have mentioned a number of challenges. It was evident from the literature that any setting requires significant effort, especially to ensure the quality of data being collected. In fact, significant investment, both in terms of financial and human resources, is required to achieve an effective dashboard. Furthermore, most of the studies available in the literature were individual case reports or anecdotal accounts rather than empirical studies. Thus, further research is required to ascertain the effectiveness of performance dashboards. In view of these findings, each organisation should make its own decisions whether or not to adopt performance dashboards. Originality/value Most of the literature is fragmented as it reports the use of different types of dashboards, namely strategic, tactical and operational, as separate tools. This literature review contributes to knowledge as it brings together the different types of dashboards and the cascading effect of one dashboard onto another in order to achieve and retain organisational alignment with the overall strategic goals.
Kehayova, Nushka; Bolashikov, Zhecho Dimitrov; Melikov, Arsen Krikor
A novel method for local hospital bed ventilation, called HBIVCU (Hospital Bed with Integrated Ventilation and Cleansing Unit), was studied in a human subject experiment. The goal of this study was to identify human response to the microenvironment generated by a hospital bed with installed HBIVCU...... and to compare with human response to the micro-environment at a hospital bed without local ventilation. 32 participants took part in two experimental conditions - hospital bed with and without installed HBIVCU. Subject’s votes on the bed microenvironment were collected via standardized questionnaires....... The subjects evaluated the perceived air quality in the ventilated bed as better compared to that in the non-ventilated bed. The whole body thermal sensation (WTS) and acceptability votes were decreasing over time for the non-ventilated bed condition. Significant differences in the local thermal sensation LTS...
McCracken, M J; McIlwain, T F; Fottler, M D
One of the major challenges facing health services management researchers is the measurement of various aspects of organizational performance. This challenge is exacerbated by a reluctance of many healthcare organizations to share data with researchers because of a fear of competitor access to these data. Even where objective, reliable and valid measures of organizational performance are available, typically they are available only in aggregate form, rather than for individual organizations. In response to these constraints, researchers have used subjective measures of performance often based on the perception of key executives. This research compares the subjective perceptions of hospital executives to the objective financial performance data of 60 hospitals. While the correlations between the subjective and objective measures vary, return of assets (ROA) and operating margin are the most valid subjective financial measures of hospital performance. Implications for future research are discussed.
V. N. Trubilin
Full Text Available In review presents data of various authors regarding the subjective results excimer laser correction of myopia by LASIK. It was revealed that a group of patients with a high degree of dissatisfaction amounts to 4.6% of the total in all studies. High subjective results are confirmed by the positive dynamics of the «quality of life» of the patient.
Silver, Patty C; Kollef, Marin H; Clinkscale, Darnetta; Watts, Peggy; Kidder, Robin; Eads, Brittany; Bennett, Debbie; Lora, Carolyn; Quartaro, Michael
Patients with COPD often require repeated emergency department visits and hospitalizations for COPD exacerbations. Such readmissions increase health-care costs and expose COPD patients to the added risks of nosocomial infections and increased mortality. To determine whether a respiratory therapist (RT) disease management program could reduce re-hospitalization and emergency department visits, a prospective, single-center, unblinded, randomized trial was performed. We enrolled 428 subjects (214 intervention, 214 control). The primary outcome (combined non-hospitalized emergency department visits and hospital readmissions for a COPD exacerbation during the 6-month follow-up) was similar for the study groups (91 vs 159, P = .08). When the 2 components of the primary end point were analyzed individually, the percentage of subjects with non-hospitalized emergency department visits for COPD exacerbations was similar between groups (15.0% vs 15.9%, P = .79). Readmission for a COPD exacerbation was significantly lower in the intervention group (20.1% vs 28.5%, P = .042). The median (interquartile range) duration of hospitalization for a COPD exacerbation was less for the intervention group (5 [3-11] d vs 8 [4-18.5] d, P = .045). In-patient hospital days (306 d vs 523 d, P = .02) and ICU days (17 d vs 53 d, P = .02) due to COPD exacerbations were significantly less for the intervention group. Mortality was similar for both groups (1.4% vs 0.9%, P > .99). Our RT disease management program was associated with less readmission, fewer ICU days, and shorter hospital stays due to COPD exacerbations. Further studies are needed to determine the optimal utilization of RT disease management teams for patients with COPD to optimize outcomes and prevent return hospital visits. (ClinicalTrials.gov registration NCT01543217.). Copyright © 2017 by Daedalus Enterprises.
da Silva Fink, Jaqueline; Daniel de Mello, Paula; Daniel de Mello, Elza
Subjective Global Assessment (SGA) is a nutritional assessment tool widely used in hospital clinical practice, even though it is not exempted of limitations in relation to its use. This systematic review intended to update knowledge on the performance of SGA as a method for the assessment of the nutritional status of hospitalized adults. PubMed data base was consulted, using the search term "subjective global assessment". Studies published in English, Portuguese or Spanish, between 2002 and 2012 were selected, excluding those not found in full, letters to the editor, pilot studies, narrative reviews, studies with n research with non-hospitalized populations or those which used a modified version of the SGA. Of 454 eligible studies, 110 presented eligibility criteria. After applying the exclusion criteria, 21 studies were selected, 6 with surgical patients, 7 with clinical patients, and 8 with both. Most studies demonstrated SGA performance similar or better than the usual assessment methods for nutritional status, such as anthropometry and laboratory data, but the same result was not found when comparing SGA and nutritional screening methods. Recently published literature demonstrates SGA as a valid tool for the nutritional diagnosis of hospitalized clinical and surgical patients, and point to a potential superiority of nutritional screening methods in the early detection of malnutrition. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Leonardo Mousinho Guerra
Full Text Available Backgound and Objectives: Surgical instruments are widely reprocessed, mainly in developing countries, where the cost of using these materials is high. Scientifi c literature indicates the absence of validated cleaning and sterilization processes. The study aimed at evaluating, through a literature review, the evidence to support or not the practice of reprocessing and reuse of originally single-use, medical-hospital materials. Methods: A total of 27 articles in English and Portuguese were selected from journals indexed in the LILACS, Pubmed and Medline databases, as well as studies published in ScienceDirect website using the following key words: sterilization, single-use articles, hospital infection and surgical instruments. Articles that did not fi t the study subject were excluded. Results: There was a great variety of studied instruments and reprocessing methods. Most articles emphasize the sterilization ineffectiveness, identifying microorganisms at the end of the process. Conclusion: Based on the current knowledge, it is important to consider each case validating surgical materials reprocessing and reuse protocols based on scientific knowledge. Based on the analysis of the study articles, we concluded that this practice cannot be performed indiscriminately. KEYWORDS: Sterilization. Cross infection. Surgical Equipment. Public Health.
Review of Paediatric Admissions In Mongomo Provincial Hospital, Wele Nzas, Equatorial Guinea. Nnamdi B Onyire. Abstract. Background: The author was part of the Technical Aid Corps team of the Nigerian Government to Mongomo Provincial Hospital, Wele Nzas province of Equatorial Guinea, between May 1997 and ...
A retrospective review of hospital maternal deaths at Jimma Hospital, Southwestern Ethiopia, covering the period from September 1990 to May 1999 was conducted with the objectives of determining the overall maternal mortality rate, observing trend of maternal mortality during the period, and identifying major causes of ...
Full Text Available The article is devoted to the study of the relationship between man and the space around him, namely between the patient and hospital environment. The article gives a little insight into the history of the issue. The study held in a number of hospitals explored the influence of hospital environment on the psychological state of patients and their recovery, as well as the searching of behavior patterns of patients staying in the hospital. There are several main factors in the right treatment: the doctor’s qualification, quality of medical equipment, novelty of medical technology and medicines prescribed to patients but also the conditions of the hospital environment and trusting relationship between patient and doctor as well. This theme is insufficiently explored especially in Russian medicine. Its studying will serve as a referral base for a more effective treatment of patients, and also for a creating a conducive hospital environment. This theme is interdisciplinary in nature. Mainly it refers to the subject of environmental psychology, also located at the junction of personality, health psychology and rehabilitation psychology.
Machado, Juliana Pires; Martins, Ana Cristina Marques; Martins, Mônica Silva
Quality assessment of hospital services has drawn growing international attention, driven by demand from funders, providers, practitioners, and patients. The objective of this study was to review the literature on hospital quality assessment in Brazil and analyze the main approaches, methodologies, and indicators used in the studies. The research design was a systematic literature review of scientific articles and doctoral and Master's theses published from 1990 to 2011. The review identified 2,169 documents, and 62 were included in the review, representing 48 separate studies. Most studies used secondary data and analyzed effectiveness, adequacy, safety, and efficiency, emphasizing the application of mortality rate, adequacy rate, adverse events rate, and length of stay. Methods to control differences in patient risks were mostly applied. This review identified central elements for both the development of this theme and the improvement of hospital care in Brazil.
Tan, Sheau Kang; Loh, Yet Hua; Choong, Hui Lin; Suhail, Sufi M
Evidence has validated that the nutritional status of hospitalized patients on haemodialysis could be compromised because of admission-related and hospital-associated morbidities on the background of their kidney disease. However, nutritional status is not assessed and monitored routinely during the hospitalization period. The aim of the present study was to assess the nutritional status of hospitalized patients requiring haemodialysis with the subjective global assessment (SGA) tool during the hospitalization period. This is a prospective cohort study conducted in an acute tertiary general hospital. Patients aged 21-75 years old, admitted for various illnesses and requiring haemodialysis between November 2011 and May 2012 were enrolled into this study. A trained dietician assessed patients' nutritional status with the SGA tool, which included historical data on weight change, dietary intake, gastrointestinal symptoms, functional capacity, comorbidities and physical examination on subcutaneous fat loss, muscle wasting and presence of oedema and/or ascites. Patients were categorized under three groups: SGA-A (well-nourished), SGA-B (moderately malnourished) and SGA-C (severely malnourished). Eighty patients (mean ± SD age = 59 ± 10 years; 76% Chinese ethnicity) were assessed. Mean ± SD body mass index (BMI) was 25.1 ± 6.1 kg/m(2) . SGA categories were 48% SGA-A, 46% SGA-B, and 6% SGA-C. Mean energy and protein intake (P nutritional status. More than half of the hospitalized patients requiring haemodialysis were malnourished. It is important to incorporate SGA in the care of hospitalized haemodialysis patients for early detection of malnutrition and for medical nutrition therapy to optimise patients' nutritional status for better outcomes. © 2015 Asian Pacific Society of Nephrology.
Adriana Fonseca Teixeira
Full Text Available Abstract Objective: This systematic review aimed to verify the available scientific evidence on the clinical performance and diagnostic accuracy of nutritional screening tools in hospitalized pediatric patients. Data source: A search was performed in the Medline (National Library of Medicine United States, LILACS (Latin American and Caribbean Health Sciences, PubMed (US National Library of Medicine National Institutes of Health, in the SCIELO (Scientific Electronic Library Online, through CAPES portal (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, bases Scopus e Web of Science. The descriptors used in accordance with the Descriptors in Health Sciences (DeCS/Medical Subject Headings (MeSH list were “malnutrition”, “screening”, and “pediatrics”, as well as the equivalent words in Portuguese. Summary of the findings: The authors identified 270 articles published between 2004 and 2014. After applying the selection criteria, 35 were analyzed in full and eight articles were included in the systematic review. We evaluated the methodological quality of the studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS. Five nutritional screening tools in pediatrics were identified. Among these, the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP showed high sensitivity, almost perfect inter-rater agreement and between the screening and the reference standard; the Screening Tool Risk on Nutritional Status and Growth (STRONGkids showed high sensitivity, lower percentage of specificity, substantial intra-rater agreement, and ease of use in clinical practice. Conclusions: The studies included in this systematic review showed good performance of the nutritional screening tools in pediatrics, especially STRONGkids and STAMP. The authors emphasize the need to perform for more studies in this area. Only one tool was translated and adapted to the Brazilian pediatric population, and it is
McGain, Forbes; Naylor, Chris
Hospitals are significant contributors to natural resource depletion and environmental change. Our objective was to establish the extent to which hospital environmental sustainability has been studied and the key issues that emerge for policy, practice and research. The PubMed, Engineering Village, Cochrane and King's Fund databases were searched for articles relating to hospital environmental sustainability published in English between 1 January 1990 and 1 October 2013. Further studies were found by review of reference lists. One hundred ninety-three relevant articles were found and 76 were selected for inclusion in the review. Common research themes were identified: hospital design, direct energy consumption, water, procurement, waste, travel and psychology and behaviour. Some countries (particularly the United Kingdom) have begun to invest systematically in understanding the environmental effects of hospitals. We found large variability in the extent of the evidence base according to topic. Research regarding the architectural fabric of hospital buildings is at a relatively mature stage. Similarly, there is a developed research base regarding devices and technologies used within hospitals to reduce the environmental effects of direct hospital energy and water use. Less is known about the clinical, psychological and social factors that influence how health care professionals use resources, travel to/from hospital, and interact with the buildings and technologies available. A significant part of the environmental footprint of hospitals relates to clinical practice, e.g. decisions regarding the use of pharmaceuticals and medical devices. Medical 'cradle to grave' life cycle assessment studies have been published to understand the full financial and environmental costs of hospital activities. The effects of preventive or demand management measures which avoid unnecessary hospital procedures are likely to be much greater than incremental changes to how hospital
Full Text Available Abstract Background This study tested the homeostatic model of subjective quality of life in a group of 47 short stay patients as they progressed through the stages of hospitalization for surgery. Method Participants completed a questionnaire measuring subjective quality of life, positive and negative affect, self-esteem, optimism and cognitive flexibility, the day prior to admission (T1, two days post-operation (T2 and one week after discharge (T3. Neuroticism and Extroversion were measured at Time 1. Results All variables remained stable across the three times, apart from positive affect, which dropped significantly post-operation but returned to its previous level post discharge. Conclusion Although the homeostatic model of subjective quality of life was supported at Time 1, the analyses raise doubts about the stability of personality. This finding is consistent with recent discussions of personality.
Ali, Mustafa; Wang, Wenping; Chaudhry, Nawaz; Geng, Yong
Health care activities can generate different kinds of hazardous wastes. Mismanagement of these wastes can result in environmental and occupational health risks. Developing countries are resource-constrained when it comes to safe management of hospital wastes. This study summarizes the main issues faced in hospital waste management in developing countries. A review of the existing literature suggests that regulations and legislations focusing on hospital waste management are recent accomplishments in many of these countries. Implementation of these rules varies from one hospital to another. Moreover, wide variations exist in waste generation rates within as well as across these countries. This is mainly attributable to a lack of an agreement on the definitions and the methodology among the researchers to measure such wastes. Furthermore, hospitals in these countries suffer from poor waste segregation, collection, storage, transportation and disposal practices, which can lead to occupational and environmental risks. Knowledge and awareness regarding proper waste management remain low in the absence of training for hospital staff. Moreover, hospital sanitary workers, and scavengers, operate without the provision of safety equipment or immunization. Unsegregated waste is illegally recycled, leading to further safety risks. Overall, hospital waste management in developing countries faces several challenges. Sustainable waste management practices can go a long way in reducing the harmful effects of hospital wastes.
Vothknecht, Sylke; Schoevers, Robert A.; de Haan, Lieuwe
Objective: The Subjective Well-being under Neuroleptic Treatment scale (SWN) is the most widely used self-rating scale in recent research of subjective well-being in schizophrenia. We reviewed all available publications on relevant research of subjective well-being using the SWN, in order to
Vothknecht, Sylke; Schoevers, Robert A.; de Haan, Lieuwe
Objective: The Subjective Well-being under Neuroleptic Treatment scale (SWN) is the most widely used self-rating scale in recent research of subjective well-being in schizophrenia. We reviewed all available publications on relevant research of subjective well-being using the SWN, in order to
da Silva Fink, Jaqueline; de Mello, Elza Daniel; Beghetto, Mariur Gomes; Luft, Vivian Cristine; de Jezus Castro, Stela Maris; de Mello, Paula Daniel
There is no method to be used as a reference standard for nutritional assessment. This study aims to develop and verify the performance of a new tool, based on the Item Response Theory (IRT), from the Subjective Global Assessment (SGA) questionnaire, in hospitalized adult patients. Retrospective cohort study, composed by secondary database, formed by patients included from October 2005 to June 2006. The new tool presented was developed through the usage of cumulative models from the IRT. Out of 1503 evaluated patients, 2/3 were randomly selected to the development sample of the new tool and 1/3 to the performance verification sample. After item adjustments, the "Nutritional Assessment Score" (NAS) was proposed, with reduced number of questions, and, in comparison to SGA, less polytomic items. NAS demonstrates association to variables that are clinically relevant (hospital mortality, long hospital stay, serum albumin and body mass index) and has shown itself to be more precise to patients with the worst degrees of nutritional status. Results point to the validation of the NAS in detecting, accurately, the nutritional status of hospitalized patients. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Rose, John; Lees-Warley, Gemma; Thrift, Su
This article explores the lived experiences of men with mild intellectual disabilities who have deliberately set a fire and are detained in a secure hospital. Semi-structured interviews were used to explore the subjective experiential claims of seven male firesetters with mild intellectual disabilities residing in a forensic intellectual disability hospital. Interpretative Phenomenological Analysis was used to interpret participants' meaning making of their firesetting. Five super-ordinate themes emerged from the analysis: (a) "the importance of the first fire," (b) "firesetting to escape distress," (c) "firesetting to enable positive emotional experiences," (d) "firesetting to communicate with services," and (e) "Fire Setters Treatment Programme." The analysis provides an understanding of why some firesetting behaviours emerge and highlights factors that contribute to the maintenance and desistence of repeat firesetting acts. The findings are considered in relation to evolving risk assessment measures and risk reduction strategies for facilitating rehabilitation into community settings. © The Author(s) 2015.
Körber, Michael; Schmid, Klaus; Drexler, Hans; Kiesel, Johannes
Medical and nursing shortages in rural areas represent a current serious public health problem. The healthcare of the rural population is at risk. This study compares perceived workload, job satisfaction and work-life balance of physicians and nurses at a clinic in a rural area with two clinics of a University hospital. Physicians and nurses were interviewed anonymously with a standardized questionnaire (paper and pencil), including questions on job satisfaction, subjective workload and work-life balance. The response rate was almost 50% in the University hospital as well as in the municipal hospital. 32 physicians and 54 nurses from the University hospital and 18 physicians and 137 nurses from the municipal hospital participated in the survey. Nurses at the University hospital assessed the organization of the daily routine with 94.1% as better than those at the municipal hospital (82.4%, p=0.03). Physicians at the University hospital were able to better implement acquired knowledge at a University clinic with 87.5% than their counterparts at the municipal hospital (55.5%, p=0.02). In contrast to their colleagues at the municipal hospital, only 50% of the physicians at the University hospital subjectively considered their workload as just right (83.3% municipal, p=0.02). 96.9% of the physicians at the University hospital were "daily" or "several times a week" under time pressure (municipal 50%, pwork and family life (62.9% University hospital, 72.8% Municipal hospital). In contrast, only 20% of the physicians at the University Hospital but 42.9% of the physicians of the municipal hospital had sufficient opportunities to balance workload and family (p=0.13). The return rate of almost 50% can be described as good. Due to the small number of physicians, especially from the municipal hospital, it can be assumed that some interesting differences could not be detected. There were only slight differences between the nurses from the two hospitals. In contrast, subjective
Jesús Vega Encabo
Full Text Available In this paper, I claim that subjectivity is a way of being that is constituted through a set of practices in which the self is subject to the dangers of fictionalizing and plotting her life and self-image. I examine some ways of becoming subject through narratives and through theatrical performance before others. Through these practices, a real and active subjectivity is revealed, capable of self-knowledge and self-transformation.
Phillips, Paul A.; Moutinho, Luiz
Strategic planning remains one of the most popular management tools, but theoretical and empirical developments in the academic literature have been a slow burn. This paper addresses this gap and provides an up-to-date review of hospitality and tourism strategic planning research. We review strategic planning research from 1995 to 2013 in seven leading tourism academic journals, and adopt a modern and broad conceptualization of strategic planning. While there is some awareness of effective to...
Dianat, Iman; Sedghi, Ali; Bagherzade, Javad; Jafarabadi, Mohammad Asghari; Stedmon, Alex W
A field study was conducted to evaluate the illumination levels, to examine the effect of lighting conditions (including lighting characteristics and disturbances) on employee satisfaction, job performance, safety and health, and to compare the employees' perception of lighting level with actual illuminance levels in a hospital setting using both questionnaire and physical illuminance measurements. The illumination levels varied across different locations within the hospital and were lower than standards for 52.2% of the workplaces surveyed. Most respondents indicated that at least one of the four lighting characteristics (i.e. light level, type of light sources, light colour and use of daylight) was inappropriate, and that at least one of the three lighting disturbances (i.e. flickering lights, glare and unwanted shadows) was a major disturbance to them. The employees' perceptions of illuminance generally reflected the actual illuminance levels. The more appropriate maintenance or installation of lighting fixtures was rated as the most appropriate for improving lighting. The findings suggest that environmental ergonomics should be given a more prominent role in hospital building and workplace design to support safer healthcare facilities (for staff and potentially for patients). Good lighting is essential to improve employee performance, health and safety. The findings suggest that quantitative physical measurements should be supplemented by qualitative subjective assessments to provide a more holistic approach where specific details about the lighting condition in each working environment are incorporated from the workers' perspective.
Zegers, H.W.; Hesselink, G.; Geense, W.; Vincent, C.; Wollersheim, H.
OBJECTIVE: To provide an overview of effective interventions aimed at reducing rates of adverse events in hospitals. DESIGN: Systematic review of systematic reviews. DATA SOURCES: PubMed, CINAHL, PsycINFO, the Cochrane Library and EMBASE were searched for systematic reviews published until October
Ottrey, Ella; Porter, Judi
Most patients in developed countries solely depend on the hospital menu to order their food. The provision of menu choices to patients differs between facilities. The purpose of this paper is to determine which strategies that provide menu choices to patients are effective in improving clinical and non-clinical outcomes in hospital. Five databases were searched to identify relevant publications. Prospective research published in English with the menu as the primary intervention was included. Study eligibility was determined and risk of bias assessed. Outcome data were combined narratively due to absence of homogeneous study design and outcomes. Of the 2,201 records screened, six studies met inclusion criteria. Standardised menu formatting and the spoken menu system were found to improve meal tray accuracy. The spoken menu and computerised interactive menu selector system enhanced aspects of patient satisfaction without cost increases. Descriptive menus may increase food consumption. Branding food items was not well supported by patients. One study rated positively for study quality with the remaining five studies receiving neutral quality ratings. The small number of studies conducted on each intervention and the quality of the evidence made it difficult to establish a solid evidence base around providing menu choices to patients. Further research is needed on menu ordering systems, including spoken and visual menus, to determine their impact on outcomes in hospital. This review is first to examine the effectiveness of menu interventions in hospital. Hospital foodservice departments should consider these findings when reviewing local systems.
Brand, Caroline A; Barker, Anna L; Morello, Renata T; Vitale, Michael R; Evans, Sue M; Scott, Ian A; Stoelwinder, Johannes U; Cameron, Peter A
The objective of this review was to critically appraise the literature relating to associations between high-level structural and operational hospital characteristics and improved performance. The Cochrane Library, MEDLINE (Ovid), CINAHL, proQuest and PsychINFO were searched for articles published between January 1996 and May 2010. Reference lists of included articles were reviewed and key journals were hand searched for relevant articles. and data extraction Studies were included if they were systematic reviews or meta-analyses, randomized controlled trials, controlled before and after studies or observational studies (cohort and cross-sectional) that were multicentre, comparative performance studies. Two reviewers independently extracted data, assigned grades of evidence according to the Australian National Health and Medical Research Council guidelines and critically appraised the included articles. Data synthesis Fifty-seven studies were reported within 12 systematic reviews and 47 observational articles. There was heterogeneity in use and definition of performance outcomes. Hospital characteristics investigated were environment (incentives, market characteristics), structure (network membership, ownership, teaching status, geographical setting, service size) and operational design (innovativeness, leadership, organizational culture, public reporting and patient safety practices, information technology systems and decision support, service activity and planning, workforce design, staff training and education). The strongest evidence for an association with overall performance was identified for computerized physician order entry systems. Some evidence supported the associations with workforce design, use of financial incentives, nursing leadership and hospital volume. There is limited, mainly low-quality evidence, supporting the associations between hospital characteristics and healthcare performance. Further characteristic-specific systematic reviews are
Full Text Available Maria Crema, Chiara Verbano Department of Management and Engineering, University of Padova, Vicenza, Italy Purpose: The need to respond to accreditation institutes' and patients' requirements and to align health care results with increased medical knowledge is focusing greater attention on quality in health care. Different tools and techniques have been adopted to measure and manage quality, but clinical errors are still too numerous, suggesting that traditional quality improvement systems are unable to deal appropriately with hospital challenges. The purpose of this paper is to grasp the current tools, practices, and guidelines adopted in health care to improve quality and patient safety and create a base for future research on this young subject. Methods: A systematic literature review was carried out. A search of academic databases, including papers that focus not only on lean management, but also on clinical errors and risk reduction, yielded 47 papers. The general characteristics of the selected papers were analyzed, and a content analysis was conducted. Results: A variety of managerial techniques, tools, and practices are being adopted in health care, and traditional methodologies have to be integrated with the latest ones in order to reduce errors and ensure high quality and patient safety. As it has been demonstrated, these tools are useful not only for achieving efficiency objectives, but also for providing higher quality and patient safety. Critical indications and guidelines for successful implementation of new health managerial methodologies are provided and synthesized in an operative scheme useful for extending and deepening knowledge of these issues with further studies. Conclusion: This research contributes to introducing a new theme in health care literature regarding the development of successful projects with both clinical risk management and health lean management objectives, and should address solutions for improving health
Crema, Maria; Verbano, Chiara
Purpose The need to respond to accreditation institutes’ and patients’ requirements and to align health care results with increased medical knowledge is focusing greater attention on quality in health care. Different tools and techniques have been adopted to measure and manage quality, but clinical errors are still too numerous, suggesting that traditional quality improvement systems are unable to deal appropriately with hospital challenges. The purpose of this paper is to grasp the current tools, practices, and guidelines adopted in health care to improve quality and patient safety and create a base for future research on this young subject. Methods A systematic literature review was carried out. A search of academic databases, including papers that focus not only on lean management, but also on clinical errors and risk reduction, yielded 47 papers. The general characteristics of the selected papers were analyzed, and a content analysis was conducted. Results A variety of managerial techniques, tools, and practices are being adopted in health care, and traditional methodologies have to be integrated with the latest ones in order to reduce errors and ensure high quality and patient safety. As it has been demonstrated, these tools are useful not only for achieving efficiency objectives, but also for providing higher quality and patient safety. Critical indications and guidelines for successful implementation of new health managerial methodologies are provided and synthesized in an operative scheme useful for extending and deepening knowledge of these issues with further studies. Conclusion This research contributes to introducing a new theme in health care literature regarding the development of successful projects with both clinical risk management and health lean management objectives, and should address solutions for improving health care even in the current context of decreasing resources. PMID:24307833
Lemetti, T; Stolt, M; Rickard, N; Suhonen, R
Nurses play an important role in the treatment and care of adults in both hospital and primary health care working within complex and fragmented organizational systems. As the nature of health care changes and hospital and primary care sectors become more closely associated, nurses in both sectors have an obligation to increase their collaboration. This study aimed to increase the understanding of collaboration between nurses working with adults in hospital and primary health care, and to facilitate the future measurement of this collaboration. A literature review was undertaken in July and August 2013 using CINAHL and MEDLINE databases from the earliest to August 2013. The searches produced 4951 citations that were reduced to 22 articles for review using a four-step inclusion strategy. Inductive content analysis was used to analyse the data. It is suggested that collaboration is a process that contains (1) collaboration precursors: the opportunity to participate, knowledge and shared objectives; (2) elements of collaboration: competency, awareness and understanding of work roles and interaction; and (3) processes and outcomes: the events or behaviours that are the consequences of the collaboration between hospital and primary healthcare nurses. The results indicate that collaboration between hospital and primary healthcare nurses is an important and integral part of the work of nurses and a process consisting of several predictable issues leading to useful care outcomes. Current healthcare changes make it a requirement for hospital and primary healthcare nurses to collaborate when working with adults to continue to meet the needs of patients. The findings of this study can be used to improve collaboration in practice and to devise research to improve collaboration between hospital and primary healthcare nurses. © 2015 International Council of Nurses.
Clanet, Romain; Bansard, Mathieu; Humbert, Xavier; Marie, Véronique; Raginel, Thibaut
Communication between general practitioners (GPs) and hospitals is one of the weak points of our health system. Unfortunately, hospital discharge summaries, the cornerstone of this communication, tend to be poorly defined. The purpose of this study was to identify the key elements of hospital discharges ummaries, with particular attention to GP expectations. A systematic review of the international literature was conducted by searching Cochrane, Medline, Systeme universitaire de documentation (SUDoc) and Banque de donnees en santé publique (BDSP) databases as well as the French journals La Revue du Praticien, Prescrire and Exercer. This database and journal review identified 10,551 publications, 38 of which were finally included in this analysis. The preferred maximum time to reception of the discharge summary was one week. This summary should not exceed four half pages. The desired content did not differ between GPs and hospital practitioners. GPs expressed the desire for a brief liaison letter given to the patient at the time of discharge. GPs expected the discharge summary to contain the reason for admission, treatment on discharge, the main diagnosis and subsequent management. A standardized and structured form was preferred, but a narrative form was not recommended. Special attention had to be paid to treatment on discharge and outstanding results at the time of discharge. The elements identified from the literature will be used as a basis for a subsequent study designed to formalize discharge summaries for GPs.
Pirani, Sanaa I; Arafat, Hassan A
Solid waste management is a key aspect of the environmental management of establishments belonging to the hospitality sector. In this study, we reviewed literature in this area, examining the current status of waste management for the hospitality sector, in general, with a focus on food waste management in particular. We specifically examined the for-profit subdivision of the hospitality sector, comprising primarily of hotels and restaurants. An account is given of the causes of the different types of waste encountered in this sector and what strategies may be used to reduce them. These strategies are further highlighted in terms of initiatives and practices which are already being implemented around the world to facilitate sustainable waste management. We also recommended a general waste management procedure to be followed by properties of the hospitality sector and described how waste mapping, an innovative yet simple strategy, can significantly reduce the waste generation of a hotel. Generally, we found that not many scholarly publications are available in this area of research. More studies need to be carried out on the implementation of sustainable waste management for the hospitality industry in different parts of the world and the challenges and opportunities involved. Copyright © 2014 Elsevier Ltd. All rights reserved.
Full Text Available Ahmed Ameer,1 Soraya Dhillon,1 Mark J Peters,2 Maisoon Ghaleb11Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; 2Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK Objective: Medication administration is the last step in the medication process. It can act as a safety net to prevent unintended harm to patients if detected. However, medication administration errors (MAEs during this process have been documented and thought to be preventable. In pediatric medicine, doses are usually administered based on the child's weight or body surface area. This in turn increases the risk of drug miscalculations and therefore MAEs. The aim of this review is to report MAEs occurring in pediatric inpatients. Methods: Twelve bibliographic databases were searched for studies published between January 2000 and February 2015 using “medication administration errors”, “hospital”, and “children” related terminologies. Handsearching of relevant publications was also carried out. A second reviewer screened articles for eligibility and quality in accordance with the inclusion/exclusion criteria. Key findings: A total of 44 studies were systematically reviewed. MAEs were generally defined as a deviation of dose given from that prescribed; this included omitted doses and administration at the wrong time. Hospital MAEs in children accounted for a mean of 50% of all reported medication error reports (n=12,588. It was also identified in a mean of 29% of doses observed (n=8,894. The most prevalent type of MAEs related to preparation, infusion rate, dose, and time. This review has identified five types of interventions to reduce hospital MAEs in children: barcode medicine administration, electronic prescribing, education, use of smart pumps, and standard concentration. Conclusion: This review has identified a wide variation in the prevalence of hospital MAEs in children. This is attributed to
Wind, A; van Harten, W H
Although benchmarking may improve hospital processes, research on this subject is limited. The aim of this study was to provide an overview of publications on benchmarking in specialty hospitals and a description of study characteristics. We searched PubMed and EMBASE for articles published in English in the last 10 years. Eligible articles described a project stating benchmarking as its objective and involving a specialty hospital or specific patient category; or those dealing with the methodology or evaluation of benchmarking. Of 1,817 articles identified in total, 24 were included in the study. Articles were categorized into: pathway benchmarking, institutional benchmarking, articles on benchmark methodology or -evaluation and benchmarking using a patient registry. There was a large degree of variability:(1) study designs were mostly descriptive and retrospective; (2) not all studies generated and showed data in sufficient detail; and (3) there was variety in whether a benchmarking model was just described or if quality improvement as a consequence of the benchmark was reported upon. Most of the studies that described a benchmark model described the use of benchmarking partners from the same industry category, sometimes from all over the world. Benchmarking seems to be more developed in eye hospitals, emergency departments and oncology specialty hospitals. Some studies showed promising improvement effects. However, the majority of the articles lacked a structured design, and did not report on benchmark outcomes. In order to evaluate the effectiveness of benchmarking to improve quality in specialty hospitals, robust and structured designs are needed including a follow up to check whether the benchmark study has led to improvements.
Gil-Alarcón, Guillermo; Sánchez-Villegas, María Del Carmen; Hugo Reynoso, Víctor
Mythic, out-dated, ambiguous and sometimes iatrogenic procedures, still remain in pre-hospital and hospital ophidian accident treatment. Errors, omissions and ignorance make ophidian accidents appear more dangerous than they truly are, resulting in a general public contempt toward snakes. Here we present an updated review of current knowledge on pre-hospital and hospital treatment of ophidian bite incidents, including indications, recommendations and logic errors. We describe an appropriate treatment for native Mexican poisonous snakebites using fabotherapics, based on our experience. Adequate initial pre-hospital and hospital management is crucial for a successful outcome of this medical emergency. We describe the state of the art in snake bite research discussing those procedures where research is needed to implement them either by the patient, first responders, paramedics and doctors. We suggest proposals to achieve even more efficient management of fabotherapics based on support networks. Finally, we emphasize prevention as the main subject of venom bite treatment, as it is always more adequate and economic to invest in prevention than to spend on mitigation during emergency and recovery.
The article is devoted to the study of the relationship between man and the space around him, namely between the patient and hospital environment. The article gives a little insight into the history of the issue. The study held in a number of hospitals explored the influence of hospital environment on the psychological state of patients and their recovery, as well as the searching of behavior patterns of patients staying in the hospital. There are several main factors in the right treatment: ...
Lauren Machado Pinto
Full Text Available : Introduction: Malnutrition is configured as a health condition that causes deficits in occupational performance. Objective: To establish a correlation between nutritional status and occupational performance in activities of daily life (ADLs according to the desnutrition state level. Methodology: A descriptive, exploratory, cross-sectional evaluation of 50 patients diagnosed with chronic malnutrition admitted to a University Hospital in Curitiba, Parana state. We used the Functional Independence Measure (FIM and a semi-structured questionnaire in which the subjects named the three main performance limiting reasons. The Kruskal-Wallis test was used to identify the existence of differences between at least two groups in the analysis, while the test of Multiple Comparisons was used to determine which pairs of groups showed statistically significant differences at 95% significance level (p ≤ 0.05. Results: We assessed 28 (56% female and 22 (44% male patients with mean age of 50.16 (±16.74 for one year. Out of these, 19 (38% presented mild chronic malnutrition, 16 (32% showed moderate chronic malnutrition, and 14 (28% presented severe chronic malnutrition. We identified changes particularly in activities evaluated in the use of motor FIM, with relevant alterations of dependence level for the states of moderate to severe malnutrition. Patients’ complaints were in agreement with those pointed by the literature as symptoms of malnutrition. Conclusion: This study confirms the correlation between deterioration in nutritional status and high dependence level upon ADLs.
Despite the presumed centrality of sexual consent to definitions of sexual violence, it remains an ambiguous and often unexamined concept both in lay and professional/scientific discourses. The following literature review of peer-reviewed research studying sexual consent as a scientific object will thematically present major findings from said…
Lorente, Sonia; Losilla, Josep-Maria; Vives, Jaume
To analyse the psychometric properties and the utility of instruments used to measure patient comfort, physical, social, psychospiritual and/or environmental, during hospitalization. There are no systematic reviews nor psychometric reviews of instruments used to measure comfort, which is considered an indicator of quality in health care associated with quicker discharges, increased patient satisfaction and better cost-benefit ratios for the institution. Psychometric review. MEDLINE, CINAHL, PsycINFO, Web of Knowledge, ProQuest Thesis&Dissertations, Google. We limited our search to studies published between 1990-2015. The psychometric analysis was performed using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN), along with the Quality Criteria for Measurement Properties. The utility of the instruments was assessed according to their cost-efficiency, acceptability and educational impact. Protocol registration in PROSPERO, CRD42016036290. Instruments reviewed showed moderate methodological quality and their utility was poorly reported. Thus, we cannot recommend any questionnaire without reservations, but the Comfort Scale, the General Comfort Questionnaire and their adaptations in adults and older patients, the Psychosocial Comfort Scale and the Incomfort des Patients de Reanimation are the most recommendable instruments to measure comfort. The methodology of the studies should be more rigorous and authors should adequately report the utility of instruments. This review provides a strategy to select the most suitable instrument to assess patient comfort according to their psychometric properties and utility, which is crucial for nurses, clinicians, researchers and institutions. © 2017 John Wiley & Sons Ltd.
Arefian, Habibollah; Heublein, Steffen; Scherag, André; Brunkhorst, Frank Martin; Younis, Mustafa Z; Moerer, Onnen; Fischer, Dagmar; Hartmann, Michael
This article systematically reviews research on the costs of sepsis and, as a secondary aim, evaluates the quality of economic evaluations reported in peer-reviewed journals. We systematically searched the MEDLINE, National Health Service (Abstracts of Reviews of Effects, Economic Evaluation and Health Technology Assessment), Cost-effectiveness Analysis Registry and Web of Knowledge databases for studies published between January 2005 and June 2015. We selected original articles that provided cost and cost-effectiveness analyses, defined sepsis and described their cost calculation method. Only studies that considered index admissions and re-admissions in the first 30 days were published in peer-reviewed journals and used standard treatments were considered. All costs were adjusted to 2014 US dollars. Medians and interquartile ranges (IQRs) for various costs of sepsis were calculated. The quality of economic studies was assessed using the Drummond 10-item checklist. Overall, 37 studies met our eligibility criteria. The median of the mean hospital-wide cost of sepsis per patient was $32,421 (IQR $20,745-$40,835), and the median of the mean ICU cost of sepsis per patient was $27,461 (IQR $16,007-$31,251). Overall, the quality of economic studies was low. Estimates of the hospital-related costs of sepsis varied considerably across the included studies depending on the method used for cost calculation, the type of sepsis and the population that was examined. A standard model for conducting cost improve the quality of studies on the costs of sepsis. Copyright © 2016 The British Infection Association. All rights reserved.
Sarkis, Rani A; Lee, Jong Woo
Hospital-acquired encephalopathy is a widely prevalent disorder. The quantitative changes in EEG associated with this condition have long been noted, including slowing of the background frequency and changes in the frequency band power. EEG has had limited clinical use, despite its ability to continuously track clinical severity. We review the development of the use of EEG and particularly quantitative EEG in the assessment of hospital-acquired encephalopathy. Recent advances in EEG technology have included network and microstate analyses, and continuous EEG monitoring, leading to renewed interest in the use of quantitative EEG. We describe the development of microstate analysis that has allowed novel quantitative analysis of the resting state background. We examined the microstates of 16 inpatients with encephalopathy and 20 control patients. The global variance explained by the four standard resting microstates was smaller in patients with encephalopathy. This suggests a decrease in microstate stability, indicating a breakdown in the resting state network dynamics. Modern analysis and acquisition techniques hold the promise of renewed interest in quantitative EEG techniques in the assessment of hospital-acquired encephalopathy.
Huster, René J; Raud, Liisa
Over the last years we saw a steady increase in the relevance of big neuroscience data sets, and with it grew the need for analysis tools capable of handling such large data sets while simultaneously extracting properties of brain activity that generalize across subjects. For functional magnetic resonance imaging, multi-subject or group-level independent component analysis provided a data-driven approach to extract intrinsic functional networks, such as the default mode network. Meanwhile, this methodological framework has been adapted for the analysis of electroencephalography (EEG) data. Here, we provide an overview of the currently available approaches for multi-subject data decomposition as applied to EEG, and highlight the characteristics of EEG that warrant special consideration. We further illustrate the importance of matching one's choice of method to the data characteristics at hand by guiding the reader through a set of simulations. In sum, algorithms for group-level decomposition of EEG provide an innovative and powerful tool to study the richness of functional brain networks in multi-subject EEG data sets.
Oliver, D; Hopper, A; Seed, P
To analyze published hospital fall prevention programs to determine whether there is any effect on fall rates. To review the methodological quality of those programs and the range of interventions used. To provide directions for further research. Systematic review of published hospital fall prevention programs. Meta-analysis. Keyword searches of Medline, CINAHL, monographs, and secondary references. All papers were included that described fall rates before and during intervention. Risk ratios and 95% Confidence Intervals (95% CI) were estimated and random effects meta-analysis employed. Begg's test was applied to detect possible publication bias. Separate meta-analysis regressions were performed to determine whether individual components of multifaceted interventions were effective. A total of 21 papers met the criteria (18 from North America), although only 10 contained sufficient data to allow calculation of confidence intervals. A rate ratio of fall rate, resulting from an intervention. Three were randomized controlled trials (pooled rate ratio 1.0 (CI 0.60, 1.68)), seven prospective studies with historical control (0.76 (CI 0.65, 0.88)). Pooled effect rate ratio from these 10 studies was 0.79 (CI 0.69, 0.89). The remaining 11 studies were prospective studies with historical control describing fall rates only. Individual components of interventions showed no significant benefit. The pooled effect of about 25% reduction in the fall rate may be a result of intervention but may also be biased by studies that used historical controls not allowing for historical trends in the fall rate before and during the intervention. The randomized controlled trials apparent lack of effect might be due to a change in practice when patients and controls were in the same unit at the same time during a study. Studies did not analyze compliance with the intervention or opportunity costs resulting from the intervention. Research and clinical programs in hospital fall prevention should
Advancing quality in health services requires structures and processes that are informed by consumer input. Although this agenda is well recognised, few researchers have focussed on the establishment and maintenance of customer input throughout the structures and processes used to produce high-quality, safe care. We present an analysis of literature outlining the barriers and enablers involved in community representation in hospital governance. The review aimed to explore how community representation in hospital governance is achieved. Studies spanning 1997-2012 were analysed using Donabedian' s model of quality systems as a guide for categories of interest: structure, in relation to administration of quality; process, which is particularly concerned with cooperation and culture; and outcome, considered, in this case, to be the achievement of effective community representation on quality of care. There are limited published studies on community representation in hospital governance in Australia. What can be gleaned from the literature is: 1) quality subcommittees set up to assist Hospital Boards are a key structure for involving community representation in decision making around quality of care, and 2) there are a number of challenges to effectively developing the process of community representation in hospital governance: ambiguity and the potential for escalated indecision; inadequate value and consideration given to it by decision makers resulting in a lack of time and resources needed to support the community engagement strategy (time, facilitation, budgets); poor support and attitude amongst staff; and consumer issues, such as feeling isolated and intimidated by expert opinion. The analysis indicates that: quality subcommittees set up to assist boards are a key structure for involving community representation in decision making around quality of care. There are clearly a number of challenges to effectively developing the process of community representation in
Petermans, Jean; Velghe, Anja; Gillain, Daniel; Boman, Xavier; Van Den Noortgate, Nele
A systematic review of the international literature concerning the organisation of the Geriatric Day Hospital (GDH) was performed. From 1987 till now, few papers were found describing the activity and the effectiveness of the GDH. All the studies comparing specific geriatric approaches to regular medicine demonstrate the efficiency of geriatric care, particularly the geriatric assessment. So, with a degree of evidence 1a, a better outcome is found for patients undergoing a geriatric assessment and intervention, compared to patients having no geriatric assessment at all. However, there is no evidence of benefit for the geriatric day hospital compared to patients treated in a geriatric ward or other location of geriatric care. Moreover, there is no clear consensus on the settings and activities of a geriatric day hospital. Terms as day unit, day hospital, day care, are used interchangeably and are not always covering the same activity. The same remark can be made on the exact composition of the geriatric multidisciplinary team and its role. However nurses and paramedical workers are always mentioned as all performing geriatric assessment. The diagnostic activities on the GDH are seldom described and studied. More information is available on rehabilitation activity, often developed in specific patient populations such as stroke patients, dementia patients, cardiac patients or patients with other chronic diseases. In this selected patient populations positive effects on outcome are shown in the GDH (level of evidence 1a). Another problem is the heterogeneity of the population. For scientific reason the GDH should focus on organising care for specific medical problems. Diseases as dementia, stroke, cardiac insufficiency, could be good models to investigate the efficiency of geriatric assessment and interventions within the setting of a GDH.
Goto, Masashi; Koyama, Hiroshi; Takahashi, Osamu; Fukui, Tsuguya
To describe characteristics and outcomes for patients hospitalized with fever, not only patients with fever of unknown origin (FUO). Medical records were reviewed for 226 consecutive patients hospitalized in a Japanese referral hospital with fever as one of the clinical problems. Although the majority of illnesses involved some sort of infection (54%), noninfectious inflammatory diseases, particularly adult Still's disease (n=6) and primary vasculitis syndromes (n=5) including 3 cases of Behçet's disease, represented the leading cause in patients who met the definition of FUO [16/51(31%)]. Tuberculosis (n=6) and psychological disorders (n=6) were associated with late diagnosis. However, there was only one patient meeting the definition of FUO among those with a psychological disorder. Among the patients with prolonged fever who did not strictly meet the definition of FUO, there was a considerable number of patients with critical illnesses, such as intra-abdominal abscess, polymyalgia rheumatica, sarcoidosis, ulcerative colitis, Castleman's disease, hematological and solid malignancies, and panhypopituitarism. Drug-induced fever, systemic viral infection and unspecified vasculitis were difficult to definitively diagnose, although these pathologies were suspected as causes of fever. Follow-up of patients without definitive diagnosis at discharge confirmed that the fever subsided spontaneously or the cause of fever was properly treated after diagnosis in every patient and that none died of the underlying febrile illness. The present findings, from all patients displaying fever at hospitalization, are in agreement with findings from prior FUO series. Strict use of the definition of FUO is thus unwarranted when managing patients with prolonged fever.
Generally, growth rate, milk production and feed efficiency were higher in animals (sheep, goats and cattle) fed broiler litter-based diet than in animals fed control diet (without broiler litter). This paper reviews the nutritional value, health hazard, processing techniques and factors affecting the acceptability of broiler litter as ...
Michaelson, M; Walsh, E; Bradley, C P; McCague, P; Owens, R; Sahm, L J
Prescribing error may result in adverse clinical outcomes leading to increased patient morbidity, mortality and increased economic burden. Many errors occur during transitional care as patients move between different stages and settings of care. To conduct a review of medication information and identify prescribing error among an adult population in an urban hospital. Retrospective review of medication information was conducted. Part 1: an audit of discharge prescriptions which assessed: legibility, compliance with legal requirements, therapeutic errors (strength, dose and frequency) and drug interactions. Part 2: A review of all sources of medication information (namely pre-admission medication list, drug Kardex, discharge prescription, discharge letter) for 15 inpatients to identify unintentional prescription discrepancies, defined as: "undocumented and/or unjustified medication alteration" throughout the hospital stay. Part 1: of the 5910 prescribed items; 53 (0.9%) were deemed illegible. Of the controlled drug prescriptions 11.1% (n = 167) met all the legal requirements. Therapeutic errors occurred in 41% of prescriptions (n = 479) More than 1 in 5 patients (21.9%) received a prescription containing a drug interaction. Part 2: 175 discrepancies were identified across all sources of medication information; of which 78 were deemed unintentional. Of these: 10.2% (n = 8) occurred at the point of admission, whereby 76.9% (n = 60) occurred at the point of discharge. The study identified the time of discharge as a point at which prescribing errors are likely to occur. This has implications for patient safety and provider work load in both primary and secondary care.
Urushihara, Hisashi; Murakami, Yuka; Matsui, Kenji; Tashiro, Shimon
Under the Japanese drug regulatory system, post-marketing studies (PMS) must be in compliance with Good Post-marketing Study Practice (GPSP). The GPSP Ordinance lacks standards for the ethical conduct of PMSs; although only post-marketing clinical trials are subject to Good Clinical Practice. We conducted a web-based questionnaire survey on the ethical conduct of PMSs in collaboration with the Japanese Society of Hospital Pharmacists and pharmacists belonging to the Society. 1819 hospitals around Japan answered the questionnaire, of which 503 hospitals had conducted company-sponsored PMSs in 2015. 40.2% of the hospitals had obtained informed consent from participating patients in at least one PMS conducted in 2015, the majority of which was in written form. The first and second most frequent reasons for seeking informed consent in PMSs were to meet protocol requirements, followed by the requirement to meet institutional standard operational procedures and the request of the ethical review board of the hospital. Ethical review of PMSs was conducted in 251 hospitals. Despite a lack of standards for informed consent and ethical review in PMSs, a considerable number of study sites employed informed consent and ethical review for PMSs. While company policies and protocols are likely to be major determinants of the ethical conduct of PMSs, the governmental regulatory agency should also play a significant role in implementing a standardized ethical code for the conduct of PMSs.
... PROVISIONS CERTIFICATION OF OPIOID TREATMENT PROGRAMS Procedures for Review of Suspension or Proposed Revocation of OTP Certification, and of Adverse Action Regarding Withdrawal of Approval of an Accreditation Body § 8.23 Limitation on issues subject to review. The scope of review shall be limited to the facts...
Vilanova, J C
It can be very complicated to obtain relevant information through searching the medical literature if you do not know how it is organized and indexed or if you do not know how to use the specialized databases. For a successful review of the literature, you need to know what you are looking for and the key words for an effective search of the specialized databases and libraries and especially of the internet. It is essential to critically evaluate the information selected. Finally, using a reference manager can facilitate the gathering, organization, systematization, and integration of the bibliographic references in the documents generated in the study. This article aims to provide guidelines for efficient searching for information and for accurate, critical use of the literature. It makes recommendations about strategies for managing references to help to ensure the success of a research project. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.
Horo, K; Koffi, M O; Dje Bi, H; Bemba, L P; Adanon, K D N; Brou-Gode, V C; Ahui, J M B; Kouassi, A B; N'Gom, A; Koffi, N; Aka-Danguy, E
The HIV infection is a problem of public health in Côte d'Ivoire. Voluntary screening is encouraged for the premature management of HIV infected patients before the stage of serious opportunist affections. Antiretroviral therapy became free. The purpose of this study was to describe the characteristics of HIV infected subject infected in hospitalization of pneumology. Our retrospective and analytic study concerned the activity period from January 2001 to December 2012 of pneumology department of Cocody university hospital. On 1141 recorded files, the prevalence of HIV infection was 48.20%. The multi-varied analysis showed the following results. Male patients were less HIV infected (OR=0.490 [0.363-0.661]) as the old patients of more than 64 years (OR=0.150 [0.080-0.280]). In case of HIV infection, infectious pathology, severe anemia and renal insufficiency were dominating respectively with OR=1.763 (1.212-2.564), OR=3.167 (2.125-4.720) and OR=2.054 (1.335-3.161). A stronger mortality was associated with HIV infection (OR=1.920 [1.312-2.809]). HIV infection always remains frequented in pneumology hospitalization in Abidjan with late discovery, source of complications and abnormally high death rate. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Cabral, Damien J; Wurster, Jenna I; Flokas, Myrto E; Alevizakos, Michail; Zabat, Michelle; Korry, Benjamin J; Rowan, Aislinn D; Sano, William H; Andreatos, Nikolaos; Ducharme, R Bobby; Chan, Philip A; Mylonakis, Eleftherios; Fuchs, Beth Burgwyn; Belenky, Peter
In recent years, a growing amount of research has begun to focus on the oral microbiome due to its links with health and systemic disease. The oral microbiome has numerous advantages that make it particularly useful for clinical studies, including non-invasive collection, temporal stability, and lower complexity relative to other niches, such as the gut. Despite recent discoveries made in this area, it is unknown how the oral microbiome responds to short-term hospitalization. Previous studies have demonstrated that the gut microbiome is extremely sensitive to short-term hospitalization and that these changes are associated with significant morbidity and mortality. Here, we present a comprehensive pipeline for reliable bedside collection, sequencing, and analysis of the human salivary microbiome. We also develop a novel oral-specific mock community for pipeline validation. Using our methodology, we analyzed the salivary microbiomes of patients before and during hospitalization or azithromycin treatment to profile impacts on this community. Our findings indicate that azithromycin alters the diversity and taxonomic composition of the salivary microbiome; however, we also found that short-term hospitalization does not impact the richness or structure of this community, suggesting that the oral cavity may be less susceptible to dysbiosis during short-term hospitalization.
Full Text Available Introduction: All pregnant women are at risk of obstetrical complications which occurs during labour and delivary that lead to maternal death. Here to report a 10 year review of maternal mortality ratio in "Paropakar Maternity and Women's Hospital (PMWH" Thapathali Kathmandu, Nepal. Methods: Medical records of 66 maternal deaths were reviewed to study the likely cause of each death over the study period. Results: There were a total of 66 maternal deaths. While 192487 deliveries conducted over the 10 year period. The maternal mortality ratio (MMR was 356.64/100000 live birth. The highest MMR of 74.22/100,000 was observed in 2059 and lowest was 17.42/100,000 in 2068 B.S. Leading cause of MMR was remained hemorrhage accounting for 30.30% followed by eclampsia 24.24%. Sepsis, suspected cases of pulmonary embolism and amniotic fluid embolism each contributing 15.15%, 4.54% and 3.03% respectively. Where as anesthetic complication and abortion constiuates 6.06 % each equally for maternal death. The death noted in older women (30+year were 36.36%. Primipara accounted for more deaths (51.51%. Conclusions: The fall in maternal mortality rate has been observed except for year 2063 BS. Haemorrhage is the main contributing cause behind maternal mortality.
Full Text Available Background. Previous evidence on factors and causes of readmissions associated with high-impact users of stroke is scanty. The aim of the study was to investigate common causes and pattern of short- and long-term readmissions stroke patients by conducting a systematic review of studies using hospital administrative data. Common risk factors associated with the change of readmission rate were also examined. Methods. The literature search was conducted from 15 February to 15 March 2016 using various databases, such as Medline, Embase, and Web of Science. Results. There were a total of 24 studies (n=2,126,617 included in the review. Only 4 studies assessed causes of readmissions in stroke patients with the follow-up duration from 30 days to 5 years. Common causes of readmissions in majority of the studies were recurrent stroke, infections, and cardiac conditions. Common patient-related risk factors associated with increased readmission rate were age and history of coronary heart disease, heart failure, renal disease, respiratory disease, peripheral arterial disease, and diabetes. Among stroke-related factors, length of stay of index stroke admission was associated with increased readmission rate, followed by bowel incontinence, feeding tube, and urinary catheter. Conclusion. Although risk factors and common causes of readmission were identified, none of the previous studies investigated causes and their sequence of readmissions among high-impact stroke users.
Mulware, Stephen Juma
in the carcinogenesis progression is DNA damage, which results in DNA lesions like strand breaks and the sister-chromatid exchange. This article reviews the carcinogenicity of various trace elements.
Berdot, Sarah; Gillaizeau, Florence; Caruba, Thibaut; Prognon, Patrice; Durieux, Pierre; Sabatier, Brigitte
Context Drug administration in the hospital setting is the last barrier before a possible error reaches the patient. Objectives We aimed to analyze the prevalence and nature of administration error rate detected by the observation method. Data Sources Embase, MEDLINE, Cochrane Library from 1966 to December 2011 and reference lists of included studies. Study Selection Observational studies, cross-sectional studies, before-and-after studies, and randomized controlled trials that measured the rate of administration errors in inpatients were included. Data Extraction Two reviewers (senior pharmacists) independently identified studies for inclusion. One reviewer extracted the data; the second reviewer checked the data. The main outcome was the error rate calculated as being the number of errors without wrong time errors divided by the Total Opportunity for Errors (TOE, sum of the total number of doses ordered plus the unordered doses given), and multiplied by 100. For studies that reported it, clinical impact was reclassified into four categories from fatal to minor or no impact. Due to a large heterogeneity, results were expressed as median values (interquartile range, IQR), according to their study design. Results Among 2088 studies, a total of 52 reported TOE. Most of the studies were cross-sectional studies (N=46). The median error rate without wrong time errors for the cross-sectional studies using TOE was 10.5% [IQR: 7.3%-21.7%]. No fatal error was observed and most errors were classified as minor in the 18 studies in which clinical impact was analyzed. We did not find any evidence of publication bias. Conclusions Administration errors are frequent among inpatients. The median error rate without wrong time errors for the cross-sectional studies using TOE was about 10%. A standardization of administration error rate using the same denominator (TOE), numerator and types of errors is essential for further publications. PMID:23818992
Monacelli, F; Sartini, M; Bassoli, V; Becchetti, D; Biagini, A L; Nencioni, A; Cea, M; Borghi, R; Torre, F; Odetti, P
The aim of the present study was to validate the photographic indirect method as an accurate and specific tool to assess nutritional intake in a cohort of elderly hospitalized patients. this is a prospective observational study. hospital (geriatric acute ward and transitional care of IRCCSS AUO San Martino Hospital, Genoa, Italy). 255 consecutive elderly hospitalized patients. assessment of malnutrition by: Mini nutritional assessment (MNA) and abbreviated Comprehensive geriatric assessment (CIRS; Barthel index, SPMSE). The direct method (Gold standard): food dish weight (before lunch) and residual (after lunch) food dish weight and estimation of the percentage of eaten food and of residual food for each dish. The percentages of food intake and residual food were calculated according to the following formula: intake %= initial weight of the dishes- residual food weight)/ initial weight dish x100. The unit of variable was the percentage. The indirect photographic method with extrapolation of the lunch food intake by photographic method confronting initial meal and residual meal (25% quartile food dish estimation). The results showed a significant correlation between the direct method (weighing residual food) and the indirect photographic method(n=255; r=0.9735; ptherapeutic interventions.
Reviews the subjective probability estimation literature of six schools of human judgement and decision making: decision theory, behavioral decision theory, psychological decision theory, social judgement theory, information integration theory, and attribution theory. Implications for probabilistic information retrieval are discussed, including…
Kedia, Rohit; Desouza, Cyrus; Smith, Lynette M; Shivaswamy, Vijay
The aim of this study was to compare the changes in the total daily dose (TDD) of insulin of patients on U-500 insulin; before hospitalization, during hospitalization and six weeks after discharge. A retrospective chart review of veterans with type 2 diabetes receiving U-500 insulin in the ambulatory setting and who were admitted between 2012 and 2015 was performed. During hospitalization, patients were transitioned to receive U-100 insulin (detemir or glargine for basal and aspart for bolus). Paired t-tests were conducted to compare TDD of insulin during hospitalization to prior to admission and at six week of follow-up. The average hemoglobin A1c at the time of hospital admission was 8.3±1.5% (n=20). The average TDD of insulin during hospitalization (124±67units) was significantly less than prior to admission (295±123units) and at six week follow-up (310±105units). The average glucose during hospitalization was 180±36mg/dL. Hypoglycemia was less than 0.5%. We showed that patients received significantly less total daily insulin while hospitalized compared to their insulin doses in the ambulatory setting, and we demonstrate that patients receiving U-500 insulin can be safely transitioned to U-100 insulin while hospitalized, with minimal hypoglycemia. Published by Elsevier Inc.
Kosse, Nienke M.; Dutmer, Alisa L.; Dasenbrock, Lena; Bauer, Juergen M.; Lamoth, Claudine J. C.
Background: Old adults admitted to the hospital are at severe risk of functional loss during hospitalization. Early in-hospital physical rehabilitation programs appear to prevent functional loss in geriatric patients. The first aim of this review was to investigate the effect of early physical
A review of infant and young child feeding practice in hospital and the home in KwaZulu-Natal Midlands. ... South African Journal of Clinical Nutrition ... children up to the age of five years, and healthcare professionals in state hospitals, was conducted in 2011 in 12 hospitals in the KwaZulu-Natal Midlands, South Africa.
Patel, Mayur; Patel, Ina M; Patel, Yash M; Rathi, Suresh K
The aim of this observational study was to describe the profile of subjects with type 2 diabetes mellitus from Gujarat, India. The study was performed with newly-diagnosed 622 type 2 diabetic subjects who attended the Department of Diabetology, All India Institute of Diabetes and Research and Yash Diabetes Specialties Centre (Swasthya), Ahmedabad, during August 2006-January 2009. The subjects completed an interviewer-administered questionnaire. The questionnaire included variables, such as sociodemographic factors, presenting symptoms, risk profile (hypertension, obesity, dyslipidaemia, and glycaemic status), family history of diabetes, physical activity, and behavioural profile. Blood pressure, body mass index (BMI), glycosylated haemoglobin levels, and fasting lipid profile were measured. Descriptive and bivariate analyses were carried out using the SPSS software (version 11.5). In total; 622 type 2 diabetes mellitus (T2DM) cases with mean age of 47.7 +/- 10.9 years were studied. Of the 622 subjects, 384 (62%) were male. The majority (68%) of the T2DM subjects were obese, and 67% had a positive family history of diabetes. Renal dysfunctions and vision impairment were, respectively, found in 10% (n=62) and 9% (n=57) of the 622 T2DM subjects. The mean HbAlc level was 9.02 +/- 1.67%, and good glycaemic control (HbAlc level or =25 kg/m2) was significantly associated with hypertension among the T2DM subjects (p family history of diabetes, dyslipidaemia, uncontrolled glycaemic status, sedentary lifestyles, and hypertension were prevalent among the T2DM subjects. The characterization of this risk profile will contribute to designing more effective and specific strategies for screening and controlling T2DM in Gujarat, India.
Elsen, G.A.H. van den; Ahmed, A.I.A.; Lammers, M.; Kramers, C.; Verkes, R.J.; Marck, M.A. van der; Olde Rikkert, M.G.M.
This systematic review aims to integrate the evidence on indications, efficacy, safety and pharmacokinetics of medical cannabinoids in older subjects. The literature search was conducted using PubMed, EMBASE, CINAHL and Cochrane Library. We selected controlled trials including solely older subjects
Hassler, Frank; Reis, Olaf
The review presented here describes the state of the art of pharmacological treatment of aggression in subjects with mental retardation (MR) summing up results for both, children and adults. In general, psychopharmacological treatment of disruptive behavior in individuals with MR is similar to the treatment in subjects without MR. Compared to…
Pihlainen, Vuokko; Kivinen, Tuula; Lammintakanen, Johanna
Purpose - The purpose of this study is to describe the characteristics of management and leadership competence of health-care leaders and managers, especially in the hospital environment. Health-care leaders and managers in this study were both nursing and physician managers. Competence was assessed by evaluating the knowledge, skills, attitudes and abilities that enable management and leadership tasks. Design/methodology/approach - A systematic literature review was performed to find articles that identify and describe the characteristics of management and leadership competence. Searches of electronic databases were conducted using set criteria for article selection. Altogether, 13 papers underwent an inductive content analysis. Findings - The characteristics of management and leadership competence were categorized into the following groups: health-care-context-related, operational and general. Research limitations/implications - One limitation of the study is that only 13 articles were found in the literature regarding the characteristics of management and leadership competence. However, the search terms were relevant, and the search process was endorsed by an information specialist. The study findings imply the need to shift away from the individual approach to leadership and management competence. Management and leadership need to be assessed more frequently from a holistic perspective, and not merely on the basis of position in the organizational hierarchy or of profession in health care. Originality/value - The authors' evaluation of the characteristics of management and leadership competence without a concentrated profession-based approach is original.
Cooper, Linda; Andrew, Sharon; Fossey, Matt
In the UK, military veterans will receive care by civilian nurses in civilian hospitals. We propose that the nurses providing this care require an understanding of the unique experiences and specific health needs of veterans to deliver evidence-based care. To conduct an integrative review of published literature to explore how nursing programmes prepare nurses to care for the military veteran population in civilian hospitals. A systematic search was undertaken of a range of electronic databases, Google Scholar and hand searching of Military and Veteran health journals. Papers that focused on education of civilian nurses about veteran health and included primary research or description of practice-based innovations were included in the review. The search generated sixteen papers that were focused on nurse education in higher education institutions. Several papers focused on simulation as a teaching method for veteran-specific health issues or curriculum developments with educational innovations such as online courses. Six papers focusing in continuing professional education of nurses in the clinical setting were included as supplementary information. All papers reviewed were US focused and dated between January 2011 and September 2015. Our search concluded that there is a gap in knowledge in this subject area within a UK context, therefore our review includes UK background information to support the US findings. Civilian nurses need educational preparation to understand the specific needs of veterans. Educational institutions in the US have responded to nationwide initiatives to undertake that preparation. More empirical studies need to be undertaken to develop, test and evaluate educational innovations for preparing students and nurses delivering care to military veteran in civilian healthcare settings. Copyright © 2016 Elsevier Ltd. All rights reserved.
Kapçı, Nermin; Akçam, Mustafa; Koca, Tuğba; Dereci, Selim; Kapcı, Mücahit
To determine the nutritional status of hospitalized children at the time of admission and to investigate the relationship between diagnosis and nutritional status. Body weight, height, triceps skinfold thickness, and mid-arm circumference were measured on admission and percentages of weight-for-age, weight-for-height, body mass index, mid-arm circumference, and triceps skinfold thickness were calculated. The nutritional status was evaluated using the Waterlow, Gomez, and other anthropometric assessments. A total of 511 patients were included in the study with a mean age of 5.8±4.9 years. Malnutrition was determined in 52.7% of patients according to the Waterlow classification. Mild malnutrition was determined in 39%, moderate in 12%, and severe in 1.7%, with the characteristics of acute malnutrition in 23.9%, acute-chronic in 7.3%, and chronic in 21.5%. The highest rate of malnutrition was in the 0-2 years age group (62.3%). According to the Gomez classification, malnutrition rate was determined as 46.8%. The rates of malnutrition in malignant, gastrointestinal, and infectious diseases were 60%, 59.8%, and 54.5%, respectively. The prevalence of malnutrition in hospitalized children was noticeably high. The nutritional evaluation of all patients and an early start to nutritional support could provide a significant positive contribution.
Ong, Sherine Jue; Huang, Yhu-Chering; Tan, Hsin-Yuan; Ma, David H. K.; Lin, Hsin-Chiung; Yeh, Lung-Kun; Chen, Phil Y. F.; Chen, Hung-Chi; Chuang, Chih-Chun; Chang, Chee-Jen; Hsiao, Ching-Hsi
Background Methicillin-resistant Staphylococcus aureus (MRSA) infection is an important public health issue. The study aimed to characterize the patient demographics, clinical features, antibiotic susceptibility, and clinical outcomes of keratitis caused by S. aureus, and to make a comparison between MRSA and methicillin-sensitive S. aureus (MSSA) isolates. Methodology/Principal findings Patients (n = 59) with culture-proven S. aureus keratitis treated in Chang Gung Memorial Hospital between January 1, 2006, and December 31, 2010, were included in our study. Patients' demographic and clinical data were retrospectively reviewed. Twenty-six MRSA (44%) and 33 MSSA (56%) isolates were collected. The MRSA keratitis was significantly more common among the patients with healthcare exposure (P = 0.038), but 46.2% (12/26) of patients with MRSA keratitis were considered to have community-associated infections. All isolates were susceptible to vancomycin. MRSA isolates were significantly more resistant to clindamycin, erythromycin, and sulfamethoxazole/trimethoprim. Ocular surface disease was a significant risk factor for MRSA keratitis (P = 0.011). Visual outcome did not differ significantly between the MRSA and MSSA groups. However, age (B = 0.01, P = 0.035, 95% confidence interval [CI]: 0.001–0.019) and visual acuity at presentation (B = 0.749, Pkeratitis, especially for MRSA infections. Advanced age and poor visual acuity at presentation are important prognostic indicators for poor visual outcome in S. aureus keratitis. Oxacillin resistance may not be a significant prognostic indicator. PMID:24244625
Foster, Byron Alexander; Tom, Dina; Hill, Vanessa
To determine whether the use of hypotonic vs isotonic maintenance fluids confers an increased risk of hyponatremia in hospitalized children. A search of MEDLINE (1946 to January 2013), the Cochrane Central Registry (1991 to December 2012), Cumulative Index for Nursing and Allied Health Literature (1990 to December 2012), and Pediatric Academic Societies (2000-2012) abstracts was conducted using the terms "hypotonic fluids/saline/solutions" and "isotonic fluids/saline/solutions," and citations were reviewed using a predefined protocol. Data on the primary and secondary outcomes were extracted from original articles by 2 authors independently. Meta-analyses of the primary and secondary outcomes were performed when possible. A total of 1634 citations were screened. Ten studies (n = 893) identified as independent randomized controlled trials were included. Five studies examined subjects in the intensive care unit setting, including 4 on regular wards and 1 in a mixed setting. In hospitalized children receiving maintenance intravenous fluids, hyponatremia was seen more often in those receiving hypotonic fluids than in those receiving isotonic fluids, with an overall relative risk of 2.37 (95% CI, 1.72-3.26). Receipt of hypotonic fluids was associated with a relative risk of moderate hyponatremia (hypotonic fluids with half-normal saline found a relative risk of hyponatremia of 2.42 (95% CI, 1.32-4.45). In hospitalized children in intensive care and postoperative settings, the administration of hypotonic maintenance fluids increases the risk of hyponatremia when compared with administration of isotonic fluids. For patients on general wards, insufficient data are available based on the reviewed studies, and individual risk factors must be assessed. Copyright © 2014 Elsevier Inc. All rights reserved.
Bardach, Naomi S; Lyndon, Audrey; Asteria-Peñaloza, Renée; Goldman, L Elizabeth; Lin, Grace A; Dudley, R Adams
Patient-centred care has become a priority in many countries. It is unknown whether current tools capture aspects of care patients and their surrogates consider important. We investigated whether online narrative reviews from patients and surrogates reflect domains in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and we described additional potential domains. We used thematic analysis to assess online narrative reviews for reference to HCAHPS domains and salient non-HCAHPS domains and compared results by reviewer type (patient vs surrogate). We identified hospitals for review from the American Hospital Association database using a stratified random sampling approach. This approach ensured inclusion of reviews of a diverse set of hospitals. We searched online in February 2013 for narrative reviews from any source for each hospital. We included up to two narrative reviews for each hospital. Outpatient or emergency department reviews, reviews from self-identified hospital employees, or reviews of <10 words. 50.0% (n=122) of reviews (N=244) were from patients and 38.1% (n=93) from friends or family members. Only 57.0% (n=139) of reviews mentioned any HCAHPS domain. Additional salient domains were: Financing, including unexpected out-of-pocket costs and difficult interactions with billing departments; system-centred care; and perceptions of safety. These domains were mentioned in 51.2% (n=125) of reviews. Friends and family members commented on perceptions of safety more frequently than patients. A substantial proportion of consumer reviews do not mention HCAHPS domains. Surrogates appear to observe care differently than patients, particularly around safety. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Farias, Diego Carlos; Araujo, Fernando Oliveira de
Hospitals are complex organizations which, in addition to the technical assistance expected in the context of treatment and prevention of health hazards, also require good management practices aimed at improving their efficiency in their core business. However, in administrative terms, recurrent conflicts arise involving technical and managerial areas. Thus, this article sets out to conducta review of the scientific literature pertaining to the themes of hospital management and projects that have been applied in the hospital context. In terms of methodology, the study adopts the webiblioming method of collection and systematic analysis of knowledge in indexed journal databases. The results show a greater interest on the part of researchers in looking for a more vertically and horizontally dialogical administration, better definition of work processes, innovative technological tools to support the management process and finally the possibility of applying project management methodologies in collaboration with hospital management.
U Edmond C.Y.
Full Text Available Introduction: Hospital at home (HAH is a service that provides home-based nursing and rehabilitation services whose aim is to prevent admission or to facilitate early discharge from care in an acute hospital. Methods: We evaluated the effectiveness of early discharge hospital at home (HAH schemes for hip fracture patients over a 27-year period in a district general hospital in the United Kingdom. A long-term database for audit and research purposes is maintained for all hip fracture patients admitted to Peterborough City Hospital. The data were analysed retrospectively and patients were followed up routinely for six weeks after discharge. Results: As many as 8876 patients were admitted with a hip fracture between 1st January 1987 and 31st December 2014, of which 5512 patients were eligible for one of the two available HAH schemes. The proportion of eligible patients discharged to the HAH schemes, and their hospital stay and readmission rates were measured; 1786 patients were discharged to a HAH scheme. The proportion of patients discharged to the scheme progressively reduced from a maximum of 94% to a minimum of 13% over the study period. The length of hospital stay until discharge to the scheme progressively increased from a mean of eight days to 18 days. Discussion: We conclude that HAH schemes can potentially reduce the length of hospital stay of hip fracture patients but continued resources and service organisation have to be provided to match the increasing demand to prevent the service from becoming ineffective.
Boonstra, A.; Versluis, Arie; Vos, J.F.J.
Background: The literature on implementing Electronic Health Records (EHR) in hospitals is very diverse. The objective of this study is to create an overview of the existing literature on EHR implementation in hospitals and to identify generally applicable findings and lessons for implementers.
Gabrian, Martina; Dutt, Anne J; Wahl, Hans-Werner
Human beings impose subjective, time-related interpretations on their existence, and the experience of time is a major aspect of lifespan development. In this mini-review, we understand subjective time as the way individuals subjectively perceive and evaluate the passing of their personal "objective" lifetime. A broad range of constructs and operationalizations has been developed in (gero-) psychology to capture subjective time, including future time perspective, personal goals, or autobiographical memories. In order to theoretically integrate this yet loosely connected body of literature, we propose a conceptual model of subjective time concepts according to 2 dimensions: temporal direction (past, present, future) and thematic field (duration/expansion, time-ordered life content, and time-related evaluations, attitudes, and mindsets). This conceptual model of subjective time perceptions builds the foundation for a review of the empirical literature regarding associations of subjective time with developmental outcomes (i.e., subjective well-being and physical health) in middle and late adulthood. Empirical findings establish subjective time concepts as a consistent predictor of well-being and health. Positive subjective time perceptions (i.e., an expanded view of the future, a focus on positive past and future life content, and favorable time-related evaluations) were associated with higher well-being and better physical health, while negative subjective time perceptions in general were linked to lower levels of health and well-being. Contrasting past- and future-oriented subjective time perceptions, it appears that past-oriented subjective time perceptions have been studied primarily in relation to subjective well-being, while future-oriented time perceptions play a key role both with regard to physical health and well-being. In conclusion, we argue that a stronger integration of subjective time constructs into developmental regulation models may deepen our
Banks, Robert S.; Rainer, David
This report presents the results of a recent research project originally concerned with review of governmental initiatives for changes to hospital design and operation standards at both the federal and state levels. However. it quickly became apparent that concern with energy conservation was not impacting hospital environmental standards, especially at the state level, irrespective of the energy implications. Consequently, the study was redirected to consider all energy conservation initiatives directed toward design and operating practices unique to the hospital environment. The scope was limited to agency programs (i.e., not undertaken at the initiative of individual hospitals), applicable to non-federal public and private hospitals.
Studnicki, J; Stevens, C E
All hospital care can be characterized as either appropriate (i.e., efficatious and necessary) or inappropriate (i.e., services without benefit or services that could be provided in a less costly setting). A demonstration project combining an appropriateness determination methodology with a cybernetic control system was implemented in a study area that included six hospitals and approximately 400 practicing physicians. Project results to date indicate substantial improvements in the ratio of appropriate to inappropriate care for both hospitals and individual physicians. Evaluation research design problems and areas of future research are also discussed.
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...
Marina de Tommaso
Full Text Available Environmental context has an important impact on health and well being. We aimed to test the effects of a visual distraction induced by classical hospital waiting room (RH versus an ideal room with a sea view (IH, both represented in virtual reality (VR, on subjective sensation and cortical responses induced by painful laser stimuli (LEPs in healthy volunteers and patients with chronic migraine (CM. Sixteen CM and 16 controls underwent 62 channels LEPs from the right hand, during a fully immersive VR experience, where two types of waiting rooms were simulated. The RH simulated a classical hospital waiting room while the IH represented a room with sea viewing. CM patients showed a reduction of laser pain rating and vertex LEPs during the IH vision. The sLORETA analysis confirmed that in CM patients the two VR simulations induced a different modulation of bilateral parietal cortical areas (precuneus and superior parietal lobe, and superior frontal and cingulate girus, in respect to controls. The architectural context may interfere with pain perception, depending upon the status of subject. Many variables may change patients’ outcome and support the use of VR technology to test the best conditions for their management.
Gloria Cajiao; Dennis Lissete Morales Arias; Genny Carolina Garzón Romero; Liliana Benavides Basante; José Leonardo Acevedo Rincón
This review of scientific literature presents some tendencies, conceptual advances, empirical findings and tests that measure the predictive variables of subjective well-being. It was done through the search in bibliographical database like ProQuest, PsycArticles, Psyctest, OVID SP, books and Thesis. Two types of predictive variables were recognized- internal and external to the individual-. Both of them influence the achievement of the subjective well-being. Besides, the studies and conceptu...
Epstein, Nancy E.
Background: The use of multidisciplinary in-hospital teams limits adverse events (AE), improves outcomes, and adds to patient and employee satisfaction. Methods: Acting like "well-oiled machines," multidisciplinary in-hospital teams include "staff" from different levels of the treatment pyramid (e.g. staff including nurses′ aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others). Their enhanced teamwork counters the "silo effect" by enhancing communication...
Atif, Khaula; Khan, Habib Ullah; Maqbool, Shahzad
To study the level of job satisfaction among doctors serving in a tertiary care hospital in Lahore and ascertain its co-relation with multiple demographic variables which had a profound impact. This cross sectional study with non-probability purposive sampling was conducted at Combined Military Hospital, Lahore, from February 2014 to November 2014. Subjects were doctors serving in that hospital for minimum six months duration. Pre-formed questionnaires were distributed to volunteers (average filling time was 3 ½ to 7 minutes). Multiple demographic features were independent variables. Outcome variable was job satisfaction. Statistical analysis was done via descriptive statistics (SPSS 20), data expressed as mean ± standard deviation (SD). Out of 263 doctors serving in hospital, 203 (77.91%) volunteered to participate; response rate by depositing the filled forms was 47.78% (97 doctors). Amongst the respondents, 10 (10.3%) doctors had below average job satisfaction, 32(33.0%), 21(21.6%), 21(21.6%) and 13(13.3%) had average, above average, well above average and outstanding job satisfaction respectively. There was significant relation between job satisfaction and age group of the doctors (p 0.025), education (p 0.015), service years (p 0.013) income per month (pjob (p 0.204), working hours (p 0.089), additional duties p 0.421) and socioeconomic class (p 0.104) on outcome variable. A significant number of doctors was found discontented with their job, which may consequently impact their yield/performance. The job satisfaction can be substantially improved if these contributory factors are aptly addressed at all tiers.
Al-Zayed Adel A
Full Text Available Abstract Background Assessment of patients' satisfaction with health care services could help to identify the strengths and weaknesses of the system and provide guidance for further development. The study's objectives were to: (i assess the pattern of satisfaction with hospital care for a sample of people with schizophrenia in Kuwait, using the Verona Service Satisfaction Scale (VSSS-EU; ii compare the pattern of satisfaction with those of similar studies; and iii assess the association of VSSS seven domains with a number of variables representing met and unmet needs for care, family caregiver burden, severity of psychopathology, level of psychosocial functioning, socio-demographic characteristics, psychological well-being and objective quality of life. Methods Consecutive outpatients in stable condition and their family caregivers were interviewed with the VSSS-EU and measures of needs for care, caregiver burden, quality of life and psychopathology. Results There were 130 patients (66.1%m, mean age 36.8. While over two-thirds expressed satisfaction with the domains of "overall satisfaction", "professionals' skills", "access", "efficacy", and "relatives' involvement", only about one-third were satisfied with the domains of "information" and "types of intervention". The later two domains were the areas in which European patients had better satisfaction than our patients, while our patients expressed better satisfaction than the Europeans in the domain of "relatives' involvement". In multiple regression analyses, self-esteem, positive and negative affect were the most important correlates of the domains of service satisfaction, while clinical severity, caregiver burden and health unmet needs for care played relatively minor roles. Conclusion The noted differences and similarities with the international data, as well as the predictive power of self-esteem and affective state, support the impression that patients' attitudes towards psychiatric care
Full Text Available The Nutrition Care in Canadian Hospitals (2010–2013 study identified the prevalence of malnutrition on admission to medical and surgical wards as 45%. Nutrition practices in the eighteen hospitals, including diagnosis, treatment and monitoring of malnourished patients, were ad hoc. This lack of a systematic approach has demonstrated the need for the development of improved processes and knowledge translation of practices aimed to advance the culture of nutrition care in hospitals. A narrative review was conducted to identify literature that focused on improved care processes and strategies to promote the nutrition care culture. The key finding was that a multi-level approach is needed to address this complex issue. The organization, staff, patients and their families need to be part of the solution to hospital malnutrition. A variety of strategies to promote the change in nutrition culture have been proposed in the literature, and these are summarized as examples for others to consider. Examples of strategies at the organizational level include developing policies to support change, use of a screening tool, protecting mealtimes, investing in food and additional personnel (healthcare aides, practical nurses and/or diet technicians to assist patients at mealtimes. Training for hospital staff raises awareness of the issue, but also helps them to identify their role and how it can be modified to improve nutrition care. Patients and families need to be aware of the importance of food to their recovery and how they can advocate for their needs while in hospital, as well as post-hospitalization. It is anticipated that a multi-level approach that promotes being “food aware” for all involved will help hospitals to achieve patient-centred care with respect to nutrition.
van Loon, Kim; van Zaane, Bas; Bosch, Els J; Kalkman, Cor J; Peelen, Linda M
BACKGROUND: Failure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality. PURPOSE: In this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring
Coustasse, Alberto; Tomblin, Shane; Slack, Chelsea
.... This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption...
Full Text Available Specialist outreach clinics in primary care and rural hospital settings. The Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003798.pub2. DOI: 10.1002/14651858.CD003798.pub2.
A review of stroke admissions at a tertiary hospital in rural Southwestern ... Background: Stroke is a common neurological disorder and is the third leading cause of ... Hypertension (85.2%), diabetes mellitus (23.8%), and tobacco smoking ...
de Vries, E. N.; Ramrattan, M. A.; Smorenburg, S. M.; Gouma, D. J.; Boermeester, M. A.
INTRODUCTION: Adverse events in hospitals constitute a serious problem with grave consequences. Many studies have been conducted to gain an insight into this problem, but a general overview of the data is lacking. We performed a systematic review of the literature on in-hospital adverse events.
Bakker, F.C.; Robben, S.H.M.; Olde Rikkert, M.G.M.
BACKGROUND: Although it is widely recognised that frail older persons need adaptation of healthcare services, it is unclear how hospital care in general can best be tailored to their frailty. OBJECTIVE: To systematically review the evidence for hospital-wide interventions for older patients.
Britton, Lauren; Rosenwax, Lorna; McNamara, Beverley
Increased accountability and growing fiscal limitations in global health care continue to challenge how occupational therapy practices are undertaken. Little is known about how these changes affect current practice in acute hospital settings. This article reviews the relevant literature to further understanding of occupational therapy practice in acute physical hospital settings. A scoping review of five electronic databases was completed using the keywords Occupational therapy, acute hospital settings/acute physical hospital settings, acute care setting/acute care hospital setting, general medicine/general medical wards, occupational therapy service provision/teaching hospitals/tertiary care hospitals. Criteria were applied to determine suitability for inclusion and the articles were analysed to uncover key themes. In total 34 publications were included in the review. Analysis of the publications revealed four themes: (1) Comparisons between the practice of novice and experienced occupational therapists in acute care (2) Occupational therapists and the discharge planning process (3) Role of occupation in the acute care setting and (4) Personal skills needed and organisation factors affecting acute care practice. The current literature has highlighted the challenges occupational therapists face in practicing within an acute setting. Findings from this review enhance understanding of how occupational therapy department managers and educators can best support staff that practise in acute hospital settings. © 2015 Occupational Therapy Australia.
African Review of Economics and Finance. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 7, No 1 (2015) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Editorial: Subjective well-being in Africa.
Frakt, Austin B
Context: Hospital cost shifting—charging private payers more in response to shortfalls in public payments—has long been part of the debate over health care policy. Despite the abundance of theoretical and empirical literature on the subject, it has not been critically reviewed and interpreted since Morrisey did so nearly fifteen years ago. Much has changed since then, in both empirical technique and the health care landscape. This article examines the theoretical and empirical literature on cost shifting since 1996, synthesizes the predominant findings, suggests their implications for the future of health care costs, and puts them in the current policy context. Methods: The relevant literature was identified by database search. Papers describing policies were considered first, since policy shapes the health care market in which cost shifting may or may not occur. Theoretical works were examined second, as theory provides hypotheses and structure for empirical work. The empirical literature was analyzed last in the context of the policy environment and in light of theoretical implications for appropriate econometric specification. Findings: Most of the analyses and commentary based on descriptive, industrywide hospital payment-to-cost margins by payer provide a false impression that cost shifting is a large and pervasive phenomenon. More careful theoretical and empirical examinations suggest that cost shifting can and has occurred, but usually at a relatively low rate. Margin changes also are strongly influenced by the evolution of hospital and health plan market structures and changes in underlying costs. Conclusions: Policymakers should view with a degree of skepticism most hospital and insurance industry claims of inevitable, large-scale cost shifting. Although some cost shifting may result from changes in public payment policy, it is just one of many possible effects. Moreover, changes in the balance of market power between hospitals and health care plans
Cregan, P C; McLean, A S
Trauma is the leading cause of death for people aged under 40 years in Australia. However, data on trauma in this country have been scant and derived from teaching hospitals or "non-medical" sources such as Roads and Traffic Authority reports. To address this, a review was undertaken of trauma separations from a large suburban hospital. The Nepean Hospital is a 350-bed metropolitan hospital on the western fringe of Sydney and, since the development of "Areas" as the basic health planning units in metropolitan Sydney, it is the main hospital of the Wentworth Area Health Service. A retrospective study of trauma presentations to the hospital was undertaken to provide a "snapshot" of the hospital's trauma load. Epidemiological factors leading to this load were reviewed, together with deaths, ambulance transfers and transfers by other means. During the study period there were 2042 separations for trauma based on the International Classification of Diseases codes E800-E999. Thirty-four other patients were transferred or died without being admitted to the hospital and 72 patients were transferred after hospital admission. During this period 1236 potentially severely injured patients were seen. This study demonstrates the large trauma load presenting to a Sydney suburban hospital and shows that planning for trauma services must take account of the size and logistics of such a load. As epidemiological indices suggest that the load will increase, further accurate data on suburban trauma are needed to allow proper planning.
Full Text Available Background: Number of implanted pacemakers is in continuous increase in Maribor General Hospital. The first four pacemakers in 1972 were followed by 50 pacemakers annually in the first 10 years. In 1988 the number first exceeded 100 implanted pacemakers and in the year 2004 achieved number 372. Altogether, till the end of the year 2004 there were 4232 pacemakers implanted. Analyses of the implanted pacemakers according to pacing mode since 1986 shows small number of DDD/VDD(R pacemakers till the year 1995. Since that year its number was increasing and in the year 1998 and 1999 exceeded half of all implanted pacemakers. In period of thirty years, there were 48.3% VVI, 22.3%VVIR, 16.4% DDD, 5.8% DDDR, 6.1% VDD and 1% AAIR pacemakers implanted. We have done analysis of the all outpatients within the 30-year period (1972–2001. For this purpose 2206 records were reviewed and 2176 patients analysed. According to gender, there were 51.4% male and 48.6% female. Average age at the time of implantation was 71 years (range from 13–96 years. Most patients (58% were between 65 and 79 years of age, there were 20% younger than 65 years and 22% older than 80 years of age. There were more men in the group till 79 years of age and more women in the group older than 80 years. Average survival of the patients with pacemaker (1771 was 94.7% after one year, 56.9% after five years and 31.5% after ten years. Survival is influenced by the age of the patients and accompanying diseases of the patients at the time of implantation, especially heart failure. In patients younger than 65 years, five years survival from implantation, was 75.4% and after ten years 54.3%. In older than 80 years, five years survival from implantation was 34.4% and after ten years 11.5%. Survival of the patients with heart failure, five years after implantation was 10% and after ten years 8% worse than those without it. In 30-year period, 271 patients had two or more pacemakers implanted
The global disease burden from measles as a vaccine preventable disease remains high despite decades of interventions by various organs and agencies. To determine the prevalence and outcome of childhood cases of measles admitted into the children's emergency ward of the National hospital and highlight the ...
medical, nursing, and physiotherapy students in addition to postgraduate surgical trainees. Between April 2002 and. 2009 BCIH provided a high quality training program for. Orthopaedic Clinical Officers (OCO) in Malawi. Currently, the hospital also offers several international postgraduate opportunities including two annual ...
Summary. In Wesley Guild Hospital llesa in the South ~ West region of Nigeria a retrospective study of 105 consecutive cases operated upon for typhoid perforation between Janu— ary 1988 and November 2001 was carried out. The ages of the patients were between 4 to 70 years with a mean age of'19.2 :1: 8.81.
In Wesley Guild Hospital Ilesa in the South – West region of Nigeria a retrospective study of 105 consecutive cases operated upon for typhoid perforation between January 1988 and November 2001 was carried out. The ages of the patients were between 4 to 70 years with a mean age of 19.2 ± 8.81. There were 84 males ...
Background: Enteric fever is endemic in developing countries and frequently complicates with ileal perforation. Surgical intervention for the perforation is the usual treatment but attendant rate of postoperative complications high. It is unclear what the spec- trum of enteric fever perforations is in rural hospital practice in Kenya ...
Navarrete-Reyes, Ana Patricia; Medina-Rimoldi, Carlos Tonatiuh; Avila-Funes, José Alberto
Older adults frequently report problems of transportation. Little is known about the correlates of transportation deficiency in Latin America. Therefore, the aim of the present study was to determine the correlates of subjective transportation deficiency (STD) among community-dwelling older adults attending a tertiary care hospital in Mexico City. Cross-sectional study of 228 participants aged ≥70 years being followed in any of the outpatient clinics of a tertiary care hospital in Mexico City. Data were obtained through a structured questionnaire. Univariate and multivariate logistic regression analyses were carried out in order to identify the correlates of STD. The mean age of the participants was 79.8 years (SD 6.4) and 67.1% were women. STD was present in 46% of participants. The multivariate logistic regression model showed that female sex, illiteracy, mobility disability and the use of an assistive walking device had an independent and statistically significant association with STD. Female sex, illiteracy, mobility disability and the use of an assistive walking device were independent correlates of STD in the present study. Identifying the frequency and correlates of transportation deficiency in vulnerable populations will allow for the identification and implementation of useful public policies, as well as for the optimization of prevention and treatment strategies in an attempt to preserve mobility and autonomy, especially in low- and middle-income countries where previous work on transportation deficiency is lacking. Geriatr Gerontol Int 2017; 17: 1893-1898. © 2017 Japan Geriatrics Society.
Hussain, Zeenat; Kuzian, Edyta; Hussain, Naveed
Gender representation in Islamic bioethics research in the twenty-first century has not been studied. To study temporal trends in representation of female subjects in Islamic bioethics research, PubMed-listed publications on Islamic bioethics from years 2000 to 2014 were reviewed for gender participation in human subjects' research. There were temporal trends of increasing publications of Islamic bioethics-related human subjects' research (64 papers over 15 years; R (2) = 0.72; p < 0.0004). Female subjects were well represented with a trend toward increasing participation. This was true for women from Muslim-majority countries even in non-gender-focused studies over the past 15 years.
Purtell, D L
The Health Care Quality Improvement Act of 1986 can help protect medical professionals and healthcare facilities from antitrust and defamation claims and other forms of litigation arising from the peer review process. Some hospitals may need to make major changes in their peer review activity as a result of the act. The healthcare entity, not the physicians involved in peer review, has the burden of complying with the provisions of the act. Failure to comply with the act can lead to loss of immunity from damages, fines, and potential exclusion from the Medicare program. The potential for liability has sparked a need for hospitals to reexamine and possibly reorganize medical staff and update procedures and related governing documents. Healthcare entities may consider changes such as implementing a director of medical affairs function, choosing medical staff for multiple-year terms, and centralizing physician review files. In the 1980s many hospitals created quality assurance and risk management programs. Risk managers need to share data with quality assurance personnel, who must in turn share the information with medical staff involved with credentialing, peer review, and medical affairs management. Legal counsel will need to be familiar with the legalities of the act, as well as the hospital's peer review procedures and operations. General legal counsel should oversee coordination of hospital proceedings and assist in educating staff on the legalities of peer review.
Full Text Available Context: Currently there is a growing interest in oral health outcomes in how oral health affects quality of life. When oral health related quality of life measures are used alongside traditional clinical methods of measuring oral health status, a more comprehensive assessment of the impact of oral diseases on the several dimensions of subjective wellbeing becomes possible. In this context, we attempted to study the impact of oral diseases on quality of life, so as to address the patient′s needs in an appropriate way and thereby improving one′s quality of life. Aims: To evaluate the impact of different oral diseases on quality of life using a modified OHIP-14 questionnaire, so as to address the patient′s needs in an appropriate way and thereby improving one′s quality of life. Settings and Design: The study was carried out among 302 subjects, attending the outpatient department a dental hospital, India, for check up and treatment of their oral condition. Subjects aged above 20 years, who gave their consent for the study were included. Materials and Methods: The study sample was categorized in to two groups based upon the duration of the affecting disease - group 1 consisted of subjects suffering with chronic diseases and group 2 of subjects suffering with acute diseases. All the subjects were asked to fill up their responses in the given OHIP-14 questionnaires. The completed questionnaires were then collected and statistically analyzed. Statistical Analysis Used: To evaluate the role of age on QOL, age was divided in to 2 groups using median split procedure. For inter and intragroup comparisions, independent sample t test, anova followed by post hoc test and Chi-square tests were employed. Results: Chi square test revealed a moderately impaired quality of life among all the diseases investigated. On comparing the mean domain and total OHIP score between the two groups, the domain of psychological discomfort and disability and the total
Full Text Available Abstract. This research was aimed to analyze the excess inventories issue in pharmacy and medical equipment unit at a local hospital in Bandung which affected the service level of the hospital. As one of the busy hospital in Java, proven by the higher amount of the patient/year than in other average Java typical hospital, the hospital needs to concern about the pharmaceutical and medical equipment inventories in order to fulfill patients’ needs and in the same time keeping the inventory level under control. Therefore, an inventory control evaluation was conducted to determine the appropriate number of inventories and time of order to avoid the excessive goods in central warehouse of the hospital. By using probabilistic inventory model and continuous review policy, the pharmaceutical inventory in the hospital was calculated to compare the ideal and actual amount of the average inventory level (AIL. ABC (Always, Better, Control classification also classified in this research to identify the proper item which potentially can be reduced from the inventory. From the analysis, we have discovered that the hospital potentially able to reduce almost Rp 830 million or 57% from the overstock inventory level by using continuous review policy as the basis of inventory control calculation system. Keywords: Continuous review policy, inventory control, EOQ, ROP, AIL
Liu, Xibei; Dawod, Yaser; Wonnaparhown, Alex; Shafi, Amaan; Doo, Loomee; Yoo, Ji Won; Ko, Eunjeong; Choi, Youn Seon
Hospital palliative care has been shown to improve quality of life and optimize hospital utilization for seriously ill patients who need intensive care. The present review examined whether hospital palliative care in intensive care (ICU) and non-ICU settings will influence hospital length of stay and in-hospital mortality. A systematic search of CINAHL/EBSCO, the Cochrane Library, Google Scholar, MEDLINE/Ovid, PubMed, and the Web of Science through 12 October 2016 identified 16 studies that examined the effects of hospital palliative care and reported on hospital length of stay and in-hospital death. Random-effects pooled odds ratios and mean differences with corresponding 95% confidence intervals were estimated. Heterogeneity was measured by the I 2 test. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was utilized to assess the overall quality of the evidence. Of the reviewed 932 articles found in our search, we reviewed the full text of 76 eligible articles and excluded 60 of those, which resulted in a final total of 16 studies for analysis. Five studies were duplicated with regard to outcomes. A total of 18,330 and 9,452 patients were analyzed for hospital length of stay and in-hospital mortality from 11 and 10 studies, respectively. Hospital palliative care increased mean hospital length of stay by 0.19 days (pooled mean difference = 0.19; 95% confidence interval [CI 95%] = -2.22-2.61 days; p = 0.87; I 2 = 95.88%) and reduced in-hospital mortality by 34% (pooled odds ratio = 0.66; CI 95% = 0.52-0.84; p < 0.01; I 2 = 48.82%). The overall quality of evidence for both hospital length of stay and in-hospital mortality was rated as very low and low, respectively. Hospital palliative care was associated with a 34% reduction of in-hospital mortality but had no correlation with hospital length of stay.
Makdissi, Regina; Stewart, Scott H
There is increasing emphasis on screening, brief intervention, and referral to treatment (SBIRT) for unhealthy alcohol use in the general hospital, as highlighted by new Joint Commission recommendations on SBIRT. However, the evidence supporting this approach is not as robust relative to primary care settings. This review is targeted to hospital-based clinicians and administrators who are responsible for generally ensuring the provision of high quality care to patients presenting with a myriad of conditions, one of which is unhealthy alcohol use. The review summarizes the major issues involved in caring for patients with unhealthy alcohol use in the general hospital setting, including prevalence, detection, assessment of severity, reduction in drinking with brief intervention, common acute management scenarios for heavy drinkers, and discharge planning. The review concludes with consideration of Joint Commission recommendations on SBIRT for unhealthy alcohol use, integration of these recommendations into hospital work flows, and directions for future research.
Full Text Available Context: Large breast is a major problem because of associated symptomatology and aesthetic concerns. Reduction mammoplasty (RM resolves the symptom and at the same time improves the aesthetic appearance of the breast, hence improving self-esteem and social integration. Aims: To describe the pattern of RM in a hospital in the developing world and its impact on postgraduate surgical training. Settings and Design: A retrospective review of all the RMs done in the National Orthopaedic Hospital, Enugu (a major plastic surgery training center in Nigeria over a ten-year period (2001-2010, in the developing country of Nigeria. Subjects and Methods: All RMs done in the hospital were reviewed after retrieving their records from operation register and medical records department. Fifteen (15 cases were retrieved and analyzed. Data Analysis: Data was analyzed with Microsoft excel 2007. Results: Average age of female patients who had RM was 26.5 years and 83.3% were single. The most common complaint was abnormally large breast (macromastia. Inferior pedicle technique was commonly used. Conclusions: The results of RM are remarkable as it impact positively on the quality of life of the patients. However, the level of awareness about the availability of this service is still low in the region as shown by few cases done over the period of review and this impacts negatively on the training. The need for public awareness cannot be overemphasized.
Full Text Available Background . The provision of medical services to patients according to their expectations and needs is necessary for the comfort and quality of life of patients, as well as for the standardization of hospital procedures. In recognizing these needs and expectations, an important step is the verification of provided services in order to improve their quality. The present study was designed to determine differences in service quality, as evaluated by hospitalized patients. Objectives . The analysis of the subjective feelings of hospitalized patients concerning service quality in the context of the application of the SER VQUAL method – a pilot study. Material and methods. The study was conducted in a Lower Silesian hospital in a group of 29 young patients (women: 16, men: 13, average age: 16 diagnosed with kidney disease. In the study a standard sheet of 22 SER VQUAL statements was used, and an analysis of the validity of 5 quality areas important for the patient was conducted. Results. According to the respondents, the most important of all 5 features directly affecting the quality of life during treatment is the ability and skill of the ward staff to provide medical services, so-called reliability – 24.48%. In turn, the least important of all the study characteristics was the aesthetics and ergonomics of rooms, the presence of appropriate equipment, the so-called material dimension – 15.31%. Furthermore, service quality gaps were visible in all five service quality dimensions. Conclusions . 1. The SER VQUAL method helps to identify discrepancies between the perceptions of patients’ expectations in all dimensions of the quality of provided medical services. 2. For the patients the least important is the material dimension, and the most affecting is the dimension associated with the reliability of the medical services. 3. Improvement of the level of satisfaction with the quality of medical services requires proper planning and effective
Loh, Sook Y; Mcleod, Robert W J; Elhassan, Hassan A
The aim of this review was to compare systematically the subjective measure of trismus between different interventions to treat head and neck cancer, particularly those of the oropharynx. Using The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Guidelines, Six databases were searched for the text using various terms which include "oropharyngeal/head and neck cancer", "trismus/mouth opening" and the various treatment modalities. Included in the review were clinical studies (> or =10 patients). Three observers independently assessed the papers identified. Among the six studies reviewed, five showed a significantly worst outcome with regard to the quality-of-life questionnaire scores for a radiotherapy or surgery and radiotherapy (RT) ± chemotherapy or chemoradiotherapy when compared to surgery alone. Only one study showed no significant difference between surgery alone and other treatment modalities. Subjective quality-of-life measures are a concurrent part of modern surgical practice. Although subjective measures were utilised to measure post operative trismus successfully, there was no consensus as to which treatment modality had overall better outcomes, with conflicting studies in keeping with the current debate in this field. Larger and higher quality studies are needed to compare all three treatment modalities.
Ameer A; Dhillon S; Peters MJ; Ghaleb M
Ahmed Ameer,1 Soraya Dhillon,1 Mark J Peters,2 Maisoon Ghaleb11Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; 2Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK Objective: Medication administration is the last step in the medication process. It can act as a safety net to prevent unintended harm to patients if detected. However, medication administration errors (MAEs) during this process have been documented and t...
Full Text Available Upload poisoning is one of the most dangerous and common poisoning in Iranian children. Depression of the respiratory and central nervous systems may lead to significant toxicity. Even low doses of uploads are dangerous in pediatrics under 6 years old. Methadone is the most toxic of the uploads; small doses as low as a single tablet can lead to death. According to this information we decided to evaluate methadone poisoning in Hospitalized Children
Schaefer, Eric W; Leung, Alicia; Kravarusic, Jelena; Stone, Neil J
For hospitalists, hypertriglyceridemia (HTG) is more than cardiovascular risk. Severe HTG occurs when serum triglycerides rise above 1000 mg/dL, and it carries a risk of abdominal pain and pancreatitis. The etiology of severe HTG is usually a combination of genetic and secondary factors. A detailed history with attention to family history, medications, and alcohol consumption can often lead to the cause. Physical examination findings may stretch across multiple organ systems. Patients with severe HTG should be admitted to the hospital for aggressive medical therapy if they develop symptoms such as abdominal pain or pancreatitis. Asymptomatic patients with severe HTG who have significant short-term risk for developing symptoms require urgent consultation that may lead to a brief hospitalization to address exacerbating factors. Treatment of severe HTG includes a combination of pharmacologic agents and a restriction on dietary triglyceride intake. If oral medications fail to adequately lower triglyceride levels, intravenous insulin and in rare cases therapeutic plasma exchange may be required. To prevent recurrent severe HTG, the patient should be counseled about adherence to long-term medications and lifestyle changes. Copyright © 2011 Society of Hospital Medicine.
Full Text Available Taking into consideration that lately tourism has become one of the most significant economic activities, and hospitality as its main key part there is a need to observe constant market trend changes in order to achieve business improvements for hoteliers. Modern technologies in hospitality influence on cost reduction, increase of profit and competitiveness, and finally on enhancing guests' satisfaction. The usage of modern technologies in rational use of energy is of strategic importance for every hotel company due to reduction of costs, strengthens of competitiveness, increases of productivity, and on the other side, becomes a strategic tool which influences on business efficiency improvement. Therefore, there is a natural need and feeling of those who are stakeholders of tourism and hospitality to inform themselves about new technologies. The aim of this article is to provide insight into the latest trends, necessities and current issues in the field of for rational use of energy in all areas of hotel operations, which will result in the creation of high-quality services and provide full customer satisfaction.
Kilsdonk, Melvin; Siesling, Sabine; Otter, R.; van Harten, Willem H.
External peer review was introduced in general hospitals in the Netherlands in 1994 to assess and improve the multidisciplinary team approach in cancer care. This paper aims to explore the value, perceived impact, and (future) role of external peer review in cancer care. Semistructured interviews
Full Text Available This review of scientific literature presents some tendencies, conceptual advances, empirical findings and tests that measure the predictive variables of subjective well-being. It was done through the search in bibliographical database like ProQuest, PsycArticles, Psyctest, OVID SP, books and Thesis. Two types of predictive variables were recognized- internal and external to the individual-. Both of them influence the achievement of the subjective well-being. Besides, the studies and conceptualization about Subjetive well-being and some of the Predictive Variables were analyzed in the conclusion.
... discharge from the inpatient hospital. 422.622 Section 422.622 Public Health CENTERS FOR MEDICARE & MEDICAID... to discharge from the inpatient hospital. (a) Enrollee's right to an immediate QIO review. An enrollee has a right to request an immediate review by the QIO when an MA organization or hospital (acting...
Bahadori, Mohammadkarim; Izadi, Ahmad Reza; Ghardashi, Fatemeh; Ravangard, Ramin; Hosseini, Seyed Mojtaba
This research aimed to systematically study and outline the methods of hospital performance evaluation used in Iran. In this systematic review, all Persian and English-language articles published in the Iranian and non-Iranian scientific journals indexed from Sep 2004 to Sep 2014 were studied. For finding the related articles, the researchers searched the Iranian electronic databases, including SID, IranMedex, IranDoc, Magiran, as well as the non-Iranian electronic databases, including Medline, Embase, Scopus, and Google Scholar. For reviewing the selected articles, a data extraction form, developed by the researchers was used. The entire review process led to the selection of 51 articles. The publication of articles on the hospital performance evaluation in Iran has increased considerably in the recent years. Besides, among these 51 articles, 38 articles (74.51%) had been published in Persian language and 13 articles (25.49%) in English language. Eight models were recognized as evaluation model for Iranian hospitals. Totally, in 15 studies, the data envelopment analysis model had been used to evaluate the hospital performance. Using a combination of model to integrate indicators in the hospital evaluation process is inevitable. Therefore, the Ministry of Health and Medical Education should use a set of indicators such as the balanced scorecard in the process of hospital evaluation and accreditation and encourage the hospital managers to use them.
Sheikhbardsiri, Hojjat; Raeisi, Ahmad Reza; Nekoei-Moghadam, Mahmood; Rezaei, Fatemeh
Surge capacity is one of the most important components of hospital preparedness for responding to emergencies and disasters. The ability to provide health and medical care during a sudden increase in the number of patients or victims of disasters is a main concern of hospitals. We aimed to perform a systematic review of hospital surge capacity in emergencies and disasters with a preparedness approach. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words "surge," "surge capacity," "preparedness," "hospital emergency department," "hospital," "surge capability," "emergency," "hazard," "disaster," "catastrophe," "crisis," and "tragedy" were used in combination with the Boolean operators OR and AND. The Google Scholar, ISI Web of Science, Science Direct, PubMed, Scopus, Ovid, Pro Quest, and Wiley databases were searched. A total of 1008 articles were extracted and 17 articles were selected for final review of surge capacity based on the objective of the study. Seventeen studies (1 randomized controlled trial, 2 qualitative studies, and 14 cross-sectional studies) investigated the surge capacity of hospitals in emergencies and disasters to evaluate the best evidence to date. The results of selected articles indicated that there are various ways to increase the capacity of hospitals in 4 domains: staff, stuff, structure, and system. Surge capacity is a basic element of disaster preparedness programs. Results of the current study could help health field managers in hospitals to prepare for capacity-building based on surge capacity components to improve and promote hospital preparedness programs. (Disaster Med Public Health Preparedness. 2017;11:612-620).
Azami-Aghdash, Saber; Ebadifard Azar, Farbod; Rezapour, Aziz; Azami, Akbar; Rasi, Vahid; Klvany, Khalil
Nowadays, for quality improvement, measuring patient safety culture (PSC) in healthcare organizations is being increasingly used. The aim of this study was to clarify PSC status in Iranian hospitals using a meta-analysis method. Six databases were searched: PubMed, Scopus, Google Scholar, Cochrane Library, Magiran, SID and IranMedex using the search terms including patient safety, patient safety culture, patient safety climate and combined with hospital (such as "hospital survey on patient safety culture"), measurement, assessment, survey and Iran. A total of 11 articles which conducted using Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire initially were reviewed. To estimate overall PSC status and perform the meta-analyses, Comprehensive Meta-Analysis (CMA) software v. 2 was employed. The overall PSC score based on the random model was 50.1%. "Teamwork within hospital units" dimension received the highest score of PSC (67.4%) and "Non-punitive response to error" the lowest score (32.4%). About 41% of participants in reviewed articles evaluate their hospitals' performance in PSC as 'excellent/very good'. Approximately %52.7 of participants did not report any adverse event in the past 12 months. The results of this study show that Iranian hospitals' performances in PSC were poor. Among the 12 dimensions of HSOPSC questionnaire, the "Non-punitive response to error" achieved the lowest score and could be a priority for future interventions. In this regard, hospitals staff should be encouraged to report adverse event without fear of punitive action.
Zasciurinskiene, Egle; Lindsten, Rune; Slotte, Christer; Bjerklin, Krister
The aim is to evaluate the literature for clinical scientific data on possible effects of orthodontic treatment on periodontal status in periodontitis-susceptible subjects. A systematic literature review was performed on studies in English using PubMed, MEDLINE, and Cochrane Library central databases (1965-2014). By manually searching reference lists of selected studies, we identified additional articles; then we searched these publications: Journal of Periodontology, Periodontology 2000, Jou...
Yuan, Q; Shi, C.; Schutter, G. de; K. Audenaert; Deng, D.
This paper reviews the chloride binding of cement-based materials subjected to external chloride environments. Chloride ion exist either in the pore solution, chemically bound to the hydration products, or physically held to the surface of the hydration products. Chloride binding of cement-based material is very complicated and influenced by many factors, such as chloride concentration, cement composition, hydroxyl concentration, cation of chloride salt, temperature, supplementary cementing m...
Kruse, Ole; Grunnet, Niels; Barfod, Charlotte
of deterioration, but patients with even lower lactate levels should be considered for serial lactate monitoring. The correlation between lactate levels in arterial and venous blood was found to be acceptable, and venous sampling should therefore be encouraged, as the risk and inconvenience for this procedure......BACKGROUND: Using blood lactate monitoring for risk assessment in the critically ill patient remains controversial. Some of the discrepancy is due to uncertainty regarding the appropriate reference interval, and whether to perform a single lactate measurement as a screening method at admission...... to the hospital, or serial lactate measurements. Furthermore there is no consensus whether the sample should be drawn from arterial, peripheral venous, or capillary blood. The aim of this review was: 1) To examine whether blood lactate levels are predictive for in-hospital mortality in patients in the acute...
Full Text Available Abstract Background Hospital partnerships, mergers and cooperatives are arrangements frequently seen as a means of improving health service delivery. Many of the assumptions used in planning hospital cooperatives are not stated clearly and are often based on limited or poor scientific evidence. Methods This is a protocol for a systematic review, following the Cochrane EPOC methodology. The review aims to document, catalogue and synthesize the existing literature on the reported methods for the evaluation of hospital cooperation activities as well as methods of hospital cooperation. We will search the Database of Abstracts of Reviews of Effectiveness, the Effective Practice and Organisation of Care Register, the Cochrane Central Register of Controlled Trials and bibliographic databases including PubMed (via NLM, Web of Science, NHS EED, Business Source Premier (via EBSCO and Global Health for publications that report on methods for evaluating hospital cooperatives, strategic partnerships, mergers, alliances, networks and related activities and methods used for such partnerships. The method proposed by the Cochrane EPOC group regarding randomized study designs, controlled clinical trials, controlled before and after studies, and interrupted time series will be followed. In addition, we will also include cohort, case-control studies, and relevant non-comparative publications such as case reports. We will categorize and analyze the review findings according to the study design employed, the study quality (low versus high quality studies and the method reported in the primary studies. We will present the results of studies in tabular form. Discussion Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin hospital cooperation activities as defined in this protocol. As a result, the review will provide an evidence base for partnerships, alliances or other fields of cooperation in a hospital setting. PROSPERO
Morrisey, M A
To review the empirical literature on the effects of selective contracting and hospital competition on hospital prices, travel distance, services, and quality; to review the effects of managed care penetration and competition on health insurance premiums; and to identify areas for further research. Selective contracting has allowed managed care plans to obtain lower prices from hospitals. This finding is generalizable beyond California and is stronger when there is more competition in the hospital market. Travel distances to hospitals of admission have not increased as a result of managed care. Evidence on the diffusion of technology in hospitals and the extent to which hospitals have specialized as a result of managed care is mixed. Little research on the effects on quality has been undertaken, but preliminary evidence suggests that hospital quality has not declined and may have improved. Actual mergers in the hospital market have not affected hospital prices. Much less research has been focused on managed care markets. Greater market penetration and greater competition among managed care plans are associated with lower managed care premiums. Greater HMO penetration appears to be much more effective than PPO penetration in leading to lower premiums. While workers are willing to change plans when faced with higher out-of-pocket premiums, there is little evidence of the willingness of employers to switch plan offerings. Preliminary evidence suggests that greater managed care penetration has led to lower overall employer premiums, but the results differ substantially between employers with and without a self-insured plan. Much more research is needed to examine all aspects of managed care markets. In hospital markets, particular attention should be focused on the effects on quality and technology diffusion.
Full Text Available Background: Major ocular trauma is an injury with potential blindness in ophthalmology. The aim of this study was to evaluate the demographic and etiologic factors of major ocular trauma in a tertiary hospital in Northern Taiwan. Subjects and Methods: A retrospective review of patients who suffered from open globe injuries and underwent management in a tertiary hospital between January 1, 2005, and December 31, 2014, was conducted. Patients with prior ocular trauma, preexisting ocular conditions affecting the visual acuity (VA and those with a history of previous intraocular or refractive surgery was excluded from this study. Results: Totally 199 eyes of 195 patients were enrolled in this study. Open globe injury occurred more frequently in males than in females (136 vs. 63 patients, P < 0.0001. Workplace is the most common place of injury (56.3%, followed by home (23.1%. Among patients younger than 18-year-old, domestic-related injury was the predominant cause (78.6%, while among those aged above 18 years, occupational injuries were the most common cause (62.0%. Compared with VA measured on admission, final VA was improved in 38.6%, unchanged in 48%, and worse in 13.4%. The visual outcome was found to be significantly associated with the initial VA, posterior extent injury, length of wound, and presence of vitreous prolapse. Conclusions: Unfavorable prognostic factors for final visual outcome in these patients are related to initial VA, posterior extent injury, length of wound, and presence of vitreous prolapse. Results of this study help predict visual outcomes of open globe-injured patients in emergent counseling.
Kazemzadeh, Z; Manzari, Z S; Pouresmail, Z
This study aimed to clarify the role of nurses in planning and implementation of nursing interventions related to smoking cessation. Nearly half of all smokers die from smoking-related illnesses. Quitting smoking can reduce these problems. Smoking cessation interventions include various types helping smokers successfully quit. Studies suggest that hospitalization can be a golden opportunity for nurses helping patients to quit smoking because of No Smoking regulations. A systematic review of the literature was carried through Web of Knowledge, ProQuest, Medscape, MedlinePlus, Ovid SID, Magiran, PubMed, and Science Direct databases between 1990-2015 on the subject of interest by keywords: role of nursing in smoking cessation, nursing intervention in smoking cessation, smoking cessation, smoking quitting and interventions planned by nurse. Nineteen papers were systematic examined, dealing with smoking cessation interventions by nurses. Totally, 17 studies used counselling for quitting smoking. Most studies involved other methods such as manuals, pamphlets, brochures training or printed educational materials, audio and video file. Some studies used nicotine replacement methods for patients such as nicotine skin tags, chewing nicotine or bupropion. Moreover, 17 studies were conducted by telephone at patients' follow-up after hospital discharge. Nurses' interventions for smoking cessation play an important role in helping patients quit smoking successfully. There are a variety of interventions that nurses can employ according to the patient's condition and diagnosis of different diseases. Quitting smoking can reduce lung cancers and other health problems. Nurses play an important role in helping patients to quit smoking. © 2016 International Council of Nurses.
Full Text Available Triage is a priority classification system based on the severity of problem to do the best therapeutic proceedings for patients in the less time. A triage system should be performed in a way which can make a decision with high accuracy and in the least time for each patient. Simplicity and reliability of the performance are the most important features of a standard triage system. An appropriate triage causes to increase the quality of health care services and patients’ satisfaction rate, decrease the waiting time as well as mortality rate, and increase the yield and efficiency of emergency wards along with reducing the related expenses. Considering to the above statements, in the present study the history of triage formation was evaluated and categorizing of all triage systems regarding prehospital and hospital as well as triage in normal and critical conditions were assessed, too.
Coustasse, Alberto; Tomblin, Shane; Slack, Chelsea
Supply costs account for more than one-third of the average operating budget and constitute the second largest expenditure in hospitals. As hospitals have sought to reduce these costs, radio-frequency identification (RFID) technology has emerged as a solution. This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption. Findings show that the application of RFID to medical equipment and supplies tracking has resulted in efficiency increases in hospitals with lower costs and increased service quality. RFID technology can reduce costs, improve patient safety, and improve supply chain management effectiveness by increasing the ability to track and locate equipment, as well as monitoring theft prevention, distribution management, and patient billing. Despite ongoing RFID implementation in the hospital supply chain, barriers to widespread and rapid adoption include significant total expenditures, unclear return on investment, and competition with other strategic imperatives.
Vidal Casariego, Alfonso; Calleja Fernández, Alicia; Villar Taibo, Rocío; Urioste Fondo, Ana; Pintor de la Maza, Begoña; Hernández Moreno, Ana; Cano Rodríguez, Isidoro; Ballesteros Pomar, María D
Nutritional support for malnourished patients undergoing gastrointestinal surgery reduces the complication rate and shortens the length of stay. The efficacy of nutritional support after hospital discharge was analyzed in this systematic review. The search strategy (nutrition OR "enteral nutrition" OR "nutritional supplements" OR "oral nutritional supplements" OR "sip feed" OR "sip feeding" OR "dietary counseling") AND ("patient discharge" OR discharge OR postdischarge) AND (surgery OR operation OR "surgical procedure") was followed in Medline, CENTRAL, and Trip databases. Inclusion criteria comprised: type of study (randomized controlled trial), language (English, Spanish), and subjects (patients undergoing gastrointestinal surgery). The risk of bias was assessed by using the Cochrane methodology. Five studies which were published in six different articles and recruited 446 patients were included. A high risk of bias was detected for most of them. Nutritional support improved energy intake and protein intake when high-protein oral supplements were provided. The intervention was associated with better weight prognosis, but the data about body composition were inconsistent. In most of the trials, nutritional intervention did not enhance functional capacity or quality of life. None of the studies analyzed the effects on complications after discharge. Nutritional support provided at discharge may increase dietary intake and improve body weight, but the low quality of studies can weaken the validity of results.
This review of the governance of maternity services at South Tipperary General Hospital has focussed on the systems and processes for assurance of service quality, risk management and patient safety primarily inside the hospital but also in the Hospital Group structure within which it operates. The effectiveness of the governance arrangements is largely determined by the quality of the leadership and management – both clinical and general – which designs, implements, and oversees those systems and processes and is ultimately responsible and accountable.\\r\
Azam David Saifullah
Full Text Available Background: Due to the increasing risk of getting co-morbidity and frailty, older people tend to be prone to hospitalization. Hospitalization in older people brings many adverse effects. Moreover, when these elderly get delirium, the mortality and morbidity will increase. The risk of getting deterioration and worsening condition because of delirium would also increase. In fact, delirium assessment is not a high priority in taking care older people during hospitalization because the focus of care is treating the disease.Delirium screening as an early recognition of delirium in the hospitalized elderly inIndonesia remains unreported and even do not well evaluated. Therefore, delirium as a preventable problem or causing problems remains unrecognized. Purpose: This paper aims to review the current evidence of early assessment of delirium in hospitalized older people. Methods: A systematic review was conducted from four databases yielding to 4 articles which met the inclusion and exclusion criteria. Results: There are four focuses on the result, namely delirium screening tools, patient characteristics, identified early delirium assessment, and outcomes affected by early delirium assessment. Confusion Assessment Method (CAM was used as the delirium screening tool in the hospital. Establishing the care team involving many disciplines will give a better way to improve the integrated care and collaborative care. Conclusion: Performing CAM integrated in comprehensive geriatric assessment can be the most important thing to be undertaken when looking after the hospitalized elderly.
Iacono, Teresa; Bigby, Christine; Unsworth, Carolyn; Douglas, Jacinta; Fitzpatrick, Petya
People with intellectual disability are at risk of poor hospital experiences and outcomes. The aims were to conduct a content and quality review of research into the acute hospital experiences of both people with intellectual disabilities and their carers, and to identify research gaps. A systematic search was conducted of primary research between 2009 and 2013 that addressed the experiences of the target group in general acute care hospitals. Quality appraisal tools yielded scores for quantitative and qualitative studies, and overarching themes across studies were sought. Sixteen studies met inclusion criteria. Quality scores were 6/8 for a survey, and 2/11-9/11 (mean =5.25) for qualitative studies/components. Content analysis revealed seven over-arching themes covering individuals' fear of hospital encounters, carer responsibilities, and problems with delivery of care in hospitals including staff knowledge, skills and attitudes. Our review of eligible papers revealed that despite 20 years of research and government initiatives, people with intellectual disability continue to have poor hospital experiences. The need for research to identify and investigate care at specific points of encounter across a hospital journey (such as admission, diagnostic testing, placement on a ward, and discharge) as well as to include people with a diversity of disabilities is discussed in terms of potential to influence policy and practice across health and disability sectors.
Han, Liyuan; Liu, Yanfen; Wang, Changyi; Tang, Linlin; Feng, Xiaoqi; Astell-Burt, Thomas; Wen, Qi; Duan, Donghui; Lu, Nanjia; Xu, Guodong; Wang, Kaiyue; Zhang, Lu; Gu, Kaibo; Chen, Sihan; Ma, Jianping; Zhang, Tao; You, Dingyun; Duan, Shiwei
Hyperhomocysteinemia (HHcy) is known to increase the risk of many diseases. Factors influencing HHcy in healthy and hypertensive subjects remain under-researched. A large population-based study was conducted in 60 communities from Shenzhen, China. Responses to standardized questions on lifestyle factors and blood samples were collected from all participants after a 12-h overnight fast. Multiple linear and multivariate logistic regressions were used to explore risk factors for HHcy. Results were then compared to those from a systematic review of English-language articles listed in Pubmed, EBSCOhost, Web of Science, Embase and Cochrane libraries that investigated HHcy risk factors in healthy and hypertensive subjects. A total of 1586 healthy (Male/Female = 642/944) and 5935 hypertensive subjects (Male/Female = 2928/3007) participated in our population-based study. In logistic regression analyses, age, BMI and creatinine (Cr) were risk factors, while being female, fruit intake and physical activity were protective factors for HHcy in healthy subjects. In hypertensive subjects, seven [age, smoking, salt intake, systolic blood pressure (SBP), uric acid, triglycerides (TG), and Cr] and four [female, fruit intake, total cholesterol (TC), and glucose] factors were associated with higher and lower HHcy respectively. The review of 71 studies revealed that potential risk factors for Hcy included nutritional, physiologic, lifestyle habits, ethnicity, genetics, interactions between gene-environment, gene-gene, gene-nutritional, environment-environment, nutritional-nutritional. Our study indicates the potential importance of increasing folic acid and vitamin B supplementation, daily fruit and vegetable intake, regular exercise and refraining from tobacco smoking and alcohol consumption as preventive strategies for Hcy. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
treatment modality. Design: It is a retrospective study of all conﬁrmed. Burkitt's lymphoma of the head and neck region seen at the Obafemi Awolowo University Teaching Hospital Ile. Ife (OAUTHC) between 1986 and 2002. Patients and methods: The medical records of all the patients with the histopathologically conﬁrmed ...
Full Text Available This review will first cover the root causes of falls, identify preventive measures associated with these falls, and provide an overview of best practice of fall prevention at leading institutions. There is significant benefit in instituting a comprehensive program to reduce falls. After analyzing the results from many successful programs, it is apparent that an integrative program that consists of patient evaluations, environmental modification, and staff training can lead to a significant reduction in the overall prevalence of falls. Such programs can be implemented at a low cost and therefore represent an improvement in care with a high return on investment.
Beck, Carolyn E
A systematic review of studies comparing hypotonic versus isotonic intravenous maintenance fluids in hospitalized children was conducted to determine whether hypotonic solutions increase the risk of acute hyponatremia. Studies were identified from electronic databases and hand-searched reference lists. A total of 283 abstracts were reviewed, 55 full-text articles were retrieved, and 3 studies were included. All studies were observational and were overall inconclusive. All authors cautioned against the routine use of hypotonic maintenance fluids, but hypotonic fluid administration did not always explain the development of acute hyponatremia. Further evidence is required as to the appropriate maintenance solution for hospitalized children.
MacDonald, Elayne; Dadds, Mark R; Brennan, John L; Williams, Katrina; Levy, Florence; Cauchi, Avril J
Human research investigating the impact of intranasal oxytocin on psychological processes has accelerated over the last two decades. No review of side effects, subjective reactions and safety is available. A systematic review of 38 randomised controlled trials conducted between 1990 and 2010 that investigated the central effects of intranasal oxytocin was undertaken. A systematic search for reports of adverse reactions involving intranasal oxytocin was also completed. Since 1990, research trials have reported on N=1529 (79% male) of which 8% were participants with developmental or mental health difficulties. Dosages ranged from 18 to 40 IU, mainly in single doses but ranged up to 182 administrations. Diverse methods have been used to screen and exclude participants, monitor side effects and subject reactions. Side effects are not different between oxytocin and placebo and participants are unable to accurately report on whether they have received oxytocin and placebo. Three case reports of adverse reactions due to misuse and longer-term use of intranasal oxytocin were reported. The evidence shows that intranasal oxytocin: (1) produces no detectable subjective changes in recipients, (2) produces no reliable side-effects, and (3) is not associated with adverse outcomes when delivered in doses of 18-40 IU for short term use in controlled research settings. Future research directions should include a focus on the dosage and duration of use, and application with younger age groups, vulnerable populations, and with females. Copyright © 2011 Elsevier Ltd. All rights reserved.
Cybulska, Paulina; Ni, Andy; Jimenez-Rivera, Carolina
Introduction. Clinical presentation of viral hepatitis ranges from mild symptoms to fulminant hepatitis. Our aim is to describe clinical presentation and outcomes of children with viral hepatitis from the Eastern Ontario/Western Quebec regions of Canada. Methods. Retrospective chart review of children diagnosed with viral hepatitis at our institution from January 1, 1998, to December 31, 2007. Results. There were 261 charts reviewed, only 64 had a confirmed viral etiology: 34 (53%) hepatitis B (HBV), 16 (25%) hepatitis C (HCV), 4 (6.3%) hepatitis A (HAV), 7 (11%) cytomegalovirus (CMV), and 3 (4.7%) Epstein-Barr virus (EBV). Children with HBV presented at a mean age of 6.4 ± 4.6 years. Spontaneous seroconversion (appearance of HBVeAb and loss of HBVeAg) occurred in 21/34 (61.7%). Children with acute hepatitis (HAV, CMV, and EBV) presented with mild abdominal pain, jaundice, and fevers. Overall outcome was excellent. Conclusion. Acute and chronic hepatitis in children has a benign course; moreover, HBV spontaneous seroconversion is common in pediatric patients.
Gannon, Brenda; Jones, Cheryl; Wakai, Abel; O'Sullivan, Ronan
Key performance indicators (KPIs) are used to identify where organisational performance is meeting desired standards and where performance requires improvement. Valid and reliable KPIs depend on the availability of high-quality data, specifically, the relevant minimum data set (MDS; the core data identified as the minimum required to measure performance for a KPI) elements. However, the feasibility of collecting the relevant MDS elements is always a limitation of performance monitoring using KPIs. Preferably, data should be integrated into service delivery, and where additional data are required that are not currently collected as part of routine service delivery, there should be an economic evaluation to determine the cost of data collection. The aim of this systematic review is to synthesise the evidence base concerning the costs of data collection in hospitals for performance monitoring using KPIs, and to identify hospital data collection systems that have proven to be cost minimising. Electronic databases will be systematically searched for publications in English that examine the cost of data collection within a hospital context. The database searches will be supplemented by searching through citations and references. Screening of both titles and abstracts will be done by two independent reviewers. All disagreements will be resolved by an independent third reviewer. Data analysis will be completed and reported in a narrative review. This review will cohere the evidence base regarding cost-minimising hospital data collections systems for performance monitoring and if these are associated with potential benefits for patients. PROSPERO CRD42014007450.
Robinson, Jackie; Gott, Merryn; Ingleton, Christine
In most developed countries, acute hospitals play a significant role in palliative care provision and are the setting in which most people die. They are often the setting where a life-limiting diagnosis is made and where patients present when symptoms develop or when they are not well managed. Understanding the experiences of hospital admissions for people with a life-limiting illness and their families is essential in understanding the role acute hospitals play in providing palliative care. The aim of this review is to synthesise current evidence regarding the experience of palliative care in an acute hospital setting from the perspectives of patient and family. An integrative review was completed using standard processes followed by a process of data extraction and synthesis. Using predefined search terms, literature was sourced from five electronic databases including MEDLINE (EBSCO), CINAHL, EMBASE, Cochrane and PsycINFO between January 1990 and November 2011. Reference lists from relevant articles were cross-checked and pertinent journals hand searched for articles. In total, 32 articles were included in the review. Five recurring themes were identified from the synthesised data: symptom control and burden, communication with health professionals, decision-making related to patient care and management, inadequate hospital environment and interpersonal relationships with health professionals. This review has identified that, largely as a result of study design, our knowledge of patient and family experiences of palliative care in an acute hospital remains limited to discrete aspects of care. Further research is required to explore the total patient and family experience taking into account all aspects of care including the potential benefits of hospital admissions in the last year of life.
Digby, Robin; Lee, Susan; Williams, Allison
To identify and examine existing research exploring how people with dementia and nurses view acute hospital care. Admission to hospital can be traumatic for a person with dementia due to an inability to cope with unfamiliar environments, faces and routines. Adverse behavioural and health outcomes can result. Dementia adds complexity to patient care. Inability to deliver appropriate care is a source of stress and frustration for nurses. Integrative review of the literature 2005-2015 reporting the experience of people with dementia and nurses caring for them in an acute hospital setting (n = 24). Hospitals focus on acute medical care; consequently people with dementia are considered low priority and a disruption to normal routine. Risk management often takes priority over patient dignity. People with dementia are stigmatised. Families have significant roles to play in the care of a person with dementia in hospital but are often excluded. Nurses struggle to complete even basic patient care, and focus on tasks often at the expense of specific patient needs. Support for nurses is lacking. The job satisfaction of nurses caring for people with dementia is poor. Nurses require improved education and support to care for patients with dementia. Hospitals must focus on genuine caring concurrently with rapid discharge requirements, risk mitigation and fiscal restraint. More research is needed to inform the development of appropriate care for people with dementia in hospitals. Nurses must understand the complex needs of people with dementia in hospital. Nurse education about dementia, practical support, strong clinical leadership and role-modelling is needed. Empathy for patients regardless of diagnosis must remain a core attribute of nurses. Current hospital culture requires wider system review to mitigate against stigmatisation of patients with dementia. © 2016 John Wiley & Sons Ltd.
Hearld, Larry R; Alexander, Jeffrey A; Fraser, Irene; Jiang, H Joanna
Interest in organizational contributions to the delivery of care has risen significantly in recent years. A challenge facing researchers, practitioners, and policy makers is identifying ways to improve care by improving the organizations that provide this care, given the complexity of health care organizations and the role organizations play in influencing systems of care. This article reviews the literature on the relationship between the structural characteristics and organizational processes of hospitals and quality of care. The review uses Donabedian's structure-process-outcome and level of analysis frameworks to organize the literature. The results of this review indicate that a preponderance of studies are conducted at the hospital level of analysis and are predominantly focused on the organizational structure-quality outcome relationship. The article concludes with recommendations of how health services researchers can expand their research to enhance one's understanding of the relationship between organizational characteristics and quality of care.
Full Text Available Context: Polycystic ovarian syndrome (PCOS, the most common endocrinopathy of women in the reproductive age group seems to be adversely affected by associated thyroid dysfunction. Both pose independent risks of ovarian failure and pregnancy related complications. Aims: The present study from Eastern India is, therefore, aimed to investigate the prevalence and etiology of different thyroid disorders in PCOS subjects. Settings and Design: Cross-sectional hospital based survey-single centre observational case-control study. Materials and Methods: This prospective single-center study recruited 106 female patients with hypertrichosis and menstrual abnormality among which 80 patients were defined as having PCOS according to the revised 2003 Rotterdam criteria and comprised the study population. Another 80 age-matched female subjects were studied as the control population. Thyroid function and morphology were evaluated by measurement of serum thyroid stimulating hormone (TSH, free thyroxine levels (free T3 and free T4, anti-thyroperoxidase antibody (anti-TPO Ab, clinical examination and ultrasound (USG of thyroid gland. Statistical Analysis Used: It was done by Student′s t-test and Chi-square test using appropriate software (SPSS version 19. Results: This case-control study revealed statistically significant higher prevalence of autoimmune thyroiditis, detected in 18 patients (22.5% vs. 1.25% of control as evidenced by raised anti-TPO antibody levels (means 28.037 ± 9.138 and 25.72 ± 8.27 respectively; P = 0.035. PCOS patients were found to have higher mean TSH level than that of the control group (4.547 ± 2.66 and 2.67 ± 3.11 respectively; P value < 0.05. There was high prevalence of goiter among PCOS patients (27.5% vs. 7.5% of control, P value < 0.001. On thyroid USG a significantly higher percentage of PCOS patients (12.5%; controls 2.5% had hypoechoic USG pattern also compatible with the diagnosis of autoimmune thyroiditis. Conclusions: High
Prem, Venkatesan; Sahoo, Ramesh Chandra; Adhikari, Prabha
The aim of this systematic review was to determine if diaphragmatic breathing exercise improves quality of life (QoL) in asthma. Electronic databases were searched for randomized controlled trials (RCTs). Data were extracted and risk of bias was assessed by two independent reviewers. Three RCTs were eligible for inclusion (254 subjects). Two studies compared diaphragmatic breathing exercise to asthma education, and one compared with asthma medication. Meta-analysis was not possible due to clinical heterogeneity of the studies. All three studies had a low risk of bias. All studies reported short-term effects, and long-term effects of breathing exercise on asthma quality life. There is a moderate evidence of improvement in QoL following diaphragmatic breathing both in short-term and long-term basis.
Soni, Sandeep; Walia, Shefali; Noohu, Majumi Mohamad
The Craig Hospital Inventory of Environmental Factors instrument (CHIEF) is one of the few tools to assess the environmental barriers. The purpose of this study was to translate long and short CHIEF into Hindi language, and to determine its validity and reliability. The study design was observational case series with repeated measures. It was carried out at Indian Spinal Injuries Centre New Delhi, a specialized center for rehabilitation for spinal cord injury. The CHIEF instrument was translated from English to Hindi based on the Beaton guidelines for the cross-cultural adaptation of health status measures. The Hindi version of the CHIEF instrument was then administered on a convenience sample of 30 spinal cord injured subjects. Its content validity, internal consistency, test-rest reliability (intraclass correlation coefficient [ICC] 2,1), standard error of measurement (SEM), and minimum detectable change (MDC) were determined for both the longer and shorter version. The mean ± SD of total of Hindi-CHIEF instrument, longer version was 1.44 ± 0.82 and total score of the shorter version was 1.07 ± 0.66. The content validity determined by the content validity ratio was found to be 1 for all the items except item number 5, 11, and 12. The content validity index was 0.97 for the longer version and for the shorter version it was 0.98. Internal consistency, Cronbach's α value was found to be 0.92 and test-retest value (ICC 2,1) was 0.80 (P Hindi translated version of the CHIEF scale has acceptable content validity and reliability. It can be used to assess environmental barriers perceived by spinal cord injury patients.
Sjoding, Michael W.; Iwashyna, Theodore J.
Rationale: Pneumonia is a frequent cause of hospitalization, yet drivers of post-pneumonia morbidity remain poorly characterized. Causes of hospital readmissions may elucidate important sources of morbidity and are of particular interest given the U.S. Hospital Readmission Reductions Program. Objectives: To review the primary diagnoses of early (≤30 d) and late (≥31 d) readmissions after pneumonia hospitalization. Methods: Systematic review of MEDLINE, Embase, and CINAHL databases. We identified original research studies of adults aged 18 years or older, hospitalized for pneumonia, and for whom cause-specific readmission rates were reported. Two authors abstracted study results and assessed study quality. Measurements and Main Results: Of the 1,243 citations identified, 12 met eligibility criteria. Included studies were conducted in the United States, Spain, Canada, Croatia, and Sweden. All-cause 30-day readmission rates ranged from 16.8 to 20.1% across administrative studies; the weighted average for the studies using chart review was 11.6% (15.6% in United States–based studies). Pneumonia, heart failure/cardiovascular causes, and chronic obstructive pulmonary disease/pulmonary causes are the most common reasons for early readmission after pneumonia hospitalization. Although it was the single most common cause for readmission, pneumonia accounted for only 17.9 to 29.4% of all 30-day readmissions in administrative studies and a weighted average of 23.0% in chart review studies. After accounting for study population, there was no clear difference in findings between claims-based versus chart-review studies. Few studies assessed readmissions beyond 30 days, although the limited available data suggest similar primary diagnoses for early and late readmissions. No studies assessed whether reasons for readmission were similar to patients’ reasons for healthcare use before hospitalization. Conclusions: Pneumonia, heart failure/cardiovascular disease, and chronic
Corinne M Hohl
Full Text Available Adverse drug events are a leading cause of emergency department visits and unplanned admissions, and prolong hospital stays. Medication review interventions aim to identify adverse drug events and optimize medication use. Previous evaluations of in-hospital medication reviews have focused on interventions at discharge, with an unclear effect on health outcomes. We assessed the effect of early in-hospital pharmacist-led medication review on the health outcomes of high-risk patients.We used a quasi-randomized design to evaluate a quality improvement project in three hospitals in British Columbia, Canada. We incorporated a clinical decision rule into emergency department triage pathways, allowing nurses to identify patients at high-risk for adverse drug events. After randomly selecting the first eligible patient for participation, clinical pharmacists systematically allocated subsequent high-risk patients to medication review or usual care. Medication review included obtaining a best possible medication history and reviewing the patient's medications for appropriateness and adverse drug events. The primary outcome was the number of days spent in-hospital over 30 days, and was ascertained using administrative data. We used median and inverse propensity score weighted logistic regression modeling to determine the effect of pharmacist-led medication review on downstream health services use.Of 10,807 high-risk patients, 6,416 received early pharmacist-led medication review and 4,391 usual care. Their baseline characteristics were balanced. The median number of hospital days was reduced by 0.48 days (95% confidence intervals [CI] = 0.00 to 0.96; p = 0.058 in the medication review group compared to usual care, representing an 8% reduction in the median length of stay. Among patients under 80 years of age, the median number of hospital days was reduced by 0.60 days (95% CI = 0.06 to 1.17; p = 0.03, representing 11% reduction in the median length of stay
Pearce, Rebecca; Miles, Fiona
To ascertain morbidity and mortality of children who presented to Starship Children's Hospital with injuries from a quad bike incident from 2007 to 2014, and to review whether current guidelines are sufficient to prevent injury. A retrospective case note review of all children under the age of 16 years who presented to Starship Hospital with an injury sustained whilst riding a quad bike between January 2007 and July 2014. Twenty-seven patients were identified through both the Starship Children's Hospital Trauma and Paediatric Intensive Care databases with injuries resulting from a quad bike incident. Fifteen patients (56%) had multisystem injuries. The average injury severity score (ISS) was 14 (range 1-75). ISS was higher in those of younger age (bikes by children. Current guidelines do not, however, prevent injury in the paediatric population.
Lin, Yusen E; Stout, Janet E; Yu, Victor L
Hospital-acquired Legionnaires' disease is directly linked to the presence of Legionella in hospital drinking water. Disinfecting the drinking water system is an effective preventive measure. The efficacy of any disinfection measures should be validated in a stepwise fashion from laboratory assessment to a controlled multiple-hospital evaluation over a prolonged period of time. In this review, we evaluate systemic disinfection methods (copper-silver ionization, chlorine dioxide, monochloramine, ultraviolet light, and hyperchlorination), a focal disinfection method (point-of-use filtration), and short-term disinfection methods in outbreak situations (superheat-and-flush with or without hyperchlorination). The infection control practitioner should take the lead in selection of the disinfection system and the vendor. Formal appraisals by other hospitals with experience of the system under consideration is indicated. Routine performance of surveillance cultures of drinking water to detect Legionella and monitoring of disinfectant concentrations are necessary to ensure long-term efficacy.
Bergum, Shelly K; Canaan, Talitha; Delemos, Christi; Gall, Elizabeth Funke; McCracken, Bonnie; Rowen, Dave; Salvemini, Steve; Wiens, Kimberly
Over the past decade, implementation of the peer review process for the development of the advanced practice nurse (APN) has been emphasized. However, little exists in the literature regarding APN peer review. The peer review process is intended to help demonstrate competency of care, enhance quality improvement measures, and foster the professional growth of the APN. APNs serving on a professional governance council within a university teaching hospital developed a model of peer review for APNs. Nine months after the tool was implemented, an anonymous follow-up survey was conducted. A follow-up request was sent 4 weeks later to increase the number of respondents. Likert scales were used to elicit subjective data regarding the process. Of 81 APNs who participated in the survey, more than half (52%) felt that the process would directly improve their professional practice. Survey results show that the peer review process affected APN professional practice positively. Additional research might include pathways for remediation and education of staff, evaluation of alternate methods to improve application to clinical practice, and collection of outcome data. The models presented provide a foundation for future refinement to accommodate different APN practice settings. ©2017 American Association of Nurse Practitioners.
Storm-Versloot, Marja N.; Verweij, Lotte; Lucas, Cees; Ludikhuize, Jeroen; Goslings, J. Carel; Legemate, Dink A.; Vermeulen, Hester
Conflicting evidence exists on the effectiveness of routinely measured vital signs on the early detection of increased probability of adverse events. To assess the clinical relevance of routinely measured vital signs in medically and surgically hospitalized patients through a systematic review.
Henebiens, M.; van den Broek, Th A. A.; Vahl, A. C.; Koelemay, M. J. W.
OBJECTIVES: Our aim was to analyse the relation between hospital volume and peri-operative mortality in abdominal aortic aneurysm surgery. DESIGN: Systematic review. METHOD: The Medline, Embase and Cochrane databases were searched to identify all population based studies reporting on the volume
Groene, O.; Botje, D.; Suñol, R.; Lopez, M.A.; Wagner, C.
Purpose: Health-care providers invest substantial resources to establish and implement hospital quality management systems. Nevertheless, few tools are available to assess implementation efforts and their effect on quality and safety outcomes. This review aims to (i) identify instruments to assess
Zwerver, J.; Rieu, P.N.M.A.; Koopman, R.J.J.; Spauwen, P.H.M.; Buskens, F.G.M.; Boetes, C.; Veth, R.P.H.; Van Oostrom, C.G.
In order to gain insight into the management of patients with vascular malformations (VM) in the University Hospital Nijmegen in the past 10 years, 151 cases managed by different specialists were reviewed. To avoid the usual confusion in terminology, all recorded diagnoses were reclassified
Dekker, R; Drost, EAM; Groothoff, JW; Arendzen, JH; van Gijn, JC; Eisma, WH
The purpose of this study was to review the literature on the effects of day-hospital rehabilitation (DHR) in stroke patients. In The Netherlands DHR concerns a multidisciplinary approach to decrease disability and handicap and to optimize quality of life in an outpatient setting. Data were
Oude Hengel, K.M.; Visser, B.; Sluiter, J.K.
Physicians are exposed to a range of work-related risk factors that may result in occupational diseases. This systematic review aims at shedding light on the prevalence and incidence of musculoskeletal complaints among hospital physicians. A systematic literature search was performed in Pubmed and
. Documentation exists in; well-being of patients and staff, sleep disorders, pain distraction, confidentiality and privacy, levels of errors in hospitals. Art and the use of color: Art can be context related so one should be aware whether it is in a private ward or the foyer and related to the experience...... in treating disease can be supported by architecture which is sensitive to the contextual conditions of healing in health facilities. It is not the intention to supplant technology, but a question of supplementing the incredible advances that have been made in medicine in recent decades. The central premise......- sick-leave and work-related injuries....
Lingiardi, Vittorio; Muzi, Laura; Tanzilli, Annalisa; Carone, Nicola
Despite growing attention to the general therapist effects in a wide range of clinical settings, little is known about the individual, cross-situational, and therapy-nonspecific variables that impact on the differential effectiveness of clinicians. The current study is a systematic review of the evidence relating to the influence of therapist's subjective characteristics on outcomes of psychodynamic psychotherapies. A multistage and systematic search of articles published between 1987 and 2017 identified 30 relevant studies, which were organized into 6 areas according to the specific therapist's variable considered. Therapists' interpersonal functioning and skills showed the strongest evidence of a direct effect on treatment outcomes. Furthermore, there were preliminary evidence that therapists' attachment styles, their interpersonal history with caregivers, and their self-concept might affect outcomes through interaction effects with other constructs, such as technical interventions, patient's pathology, and therapeutic alliance. The high variability between studies on therapists' overall reflective or introspective abilities and personality characteristics suggested the need for more systematic research in these areas, whereas therapists' values and attitudes showed small effects on therapeutic outcome. The present review clarifies how a deep examination of the contribution of therapists' subjective characteristics can help elucidate the complex association between relational and technical factors related to the outcome of psychodynamic treatments. Copyright © 2017 John Wiley & Sons, Ltd.
Janice Du Mont
Full Text Available Elder abuse, a universal human rights problem, is associated with many negative consequences. In most jurisdictions, however, there are no comprehensive hospital-based interventions for elder abuse that address the totality of needs of abused older adults: psychological, physical, legal, and social. As the first step towards the development of such an intervention, we undertook a systematic scoping review.Our primary objective was to systematically extract and synthesize actionable and applicable recommendations for components of a multidisciplinary intersectoral hospital-based elder abuse intervention. A secondary objective was to summarize the characteristics of the responses reviewed, including methods of development and validation.The grey and scholarly literatures were systematically searched, with two independent reviewers conducting the title, abstract and full text screening. Documents were considered eligible for inclusion if they: 1 addressed a response (e.g., an intervention to elder abuse, 2 contained recommendations for responding to abused older adults with potential relevance to a multidisciplinary and intersectoral hospital-based elder abuse intervention; and 3 were available in English.The extracted recommendations for care were collated, coded, categorized into themes, and further reviewed for relevancy to a comprehensive hospital-based response. Characteristics of the responses were summarized using descriptive statistics.649 recommendations were extracted from 68 distinct elder abuse responses, 149 of which were deemed relevant and were categorized into 5 themes: Initial contact; Capacity and consent; Interview with older adult, caregiver, collateral contacts, and/or suspected abuser;physical/forensic, mental, psychosocial, and environmental/functional; and care plan. Only 6 responses had been evaluated, suggesting a significant gap between development and implementation of recommendations.To address the lack of evidence to
Chisenga, Jayne Z; Chalanda, Marcia; Ngwale, Mathews
Kangaroo Mother Care is an intervention that can help reduce neonatal mortality rate in Malawi but it has not been rolled out to all health facilities. Understanding the mothers׳ experience would help strategise when scaling-up this intervention. to review experiences of mothers Kangaroo Mother Care at two hospitals of Bwaila and Zomba. quantitative, descriptive using open interviews. two central hospitals in Malawi. 113 mothers that were in the Kangaroo Mother Care unit and those that had come for follow-up two weeks after discharge before the study took place. mothers had high level of knowledge about the significant benefits of Kangaroo Mother Care but 84% were not aware of the services prior to their hospitalisation. 18.6% (n=19) were not counselled prior to KMC practice. Mothers preferred KMC to incubator care. There were factors affecting compliance and continuation of KMC, which were lack of support, culture, lack of assistance with skin-to-skin contact, multiple roles of the mother and stigma. mothers had a positive attitude towards KMC once fully aware of its benefits. there is need for awareness campaigns on KMC services, provision of counselling, support and assistance which can help motivate mothers and their families to comply with the guidelines of KMC services. Copyright © 2014 Elsevier Ltd. All rights reserved.
Li, Tracey; Eisenhart, Alison; Costello, Jennifer
The results of a study to develop a hospital-wide medication review service for patients with enteral tubes to improve patient safety are presented. Inappropriate enteral administration of medications can result in occluded tubes, altered clinical response, and an increase in adverse effects. At Saint Barnabas Medical Center, a 600-bed community teaching hospital located in Livingston, New Jersey, a medication review service for patients with an enteral tube was developed. A phased approach was used. In phase 1, a retrospective chart review revealed that 43% of our patients with enteral tubes received at least one medication that should not be crushed. In phase 2, we identified formulary medications that should not be crushed based on guidance from the Institute for Safe Medication Practices. We added a "do not crush" warning to the identified medications in our electronic medication administration record and automated medication dispensing system. In phase 3, we created an automatic substitution list of medications. Phase 4 involved the development of the program in our health information technology platform. An electronic task list alerted pharmacists about patients with enteral tubes who required medication review and potential medication substitutions, as well as patients with newly removed enteral tubes who can be placed back on their original medications. In phase 5, we provided education to prescribers, nurses, and pharmacists. A hospital-wide medication review service for patients with enteral tubes at our community teaching medical center was developed. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
Andrews, Hannah; Singh, Yogen
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.
Eisen, S V; Griffin, M; Sederer, L I; Dickey, B; Mirin, S M
Managed care has emerged as the centerpiece of the health care industry's efforts to control costs and ensure appropriate use of hospital services. This study assesses the impact of managed care by preadmission approval and/or continued stay review on length of psychiatric hospitalization and clinical outcome of children and adolescents. The sample included 277 cases hospitalized in nine psychiatric specialty hospitals in 1990. Demographic and clinical characteristics, hospital ownership type, and preadmission approval or continued stay review were used as independent variables in a multiple regression model to predict length of stay and clinical outcome. Results indicate that the model accounted for 27% of the variance in length of stay. Previous psychiatric hospitalization and for-profit hospital status predicted longer hospitalization. Clinical outcome was not significantly predicted by the model. Managed care did not predict either length of stay or clinical outcome. Implications for health care reform are discussed.
Full Text Available Background: Drug craving is considered as one of the main cores of drug dependency and addiction. Multidimensionality of drug craving, its cultural-bounded features and its intra individual rapidly changing nature makes it difficult to be measured. Nowadays, regarding different psychometric approaches, there are various instruments available for measurement of different aspects of drug craving but mainly for Latin-based languages in North America and European countries. High prevalence and special conditions, and unique subcultures in substance abuse and addiction in many countries, like Iran, make the design of culturally validated instruments for drug craving assessment priority. Materials and Methods: Comprehensive review on drug craving measurement instruments for Persian speaking subjects have been performed by searching in databases (ELSEVIER, Science Direct and Scientific Information Database (SID and investigating of related documents on regional experiences. Results: In this article seven main categories of drug craving instruments have been reviewed focusing on validated versions in Persian language including: self-reports, reinforcement “proxies”, drug self administration, psycho physiological responding, neurobiological responding, cognitive processing and expressive methods. Conclusion: Reviewing on weak and strength points of each instrument group and national and regional experiences shows that designing and validating a new series of ecologically-validated instruments for multidimensional measurement of drug craving in different addiction subcultures should be prioritized to cover current methodological gaps in substance abuse studies in Iran.
van Bokhorst-de van der Schueren, M.A.E.; Guaitoli, P.R.; Jansma, E.P.; de Vet, H.C.W.
Background & aims: Numerous nutrition screening tools for the hospital setting have been developed. The aim of this systematic review is to study construct or criterion validity and predictive validity of nutrition screening tools for the general hospital setting. Methods: A systematic review of
Sibbald, Bonnie; McDonald, Ruth; Roland, Martin
A key objective in many health-care systems is to shift specialist services from acute hospitals to the community and so bring care closer to home for patients. Our aim was to review published research into the effectiveness of strategies for achieving this objective. We conducted a 'scoping' review and qualitative data synthesis of four strategies: transfer of services from hospital to primary care; relocation of hospital services to primary care; joint working between primary and acute care; and interventions to alter the referral behaviour of primary care practitioners. One hundred and nineteen studies were identified and data systematically extracted. The findings suggest that transferring hospital services to primary care, and interventions that change the referral behaviour of primary care practitioners generally reduced outpatient activity but also risked reducing quality. Savings in cost were offset by increases in overall service volume and loss of economies of scale. Relocating specialists to primary care, and joint working between primary and acute care, improved access without jeopardizing quality. However, outpatient activity was rarely reduced and costs were generally increased due to loss of economies of scale. Our findings suggest that the policy may be effective in improving access to specialist care for patients and reducing demand on acute hospitals. There is a risk, however, that the quality of care may decline and costs may increase.
There is a national focus on the adoption of healthcare technology to improve the delivery of safe, efficient, and high-quality patient care. Nurse practitioners fulfill an emerging strategic role in the hospital setting. A comprehensive literature review focused on the question: What are the barriers for nurse practitioners utilizing clinical decision support in the hospital setting? Nine studies conducted from 2011 to 2017 were the basis for this review, which identified 13 barriers for nurse practitioners utilizing clinical decision support in the hospital. Having the right information, including up-to-date evidence-based practice guidelines, accurate clinical pathways, and current clinical algorithms, was the most common barrier. Providing reliable clinical decision support is crucial as nurse practitioners become more dependent on hospital technology systems in the delivery of safe patient care. Eliminating barriers to the use of clinical decision support is important for informaticists and nurse practitioners because both groups concentrate on acceptance of decision support systems in the hospital to meet the goal of safe and high-quality patient care.
Full Text Available Introduction: The Craig Hospital Inventory of Environmental Factors instrument (CHIEF is one of the few tools to assess the environmental barriers. The purpose of this study was to translate long and short CHIEF into Hindi language, and to determine its validity and reliability. Design and Setting: The study design was observational case series with repeated measures. It was carried out at Indian Spinal Injuries Centre New Delhi, a specialized center for rehabilitation for spinal cord injury. Methods: The CHIEF instrument was translated from English to Hindi based on the Beaton guidelines for the cross-cultural adaptation of health status measures. The Hindi version of the CHIEF instrument was then administered on a convenience sample of 30 spinal cord injured subjects. Its content validity, internal consistency, test-rest reliability (intraclass correlation coefficient [ICC] 2,1, standard error of measurement (SEM, and minimum detectable change (MDC were determined for both the longer and shorter version. Results: The mean ± SD of total of Hindi-CHIEF instrument, longer version was 1.44 ± 0.82 and total score of the shorter version was 1.07 ± 0.66. The content validity determined by the content validity ratio was found to be 1 for all the items except item number 5, 11, and 12. The content validity index was 0.97 for the longer version and for the shorter version it was 0.98. Internal consistency, Cronbach's α value was found to be 0.92 and test-retest value (ICC 2,1 was 0.80 (P < 0.001. The MDC was found to be 0.99 and SEM was 0.36 for the longer version. The Cronbach's α was 0.731, ICC 2,1 was 0.63 (P < 0.001, SEM was 0.24, and MDC was 0.66 for the shorter version. Conclusion: The Hindi translated version of the CHIEF scale has acceptable content validity and reliability. It can be used to assess environmental barriers perceived by spinal cord injury patients.
Delgado, M. Kit; Meng, Lesley J.; Mercer, Mary P.; Pines, Jesse M.; Owens, Douglas K.; Zaric, Gregory S.
Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion. Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields. Results: We identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion. Conclusion: Smoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals are promising avenues for reducing diversion. PMID:24106548
Brooks, Hannah L; Kassam, Shehzad; Salvalaggio, Ginetta; Hyshka, Elaine
People with severe alcohol use disorders are at increased risk of poor acute-care outcomes, in part due to difficulties maintaining abstinence from alcohol while hospitalised. Managed alcohol programs (MAP), which administer controlled doses of beverage alcohol to prevent withdrawal and stabilise drinking patterns, are one strategy for increasing adherence to treatment, and improving health outcomes for hospital inpatients with severe alcohol use disorders. Minimal research has examined the implementation of MAPs in hospital settings. We conducted a scoping review to describe extant literature on MAPs in community settings, as well as the therapeutic provision of alcohol to hospital inpatients, to assess the feasibility of implementing formal MAPs in hospital settings and identify knowledge gaps requiring further study. Four academic and 10 grey literature databases were searched. Evidence was synthesised using quantitative and qualitative approaches. Forty-two studies met review inclusion criteria. Twenty-eight examined the administration of alcohol to hospital inpatients, with most reporting positive outcomes related to prevention or treatment of alcohol withdrawal. Fourteen studies examined MAPs in the community and reported that they help stabilise drinking patterns, reduce alcohol-related harms and facilitate non-judgemental health and social care. MAPs in the community have been well described and research has documented effective provision of alcohol in hospital settings for addressing withdrawal. Implementing MAPs as a harm reduction approach in hospital settings is potentially feasible. However, there remains a need to build off extant literature and develop and evaluate standardised MAP protocols tailored to acute-care settings. © 2018 Australasian Professional Society on Alcohol and other Drugs.
Full Text Available Background: Malnutrition has been associated with poor health outcomes in hospitalized patients. This study assessed the validity of the scored patient-generated subjective global assessment (PG-SGA in adult patients who had undergone an open appendectomy, and examined the association of this assessment tool with length of hospital stay. Methods: Nutritional status was determined by using the scored PG-SGA in adult patients (n = 86 who had undergone an open appendectomy within 24 hours of admission. Variables were compared between well-nourished and malnourished participants. Regression analysis was used to identify potential predictors for length of hospital stay. Receiver operator characteristic (ROC analysis was used to examine the validity of the PG-SGA score to predict the nutritional status. Results: On admission, 17% of the study subjects were malnourished and associated with a significantly older age (53.0 vs. 39.5, greater PG-SGA score (8 vs. 2, higher comorbidity (67% vs. 27%, and longer length of hospital stay (6.9 d vs. 4.1 d. The PG-SGA score and comorbidity were the determined risk factors for length of hospital stay after performing multiple regression analysis. Furthermore, the PG-SGA score had a significantly positive correlation with length of hospital stay (Spearman's rho = 0.378, p < 0.001. The area under the ROC curve indicating the PG-SGA score, compared with nutritional status, is 0.9751. Conclusions: The scored PG-SGA in adults receiving an appendectomy is significantly associated with length of hospital stay, and is an effective tool for assessing the nutritional status of patients with cancer and chronic illness, as well as of patients with acute surgical abdomen.
Ahmad Mohammadi; Afsoon Hassani Mehraban; Shahla A Damavandi
Objective: Cancer is one of the four leading causes of death in children. Its courses of diagnosis and treatment can cause physiologic symptoms and psychological distress that secondarily affect children's quality of life and participation in daily activities. The aim of this study was to investigate the effect of play-based occupational therapy on pain, anxiety, and fatigue in hospitalized children with cancer who were receiving chemotherapy. Methods: Two hospitalized children with acute lym...
Martínez-Velilla, N; Cadore, L; Casas-Herrero, Á; Idoate-Saralegui, F; Izquierdo, M
To critically review the effect of interventions incorporating exercise and early rehabilitation (physical therapy, occupational therapy, and physical activity) in the functional outcomes (i.e., active daily living tests, such as Barthel Index Scores, Timed-up-and go, mobility tests), and feasibility in hospitalized elderly medical patients. Systematic review of the literature. A literature search was conducted using the following databases and medical resources from 1966 to January 2014: PubMed (Medline), PEDro, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, Google Scholar, ClinicalTrials.gov, Clinical Evidence, SportsDiscus, EMBASE and UptoDate. Studies must have mentioned the effects of early rehabilitation on the above mentioned functional outcomes and feasibility. Data on the mortality, economic profile and average stay were also described. From the 6564 manuscripts potentially related to exercise performance in hospitalized elderly patients, the review focused on 1086, and 17 articles were ultimately included. Regarding functional outcomes after discharge, four studies observed significant improvement in functional outcomes following early rehabilitation, even up to twelve months after discharge. Eight studies directly or indirectly assessed the economic impact of exercise intervention. Five of them did not show any increase in costs, while three concluded that the intervention was cost effective. No adverse effect related with the interventions were mentioned. The introduction of an exercise program for hospitalized elderly patients may be feasible, and may not increase costs. Importantly, early rehabilitation may also improve the functional and healthcare.
Blank, Leah J; Rompalo, Anne M; Erbelding, Emily J; Zenilman, Jonathan M; Ghanem, Khalil G
The optimal antimicrobial regimen to treat syphilis in HIV-infected subjects remains controversial. To systematically assess the literature for studies evaluating syphilis treatment regimens in this population. Two reviewers independently assessed studies published between 1980 and June 2008 in electronic databases, trial registries and bibliographies (with no language restrictions) for content and quality. Studies that included 10 or more people, with documented HIV status, type and duration of syphilis treatment and at least 6 months of follow-up were included. The primary outcome was syphilis serological or clinical failure stratified by syphilis stage. Of 1380 unique citations, 23 studies (22 published papers and 1 conference abstract) were included in the systematic review. Owing to the significant heterogeneity among studies, pooled summary statistics could not be generated. The range of probabilities for serological failure with 2.4 million units (MU) of intramuscular benzathine penicillin G (BPG) was 6.9% (95% CI 2.6% to 14.4%) to 22.4% (11.7% to 36.6%); that of 7.2 MU of BPG in late latent syphilis was 19.4% (11.9% to 28.9%) to 31.1% (22.3% to 40.9%) and failure estimates with 18-24 MU of aqueous penicillin for the treatment of neurosyphilis were 27.3% (6.0% to 61.0%) to 27.8% (14.2% to 45.2%). The optimal antimicrobial regimen to treat syphilis in HIV-infected subjects is unknown; guideline recommendations in this population are based on little objective data.
Full Text Available The objective of the current study is to identify and classify outcome measures currently used for the assessment of rehabilitation or assistive robot devices. We conducted a systematic review of the literature using PubMed, MEDLINE, CIRRIE, and Scopus databases for studies that assessed rehabilitation or assistive robot devices from 1980 through January 2016. In all, 31 articles met all inclusion criteria. Tailor-made questionnaires were the most commonly used tool at 66.7%, while the great majority (93.9% of the studies used nonvalidated instruments. The study reveals the absence of a standard scale which makes it difficult to compare the results from different researchers. There is a great need, therefore, for a valid and reliable instrument to be available for use by the intended end users for the subjective assessment of robot devices. The study concludes by identifying two scales that have been validated in general assistive technology devices and could support the scope of subjective assessment in rehabilitation or assistive robots (however, with limited coverage and a new one called PYTHEIA, recently published. The latter intends to close the gap and help researchers and developers to evaluate, assess, and produce products that satisfy the real needs of the end users.
Tiago M Barbosa
Full Text Available In the last decades head-out aquatic exercises became one of the most important physical activities within the health system. Massive research has been produced throughout these decades in order to better understand the role of head-out aquatic exercises in populations' health. Such studies aimed to obtain comprehensive knowledge about the acute and chronic response of subjects performing head-out aquatic exercises. For that, it is assumed that chronic adaptations represent the accumulation of acute responses during each aquatic session. The purpose of this study was to describe the "state of the art" about physiological assessment of head-out aquatic exercises based on acute and chronic adaptations in healthy subjects based on a qualitative review. The main findings about acute response of head-out aquatic exercise according to water temperature, water depth, type of exercise, additional equipment used, body segments exercising and music cadence will be described. In what concerns chronic adaptations, the main results related to cardiovascular and metabolic adaptations, muscular strength, flexibility and body composition improvements will be reported
The objective of the current study is to identify and classify outcome measures currently used for the assessment of rehabilitation or assistive robot devices. We conducted a systematic review of the literature using PubMed, MEDLINE, CIRRIE, and Scopus databases for studies that assessed rehabilitation or assistive robot devices from 1980 through January 2016. In all, 31 articles met all inclusion criteria. Tailor-made questionnaires were the most commonly used tool at 66.7%, while the great majority (93.9%) of the studies used nonvalidated instruments. The study reveals the absence of a standard scale which makes it difficult to compare the results from different researchers. There is a great need, therefore, for a valid and reliable instrument to be available for use by the intended end users for the subjective assessment of robot devices. The study concludes by identifying two scales that have been validated in general assistive technology devices and could support the scope of subjective assessment in rehabilitation or assistive robots (however, with limited coverage) and a new one called PYTHEIA, recently published. The latter intends to close the gap and help researchers and developers to evaluate, assess, and produce products that satisfy the real needs of the end users.
Luíza de Oliveira Messias Ortiz
Full Text Available The incidence of Diabetes Mellitus type 1 (DM1 has increased in the last years, with a consequent growth of child hospitalizations due to diabetic prime decompensation, with growing need of an educational process. Thus, our objective was to identify in the literature the best nursing practices in diabetes education for hospitalized children with DM1 and their families. We conducted an integrative review with the descriptors: Diabetic Ketoacidosis, Diabetes Education, Nursing and Child, Hospitalized, and the free search in reference journals and similar articles. We selected four studies, and we identified three categories: Family Involvement and Empowerment in the Diabetes Educational Process; Performance of the Multi-professional Team; Definition and Content of the Educational Process. We concluded that the educational process should include the family, it should be conducted by a multi-professional team and based on scientific evidence. We identified few studies, showing the need for more studies in the field.
Iyendo, Timothy Onosahwo
Sound in hospital space has traditionally been considered in negative terms as both intrusive and unwanted, and based mainly on sound levels. However, sound level is only one aspect of the soundscape. There is strong evidence that exploring the positive aspect of sound in a hospital context can evoke positive feelings in both patients and nurses. Music psychology studies have also shown that music intervention in health care can have a positive effect on patient's emotions and recuperating processes. In this way, hospital spaces have the potential to reduce anxiety and stress, and make patients feel comfortable and secure. This paper describes a review of the literature exploring sound perception and its effect on health care. This review sorted the literature and main issues into themes concerning sound in health care spaces; sound, stress and health; positive soundscape; psychological perspective of music and emotion; music as a complementary medicine for improving health care; contradicting arguments concerning the use of music in health care; and implications for clinical practice. Using Web of Science, PubMed, Scopus, ProQuest Central, MEDLINE, and Google, a literature search on sound levels, sound sources and the impression of a soundscape was conducted. The review focused on the role and use of music on health care in clinical environments. In addition, other pertinent related materials in shaping the understanding of the field were retrieved, scanned and added into this review. The result indicated that not all noises give a negative impression within healthcare soundscapes. Listening to soothing music was shown to reduce stress, blood pressure and post-operative trauma when compared to silence. Much of the sound conveys meaningful information that is positive for both patients and nurses, in terms of soft wind, bird twitter, and ocean sounds. Music perception was demonstrated to bring about positive change in patient-reported outcomes such as eliciting
Cowan, Justin; Baker, Gus A
To evaluate measures of epilepsy-specific impact currently available for use with children and adolescents. The relative merits of the different measures are examined. Four published epilepsy-specific impact measures, the Epilepsy and Learning Disabilities Quality of Life Scale (ELDQOL), the Health-related Quality of Life in Children with Epilepsy (HRQoLCE); the Impact of Childhood Neurologic Disability Scale (ICND), the Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48), and the Quality of Life for Children with Epilepsy (QOLCE) were reviewed. There exist several shortcomings with the available measures on various psychometric criteria with not one of the currently available measures reaching acceptable psychometric standards in terms of reliability and validity. Of note are the particular inadequacies in the validation of scale content; with there being no investigation of the existence of age or ability effects for the items in any of the questionnaires reviewed. There is a clear demand for a psychometrically robust measure of subjective impact of epilepsy for children and adolescents, which is applicable to a wide age and ability range. At present, the efforts of the Canadian Pediatric Epilepsy Network with the recent publication of a novel measure holds much promise for the future. It is advocated that further efforts are made to further establish the psychometric properties of these scales and for their integration within a comprehensive outcome model for use in the evaluation of clinical interventions.
Shallcross, Rebekah; Dickson, Joanne M; Nunns, David; Mackenzie, Catharine; Kiemle, Gundi
Vulvodynia, the experience of an idiopathic pain in the form of burning, soreness, or throbbing in the vulval area, affects around 4-16% of the population. The current review used systematic search strategies and meta-ethnography as a means of identifying, analyzing, and synthesizing the existing literature pertaining to women's subjective experiences of living with vulvodynia. Four key concepts were identified: (1) Social Constructions: Sex, Women, and Femininity: Women experienced negative consequences of social narratives around womanhood, sexuality, and femininity, including the prioritization of penetrative sex, the belief that it is the role of women to provide sex for men, and media portrayals of sex as easy and natural. (2) Seeking Help: Women experienced the healthcare system as dismissive, sometimes being prescribed treatments that exacerbated the experience of pain. (3) Psychological and Relational Impact of Vulvodynia: Women experienced feeling shame and guilt, which in turn led to the experience of psychological distress, low mood, anxiety, and low self-esteem. Moreover, women reported feeling silenced which in turn affected their heterosexual relationships and their peer relationships by feeling social isolated. (4) A Way Forward: Women found changing narratives, as well as group and individual multidisciplinary approaches, helpful in managing vulvodynia. The findings of the review conclude that interventions at the individual level, as well as interventions aimed at equipping women to challenge social narratives, may be helpful for the psychological well-being of women with vulvodynia.
Donovan, Leigh A; Wakefield, Claire E; Russell, Vera; Cohn, Richard J
There has been a breadth of research on the grief experience of parents following the death of a child. However, the role and impact of hospital-based bereaved services remain unclear. To identify services offered to bereaved families in perinatal, neonatal, and pediatric hospital settings and summarize the psychosocial impact of these services and published recommendations for best practice hospital-based bereavement care. Systematic review of qualitative, quantitative, and mixed method studies guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and methodological quality appraised in accordance with the Mixed Method Appraisal Tool. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health, and PsychINFO were searched to find studies describing hospital-based bereavement services/interventions for parents, siblings, and grandparents. In all, 14 qualitative, 6 quantitative, and 10 mixed method studies were identified. Nine descriptive articles were also included. Qualitatively, family members described feeling cared for and supported by staff, a reduction in sense of isolation, and improved coping and personal growth. Quantitatively, bereavement services have most effect for parents experiencing more complex mourning. It is recommended that bereavement services be theoretically driven and evidence based, offer continuity of care prior to and following the death of a child, and provide a range of interventions for the "whole family" and flexibility in service delivery. There is a role for transitional hospital-based services/interventions for families in the lead up to and following the death of a child. Further mixed method research is required to inform best practice bereavement care guidelines in the perinatal, neonatal, and pediatric hospital settings. © The Author(s) 2014.
Donoghue, Aaron J; Nadkarni, Vinay; Berg, Robert A; Osmond, Martin H; Wells, George; Nesbitt, Lisa; Stiell, Ian G
We systematically summarize pediatric out-of-hospital cardiac arrest epidemiology and assess knowledge of effects of specific out-of-hospital interventions. We conducted a comprehensive review of published articles from 1966 to 2004, available through MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EmBase, and the Cochrane Registry, describing outcomes of children younger than 18 years with an out-of-hospital cardiac arrest. Patient characteristics, process of care, and outcomes were compared using pediatric Utstein outcome report guidelines. Effects of out-of-hospital care processes on survival outcomes were summarized. Forty-one studies met inclusion criteria; 8 complied with Utstein reporting guidelines. Included in the review were 5,363 patients: 12.1% survived to hospital discharge, and 4% survived neurologically intact. Trauma patients (n=2,299) had greater overall survival (21.9%, 6.8% intact); a separate examination of studies with more rigorous cardiac arrest definition showed poorer survival (1.1% overall, 0.3% neurologically intact). Submersion injury-associated arrests (n=442) had greater overall survival (22.7%, 6% intact). Pooled data analysis of bystander cardiopulmonary resuscitation and witnessed arrest status showed increased likelihood of survival (relative risk 1.99, 95% confidence interval 1.54 to 2.57) for witnessed arrests. The effect of bystander cardiopulmonary resuscitation is difficult to determine because of study heterogeneity. Outcomes from out-of-hospital pediatric cardiac arrest are generally poor. Variability may exist in survival by patient subgroups, but differences are hard to accurately characterize. Conformity with Utstein guidelines for reporting and research design is incomplete. Witnessed arrest status remains associated with improved survival. The need for prospective controlled trials remains a high priority.
Stein, Renato T.; Bont, Louis J.; Zar, Heather; Polack, Fernando P.; Park, Caroline; Claxton, Ami; Borok, Gerald; Butylkova, Yekaterina
Summary Background: Respiratory syncytial virus (RSV) is a major public health burden worldwide. We aimed to review the current literature on the incidence and mortality of severe RSV in children globally. Methods: Systematic literature review and meta‐analysis of published data from 2000 onwards, reporting on burden of acute respiratory infection (ARI) due to RSV in children. Main outcomes were hospitalization for severe RSV‐ARI and death. Results: Five thousand two hundred and seventy‐four references were identified. Fifty‐five studies were included from 32 countries. The global RSV‐ARI hospitalization estimates, reported per 1,000 children per year (95% Credible Interval (CrI), were 4.37 (2.98, 6.42) among children Wiley Periodicals, Inc. PMID:27740723
Hashiguchi, Nobuko; Hirakawa, Megumi; Tochihara, Yutaka; Kaji, Yumi; Karaki, Chitake
The purpose of this survey was to measure the thermal environment in a hospital during winter, and to investigate the subjective responses of patients and staff via a questionnaire. The air temperature and humidity in the sickrooms and nurse stations were measured for 3 months during winter. After 2 months, we introduced humidifiers into about half of the rooms and nurse stations as a method of improving the environment, and evaluated the effects of the installed humidifiers on the thermal conditions. In all, 36 patients and 45 staff members were asked once a week about subjective symptoms (dry and itchy skin, thirst, etc.). Before setting up the humidifiers, the existence of a low-humidity environment in the hospital during winter was confirmed, with the levels of relative humidity and humidity ratio reaching under 50% and 5g/kg DA, respectively, which is known to promote the spread of influenza viruses. However, the introduction of the humidifiers increased the relative humidity in sickrooms from 32.8% to 43.9% on average, and the air humidity in sickrooms thus almost reached the optimum range suggested by the Hospital Engineering Association of Japan (HEAJ). Additionally, complaints of thermal discomfort and dryness of air decreased among the staff, though not among the patients, after the humidifiers were installed. These results suggest that introducing humidifiers into a hospital during winter is an effective method of improving the low-humidity environment and relieving the discomfort of staff members.
Rabøl, Louise Isager; Østergaard, Doris; Mogensen, Torben
Several studies show that communication errors in healthcare teams are frequent and can lead to adverse events. Team training has been suggested as a way to safer communication and has been implemented in healthcare as classroom-based or simulation-based team training or a combination of both....... The objective of this paper is to systematically review studies evaluating the outcomes of classroom-based multiprofessional team training for hospital staff....
Renata Cristina Antonelli; José Aparecido Bellucci Junior
This is an integrative literature review, which aims to analyze scientific articles that discuss the work of nurses in the management of hospital emergency services. The databases used were Latin American and Caribbean Health Science Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), Integrated Building Environmental Communications System (IBECS), Scientific Electronic Library Online (SciELO) and Nursing Database (BDENF). To conduct the survey, 10 articles...
Winship, Christian; Williams, Brett; Boyle, Malcolm J
Many studies over the past decade have investigated delaying initial defibrillation to perform cardiopulmonary resuscitation (CPR), as it has been associated with increased rates of restoration of spontaneous circulation and/or survival. Since 2006, a number of studies have investigated these procedures. The objective of this study was to undertake a literature review examining the commencement of CPR before defibrillation in the out-of-hospital setting. A literature review was undertaken using the electronic medical databases Ovid Medline, EMBASE, CINHAL Plus, Cochrane Systematic Review and Meditext, from their commencement to the end of June 2011. Keywords used in the search included: CPR, defibrillation, ventricular fibrillation, VF, EMS, EMT, paramedic, emergency medical service, emergency medical technician, prehospital, out-of-hospital and ambulance. References of relevant articles were also reviewed. Of the 3079 articles located, 10 met the inclusion criteria. The results of these studies showed conflicting results. All retrospective studies (n=6) indicated a benefit in performing pre-shock CPR on patients with ventricular fibrillation for durations between 90 and 180 s. Conversely, all randomised controlled trials demonstrated no benefit from providing CPR before defibrillation compared with immediate defibrillation for return of spontaneous circulation, neurological outcome and/or survival to hospital discharge. However, none of the studies reported evidence that CPR before defibrillation is harmful. Conflicting evidence remains regarding the benefit of CPR before defibrillation. The establishment of a consistent timeframe of chest compressions before defibrillation in the out-of-hospital setting will provide uniformity in standards in clinical practice and education and training.
Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19) and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11). Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth) was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and frequency of visitors. These
Forster Della A
Full Text Available Abstract Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19 and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11. Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and
Coustasse, Alberto; Tomblin, Shane; Slack, Chelsea
Supply costs account for more than one-third of the average operating budget and constitute the second largest expenditure in hospitals. As hospitals have sought to reduce these costs, radio-frequency identification (RFID) technology has emerged as a solution. This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption. Findings show that the application of RFID to medical equipment and supplies tracking has resulted in efficiency increases in hospitals with lower costs and increased service quality. RFID technology can reduce costs, improve patient safety, and improve supply chain management effectiveness by increasing the ability to track and locate equipment, as well as monitoring theft prevention, distribution management, and patient billing. Despite ongoing RFID implementation in the hospital supply chain, barriers to widespread and rapid adoption include significant total expenditures, unclear return on investment, and competition with other strategic imperatives. PMID:24159272
Renata Cristina Antonelli
Full Text Available This is an integrative literature review, which aims to analyze scientific articles that discuss the work of nurses in the management of hospital emergency services. The databases used were Latin American and Caribbean Health Science Literature (LILACS, Medical Literature Analysis and Retrieval System Online (MEDLINE, Integrated Building Environmental Communications System (IBECS, Scientific Electronic Library Online (SciELO and Nursing Database (BDENF. To conduct the survey, 10 articles were selected and classified into two themes, namely: "analyzing the work of the nurse in hospital emergency services" and "organizing the nurse work in hospital emergency services". The first category discussed the functions of the nurse and the satisfaction of these professionals, and the second, the problems identified in the hospital emergency service and strategies to organize the service, respectively. The theme developed showed how the work of the nurse presents as manager of that service, in addition to various strategies to alleviate or eliminate the identified problems in the urgency and emergency units of the hospital services.
Full Text Available Context: Kangaroo Mother Care (KMC is a supportive technique that beings at the neonatal period and is one of the skin-to-skin contact methods of holding neonate by mother. This method has an important role in exclusive breastfeeding and thermal care of neonates. This study aimed to investigate the application of KMC and evaluate the effect of this technique in different neonatal outcomes, particularly in Iranian neonates. Moreover, this review can be a tool for formative evaluation for this newly introduced treatment intervention in Iran. Evidence Acquisition: This review was conducted in national and international databases concerning experience with KMC on term and preterm neonates admitted in Iranian hospitals from 2006 to 2014. The measured outcomes included physiologic, psychologic, and clinical effects of this practice on newborn infants. Results: In this study, 42 Persian and English language papers were reviewed and finally 26 articles were selected. Various effects of KMC on different factors such as analgesia; physiological effects, breastfeeding, icterus, length of hospitalization, infection, psychologic effects, and weight gain were found. Conclusions: The results showed that as a simple and suitable strategy for increasing the health status of the mothers and newborns, KMC had an important role in improvement of neonatal outcomes in neonatal wards of Iranian hospitals in recent ten years. Therefore, promoting this technique in all neonatal wards of the country can promote health status of this population.
Handayani, Putu Wuri; Hidayanto, Achmad Nizar; Budi, Indra
This study reviews the literature on the most important acceptance factors associated with Hospital Information Systems (HIS) and related technologies based on user groups' perspectives (medical staff, hospital management, administrative personnel, patient, medical student, and IT staff), which can assist researchers and hospital management to develop suitable acceptance models to improve the quality of HIS. We conducted searches in online databases with large repositories of academic studies, written in English and fully accessible by the authors. The articles being reviewed are related to health information technology (HIT), clinical information systems (CIS), HIS, electronic medical records (EMR), telemedicine or telehealth, picture archiving and communication systems (PACS), radio frequency identification (RFID), and computerized physician order entry (CPOE), where the use of most of those applications and technologies is highly integrated. A predefined string was used to extract 1,005 articles, and the results were reviewed and checked. The results of this study found 15 user acceptance factors related to HIS and related technologies that were frequently identified by a minimum of five previous studies. These factors were related to individual, technological, and organizational factors. In addition, HIS and related technologies' user acceptance factors in each user group describe different results.
Agarwal, Mansi; Shiau, Stephanie; Larson, Elaine L
Repeat HAIs among frequently hospitalized patients may be contributing to the high rates of antibiotic resistance seen in gram-negative bacteria (GNB) in hospital settings. This systematic review examines the state of the literature assessing the association between repeat GNB HAIs and changes in antibiotic susceptibility patterns. A systematic search of English language published literature was conducted to identify studies in peer-reviewed journals from 2000 to 2015. Studies must have assessed drug resistance in repeat GNB infections longitudinally at the patient level. Two researchers independently reviewed search results for papers meeting inclusion criteria and extracted data. Risk of bias was assessed using a modified quality assessment tool based on the Checklist for Measuring Study Quality and the Quality Assessment Checklist for Cases Series. From 3385 articles identified in the search, seven met inclusion criteria. Five reported lower antibiotic susceptibility in repeated infections, one found a change but did not specify in which direction, and one reported no change. All studies were of low to average quality. Despite the dearth of studies examining repeat GNB infections, evidence suggests that repeat infections result in lower antibiotic susceptibility among hospitalized patients. Larger scale studies with strong methodology are warranted. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
Spinhoven, P; Ormel, J; Sloekers, PPA; Kempen, GIJM; Speckens, AEM; VanHemert, AM; van Hemert, A.M.
Background. Research on the dimensional structure and reliability of the Hospital Anxiety and Depression Scale (HADS) and its relationship with age is scarce. Moreover, its efficacy in determining the presence of depression in different patient groups has been questioned. Methods. Psychometric
Full Text Available Insights from psychology and cognitive science have, as yet, barely entered hospital choice research. This conceptual article closes this gap by reviewing and conceptually framing the current literature on hospital choice and patient information behavior and by discussing which tools are needed to advance scientific methodology in the study of patient decision-making strategies in hospital choice. Specifically, we make a call for more experimental research in hospital choice in order to complement existing theories, methods, and tools. This article introduces computerized process-tracing tools in hospital choice research, and also outlines a hands-on example, to provide a basis for future research.
Liao, Wen-Hua; Chen, Jin-Wu; Chen, Xin; Lin, Lin; Yan, Hai-Yan; Zhou, Yu-Qi; Chen, Rui
The goal of this study was to evaluate the effects of resistance training on subjects with COPD. We performed a systematic search in MEDLINE, PubMed, Embase, CINAHL, Elsevier ScienceDirect, EBM Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov and also of leading respiratory journals for randomized controlled trials on COPD treatment for ≥ 4 weeks with resistance training compared with non-exercise control or with combined resistance and endurance training compared with endurance training alone. Data from these studies were pooled to calculate odds ratio and weighted mean differences (WMDs) with 95% CI. Eighteen trials with 750 subjects with advanced COPD met the inclusion criteria. There were 2 primary and 5 secondary outcomes. Compared with non-exercise control, resistance training led to significant improvements in the dyspnea domain of the Chronic Respiratory Disease Questionnaire (WMD of 0.59, 95% CI 0.26-0.93, I2 = 0%, P < .001), skeletal muscle strength, and percent-of-predicted FEV1 (WMD of 6.88%, 95% CI 0.41-13.35%, I2 = 0%, P = .04). The combination of resistance and endurance training significantly improved the St George Respiratory Questionnaire total score (WMD of -7.44, 95% CI -12.62 to -2.25, I2 = 0%, P = .005), each domain score, and skeletal muscle strength. There were no significant differences in 6-min walk distance, 6-min pegboard and ring test, maximum exercise work load, and maximum oxygen consumption between the 2 groups. There were no reports of adverse events related to resistance-training intervention. Resistance training can be successfully performed alone or in conjunction with endurance training without increased adverse events during pulmonary rehabilitation in COPD. Copyright © 2015 by Daedalus Enterprises.
Conn, Vicki S; Ruppar, Todd M; Enriquez, Maithe; Cooper, Pam
Inadequate medication adherence is a pervasive, under-recognized cause of poor health outcomes. Many intervention trials designed to improve medication adherence have targeted adults with adherence problems. No previous reviews have synthesized the effectiveness of medication adherence interventions focused on subjects with medication adherence difficulties. This systematic review and meta-analysis synthesized findings from medication adherence intervention studies conducted among adults with medication adherence difficulties. Primary research studies were eligible for inclusion if they tested an intervention designed to increase medication adherence among adults with documented adherence difficulties and reported medication adherence behavior outcomes. Comprehensive search strategies of 13 computerized databases, author and ancestry searches, and hand searches of 57 journals were used to locate eligible primary research. Participant demographics, intervention characteristics, and methodological features were reliably coded from reports along with medication adherence outcomes. Effect sizes for outcomes were calculated as standardized mean differences, and random effects models were used to estimate overall mean effects. Exploratory dichotomous and continuous variable moderator analyses were employed to examine potential associations between medication adherence effect size and sample, intervention, and methodological characteristics. Data were extracted from 53 reports of studies involving 8243 individual primary study participants. The overall standardized mean difference effect size for treatment vs. control subjects was 0.301. For treatment pre- vs. post-intervention comparisons, the overall effect size was 0.533. Significantly larger effect sizes were associated with interventions incorporating prompts to take medications than interventions lacking medication prompts (0.497 vs. 0.234). Larger effect sizes were also found for interventions that linked
Conn, Vicki S.; Ruppar, Todd M.; Enriquez, Maithe; Cooper, Pam
Background Inadequate medication adherence is a pervasive, under-recognized cause of poor health outcomes. Many intervention trials designed to improve medication adherence have targeted adults with adherence problems. No previous reviews have synthesized the effectiveness of medication adherence interventions focused on subjects with medication adherence difficulties. Objective This systematic review and meta-analysis synthesized findings from medication adherence intervention studies conducted among adults with medication adherence difficulties. Methods Primary research studies were eligible for inclusion if they tested an intervention designed to increase medication adherence among adults with documented adherence difficulties and reported medication adherence behavior outcomes. Comprehensive search strategies of 13 computerized databases, author and ancestry searches, and hand searches of 57 journals were used to locate eligible primary research. Participant demographics, intervention characteristics, and methodological features were reliably coded from reports along with medication adherence outcomes. Effect sizes for outcomes were calculated as standardized mean differences, and random effects models were used to estimate overall mean effects. Exploratory dichotomous and continuous variable moderator analyses were employed to examine potential associations between medication adherence effect size and sample, intervention, and methodological characteristics. Results Data were extracted from 53 reports of studies involving 8,243 individual primary study participants. The overall standardized mean difference effect size for treatment vs. control subjects was 0.301. For treatment pre- vs. post-intervention comparisons, the overall effect size was 0.533. Significantly larger effect sizes were associated with interventions incorporating prompts to take medications than interventions lacking medication prompts (0.497 vs. 0.234). Larger effect sizes were also found
Giambra, Barbara K; Stiffler, Deborah; Broome, Marion E
With advances in health care, the population of children who are technology-dependent is increasing and, therefore, the need for nurses to understand how best to engage in communication with the parents of these children is critical. Shared communication between the parents of hospitalized technology-dependent children and their nurses is essential to provide optimal care for the child. The components and behaviors of the parent-nurse communication process that improve mutual understanding of optimal care for the child had not previously been examined. Among parents of hospitalized technology-dependent children and their nurses, what communication behaviors, components, concepts, or processes improve mutual understanding of optimal care for the child? An integrative review of both qualitative and quantitative studies was conducted. Key words including communication, hospitalized, nurse, parent, pediatric, and technology-dependent were used to search databases such as Cumulative Index to Nursing and Allied Health and Medline for years 2000-2014. The data regarding the process of parent-nurse communication were extracted as they related to the mutual understanding of optimal care for the child. The data were grouped into themes and compared across studies, designs, populations, and settings. Six articles were identified that provided information regarding the processes of shared communication among the parents of hospitalized technology-dependent children and their nurses. Providing clear information, involving parents in care decisions, trust and respect for each other's expertise, caring attitudes, advocacy, and role negotiation were all found to be important factors in shared parent-nurse communication. The results of this integrative review inform our understanding of the parent-nurse communication process. The findings provide nurses with an understanding of strategies to better engage in respectful, engaging, and intentional communication with parents of
M Kit Delgado
Full Text Available Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED crowding are unclear. We performed a systematic review of published simulation studies to identify: 1 the tradeoff between ambulance diversion and ED wait times; 2 the predicted impact of patient flow interventions on reducing diversion; and 3 the optimal regional strategy for reducing diversion.Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields.Results: We identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion.Conclusion: Smoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals. [West J Emerg Med. 2013;14(5:489-498.
Full Text Available Objective: Cancer is one of the four leading causes of death in children. Its courses of diagnosis and treatment can cause physiologic symptoms and psychological distress that secondarily affect children's quality of life and participation in daily activities. The aim of this study was to investigate the effect of play-based occupational therapy on pain, anxiety, and fatigue in hospitalized children with cancer who were receiving chemotherapy. Methods: Two hospitalized children with acute lymphoblastic leukemia at least 4 months after diagnoses who received two courses of chemotherapy participated in this pilot study. Takata Play History and Iranian Children Participation Assessment Scale were used to develop intervention protocol. Nine, 30–45 min play-based occupational therapy sessions took place for each child. Children filled out the Faces Pain Scale, Visual Fatigue Scale, and Faces Anxiety Scale before and after each intervention session. Results: Pain, anxiety, and fatigue levels decreased in both participants. Furthermore, the results showed a relationship between pain, anxiety, and fatigue variables in these children. Conclusions: Play-based occupational therapy can be effective in improving pain, anxiety, and fatigue levels in hospitalized children with cancer receiving chemotherapy.
Evans, Ceri; van Woerden, Hugo C
A systematic review aimed to compare patient outcomes after (1) appendicectomy and (2) pyloromyotomy performed by different surgical specialties, surgeons with different annual volumes, and in different hospital types, to inform the debate surrounding children's surgery provision. Embase, Medline, Cochrane Library, and Health Management Information Consortium were searched from January 1990 to February 2010 to identify relevant articles. Further literature was sought by contacting experts, citation searching, and hand-searching appropriate journals. Seventeen relevant articles were identified. These showed that (1) rates of wrongly diagnosed appendicitis were higher among general surgeons, but there were little differences in other outcomes and (2) outcomes after pyloromyotomy were superior in patients treated by specialist surgeons. Surgical specialty was a better predictor of morbidity than hospital type, and surgeons with higher operative volumes had better results. Existing evidence is largely observational and potentially subject to selection bias, but general pediatric surgery outcomes were clearly dependent on operative volumes. Published evidence suggests that (1) pediatric appendicectomy should not be centralized because children can be managed effectively by general surgeons; (2) pyloromyotomy need not be centralized but should be carried out in children's units by appropriately trained surgeons who expect to see more than 4 cases per year. Copyright © 2011 Elsevier Inc. All rights reserved.
Gómez-Romero, M; Jiménez-Palomares, M; Rodríguez-Mansilla, J; Flores-Nieto, A; Garrido-Ardila, E M; González López-Arza, M V
Dementia is characterised by cognitive deterioration and the manifestation of psychological and behavioural symptoms, especially changes in perception, thought content, mood, and conduct. In addition to drug therapy, non-pharmacological treatments are used to manage these symptoms, and one of these latter treatments is music therapy. Since this novel technique in non-verbal, it can be used to treat patients with dementia at any stage, even when cognitive deterioration is very severe. Patients' responses to music are conserved even in the most advanced stages of the disease DEVELOPMENT: A literature research was carried out using the following databases: Academic Search Complete, PubMed, Science Direct y Dialnet. The period of publication was 2003 to 2013 and the search keywords were 'Music Therapy, Dementia, Behaviour, Behaviour Disorders y Behavioural Disturbances'. Out of the 2188 studies that were identified, 11 studies met inclusion criteria for the systematic review. Music therapy is beneficial and improves behavior disorders, anxiety and agitation in subjects diagnosed with dementia. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.
Shi, Xiuqin; Xue, Wenhua; Liang, Shuhong; Zhao, Jie; Zhang, Xiaojian
According to previous meta-analyses, coffee consumption reduces the risk of type 2 diabetes mellitus. However, the underlying mechanism remains unknown. Whether caffeine, the key ingredient in coffee, has a beneficial effect on the glycemic homeostasis and the anti-diabetic effect is particularly controversial. The aim of this study was to summarize the effect of acute caffeine ingestion on insulin sensitivity in healthy men. A comprehensive literature search for papers published before April 2016 was conducted in EMBASE, PubMed, and Cochrane Library databases. Randomized controlled trials (RCTs) that investigated the effect of caffeine on insulin sensitivity in healthy humans without diabetes were included. A random effects meta-analysis was conducted using Review Manager 5.3. The search yielded 7 RCTs in which caffeine intake was the single variant. Compared with placebo, caffeine intake significantly decreased the insulin sensitivity index, with a standardized mean difference of -2.06 (95% confidence interval -2.67 to -1.44, I2 = 49%, P for heterogeneity = 0.06). Acute caffeine ingestion reduces insulin sensitivity in healthy subjects. Thus, in the short term, caffeine might shift glycemic homeostasis toward hyperglycemia. Long-term trials investigating the role of caffeine in the anti-diabetic effect of coffee are needed.
Couturier, Bérengère; Carrat, Fabrice; Hejblum, Gilles
The transition from hospital to home represents a key step in the management of patients and several problems related to this transition may arise, with potential adverse effects on patient health after discharge. The purpose of our study was to explore the association between components of the hospital discharge process including subsequent continuity of care and patient outcomes in the post-discharge period. Systematic review of observational and interventional studies. We conducted a combined search in the Medline and Web of Science databases. Additional studies were identified by screening the bibliographies of the included studies. The data collection process was conducted using a standardised predefined grid that included quality criteria. A standard patient population returning home after hospitalisation. Adverse health outcomes occurring after hospital discharge. In the 20 studies fulfilling our eligibility criteria, the main discharge-process components explored were: discharge summary (n=2), discharge instructions (n=2), drug-related problems at discharge (n=4), transition from hospital to home (n=5) and continuity of care after hospital discharge (n=7). The major subsequent patient health outcomes measured were: rehospitalisations (n=18), emergency department visits (n=8) and mortality (n=5). Eight of the 18 studies exploring rehospitalisations and two of the eight studies examining emergency department visits reported at least one significant association between the discharge process and these outcomes. None of the studies investigating patient mortality reported any significant such associations between the discharge process and these outcomes. Irrespective of the component of the discharge process explored, the outcome considered (composite or not), the sample size and the study design, no consistent statistical association between hospital discharge and patient health outcome was identified. This systematic review highlights a wide heterogeneity
Hansen, Trine Graabæk; Kjeldsen, Lene Juel
rates from 39% to 100%. The 10 controlled studies generally show a positive effect on medication use and costs, satisfaction with the service and positive as well as insignificant effects on health service use. Several outcomes were statistically insignificant, but these were predominantly associated......Suboptimal medication use may lead to morbidity, mortality and increased costs. To reduce unnecessary patient harm, medicines management including medication reviews can be provided by clinical pharmacists. Some recent studies have indicated a positive effect of this service, but the quality...... and outcomes vary among studies. Hence, there is a need for compiling the evidence within this area. The aim of this systematic MiniReview was to identify, assess and summarize the literature investigating the effect of pharmacist-led medication reviews in hospitalized patients. Five databases (MEDLINE, EMBASE...
Sadler, Lynn C; Austin, Diana M; Masson, Vicki L; McArthur, Colin J; McLintock, Claire; Rhodes, Sharon P; Farquhar, Cindy M
The purpose of this study was to identify factors that contributed to severe maternal morbidity, defined by admission of pregnant women and women in the postpartum period to the intensive care unit (ICU) from 2010-2011 at Auckland City Hospital (ACH), a tertiary hospital that delivers 7500 women/year, and to determine potentially avoidable morbidity with the use of local multidisciplinary review. All admissions of pregnant women and women in the postpartum period (to 6 weeks) to the ICU at ACH from 2010-2011 were identified from hospital databases. Case notes were summarized and discussed by a multidisciplinary team. The presence of contributory factors and potentially avoidable morbidity were determined by consensus with a tool that was developed by the New Zealand Perinatal and Maternal Mortality Review Committee for the review of maternal and perinatal deaths. Specific recommendations for clinical management were identified by the multidisciplinary group. Nine pregnant women and 33 women in the postpartum period were admitted to the ICU from 2010-2011. Contributory factors were identified in 30 cases (71%); 20 cases (48%) were considered to be potentially avoidable; personnel factors were the most commonly identified avoidable causes. Specific recommendations that resulted from the study included the need for the development of guidelines for puerperal sepsis, improved planning for women at known risk of postpartum hemorrhage, enhanced supervision of junior staff, and enhanced communication through multidisciplinary meetings. Forty-eight percent of severe maternal morbidity, which was defined as admission to the ICU at ACH from 2010-2011, was considered to be potentially avoidable by a local multidisciplinary review team; priorities were identified for improvement of local maternity services. Copyright © 2013 Mosby, Inc. All rights reserved.
Ward, Jane K; Armitage, Gerry
Patients are increasingly being thought of as central to patient safety. A small but growing body of work suggests that patients may have a role in reporting patient safety problems within a hospital setting. This review considers this disparate body of work, aiming to establish a collective view on hospital-based patient reporting. This review asks: (a) What can patients report? (b) In what settings can they report? (c) At what times have patients been asked to report? (d) How have patients been asked to report? 5 databases (MEDLINE, EMBASE, CINAHL, (Kings Fund) HMIC and PsycINFO) were searched for published literature on patient reporting of patient safety 'problems' (a number of search terms were utilised) within a hospital setting. In addition, reference lists of all included papers were checked for relevant literature. 13 papers were included within this review. All included papers were quality assessed using a framework for comparing both qualitative and quantitative designs, and reviewed in line with the study objectives. Patients are clearly in a position to report on patient safety, but included papers varied considerably in focus, design and analysis, with all papers lacking a theoretical underpinning. In all papers, reports were actively solicited from patients, with no evidence currently supporting spontaneous reporting. The impact of timing upon accuracy of information has yet to be established, and many vulnerable patients are not currently being included in patient reporting studies, potentially introducing bias and underestimating the scale of patient reporting. The future of patient reporting may well be as part of an 'error detection jigsaw' used alongside other methods as part of a quality improvement toolkit.
Norrie, M W; Lane, M R
A retrospective review of patients being treated by percutaneous endoscopic gastrostomy (PEG) at Auckland Hospital from 1993-4 was undertaken in order to determine patient characteristics, clinical outcome and to compare these results with published series. The case notes of all patients having PEGs performed in the Auckland Hospital gastroenterology unit during the defined period were reviewed. Demographic details, indications, morbidity and mortality data were obtained. Data were supplemented with information obtained from the general practitioner. Fifty procedures (18 in 1993, 32 in 1994) were performed on 41 patients (29 male 12 female), with a mean age of 61 years. Neurological disorders represented the most common clinical indication (25) followed by head and neck malignancy (9). Three patients (7) died within 30 days of the procedure and 13 (32) had early complications (less than 30 days) with four (10) having late complications. Significant pain requiring narcotics occurred in 18. Results were in general comparable to published series apart from a higher early complication rate (32% vs 16%). Pain may be significant post procedure and should be anticipated. The increasing use of this procedure in our hospital reflects its acceptability to patients, relatives and staff as a means of providing nutritional support to the patient with disorders of swallowing.
Devlin, Heather M; Desai, Jay; Walaszek, Anne
Public health surveillance of diabetes during pregnancy is needed. Birth certificate and hospital discharge data are population-based, routinely available and economical to obtain and analyze, but their quality has been criticized. It is important to understand the usefulness and limitations of these data sources for surveillance of diabetes during pregnancy. We conducted a comprehensive literature review to summarize the validity of birth certificate and hospital discharge data for identifying diabetes-complicated births. Sensitivities for birth certificate data identifying prepregnancy diabetes mellitus (PDM) ranged from 47% to 52%, median 50% (kappas: min = 0.210, med = 0.497, max = 0.523). Sensitivities for birth certificate data identifying gestational diabetes mellitus (GDM) ranged from 46% to 83%, median 65% (kappas: min = 0.545, med = 0.667, max = 0.828). Sensitivities for the two studies using hospital discharge data for identifying PDM were 78% and 95% (kappas: 0.839 and 0.964), and for GDM were 71% and 81% (kappas: 0.584 and 0.840). Specificities were consistently above 98% for both data sources. Overall, hospital discharge data performed better than birth certificates, marginally so for identifying GDM but substantially so for identifying PDM. Reports based on either source alone should focus on trends and disparities and include the caveat that results under represent the problem. Linking the two data sources may improve identification of both GDM and PDM cases.
Cotton, Sian; Luberto, Christina M; Bogenschutz, Lois H; Pelley, Terri J; Dusek, Jeffrey
Complementary or integrative care therapies are promising adjunctive approaches to pain management for pediatric inpatients that are currently underused and understudied. The purpose of this study was to examine the potential benefits of integrative care therapies delivered to hospitalized children and adolescents at a large Midwestern academic pediatric medical center over a 1-year period. A retrospective chart review of an inpatient clinical database maintained by integrative care therapists over a 1-year period was used for the current study. Pre/post pain and relaxation scores associated with the delivery of inpatient integrative care therapies (primarily massage therapy and healing touch) were examined. Five-hundred nineteen hospitalized children and adolescents were treated by integrative care therapists for primarily pain or anxiety needs. Patients had a mean age of 10.2 years (standard deviation, 7.0), 224 were female (43%), 383 were white (74%), and most (393 [77%]) received massage therapy. Mean pain and relaxation scores decreased significantly from pre- to post-therapy across all demographic and clinical subgroups (p≤.001). Although integrative care therapies are increasingly requested and offered in children's hospitals, provision of these approaches is driven primarily by consumer demand rather than evidence-informed practice. Future controlled studies should examine the incremental effects of integrative care therapies as an adjunct to conventional treatment, assess how these therapies work mechanistically, and determine whether they improve outcomes, such as pain and cost, for hospitalized children and adolescents.
Eddy, Kylie; Jordan, Zoe; Stephenson, Matthew
Teamwork is seen as an important element of patient care in acute hospital settings. The complexity of the journey of care for patients highlights the need for health professionals to collaborate and communicate clearly with each other. Health organizations in western countries are committed to improving patient safety through education of staff and teamwork education programs have been integral to this focus. There are no current systematic reviews of the experience of health professionals who participate in teamwork education in acute hospital settings. The objective of this systematic review was to search for the best available evidence on the experiences of health professionals who participate in teamwork education in acute hospital settings. This review considered studies reporting on experiences of registered health professionals who work in acute hospitals. This included medical, nursing and midwifery and allied health professionals. The focus of the meta-synthesis was the experiences and reflections of health professionals who were involved in teamwork education in acute hospital settings. The geographical context for this review was acute hospitals in rural or metropolitan settings in Australia and overseas countries. The review focused on the experiences of health professionals who work in acute hospitals and participated in teamwork education programs. This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.In the absence of research studies, other text such as opinion papers, discussion papers and reports were considered. Studies published in English and from 1990 to 2013 were included in this review. The literature search for relevant papers occurred between 13 September and 26 October 2013. A three-step search strategy was utilized in this review. The databases searched were PubMed, CINAHL, Embase and Scopus. The
Mistiaen, P.; Francke, A.L.; Poot, E.
BACKGROUND: Many patients encounter a variety of problems after discharge from hospital and many discharge (planning and support) interventions have been developed and studied. These primary studies have already been synthesized in several literature reviews with conflicting conclusions. We
Leendertse, A. J.; de Koning, G. H. P.; Goudswaard, A. N.; Belitser, S. V.; Verhoef, M.; de Gier, H. J.; Egberts, A. C. G.; van den Bemt, P. M. L. A.
What is known and objective Limited and conflicting evidence exists on the effect of a multicomponent pharmaceutical care intervention (i.e. medication review, involving collaboration between general practitioners (GPs), pharmacists and patients) on medication-related hospitalizations, survival,
Berendsen, AJ; Schuling, J; Meyboom-De Jong, B
Hospital at home; a review of the literature on the effects of a form of transmural care Objective. To evaluate the effects of hospital at home on health outcomes and quality of life of patients and carers; to evaluate the costs of this form of care and the experiences of the (para)medics involved.
Sally Lindsay; Hartman, Laura R.; Nick Reed; Caron Gan; Nicole Thomson; Beverely Solomon
Objectives We reviewed the literature on interventions that aimed to improve hospital-to-school reintegration for children and youth with acquired brain injury (ABI). ABI is the leading cause of disability among children and youth. A successful hospital-to-school reintegration process is essential to the rehabilitative process. However, little is known about the effective components of of such interventions. Methods and findings Our research team conducted a systematic review, completing comp...
Shen, Nicole T; Maw, Anna; Tmanova, Lyubov L; Pino, Alejandro; Ancy, Kayley; Crawford, Carl V; Simon, Matthew S; Evans, Arthur T
Systematic reviews have provided evidence for the efficacy of probiotics in preventing Clostridium difficile infection (CDI), but guidelines do not recommend probiotic use for prevention of CDI. We performed an updated systematic review to help guide clinical practice. We searched MEDLINE, EMBASE, International Journal of Probiotics and Prebiotics, and The Cochrane Library databases for randomized controlled trials evaluating use of probiotics and CDI in hospitalized adults taking antibiotics. Two reviewers independently extracted data and assessed risk of bias and overall quality of the evidence. Primary and secondary outcomes were incidence of CDI and adverse events, respectively. Secondary analyses examined the effects of probiotic species, dose, timing, formulation, duration, and study quality. We analyzed data from 19 published studies, comprising 6261 subjects. The incidence of CDI in the probiotic cohort, 1.6% (54 of 3277), was lower than of controls, 3.9% (115 of 2984) (P probiotic users was 0.42 (95% confidence interval, 0.30-0.57; I 2 = 0.0%). Meta-regression analysis demonstrated that probiotics were significantly more effective if given closer to the first antibiotic dose, with a decrement in efficacy for every day of delay in starting probiotics (P = .04); probiotics given within 2 days of antibiotic initiation produced a greater reduction of risk for CDI (relative risk, 0.32; 95% confidence interval, 0.22-0.48; I 2 = 0%) than later administration (relative risk, 0.70; 95% confidence interval, 0.40-1.23; I 2 = 0%) (P = .02). There was no increased risk for adverse events among patients given probiotics. The overall quality of the evidence was high. In a systematic review with meta-regression analysis, we found evidence that administration of probiotics closer to the first dose of antibiotic reduces the risk of CDI by >50% in hospitalized adults. Future research should focus on optimal probiotic dose, species, and formulation. Systematic
Kim, Dong H; Duco, Bernard; Wolterman, Daniel; Stokes, Charles; Brace, Rod; Solomon, Robert A; Barbaro, Nicholas; Westmark, Richard; MacDougall, David; Bean, James; O'Leary, Joanna; Moayeri, Nicole; Dacey, Ralph G; Berger, Mitchel S; Harbaugh, Robert
As healthcare delivery shifts from fee-for-service, episodic care to pay for performance and population health, both hospitals and physicians are looking for new forms of integration. A number of regulations and restrictions govern physician relationships with hospitals. In this paper, we review the legal basis for such relationships and the options available. We also survey neurosurgeons and hospital executives to gain their perspective on the current situation and likely future. Two series of structured interviews were conducted with 10 neurosurgeons who work in a range of situations in diverse markets, and with Memorial Hermann Healthcare System senior executive leadership. Their responses form the basis for the subsequent discussion. Neurosurgeons can be independent, join a confederation such as an Independent Physician Association or another type of "clinically integrated" network, or be employed by a hospital, medical school, or physician group. With varying levels of integration comes the strength of size, management expertise, negotiating leverage, economies of scale, and possibly financial advantages, but with impact on autonomy and independence. Constructive alignment can lead to a win-win situation for both the individual physician and the organization, but options vary widely due to heterogeneous local conditions. This paper reviews possible relationships, moving along a spectrum from no financial integration to full integration. Concepts such as physician leasing, professional service agreements, "clinical integration," and employment are presented. This paper offers a practical reference that might be useful to a new graduate, independent neurosurgeon considering integration, or employed physicians considering alternatives. Copyright © 2016 by the Congress of Neurological Surgeons.
Ajami, Sima; Rajabzadeh, Ahmad; Ketabi, Saeedeh
Organizations try to outsource their activities as much as possible in order to prevent the problems and use organizational capabilities in Information Technology (IT) field. The purpose of this paper was first, to express the effective criteria for selecting suppliers of IT services, second, to explain the advantages and disadvantages of outsourcing IT in hospitals. This study was narrative review, which search was conducted with the help of libraries, books, conference proceedings, and databases of Science Direct, PubMed, Proquest, Springer, and SID (Scientific Information Database). In our searches, we employed the following keywords and their combinations: Outsourcing, information technology, hospital, decision making, and criteria. The preliminary search resulted in 120 articles, which were published between 2000 and 2013 during July 2013. After a careful analysis of the content of each paper, a total of 46 papers were selected based on their relevancy. The criteria and sub-criteria influencing outsourcing decisions in Iranian hospitals were identified in six major categories including administrative issues, issues related to the service/product, technology factors, environmental factors, risks, and economic factors associated with 15 sub-criteria containing business integration, dependence on suppliers, human resources, focus on core competencies, facilities and physical capital, innovation, quality, speed of service delivery, flexibility, market capabilities, geographical location, security, management control, cost, and financial capability. Identify the advantages and disadvantages of outsourcing and effective criteria in IT services supplier selection causes the managers be able to take the most appropriate decision to select supplier of IT services. This is a general review on influencing criteria for electing of supplier of information technology services in hospitals.
Tanaka, Akiko; Kawamura, Masao; Yamada, Kazuko; Morioka, Ikuharu
The aim of this study is to clarify the association between teaching and support skills and the subjective effectiveness of nutritional guidance of registered dietitians working at hospitals. We carried out a questionnaire survey of registered dietitians at hospitals in a Japanese prefecture. The utilization of nutritional teaching skills in nutritional guidance was investigated using a self-produced 36-item questionnaire that was designed to be mainly used for diabetic patients in 4 settings: first guidance, first assessment, contemplation stage, and preparation stage. The support skills were evaluated by Kikuchi's Scale of Social Skills: 18 items. The subjective effectiveness of nutritional guidance was defined by the behavioral change of the patients after nutritional guidance as evaluated by a registered dietitian. There were 75 respondents (response rate 46.6 %). Among the teaching skills, basic skills in an interview were often used, but some related to coaching skills were not in common use in nutritional guidance. Based on the results of principal component analysis, we created a scale for scoring the utilization of nutritional teaching skills in each setting. Multiple linear regression analysis illustrated that high subjective effectiveness of nutritional guidance was associated with high score of teaching skills in the preparation stage setting and high score of support skills. These results show that, in addition to frequent use of nutritional teaching skills, improvement of support skills is also necessary to enhance the effectiveness of nutritional guidance.
Danúbia da Cunha Antunes SARAIVA
Full Text Available ABSTRACT Objective Cross-cultural adaptation and content validation of the Brazilian Portuguese version of the Subjective Global Nutritional Assessment questionnaire (originally in English for use in hospitalized children and adolescents being treated in a reference institute of oncology. Methods The cross-cultural adaptation process consisted of the following stages: conceptual, item, semantic, and operational equivalence. The conceptual equivalence and item was carried out through discussion with members of an expert committee. Semantic equivalence was evaluated through initial translation, synthesis of translations, back translation, discussions with experts, and pretest with 32 patients. During operational equivalence, the experts discussed about the format of questions and instructions, setting, target populations, and mode of administration to later propose a final version. Content validation was performed by the expert committee. Results Minor modifications were made in the instrument to facilitate its use in the Brazilian socio-cultural context. Pretest results showed that the instrument is easily understood by health care professionals and the target population. Conclusion The cross-cultural adaptation and validation of the Subjective Global Nutritional Assessment allowed obtaining a Brazilian version equivalent to the original. The adapted instrument will be an important tool for the subjective assessment of the nutritional status of pediatric patients hospitalized with cancer.
Wouk, Kathryn; Tully, Kristin P; Labbok, Miriam H
The Ten Steps to Successful Breastfeeding outline maternity practices that protect, promote, and support breastfeeding and serve as the foundation for the Baby-Friendly Hospital Initiative. Research aim: This systematic review describes interventions related to Step 3 of the Ten Steps, which involves informing pregnant women about the benefits and management of breastfeeding. Our main objective was to determine whether prenatal clinic- or hospital-based breastfeeding education increases breastfeeding initiation, duration, or exclusivity. The electronic databases MEDLINE and CINAHL were searched for peer-reviewed manuscripts published in English between January 1, 2000, and May 5, 2016. Bibliographies of relevant systematic reviews were also screened to identify potential studies. Thirty-eight studies were included. The research studies were either randomized controlled trials or quasi-experimental studies conducted in developed or developing countries. Findings suggest that prenatal interventions, delivered alone or in combination with intrapartum and/or postpartum components, are effective at increasing breastfeeding initiation, duration, or exclusivity where they combine both education and interpersonal support and where women's partners or family are involved. However, varying study quality and lack of standardized assessment of participants' breastfeeding intentions limited the ability to recommend any single intervention as most effective. Future studies should test the strength of maternal breastfeeding intentions, assess the role of family members in influencing breastfeeding outcomes, compare the effectiveness of different health care providers, and include more explicit detail about the time and full cost of different interventions.
Full Text Available Khaled Aldhwaihi, Fabrizio Schifano, Cinzia Pezzolesi, Nkiruka Umaru Department of Pharmacy, University of Hertfordshire, Hatfield, UK Background: Dispensing errors are common in hospital pharmacies. Investigating dispensing errors is important for identifying the factors involved and developing strategies to reduce their occurrence. Objectives: To review published studies exploring the incidence and types of dispensing errors in hospital pharmacies and factors contributing to these errors. Methods: Electronic databases including PubMed, Scopus, Ovid, and Web of Science were searched for articles published between January 2000 and January 2015. Inclusion criteria were: studies published in English, and studies investigating type, incidence and factors contributing to dispensing errors in hospital pharmacies. One researcher searched for all relevant published articles, screened all titles and abstracts, and obtained complete articles. A second researcher assessed the titles, abstracts, and complete articles to verify the reliability of the selected articles. Key findings: Fifteen studies met the inclusion criteria all of which were conducted in just four countries. Reviewing incident reports and direct observation were the main methods used to investigate dispensing errors. Dispensing error rates varied between countries (0.015%–33.5% depending on the dispensing system, research method, and classification of dispensing error types. The most frequent dispensing errors reported were dispensing the wrong medicine, dispensing the wrong drug strength, and dispensing the wrong dosage form. The most common factors associated with dispensing errors were: high workload, low staffing, mix-up of look-alike/sound-alike drugs, lack of knowledge/experience, distractions/interruptions, and communication problems within the dispensary team. Conclusion: Studies relating to dispensing errors in hospital pharmacies are few in number and have been conducted in
Anderson, Peter; Fee, Peter; Shulman, Rob; Bellingan, Geoffrey; Howell, David
A comprehensive review of the clinical audit programme in a teaching hospital intensive care unit. A retrospective analysis of the clinical audit projects undertaken within the intensive care unit over the preceding 2 years and compared with published national guidelines for clinical audit. A 27-bedded teaching hospital intensive care unit in the UK. Each audit project was reviewed independently by two assessors. The following questions were assessed. 1. Were the projects true audits? 2. Were they prospective of retrospective? 3. Did the projects have input from appropriate members of the multidisciplinary team. 4. How many of the audit projects were re-audits? 5. Of the re-audits how many showed evidence of service improvement? each audit project was also scored against the Audit Project Assessment Tool produced by the UK Clinical Governance Support Team. Of the twenty five audit projects reviewed twenty two were considered to be true audits. All of the projects used only retrospective data. Audit projects were contributed from all sections of the multidisciplinary critical care team but there were few truly multidisciplinary projects. Four of the audit projects were re-audits, of these three showed service improvement and one showed deterioration. Of the twenty two true audit projects reviewed, eleven were classified as good quality projects using the Audit Project Assessment Tool. Despite the clinical audit programme being active and well supported, objective evidence of clinical governance benefit was lacking. The overall clinical audit programme has been revitalised by a series of improvements since undertaking this review and this approach is recommended to other organizations who are interested in improving their clinical audit performance.
Da Rin Della Mora, R; Bagnasco, A; Sasso, L
Paediatric hospitals can be perceived by children, parents, health professionals as 'safe' places, but accidents do occur. To review publications relating to in-hospital paediatric accidents and highlight the state-of-the-science concerning this issue especially in relation to falls, and the evolution of research addressing this issue. Integrative review of papers published before March 2011 on accidents and falls occurred in hospitalized children. Electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature and Cochrane Library databases) and further hand searching through references were searched. The inclusion criteria were articles involving observational, quasi-experimental or experimental studies in English or Italian. Exclusion criteria were articles addressing the outcomes of falls caused by suspect violence on children. Thirteen studies in English were included. Of the 13 studies conducted between 1963 and 2010, 10 had been conducted in the last 5 years; 10 in the USA. The studies were divided into two categories: contextualization and prevention of the 'accident' or 'fall' phenomenon (10 studies), and fall risk assessment (three studies). The most frequent type of design was observational explorative/descriptive. Several areas of investigation were explored (hazardous environment, children's characteristics correlated to accidents/falls, characteristics of the accidents/falls and their outcomes, paediatric fall risk factors and risk assessment tools, fall risk prevention programmes, parents' perceptions of accident/fall risks, etc.). No comparable methods were used to investigate the contextualization and prevention of the 'accident' and 'fall' phenomena; proposed fall risk assessment tools were not evaluated for their reliability and validity. Consensus would be needed around the approach to accidents in terms of: the definition of 'accident' and 'fall'; 'fall-related injury' and respective classifications; the frequency and
Saw, Anna E; Main, Luana C; Gastin, Paul B
Monitoring athlete well-being is essential to guide training and to detect any progression towards negative health outcomes and associated poor performance. Objective (performance, physiological, biochemical) and subjective measures are all options for athlete monitoring. We systematically reviewed objective and subjective measures of athlete well-being. Objective measures, including those taken at rest (eg, blood markers, heart rate) and during exercise (eg, oxygen consumption, heart rate response), were compared against subjective measures (eg, mood, perceived stress). All measures were also evaluated for their response to acute and chronic training load. The databases Academic search complete, MEDLINE, PsycINFO, SPORTDiscus and PubMed were searched in May 2014. Fifty-six original studies reported concurrent subjective and objective measures of athlete well-being. The quality and strength of findings of each study were evaluated to determine overall levels of evidence. Subjective and objective measures of athlete well-being generally did not correlate. Subjective measures reflected acute and chronic training loads with superior sensitivity and consistency than objective measures. Subjective well-being was typically impaired with an acute increase in training load, and also with chronic training, while an acute decrease in training load improved subjective well-being. This review provides further support for practitioners to use subjective measures to monitor changes in athlete well-being in response to training. Subjective measures may stand alone, or be incorporated into a mixed methods approach to athlete monitoring, as is current practice in many sport settings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Full Text Available Traumatic events after a road traffic accident (RTA can be physical and/or psychological. Posttraumatic stress disorder (PTSD is one of the major psychological conditions which affect accident victims. Psychological issues may not be addressed in the emergency department(ED immediately. There have been reports about a mismatch between the timely referrals from ED to occupational or primary care services for these issues. If left untreated, there may be adverse effects on quality of life (QOL and work productivity. Hospital expenses, loss of income, and loss of work could create a never ending cycle for financial difficulties and burden in trauma victims. The aim of our review is to address the magnitude of PTSD in post-RTA hospitalized patients in Indian subcontinent population. We also attempted to emphasis on few management guidelines. A comprehensive search was conducted on major databases with Medical Subject Headings (MeSH term ′PTSD or post-traumatic stress′ and Emergency department and vehicle or road or highway or automobile or car or truck or trauma and India. Out of 120 studies, a total of six studies met our inclusion criteria and were included in the review. Our interpretation of the problem is that; hospital expenditure due to trauma, time away from work during hospitalization, and reduction in work performance, are three major hits that can lead RTA victims to financial crisis. Proposed management guidelines are; establish a coordinated triage, implementing a screening tool in the ED, and provide psychological counseling.
Mitchell, H; Porter, J
Disease-related malnutrition is known to have significant clinical and economic consequences. This systematic review of recent evidence aimed to establish the cost-effectiveness of identifying and treating malnutrition in the hospital setting. A search of four electronic databases and the Internet was conducted for relevant publications from 2003 to 2013. The search strategy considered both nutritional care and healthcare costs. Hospitalised adults with, or at risk of malnutrition, were the focus of the review. Eligibility criteria included publications of original research to identify or treat malnutrition through usual care. Studies with a focus on enteral and parenteral nutrition interventions were beyond the scope of the review. Methodological quality was assessed using the Consensus on Health Economic Criteria checklist. Of the 1174 records identified through database searching, 19 full-text articles were assessed for eligibility. Three studies were included in the final review, highlighting the absence of recent high quality cost-effectiveness studies in this field. One economic modelling study and two prospective clinical trials were included of moderate to high methodological quality. Definite conclusions could not be drawn regarding the cost-effectiveness of individual interventions because of the heterogeneity of treatments, controls and populations. The present review highlights an evidence gap in the care of malnourished hospitalised adults, limiting the ability of clinicians and healthcare managers to make informed, cost-effective treatment decisions. Further economic evaluations are needed and should be considered as a routine component of future research. © 2015 The British Dietetic Association Ltd.
Patterson, Stephanie Y.; Smith, Veronica; Mirenda, Pat
Aim: The purpose of this systematic review was to examine research utilizing single subject research designs (SSRD) to explore the effectiveness of interventions designed to increase parents' ability to support communication and social development in children with autism spectrum disorders (ASDs). Method: Included studies were systematically…
Sharma, Dibyendu; Kannan, Ravi; Tapkire, Ritesh; Nath, Soumitra
Cancer patients frequently experience malnutrition. Cancer and cancer therapy effects nutritional status through alterations in the metabolic system and reduction in food intake. In the present study, fifty seven cancer patients were selected as subjects from the oncology ward of Cachar Cancer Hospital and Research Centre, Silchar, India. Evaluation of nutritional status of cancer patients during treatment was carried out by scored Patient-Generated Subjective Global Assessment (PG-SGA). The findings of PG-SGA showed that 15.8% (9) were well nourished, 31.6% (18) were moderately or suspected of being malnourished and 52.6% (30) were severely malnourished. The prevalence of malnutrition was highest in lip/oral (33.33%) cancer patients. The study showed that the prevalence of malnutrition (84.2%) was high in cancer patients during treatment.
Francisco J. Karkow
Full Text Available A cross-sectional study of 120 subjects was performed with the purpose of evaluating stress hormones and emotional stress (anxiety in outpatient and hospitalized subjects. The aims were to determine the degree of objective stress, as well as to correlate this finding with subjective findings, estimated using Beck's Anxiety Inventory.. METHOD: Three populations were investigated, namely outpatient clinical cases (Group I, n = 30, hospitalized clinical individuals (Group II, n = 30, and hospitalized surgical candidates (Group III, n = 30. Controls (Group IV, n = 30 were healthy volunteers who were health-care professionals and students. To avoid hormone interactions, only men were enrolled in all groups. All hospitalized subjects were tested on admission and before therapeutic interventions. Fasting epinephrine, norepinephrine, and cortisol were measured in the morning, and Beck's Anxiety Inventory was adminstered by a trained psychologist. RESULTS: The 3 patient groups displayed higher anxiety levels than the controls. Hormone concentrations did not present remarkable changes and did not correlate with subjective stress (anxiety. CONCLUSIONS: 1 Subjective disorders (as determined with Beck's Anxiety Inventory were a common finding in both outpatient and hospitalized populations, without differences between the various groups; 2 Objective stress (as determined by elevated hormone levels was more difficult to confirm-findings rarely exceeded the reference range; 3 Correlation between the two variables could not be demonstrated; 4 Further studies are necessary to define stress quantification and interpretation in patient populations, especially in relationship with nutritional diagnosis and dietetic prescription.Um estudo transversal de 120 indivíduos foi executado visando avaliar hormônios do estresse e estresse subjetivo (ansiedade em casos ambulatoriais e hospitalizados. O objetivo era determinar o grau de estresse objetivo, bem como
Lankston, Louise; Cusack, Pearce; Fremantle, Chris; Isles, Chris
Summary In 2006 a Department of Health Working Group on Arts and Health reported that the arts have ‘a clear contribution to make and offer major opportunities in the delivery of better health, wellbeing and improved experience for patients, service users and staff alike’. In this review we examine the evidence underpinning this statement and evaluate the visual art of three of Scotland's newest hospitals: the Royal Infirmary of Edinburgh, the new Stobhill Hospital, and the new Victoria Infirmary in Glasgow. We conclude that art in hospitals is generally viewed positively by both patients and staff, but that the quality of the evidence is not uniformly high. Effects may be mediated by psychological responses to colour hue, brightness and saturation. Colours that elicit high levels of pleasure with low levels of arousal are most likely to induce a state of calm, while those causing displeasure and high levels of arousal may provoke anxiety. The fact that patients frequently express a preference for landscape and nature scenes is consistent with this observation and with evolutionary psychological theories which predict positive emotional responses to flourishing natural environments. Contrary to a view which may prevail among some contemporary artists, patients who are ill or stressed about their health may not always be comforted by abstract art, preferring the positive distraction and state of calm created by the blues and greens of landscape and nature scenes instead. PMID:21127332
Smismans, Annick; Vantrappen, Astrid; Verbiest, Freija; Indevuyst, Christophe; Van den Poel, Bea; von Winckelmann, Sandrina; Peeters, Annelore; Ombelet, Sara; Lybeert, Peter; Heremans, Andre; Frans, Eric; Ho, Erwin; Frans, Johan
Since its introduction in the 1970s in the United States, outpatient parenteral antibiotic/antimicrobial therapy (OPAT) has been adopted internationally for long-term intravenous (IV) treatment of stable infectious diseases. The aim is to provide a safe and successful completion of IV antimicrobial treatment at the ambulatory care center or at home without complications and costs associated with hospitalization. OPAT implementation has been accelerated by progress in vascular access devices, newly available antibiotics, the emphasis on cost-savings, as well as an improved patient comfort and a reduced incidence of health care associated infections with a similar outcome. OPAT utilization is supported by an extensive published experience and guidelines of the British Society of Antimicrobial Chemotherapy and the Infectious Diseases Society of America for adults as well as for children. Despite these recommendations and its widespread adoption, in Belgium OPAT is only fully reimbursed and established for cystic fibrosis patients. Possible explanations for this unpopularity include physician unfamiliarity and a lack of uniform funding arrangements with higher costs for the patient. This article aims to briefly review benefits, risks, indications, financial impact for supporting OPAT in a non-university hospital as standard of care. Our experience with OPAT at the ambulatory care center of our hospital and its subsequent recent introduction in the home setting is discussed.
Full Text Available Abstract Objective Retrorectal tumours are rare lesions in adults. The diagnosis of retrorectal lesion is often difficult and misdiagnosis is common. We present significant number of cases in view of scarce information available on this matter. Methods 14 patients were treated at Vilnius university hospital "Santariskiu klinikos" Centre of abdominal surgery from 1997 to 2010. The case notes of patients who underwent surgery for a retrorectal tumour were reviewed retrospectively. Surgical histories, operations, histological tumour type, surgical time, weight of the specimen, blood loss, length of stay were analysed. Results 13 patients underwent laparotomy, 1 patient had combined perineal approach and laparotomy. The most common types of the tumour were fibroma (3 cases, leiomyosarcoma (2 cases. 5 tumours (35,7% were found to be malignant. 57% of the patients had undergone at least one operation prior to definitive treatment. 5 female patients were initially admitted under gynaecologists. Hospital stay varied from 14 days to 22 days (mean 16,2 days. A report of a representative case is presented. Conclusions Retrorectal lesions in female patients can mimic gynaecological pathology. Patients with this rare pathology are to be treated in a major tertiary hospital by surgeons, who are able to operate safely in the retrorectal space.
Trotta, Annarita; Cardamone, Emma; Cavallaro, Giusy; Mauro, Marianna
Teaching hospitals (THs) simultaneously serve three different roles: offering medical treatment, teaching future doctors and promoting research. The international literature recognises such organisations as 'peaks of excellence' and highlights their economic function in the health system. In addition, the literature describes the urgent need to manage the complex dynamics and inefficiency issues that threaten the survival of teaching hospitals worldwide. In this context, traditional performance measurement systems that focus only on accounting and financial measures appear to be inadequate. Given that THs are highly specific and complex, a multidimensional system of performance measurement, such as the Balanced Scorecard (BSC), may be more appropriate because of the multitude of stakeholders, each of whom seek a specific type of accountability. The aim of the paper was twofold: (i) to review the literature on the BSC and its applications in teaching hospitals and (ii) to propose a scorecard framework that is suitable for assessing the performance of THs and serving as a guide for scholars and practitioners. In addition, this research will contribute to the ongoing debate on performance evaluation systems by suggesting a revised BSC framework and proposing specific performance indicators for THs. Copyright © 2012 John Wiley & Sons, Ltd.
Lankston, Louise; Cusack, Pearce; Fremantle, Chris; Isles, Chris
In 2006 a Department of Health Working Group on Arts and Health reported that the arts have 'a clear contribution to make and offer major opportunities in the delivery of better health, wellbeing and improved experience for patients, service users and staff alike'. In this review we examine the evidence underpinning this statement and evaluate the visual art of three of Scotland's newest hospitals: the Royal Infirmary of Edinburgh, the new Stobhill Hospital, and the new Victoria Infirmary in Glasgow. We conclude that art in hospitals is generally viewed positively by both patients and staff, but that the quality of the evidence is not uniformly high. Effects may be mediated by psychological responses to colour hue, brightness and saturation. Colours that elicit high levels of pleasure with low levels of arousal are most likely to induce a state of calm, while those causing displeasure and high levels of arousal may provoke anxiety. The fact that patients frequently express a preference for landscape and nature scenes is consistent with this observation and with evolutionary psychological theories which predict positive emotional responses to flourishing natural environments. Contrary to a view which may prevail among some contemporary artists, patients who are ill or stressed about their health may not always be comforted by abstract art, preferring the positive distraction and state of calm created by the blues and greens of landscape and nature scenes instead.
Goedhart, Nicole S; van Oostveen, Catharina J; Vermeulen, Hester
To assess and synthesise studies reporting direct associations between the structural empowerment of frontline nurses and quality outcomes, and to identify gaps in the current literature. The empowerment of nurses seems essential for delivering high-quality patient care. Understanding the relationship between empowerment and quality outcomes would enable nurse managers to make informed choices on improving the quality of care. A scoping review examining the relationship between the structural empowerment of nurses and the quality, effectiveness, safety, efficiency and patient-centredness of care in hospitals. Searching in MEDLINE, CINAHL, Business Source Premier and Embase identified 672 potentially relevant articles. Independent selection, quality assessment, data extraction and analysis were completed. Twelve cross-sectional studies originating from North America were included. These studies showed a variety of quality outcomes and statistics used. All studies reported positive associations between the structural empowerment of nurses, nurse assessed quality of care and patient safety climate, and work and unit effectiveness. Nurses having access to empowering structures positively affects the quality outcomes, i.e. quality, effectiveness, safety, efficiency and patient-centredness of patient care in hospitals. Nurse managers and leaders should ensure empowering work conditions for nurses in order to increase hospitals' quality of patient care. © 2017 John Wiley & Sons Ltd.
Full Text Available A survey was conducted among editors of journals publishing in the field of chemistry, chemical technology and related topics in Serbia, aiming to collect information on their experience, problems and difficulties during peer-review process. Editors from 22 journals out of 27 which regularly published during 2015 replied. General data on journals were collected from responses obtained from editors-in-chief, whereas all editors (including sub-editors and section editors participated in a questionnaire concerning peer-review procedure. Additionally, they were asked to evaluate quality of reports and attitude of reviewers, discuss present situation and suggest measures to improve peer-review process. Greatest problems encountered by editors in peer-review process can be summarized as follows: low rate of acceptance to review, low quality of reports, sometimes due to reviewer’s bias or his/her inability to properly understand review process. A method used to search for reviewers does not substantially influence quality of reports. Editors agree that introduction of On-Line process and creation of precise instructions for reviewers, education of potential reviewers, as well as social, public and professional recognition and appreciation of reviewers’ work, are the most important measures to improve quality of peer-review process and, consecutively, quality of published articles and journals.
Jones, Cheryl; Gannon, Brenda; Wakai, Abel; O'Sullivan, Ronan
Key performance indicators (KPIs) are used to identify where organisational performance is meeting desired standards and where performance requires improvement. Valid and reliable KPIs depend on the availability of high-quality data, specifically the relevant minimum data set ((MDS) the core data identified as the minimum required to measure performance for a KPI) elements. However, the feasibility of collecting the relevant MDS elements is always a limitation of performance monitoring using KPIs. Preferably, data should be integrated into service delivery, and, where additional data are required that are not currently collected as part of routine service delivery, there should be an economic evaluation to determine the cost of data collection. The aim of this systematic review was to synthesise the evidence base concerning the costs of data collection in hospitals for performance monitoring using KPI, and to identify hospital data collection systems that have proven to be cost minimising. We searched MEDLINE (1946 to May week 4 2014), Embase (1974 to May week 2 2014), and CINAHL (1937 to date). The database searches were supplemented by searching for grey literature through the OpenGrey database. Data was extracted, tabulated, and summarised as part of a narrative synthesis. The searches yielded a total of 1,135 publications. After assessing each identified study against specific inclusion exclusion criteria only eight studies were deemed as relevant for this review. The studies attempt to evaluate different types of data collection interventions including the installation of information communication technology (ICT), improvements to current ICT systems, and how different analysis techniques may be used to monitor performance. The evaluation methods used to measure the costs and benefits of data collection interventions are inconsistent across the identified literature. Overall, the results weakly indicate that collection of hospital data and improvements in data
Parra Pérez, V; Vargas Cárdenas, G; Astete Benavides, M; Valdivia Roldán, M; Morán Tisoc, L; Nuñez Calixto, N; Chávez Rossell, M; Mayurí Bravo De Rueda, C
The choledocholithiasis is a frequent complication of gallstone disease. The endoscopic retrograde cholangiopancreatography (ERCP) is suitable for its diagnosis and treatment. That approach has both significative morbility and mortality so others methods of diagnosis have been proposed such as intraoperatorycholangiography (IOC) and magnetic resonance cholangiography (MRC), reserving ERCP only for therapy purpose. Verify the utility of choledocholithiasis predictors described in literature This study is a correlational observational transversal prospective approach. It was performed at the Arzobispo Loayza Hospital from August 2004 to January 2005. Many clinical, biochemical and ecographyc predictors of choledocholithiasis were analyzed in 151 patient underwent to ERCP. In all peopleunder study and analyzing separately patients underwent to cholecystectomy or not previous to ERCP, it was identified some risk factors for choledocholithiasis by means of both univariate and multivariate analysis. The univariate analysis showed a relationships among age, icterus, cholangytis, direct bilirrubin, amylase, lactic deshidrogenasa, ductal dilatation (>8 mm) and choledocholithiasis. In all groups, the multivariate analysis determined that ductal dilatation by ecography was the unique predictor for choledocholithiasis in the group of patients postoperated. None single indicator was able to predict with accuracy the choledocholithiasis. However, the parameters described in the literature are useful in our country.
Full Text Available Background. Corneal blindness from healed infected keratitis is one of the most preventable causes of monocular blindness in developing countries, including Malaysia. Our objectives were to identify the causative fungi, predisposing risk factors, the proportion of correct clinical diagnosis, and visual outcome of patients treated in our hospital. Methods. A retrospective review of medical and microbiology records was conducted for all patients who were treated for fungal keratitis at Hospital Universiti Sains Malaysia from January 2007 until December 2011. Results. Forty-seven patients (47/186, 25.27% were treated for fungal keratitis during the study period. This demonstrated that the incidence of fungal keratitis has increased each year from 2007 to 2011 by 12.50%, 17.65%, 21.21%, 26.83%, and 28.57%, respectively. The most common predisposing factors were injury to the eye followed by use of topical steroid, and preexisting ocular surface disease. Fusarium species were the most common fungal isolated, followed by Candida species. Clinical diagnosis of fungal keratitis was made in 26 of the 41 (63.41% cases of positive isolates. Of these, in eleven cases (23.40% patients required surgical intervention. Clinical outcome of healed scar was achieved in 34 (72.34% cases. Conclusions. The percentage of positive fungal isolated has steadily increased and the trend of common fungal isolated has changed. The latest review regarding fungal keratitis is important for us to improve patients' outcome in the future.
Bruna Coelho Nepomuceno
Full Text Available Objetivo: conhecer os significados e os sentimentos dos pacientes quanto ao fato de tomar banho no leito. Materiais e métodos: estudo de abordagem qualitativa e exploratória, tendo sido entrevistados 20 pacientes hospitalizados. Para a coleta de dados utilizou-se um roteiro de entrevista semiestruturada, gravada e transcrita na íntegra. Foi utilizado o método do Discurso do Sujeito Coletivo para análise dos dados. Resultados: para os pacientes hospitalizados, banho no leito significa “impossibilidade de locomover” e “seguro”. Os sentimentos dos pacientes hospitalizados variaram entre “vergonha” e “incapacidade”. Conclusão: os discursos encontrados podem cooperar para a melhoria da abordagem da equipe de enfermagem ao realizar um cuidado cotidiano e básico da vida diária. Objective: to identify the meanings and feelings of patients considering the action of to take a bath in bed. Materials and methods: qualitative and exploratory study, 20 patients hospitalized were interviewed. To collect data, we used semi-structured interviews, recorded and transcribed in full. We used the method of the Collective Subject Discourse for data analysis. Results: for hospitalized patients, bathing in bed means "inability to move" and "safe". The feelings of hospitalized patients ranged from "shame" and "disability." Conclusion: the discourses found can cooperate to improve the approach of the nursing staff by performing a basic daily care and daily life.
Raslan, Mariana; Gonzalez, Maria Cristina; Torrinhas, Raquel Suzana M M; Ravacci, Graziela Rosa; Pereira, Julio C R; Waitzberg, Dan L
We evaluated the ability of Nutritional Risk Screening 2002 (NRS 2002) and Subjective Global Assessment (SGA) to predict malnutrition related to poor clinical outcomes. We assessed 705 patients at a public university hospital within 48 h of admission. Logistic regression and number needed to screen (NNS) were calculated to test the complementarity between the tools and their ability to predict very long length of hospital stay (VLLOS), complications, and death. Of the patients screened, 27.9% were at nutritional risk (NRS+) and 38.9% were malnourished (SGA B or C). Compared to those patients not at nutritional risk, NRS+, SGA B or C patients were at increased risk for complications (p=0.03, 0.02, and 0.003, respectively). NRS+ patients had an increased risk of death (p=0.03), and SGA B and C patients had an increased likelihood of VLLOS (p=0.008 and pSGA C had lower estimates of NNS than patients who were NRS+ or SGA C only, though their confidence intervals did overlap. The concurrent application of SGA in NRS+ patients might enhance the ability to predict poor clinical outcomes in hospitalized patients in Brazil. Copyright © 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Alberto, L; Marshall, A P; Walker, R; Aitken, L M
Sepsis is a condition widely observed outside critical care areas. To examine the application of sepsis screening tools for early recognition of sepsis in general hospitalized patients to: (i) identify the accuracy of these tools; (ii) determine the outcomes associated with their implementation; and (iii) describe the implementation process. A systematic review method was used. PubMed, CINAHL, Cochrane, Scopus, Web of Science, and Embase databases were systematically searched for primary articles, published from January 1990 to June 2016, that investigated screening tools or alert mechanisms for early identification of sepsis in adult general hospitalized patients. The review protocol was registered with PROSPERO (CRD42016042261). More than 8000 citations were screened for eligibility after duplicates had been removed. Six articles met the inclusion criteria testing two types of sepsis screening tools. Electronic tools can capture, recognize abnormal variables, and activate an alert in real time. However, accuracy of these tools was inconsistent across studies with only one demonstrating high specificity and sensitivity. Paper-based, nurse-led screening tools appear to be more sensitive in the identification of septic patients but were only studied in small samples and particular populations. The process of care measures appears to be enhanced; however, demonstrating improved outcomes is more challenging. Implementation details are rarely reported. Heterogeneity of studies prevented meta-analysis. Clinicians, researchers and health decision-makers should consider these findings and limitations when implementing screening tools, research or policy on sepsis recognition in general hospitalized patients. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
To systematically review intervention studies on antibiotic prophylaxis in clean or clean-contaminated surgery in Chinese hospitals from 2000 to 2012. Published peer reviewed articles, unpublished documents and reports, and gray literature were identified through searching CNKI, CBM, VIP, PubMed (MEDLINE), WHO database, and the official websites of the Ministry of Health of China, provincial health authorities and medical university internal publications. Eighty-two studies were identified. Circulation and localization of central rules, regulations and guidelines; clinical pharmacists' involvement; technical, administrative, and managerial strategies were the mostly adopted interventions. Except one study, all claimed effectiveness of interventions. Limited effects were observed for non-indicated clean surgery. Huge gaps still existed between the international agreed guidelines and the claimed best performance following interventions. The following were critical to have more effective interventions: recognition, acceptance, and enforcement strategies of rules, regulations, and guidelines; intervention persistence and intensity; health information system; removal of health system perverse incentives; patient-doctor relationship; public education; and access to unbiased medicines information. A total 4 of 82 studies were pre-post studies with control; all others were simple pre-post studies without control. Simple measurement of the outcome indicators as an average for pre-post intervention groups and changes in between failed to distinguish the real intervention effect from confounding factors, and failed to adjust underlying trends. Interventions on surgical antibiotic prophylaxis in Chinese hospitals during 2000-2012 brought limited positive effects. There are still huge gaps between the Chinese situation and internationally agreed standards. More advanced study methodologies are needed to have better documentation of evidence of the most effective interventions
Kim van Loon
Full Text Available Failure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality.In this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring improves early diagnosis of patient deterioration and reduces critical incidents on hospital wards.Studies were retrieved from Medline, Embase, CINAHL, and the Cochrane library, searched from 1970 till October 25, 2014.Electronic databases were searched using keywords and corresponding synonyms 'ward', 'continuous', 'monitoring' and 'respiration'. Pediatric, fetal and animal studies were excluded.Since no validated tool is currently available for diagnostic or intervention studies with continuous monitoring, methodological quality was assessed with a modified tool based on modified STARD, CONSORT, and TREND statements.Six intervention and five diagnostic studies were included, evaluating the use of eight different devices for continuous respiratory monitoring. Quantitative data synthesis was not possible because intervention, study design and outcomes differed considerably between studies. Outcomes estimates for the intervention studies ranged from RR 0.14 (0.03, 0.64 for cardiopulmonary resuscitation to RR 1.00 (0.41, 2.35 for unplanned ICU admission after introduction of continuous respiratory monitoring.The methodological quality of most studies was moderate, e.g. 'before-after' designs, incomplete reporting of primary outcomes, and incomplete clinical implementation of the monitoring system.Based on the findings of this systematic review, implementation of routine continuous non-invasive respiratory monitoring on general hospital wards cannot yet be advocated as results are inconclusive, and methodological quality of the studies needs improvement. Future research in this area should focus on technology explicitly suitable for low care settings and tailored alarm and
Soares Menezes, Karla Vanessa Rodrigues; Auger, Claudine; de Souza Menezes, Weslley Rodrigues; Guerra, Ricardo Oliveira
Independent mobility is a key factor in predicting morbidity and determining hospital discharge readiness for older patients. The main objective was identify and appraise relevant instruments for the measurement of mobility of hospitalized geriatric patients. A systematic review was performed in two consecutive steps. Based on the definition of mobility of the International Classification of Functioning (ICF). Step 1 identified mobility measurement instruments used to assess patients 60 years of age and over hospitalized in acute care or intensive geriatric rehabilitation unit. Aim of the instrument, coverage of mobility construct, applicability (format, training required, administration time and use of assistive devices) were extracted. For each included instrument, Step 2 identified and appraised articles reporting about their measurement properties. Consensus-based Standards for the selection of health status Measurement INstruments (COSMIN) was used by two independent reviewers to critically appraise and compare the measurement properties. Step 1 resulted in 6350 articles, of which 28 articles reported about 17 different instruments. Step 2 retained 11 instruments with 70 articles reporting about their measurement properties in various settings. Judgement-based instruments (n=5) covered the ICF mobility construct more broadly than performance-based measures (n=6). Our results showed that 3 instruments (DEMMI, SPPB and Tinetti scale) had the most extensive and robust measurement properties, and from those, SPPB and DEMMI covered the mobility construct more broadly but SPPB had the longest administration (10-15min). Conclusion SPPB presents the best balance between mobility coverage, measurement properties and applicability to acute care or intensive geriatric rehabilitation unit. Copyright © 2017 Elsevier B.V. All rights reserved.
Ajami, Sima; Khaleghi, Lida
At present, the solutions to prevent bedsore include using various techniques for movement and displacement of patients, which is not possible for some patients or dangerous for some of them while it also poses problems for health care providers. On the other hand, development of information technology in the health care system including application of wireless sensor networks (WSNs) has led to easy and quick service-providing. It can provide a solution to prevent bedsore in motionless and disabled patients. Hence, the aim of this article was first to introduce WSNs in hospital beds and second, to identify the benefits and challenges in implementing this technology. This study was a nonsystematic review. The literature was searched for WSNs to reduce and prevent bedsores with the help of libraries, databases (PubMed, SCOPUS, and EMBASE), and also searches engines available at Google Scholar including during 1974-2014 while the inclusion criteria were applied in English and Persian. In our searches, we employed the following keywords and their combinations: "wireless sensor network," "smart bed," "information technology," "smart mattress," and "bedsore" in the searching areas of titles, keywords, abstracts, and full texts. In this study, more than 45 articles and reports were collected and 37 of them were selected based on their relevance. Therefore, identification and implementation of this technology will be a step toward mechanization of traditional procedures in providing care for hospitalized patients and disabled people. The smart bed and mattress, either alone or in combination with the other technologies, should be capable of providing all of the novel features while still providing the comfort and safety features usually associated with traditional and hospital mattresses. It can eliminate the expense of bedsore in the intensive care unit (ICU) department in the hospital and save much expense there.
Wilkins, Alexa; Earnest, Jaya; Mccarthy, Elizabeth Anne; Shub, Alexis
Timor-Leste has high maternal and infant mortality rates. Estimates of stillbirths are unreliable and limited by poor collection of vital health statistics. Lack of accurate data impedes the development of interventions to address local determinants of stillbirth. This study aimed to identify the rate, timing and causes of stillbirths at National Hospital Guido Valadares in Dili, Timor-Leste, between November 2009 and December 2010, during which data were available. Hospital birth registry and maternal records were retrospectively reviewed to identify stillbirths during the study period. The simplified Cause of Death and Associated Conditions system was utilised to classify stillbirths. One hundred and fifty-three stillbirths were identified, producing a stillbirth rate of 29 per 1000 births. Of stillbirths with known timing, 70 (66.7%) occurred antepartum and 35 (33.3%) intrapartum. Cause of death could not be ascertained in 62.7% of cases due to poor or missing records. Where identified, the three most commonly classified causes of death were intrapartum fetal asphyxia, maternal infection and maternal hypertensive disorder. This study highlights the need for standardised recording and coding of perinatal deaths at HNGV. The high proportion of antenatal death transfers from community health centres demonstrates the need for community and hospital staff training to improve the quality of antenatal and intrapartum obstetric care. A prospective study of stillbirths is recommended to obtain reliable data on the determinants of stillbirths in Timor-Leste. These data would inform evidence-based interventions for the improvement of maternity and obstetric care in community and hospital settings. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Full Text Available At present, the solutions to prevent bedsore include using various techniques for movement and displacement of patients, which is not possible for some patients or dangerous for some of them while it also poses problems for health care providers. On the other hand, development of information technology in the health care system including application of wireless sensor networks (WSNs has led to easy and quick service-providing. It can provide a solution to prevent bedsore in motionless and disabled patients. Hence, the aim of this article was first to introduce WSNs in hospital beds and second, to identify the benefits and challenges in implementing this technology. This study was a nonsystematic review. The literature was searched for WSNs to reduce and prevent bedsores with the help of libraries, databases (PubMed, SCOPUS, and EMBASE, and also searches engines available at Google Scholar including during 1974-2014 while the inclusion criteria were applied in English and Persian. In our searches, we employed the following keywords and their combinations: "wireless sensor network," "smart bed," "information technology," "smart mattress," and "bedsore" in the searching areas of titles, keywords, abstracts, and full texts. In this study, more than 45 articles and reports were collected and 37 of them were selected based on their relevance. Therefore, identification and implementation of this technology will be a step toward mechanization of traditional procedures in providing care for hospitalized patients and disabled people. The smart bed and mattress, either alone or in combination with the other technologies, should be capable of providing all of the novel features while still providing the comfort and safety features usually associated with traditional and hospital mattresses. It can eliminate the expense of bedsore in the intensive care unit (ICU department in the hospital and save much expense there.
Gabutti, Irene; Mascia, Daniele; Cicchetti, Americo
The healthcare scenario in developed countries is changing deeply: patients, who are frequently affected by multi-pathological chronic conditions, have risen their expectations. Simultaneously, there exist dramatic financial pressures which require healthcare organizations to provide more and better services with equal (or decreasing) resources. In response to these challenges, hospitals are facing radical transformations by bridging, redesigning and engaging their organization and staff. This study has the ambitious aim to shed light and clearly label the trends of change hospitals are enhancing in developed economies, in order to fully understand the presence of common trends and which organizational models and features are inspiring the most innovative organizations. The purpose is to make stock of what is known in the field of hospital organization about how hospitals are changing, as well as of how such change may be implemented effectively through managerial tools. To do so the methodology adopted integrates a systematic literature review to a wider engaged research approach. Evidence suggests that the three main pillars of change of the system are given by the progressive patient care model, the patient-centered approach and the lean approach. However, there emerge a number of gaps in what is known about how to exploit drivers of change and their effects. This study confirms that efforts in literature are concentrated in analyzing circumscribed experiences in the implementation of new models and approaches, failing therefore to extend the analysis at the organizational and inter-organizational level in order to legitimately draw consequences to be generalized. There seem to be a number of "gaps" in what is known about how to exploit drivers of change and their effects, suggesting that the research approach privileged till now fails in providing a clear guidance to policy makers and to organizations' management on how to concretely and effectively implement
Meckler, Garth; Hansen, Matthew; Lambert, William; O'Brien, Kerth; Dickinson, Caitlin; Dickinson, Kathryn; Van Otterloo, Joshua; Guise, Jeanne-Marie
Studies of adult hospital patients have identified medical errors as a significant cause of morbidity and mortality. Little is known about the frequency and nature of pediatric patient safety events in the out-of-hospital setting. We sought to quantify pediatric patient safety events in EMS and identify patient, call, and care characteristics associated with potentially severe events. As part of the Children's Safety Initiative -EMS, expert panels independently reviewed charts of pediatric critical ambulance transports in a metropolitan area over a three-year period. Regression models were used to identify factors associated with increased risk of potentially severe safety events. Patient safety events were categorized as: Unintended injury; Near miss; Suboptimal action; Error; or Management complication ("UNSEMs") and their severity and potential preventability were assessed. Overall, 265 of 378 (70.1%) unique charts contained at least one UNSEM, including 146 (32.8%) errors and 199 (44.7%) suboptimal actions. Sixty-one UNSEMs were categorized as potentially severe (23.3% of UNSEMs) and nearly half (45.3%) were rated entirely preventable. Two factors were associated with heightened risk for a severe UNSEM: (1) age 29 days to 11 months (OR 3.3, 95% CI 1.25-8.68); (2) cases requiring resuscitation (OR 3.1, 95% CI 1.16-8.28). Severe UNSEMs were disproportionately higher among cardiopulmonary arrests (8.5% of cases, 34.4% of severe UNSEMs). During high-risk out-of-hospital care of pediatric patients, safety events are common, potentially severe, and largely preventable. Infants and those requiring resuscitation are important areas of focus to reduce out-of-hospital pediatric patient safety events.
Watts, Robin; Wilson, Sally
Nesmith identified two roles for the physical settings in which health care is provided. One is as a tool to support productivity and effectiveness and the second is as healer: "… they are an end in themselves - aiding in the healing and wellness process through psychological and physiological effect…" (p. 671). Research to confirm this statement has been slowly accumulating over the last two decades, but primarily in the area of adult care. Although there are a plethora of articles describing the various creative and innovative approaches to physical design in paediatric hospitals, very few of these innovations have been evaluated in terms of their impact on the health outcomes of children and their families. The objective of this review was to determine from the available evidence the impact of the physical paediatric hospital environment on health outcomes of children and adolescents. Using a defined search and retrieval method, a wide range of indexes of periodical articles were accessed for the period 1980 to 2008 including both health and architectural databases. Unpublished studies from 1991 were sought using a variety of sources including Dissertation Abstracts, Index to Theses, conference proceedings, research and clinical trials registers and web sites of relevant professional associations. The review considered studies using either quantitative or qualitative methodologies or mixed methods that assessed the impact of physical design elements of a paediatric hospital environment including architectural, interior design, ambient features and /or features that supported patient and family centred care. The primary outcomes of interest were clinical or psychological, with other outcomes of interest being patient - family perceptions, including safety and security. Each study was assessed independently by two reviewers prior to inclusion in the review using standardised critical appraisal instruments developed by the Joanna Briggs Institute. As both
Natasha, Khurshid; Hussain, Akhtar; Khan, A K Azad
Data on association between depression and diabetes during the pregnancy period in Asia, specifically in Bangladesh are scarce. The study was designed to measure the prevalence of depression during pregnancy with or without Gestational Diabetes Mellitus (GDM). Seven hundred and forty eight pregnant women (382 with GDM, 366 without-GDM) attending at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, participated in the study. Blood glucose was measured following both WHO and ACOG criteria; GDM was diagnosed within 24-28 weeks. Depressive symptoms were assessed following MADRS scale. Semi-structured questionnaire was used to record their socio-demographic status and clinical and family history. Blood pressure, height, weight were also measured. Overall prevalence of depression was 18.32 %. Depression was higher in GDM subjects (25.92 %) compared to without-GDM subjects (10.38 %) with mean age of of 28.34 and 27.17 years respectively. Prevalence of depression was alarming in both the extreme of age. Dwelling place (P < 0.009) and past history of GDM (P < 0.018) had strong association with Depression. Higher prevalence of depression was found in Primipara whereas the risk of GDM increased with parity. Other obstetrical factors did not show any significant association with depression and GDM. Income (self and total family), physical exercise, sedentary lifestyle and workload had no significant statistical association with depression or GDM. Higher rate of depression in pregnancy deserves medical attention especially women diagnosed with GDM. Further studies should estimate adverse pregnancy outcome for untreated depression especially in GDM cases.
Mas, Miquel Àngel; Santaeugènia, Sebastià
This scoping review focused on the opportunity of developing new hospital-at-home schemes in our health systems adapted to older patients with complex conditions due to acute illness. A review was conducted on articles including, randomized controlled trials, systematic reviews and meta-analysis in PubMed and Cochrane Library, from January 1990 to July 2013. Search terms were: hospital-at-home, Early Supported Discharge, hospital in the home and home hospitalization. An analysis was performed to include: the intervention model (admission avoidance or early discharge), age, diagnosis, main inclusion criteria and intervention characteristics (disciplines involved, duration of intervention, main outcomes and objectives). It is concluded that there are several models of hospital-at-home care, with favorable clinical outcomes. The majority of teams in our country focused on acute health care in the less elderly with chronic diseases. Other schemes based on comprehensive geriatric assessment and interdisciplinary teams specialized in complex interventions are also highlighted. The development of comprehensive geriatric assessment based hospital-at-home care by teams led by geriatricians is an opportunity to develop alternatives to conventional hospitalization interventions tailored to older patients. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.
von Vopelius-Feldt, Johannes; Brandling, Janet; Benger, Jonathan
Improving survival after out-of-hospital cardiac arrest (OHCA) is a priority for modern emergency medical services (EMS) and prehospital research. Advanced life support (ALS) is now the standard of care in most EMS. In some EMS, prehospital critical care providers are also dispatched to attend OHCA. This systematic review presents the evidence for prehospital critical care for OHCA, when compared to standard ALS care. We searched the following electronic databases: PubMed, EmBASE, CINAHL Plus and AMED (via EBSCO), Cochrane Database of Systematic Reviews, DARE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, NIHR Health Technology Assessment Database, Google Scholar and ClinicalTrials.gov. Search terms related to cardiac arrest and prehospital critical care. All studies that compared patient-centred outcomes between prehospital critical care and ALS for OHCA were included. The review identified six full text publications that matched the inclusion criteria, all of which are observational studies. Three studies showed no benefit from prehospital critical care but were underpowered with sample sizes of 1028-1851. The other three publications showed benefit from prehospital critical care delivered by physicians. However, an imbalance of prognostic factors and hospital treatment in these studies systematically favoured the prehospital critical care group. Current evidence to support prehospital critical care for OHCA is limited by the logistic difficulties of undertaking high quality research in this area. Further research needs an appropriate sample size with adjustments for confounding factors in observational research design. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available In his book "Subjectivity," Andreas RECKWITZ interprets the work of a series of structuralist and poststructuralist authors in relation to the analysis of subjectivity. In the following article I reconstruct this interpretation and attempt to critically analyze the empirical explanatory power of these authors. An excerpt from the school routine of a German class is used to show how these various "subject-theoretical analysis strategies" may lead to different, interesting, and insightful interpretations. It also becomes clear that the idea of subjectivity, and therefore of education and maturity, cannot be abandoned. Without this idea, the application of pedagogy would be cynical, and the ability to understand it impossible. URN: urn:nbn:de:0114-fqs090222
Álvarez, María José; Fernández, Daniel; Gómez-Salgado, Juan; Rodríguez-González, Dolores; Rosón, María; Lapeña, Santiago
The aim of this study was to perform a systematic review to identify, evaluate and summarise studies on the administration of therapeutic massage to preterm neonates during their stay in the NICU, and to assess their methodological quality. systematic review following PRISMA statements guidelines. A comprehensive search was performed including relevant articles between January 2004 and December 2013, using the following electronic databases: Medline, PEDro, Web of Science and Scopus. Two reviewers conducted a review of the selected articles: one evaluated the methodological quality of the studies and performed data extraction and the other performed a cross-check. Divergences of opinion were resolved by discussion with a third reviewer. The studies reviewed implemented a wide variety of interventions and evaluation methods, and therefore it was not possible to perform a meta-analysis. The following data were extracted from each article: year of publication, study design, participants and main measurements of outcomes obtained through the intervention. A non-quantitative synthesis of the extracted data was performed. Level of evidence was graded using the Jadad Scale. A total of 23 articles met the inclusion criteria and were thus included in the review; these presented a methodological quality ranging from 1 to 5 points (with a mean of 3 points). Most studies reported that the administration of various forms of therapeutic massage exerted a beneficial effect on factors related to the growth of preterm infants. The causes indicated by the researchers for these anthropometric benefits included increased vagal activity, increased gastric activity and increased serum insulin levels. Other demonstrated benefits of massage therapy when administered to hospitalised preterm infants included better neurodevelopment, a positive effect on brain development, a reduced risk of neonatal sepsis, a reduction in length of hospital stay and reduced neonatal stress. Although based on
Medication errors are commonly affected by breakdowns in communication. Interdisciplinary collaboration is an important means of facilitating communication between health professionals in clinical practice. To date, there has been little systematic examination of past research in this area. Areas covered: The aims of this integrative review are to examine how interdisciplinary collaboration influences medication errors in hospitals, the araes of interdisciplinary collaboration that have been researched in previous work, and recommendations for future research and practice. An integrative review was undertaken of research papers (N = 30) published from inception to August 2017 using MEDLINE, the Cochrane Library, CINAHL, PsycINFO, and Embase. Expert opinion: Five different areas of interdisciplinary collaboration were identified in research involving medication errors. These areas were: communication through tools including guidelines, protocols, and communication logs; participation of pharmacists in interdisciplinary teams; collaborative medication review on admission and at discharge; collaborative workshops and conferences; and complexity of role differentiation and environment. Despite encouraging results demonstrated in past research, medication errors continued to occur. Increased focus is needed on developing tailored, individualized strategies that can be applied in particular contexts to create further reductions in medication errors. Greater understandings are also needed about the changing roles of various disciplines.
Survey of the Information-Seeking Behaviour of Hospital Professionals at a Public Cancer Hospital in Greece Proves the Value of Hospital Libraries. A Review of: Kostagiolas, P. A., Ziavrou, K., Alexias, G., & Niakas, D. (2012. Studying the information-seeking behavior of hospital professionals: The case of METAXA Cancer Hospital in Greece. Journal of Hospital Librarianship, 12(1, 33-45.
Full Text Available Objective – To study the information-seeking practices of hospital staff and weigh the impact of hospital libraries on effective information-seeking.Design – Survey questionnaire.Setting – Large public cancer hospital in Greece.Subjects – The authors surveyed 49 physicians, 43 nursing staff members, 25 administrative staff members, 23 paramedical staff members, and 5 technical staff members, totaling 145 health professionals.Methods – Participants were given a questionnaire comprised of five parts: general information (including gender, age, education, position, and professional experience; questions on computer and Internet accessibility; questions regarding individual information needs; questions on information-seeking obstacles; and a question regarding the satisfaction with the current degree of information availability in the hospital. The last question was ranked using a 5-point Likert scale. Each questionnaire was distributed with a cover letter explaining the anonymity and consent of the respondent. Hospital members were randomly selected using a number generator and respondents returned completed surveys to the hospital personnel office in a sealed envelope within a specified time frame. The sampled group was representative of the overall population of the hospital.Main Results – The authors discuss demographic data of respondents: 65.7% were women; 56.7% were over 40 years old; 29.0% were graduates of higher technological institutes; 28.3% were university graduates; 9.7% held a postgraduate degree; 8.3% had a PhD; and 1.4% had only secondary education. As for the remainder of the survey questions: 64% of respondents had access to the Internet both at home and at work, while only 8.2% had no access to the Internet at all; most respondents noted using the Internet for seeking scientific information (83.0% and e-mail communication (65.3%; the main obstacle respondents noted experiencing when seeking information was the lack of
Zaw, W; McDonald, J
Ex-preterm infants are vulnerable to respiratory syncytial virus (RSV) bronchiolitis and their hospital admission is associated with increased morbidity. Palivizumab is currently available as prophylaxis against RSV infection but its use in ex-preterm infants is controversial. A retrospective case review study was, therefore, carried out to determine the rate of readmission with RSV bronchiolitis among ex-preterm infants in the Highland Region of Scotland and to estimate the hospital cost per admission. Between 1995 and 1999, a total of 3,046 children under 2 years of age were admitted to Raigmore Hospital, 1,691 of whom (60.4%) lived outwith Inverness. 507 children had acute bronchiolitis and ex preterm infants with RSV positive bronchiolitis accounted for 3.6% of total admissions with acute bronchiolitis. 72% of these children lived outwith Inverness. The median length of hospital stay for children born at less than 30 weeks and for children who had had bronchopulmonary dysplasia (BPD) was 6 and 10.5 days respectively. The average hospital costs per admission for children of less than 30 weeks and children of more than 30 weeks were 3,376 Pounds and 2,074 Pounds respectively. It was more expensive for children with BPD (4,431 Pounds per admission) when compared with those without BPD (1,959 Pounds per admission). This study has shown that most of the children admitted to hospital lived outwith Inverness, many at some considerable distance, and this, as much as severity of illness, may have contributed to hospital admission. Further studies are required to determine productivity losses associated with RSV infection and justification of use of Palivizumab in ex preterm infants of less than 30 weeks gestation and of BPD living in remote areas of Scottish Highlands.
Full Text Available This survey was the evaluation of the program on Polio Eradication through Acute Flaccid Paralysis (AFP Surveillance especially Hospital Based Surveillance. The evaluation was done by reviewing the Hospitals' Record (Hospital Based Survey. The objective of the survey was to estimate the under reported of routine reporting system, which the data of the survey used as a gold standard. The results showed that due to incomplete of the records in several hospitals, some of AFP cases might be could not be covered. However the under reported of the routine surveillance system was more than 50%. It seems that the strengthening of supervision was still needed to increase coverage of the routine surveillance system. Keywords: hospitals; medical record; acute flocid paralysis
Full Text Available This systematic review sought to assess the costs and benefits of interventions preventing hospital-acquired infections and to evaluate methodological and reporting quality.We systematically searched Medline via PubMed and the National Health Service Economic Evaluation Database from 2009 to 2014. We included quasi-experimental and randomized trails published in English or German evaluating the economic impact of interventions preventing the four most frequent hospital-acquired infections (urinary tract infections, surgical wound infections, pneumonia, and primary bloodstream infections. Characteristics and results of the included articles were extracted using a standardized data collection form. Study and reporting quality were evaluated using SIGN and CHEERS checklists. All costs were adjusted to 2013 US$. Savings-to-cost ratios and difference values with interquartile ranges (IQRs per month were calculated, and the effects of study characteristics on the cost-benefit results were analyzed.Our search returned 2067 articles, of which 27 met the inclusion criteria. The median savings-to-cost ratio across all studies reporting both costs and savings values was US $7.0 (IQR 4.2-30.9, and the median net global saving was US $13,179 (IQR 5,106-65,850 per month. The studies' reporting quality was low. Only 14 articles reported more than half of CHEERS items appropriately. Similarly, an assessment of methodological quality found that only four studies (14.8% were considered high quality.Prevention programs for hospital acquired infections have very positive cost-benefit ratios. Improved reporting quality in health economics publications is required.
Van Grootven, Bastiaan; Flamaing, Johan; Dierckx de Casterlé, Bernadette; Dubois, Christophe; Fagard, Katleen; Herregods, Marie-Christine; Hornikx, Miek; Laenen, Annouschka; Meuris, Bart; Rex, Steffen; Tournoy, Jos; Milisen, Koen; Deschodt, Mieke
geriatric consultation teams have failed to impact clinical outcomes prompting geriatric co-management programmes to emerge as a promising strategy to manage frail patients on non-geriatric wards. to conduct a systematic review of the effectiveness of in-hospital geriatric co-management. MEDLINE, EMBASE, CINAHL and CENTRAL were searched from inception to 6 May 2016. Reference lists, trial registers and PubMed Central Citations were additionally searched. randomised controlled trials and quasi-experimental studies of in-hospital patients included in a geriatric co-management study. Two investigators performed the selection process independently. standardised data extraction and assessment of risk of bias were performed independently by two investigators. twelve studies and 3,590 patients were included from six randomised and six quasi-experimental studies. Geriatric co-management improved functional status and reduced the number of patients with complications in three of the four studies, but studies had a high risk of bias and outcomes were measured heterogeneously and could not be pooled. Co-management reduced the length of stay (pooled mean difference, -1.88 days [95% CI, -2.44 to -1.33]; 11 studies) and may reduce in-hospital mortality (pooled odds ratio, 0.72 [95% CI, 0.50-1.03]; 7 studies). Meta-analysis identified no effect on the number of patients discharged home (5 studies), post-discharge mortality (3 studies) and readmission rate (4 studies). there was low-quality evidence of a reduced length of stay and a reduced number of patients with complications, and very low-quality evidence of better functional status as a result of geriatric co-management.
Neves, Leonardo F; Reis, Manoela H; Plentz, Rodrigo D M; Matte, Darlan L; Coronel, Christian C; Sbruzzi, Graciele
Inspiratory muscle training (IMT) produces beneficial effects in COPD subjects, but the effects of expiratory muscle training (EMT) and EMT plus IMT in ventilatory training are still unclear. The aim of this study was to systematically review the effects of EMT and EMT plus IMT compared to control groups of COPD subjects. This study is a systematic review and meta-analysis. The search strategy included MEDLINE, Embase, LILACS, PEDro, and Cochrane CENTRAL and also manual search of references in published studies on the subject. Randomized trials comparing EMT and EMT plus IMT versus control groups of subjects with COPD were included. The outcomes analyzed were respiratory muscle strength and functional capacity. Two reviewers independently extracted the data. The search retrieved 609 articles. Five studies were included. We observed that EMT provided higher gain in maximum expiratory pressure (P(E(max)) 21.49 cm H2O, 95% CI 13.39-29.59) and maximum inspiratory pressure (P(I(max)) 7.68 cm H2O, 95% CI 0.90-14.45) compared to control groups. There was no significant difference in the 6-min walk test distance (29.01 m, 95% CI -39.62 to 97.65) and dyspnea (0.15, 95% CI -0.77 to 1.08). In relation to EMT plus IMT, we observed that P(E(max)) (31.98 cm H2O, 95% CI 26.93-37.03) and P(I(max)) (27.98 cm H2O, 95% CI 20.10-35.85) presented higher values compared to control groups. EMT and EMT plus IMT improve respiratory muscle strength and can be used as part of the treatment during pulmonary rehabilitation of subjects with severe to very severe COPD. Copyright © 2014 by Daedalus Enterprises.
In hospital units, the network of interdependent relationships between midwives and doctors has positioned midwives within hierarchical relationships of power. Others argue that the physical layout of hospital wards created by biomedicine makes it difficult for midwives to provide midwifery led care. The aim of this review is to identify factors that support change in the delivery of the midwifery led care in hospital settings. A narrative review was chosen as this method allows for greater flexibility in the selection of studies and can lead to the inclusion of a wider range of literature. Eight high quality papers from the UK, Sweden, Canada and Australia were selected for review. Papers focused on improving the delivery of midwife led care in hospital midwifery units, labour and postnatal wards. Key themes were identified as supporting change in the delivery of midwifery led care were ownership of change, capability to change and transformational leadership. The findings demonstrate the importance of social support and clinical leadership in bringing about subtle changes in hospital based midwifery led care. Ultimately improved understanding of the factors that support the delivery of the midwifery led care in hospital settings may improve women's choice and highlight the role of the midwife as the practitioner of normal childbirth. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
Full Text Available In view of the tremendous potential benefits of clinical information systems (CIS for the quality of patient care; it is hard to understand why not every CIS is embraced by its targeted users, the physicians. The aim of this study is to propose a framework for assessing hospital physicians' CIS-acceptance that can serve as a guidance for future research into this area. Hereto, a review of the relevant literature was performed in the ISI Web-of-Science database. Eleven studies were withheld from an initial dataset of 797 articles. Results show that just as in business settings, there are four core groups of variables that influence physicians' acceptance of a CIS: its usefulness and ease of use, social norms, and factors in the working environment that facilitate use of the CIS (such as providing computers/workstations, compatibility between the new and existing system.... We also identified some additional variables as predictors of CIS-acceptance.
Full Text Available We report two cases of bacteremia due to Clostridium difficile from two French hospitals. The first patient with previously diagnosed rectal carcinoma underwent courses of chemotherapy, and antimicrobial treatment, and survived the C. difficile bacteremia. The second patient with colon perforation and newly diagnosed lung cancer underwent antimicrobial treatment in an ICU but died shortly after the episode of C. difficile bacteremia. A review of the literature allowed the identification of 137 cases of bacteremia between July 1962 and November 2016. Advanced age, gastro-intestinal disruption, severe underlying diseases and antimicrobial exposure were the major risk factors for C. difficile bacteremia. Antimicrobial therapy was primarily based on metronidazole and/or vancomycin. The crude mortality rate was 35% (21/60.
Morello, Renata Teresa; Lowthian, Judy A; Barker, Anna Lucia; McGinnes, Rosemary; Dunt, David; Brand, Caroline
To determine the effectiveness of patient safety culture strategies to improve hospital patient safety climate. Electronic search of the Cochrane Library, OVID Medline, Embase, CINAHL, proQuest and psychinfo databases, with manual searches of quality and safety websites, bibliographies of included articles and key journals. English language studies published between January 1996 and April 2011 that measured the effectiveness of patient safety culture strategies using a quantitative measure of patient safety climate in a hospital setting. Studies included were randomised controlled trials (RCTs), non-RCTs, controlled before and after studies, interrupted time series and historically controlled studies. Data extraction and critical appraisal were conducted by two independent reviewers. Study design, intervention, level of application, setting, study participants, safety climate outcome measures and implementation lessons were extracted from each article. Over 2000 articles were screened, with 21 studies meeting the inclusion criteria, one cluster RCT, seven controlled before and after studies, and 13 historically controlled studies. There was marked methodological heterogeneity amongst studies. Impacts of 11 different strategies were reported. There was some evidence to support that leadership walk rounds (p=0.02) and multi-faceted unit-based programmes (p < 0.05) may have a positive impact on patient safety climate. Despite strong face validity for a variety of patient safety culture strategies, there is limited evidence to support definitive impacts on patient safety climate outcomes. Organisations are advised to consider robust evaluation designs when implementing these potentially resource intensive strategies.
As the UK population lives to older ages, with more complex health and social care needs, there comes a time when going to live in a care home might be essential for a frail, older person. Residents and their families expect high-quality care in return for the costs of their placements, but often find this is not the case ( Help the Aged, 2006 ). In order to improve quality in care homes, the Lincolnshire Community Health Services NHS Trust are piloting a care home support team. The new service aims to provide education and training to an unpredictable workforce, with the addition of regular ward rounds in care homes to ensure more proactive care for residents, in order to reduce unnecessary hospital admissions and improve the quality of care offered. This article looks at the literature relating to education and training for staff in care homes to support this service. It also aims to use the reviewed articles to identify specific training and education needed to improve quality of care for residents and reduce avoidable hospital admissions.
Fader, Tim; Parks, John; Khan, Najeeb Ullah; Manning, Richard; Stokes, Sonya; Nasir, Nasir Ahmad
The purpose of this study is to amplify the knowledge base of the epidemiology, symptoms, and signs of extrapulmonary tuberculosis (EPTB) in Afghanistan. This is a retrospective review of EPTB diagnosed at CURE International Hospital and CURE Family Health Center (FHC) in Kabul, Afghanistan during a recent 20-month period. One hundred eighteen cases were identified from patients presenting to the hospital and FHC. This group represents the spectrum of EPTB seen at a single referral center in Kabul. The ratio of females to males was 2.03:1. Lymph node tuberculosis comprised the greatest number of EPTB cases (37.3%, n=44). The central nervous system was the next most frequent site of EPTB involvement (20.3%, n=24), followed in descending order by skeletal, pleural, abdominal, cutaneous, genitourinary, pericardial, miliary, and breast tuberculosis. The 2:1 ratio of female to male EPTB cases coincides with the unusual epidemiologic pattern seen in smear-positive pulmonary TB in Afghanistan. As the first epidemiological report of EPTB from Afghanistan, this study illustrates the varied presentations of EPTB that should be known by healthcare workers throughout the country. Copyright 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Schneider, K C
The "anti-dumping" provisions under Section 1867 of the Social Security Act have been clarified and strengthened by recent amendments. Medicare-participating hospitals must post signs informing the public of their obligation to examine, treat, and appropriately transfer individuals who request emergency services in the emergency department. Inquiries about an individual's method of payment or insurance source may not delay examination or treatment. Qualified personnel must perform medical screening of all emergency patients, and those to be transferred with emergency medical conditions which have not been stabilized must receive treatment to minimize the risk of transfer. There are stepped-up requirements for informed patient consent and documentation that the medical benefits of a transfer outweigh the risks. In physician-initiated transfers, the receiving hospital must be sent certification by a physician that the benefits of transfer outweigh the risks. Since there is evidence that medically appropriate transfers of persons with emergency medical conditions may actually be underutilized, particularly in rural settings, medical reviewers should avoid an anti-transfer bias.
Alving, Berit Elisabeth; Christiansen, Janne Buck; Thrysoe, Lars
The purpose of this literature review is to provide an overview of the information retrieval behaviour of clinical nurses, in terms of the use of databases and other information resources and their frequency of use. Systematic searches carried out in five databases and handsearching were used to identify the studies from 2010 to 2016, with a populations, exposures and outcomes (PEO) search strategy, focusing on the question: In which databases or other information resources do hospital nurses search for evidence based information, and how often? Of 5272 titles retrieved based on the search strategy, only nine studies fulfilled the criteria for inclusion. The studies are from the United States, Canada, Taiwan and Nigeria. The results show that hospital nurses' primary choice of source for evidence based information is Google and peers, while bibliographic databases such as PubMed are secondary choices. Data on frequency are only included in four of the studies, and data are heterogenous. The reasons for choosing Google and peers are primarily lack of time; lack of information; lack of retrieval skills; or lack of training in database searching. Only a few studies are published on clinical nurses' retrieval behaviours, and more studies are needed from Europe and Australia. © 2018 Health Libraries Group.
Land, R; Siskind, D; McArdle, P; Kisely, S; Winckel, K; Hollingworth, S A
The objective of this study was to perform a systematic review and meta-analysis of studies reporting the impact of clozapine on hospital use in people with a psychotic illness. PubMed, EMBASE, PsycINFO and the Cochrane Schizophrenia Group Trials Register were systematically searched from inception to 12 October 2016. We included all trials and observational studies, except case reports. Thirty-seven studies were included. Clozapine significantly reduced the proportion of people hospitalised compared to control medicines (RR = 0.74; 95% CI: 0.69-0.80, P clozapine treatment compared to before clozapine treatment in both controlled (MD = -34.41 days; 95% CI: -68.22 to -0.60 days, P = 0.046, n = 162) and uncontrolled studies (MD = -52.86 days; 95% CI: -79.86 days to -25.86 days, P Clozapine and control medicines had a similar time to rehospitalisation (-19.90 days; 95% CI: -62.42 to 22.63 days, P = 0.36). Clozapine treatment reduced the number of people hospitalised and the number of bed days after treatment compared with before treatment. Clozapine has the potential to reduce acute hospital use among people with treatment refractory schizophrenia. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Public health safety and environmental management are concerns that pose challenges worldwide. This paper briefly assesses a selected impact of the environment on public health. The study used an assessment of environmental mechanism to analyse the underlying different pathways in which the health sector is affected in inadequate hospital and health care settings. We reviewed the limited available evidence of the association between the health sector and the environment, and the likely pathways through which the environment influences health. The paper also models the use of private health care as a function of costs and benefits relative to public care and no care. The need to enhancing policies to improve the administration of health services, strengthening interventions on environment using international agreements, like Rio Conventions, including measures to control hospital-related infection, planning for human resources and infrastructure construction development have linkage to improve environment care and public health. The present study findings partly also demonstrate the influence of demand for health on the environment. The list of possible interventions includes enhancing policies to improve the administration of health services, strengthening Rio Conventions implementation on environmental concerns, control of environmental hazards and public health. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Fabiana Cristina Santos
Full Text Available This study aimed to identify the profile of the nurse who in oncology units and leadership practices adopted by these professionals. It consists in an integrative review and the data collection was performed in six different electronic databases in the period September-December 2012. Were selected 14 articles, published between 2003 to 2011. Two categories were identified: Profile social, academic and professional training of the nurses and Leadership Practices adopted by nurses of hospital oncology units. The nurses are female, aged between 29-67 years and experience in more than five years, with insufficient academic preparation during their graduation. It Identifies the need for professional development through technical and scientific specializations, refresher courses and participation in conferences. Analyzing studies it appears that leadership practices adopted by nurses defy established, encouraging the team to expand the knowledge and professional development; inspire a shared vision through the enhancement of teamwork, because there is concern of the nurse leader to encourage team members through the praise for successful work. The study should cause reflection of nurses and managers of health services as the appropriate profile for the development of activities in oncology hospital units.
Smith, Christopher Matthew; Colquhoun, Michael C
Out-of-hospital cardiac arrest (OHCA) in children and adolescents is rare, with a minority of cases occurring at school. When OHCA does occur at school it is more likely to affect an adult than a student. Developing comprehensive strategies to treat cardiac arrest occurring at schools would be helped by accurate data regarding its epidemiology. A systematic review was undertaken. An electronic search strategy of MEDLINE and EMBASE databases was devised and relevant papers reporting data on school-based OHCA incidence and/or outcome in both adults and children were identified. Further articles were obtained from the bibliographies of these papers and from related articles. Nine studies were included in the systematic review. Cardiac arrest incidence was one per 23.8-284.1 schools per year. Cardiac arrest incidence amongst students, reported in some studies, was 0.17-4.4 per 100,000 students per year. Studies also reported, although not universally, rates of witnessed OHCA (25.0-97.2%), VF (57.4-67.6%), bystander CPR (25.0-94.4%) and automated external defibrillator (AED) use (23.4-91.5%). Survival to hospital discharge or at one month was between 31.9% and 71.2%. Cardiac arrest in schools is rare, and more likely to occur in adults than children. Outcomes are better than OHCA occurring at other locations, probably due to the high proportion of witnessed arrests and high rates of bystander CPR. It is likely that school-based AEDs will rarely be needed, but have the potential to make a dramatic impact on outcome. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Thirugnanam, Subarna; Pinto, Ruxandra; Cook, Deborah J; Geerts, William H; Fowler, Robert A
Despite evidence-based guidelines for venous thromboembolism prevention, substantial variability is found in practice. Many economic evaluations of new drugs for thromboembolism prevention do not occur prospectively with efficacy studies and are sponsored by the manufacturers, raising the possibility of bias. We performed a systematic review of economic analyses of venous thromboembolism prevention in hospitalized patients to inform clinicians and policy makers about cost-effectiveness and the potential influence of sponsorship. We searched MEDLINE, EMBASE, Cochrane Databases, ACP Journal Club, and Database of Abstracts of Reviews of Effects, from 1946 to September 2011. We extracted data on study characteristics, quality, costs, and efficacy. From 5,180 identified studies, 39 met eligibility and quality criteria. Each addressed pharmacologic prevention: low-molecular-weight heparins versus placebo (five), unfractionated heparin (12), warfarin (eight), one or another agents (five); fondaparinux versus enoxaparin (11); and rivaroxaban and dabigatran versus enoxaparin (two). Low-molecular-weight heparins were most economically attractive among most medical and surgical patients, whereas fondaparinux was favored for orthopedic patients. Fondaparinux was associated with increased bleeding events. Newer agents rivaroxaban and dabigatran may offer additional value. Of all economic evaluations, 64% were supported by manufacturers of a "new" agent. The new agent had a favorable outcome in 38 (97.4%) of 39 evaluations [95% confidence interval [CI] (86.5 to 99.9)]. Among studies supported by a pharmaceutical company, the sponsored medication was economically attractive in 24 (96.0%) of 25 [95% CI, 80.0 to 99.9)]. We could not detect a consistent bias in outcome based on sponsorship; however, only a minority of studies were unsponsored. Low-molecular-weight heparins and fondaparinux are the most economically attractive drugs for venous thromboembolism prevention in
Several studies have observed an increased risk of respiratory infections in subjects doing heavy physical exercise. Vitamin C has been shown to affect some parts of the immune system, and accordingly it seems biologically conceivable that it could have effects on the increased incidence of respiratory infections caused by heavy physical stress. In this report the results of three placebo-controlled studies that have examined the effect of vitamin C supplementation on common cold incidence in subjects under acute physical stress are analyzed. In one study the subjects were school-children at a skiing camp in the Swiss Alps, in another they were military troops training in Northern Canada, and in the third they were participants in a 90 km running race. In each of the three studies a considerable reduction in common cold incidence in the group supplemented with vitamin C(0.6-1.0 g/day) was found. The pooled rate ratio (RR) of common cold infections in the studies was 0.50 (95% CI: 0.35-0.69) in favour of vitamin C groups. Accordingly, the results of the three studies suggest that vitamin C supplementation may be beneficial for some of the subjects doing heavy exercise who have problems with frequent upper respiratory infections.
subjective probabil- ity estimates have been incorporated routinely into tactical intelligence comunications . Research in the area of intelligence...analysis: Report on Phase I. Report FSC-71-5047. Gaithersburg, Md.: International Business Machines (IBM), Federal Systems Division, 1971. Kelly, C. W
Read, Sanna; Grundy, Emily; Foverskov, Else
Objectives: Previous studies of older European populations have established that disability and morbidity vary with indicators of socio-economic position (SEP). We undertook a systematic narrative review of the literature to ascertain to what extent there is evidence of similar inequalities in the subjective health and well-being of older people in Europe. Method: Relevant original research articles were searched for using Medline, Global Health, Embase, Social Policy and Practice, Cinahl, Web of Science and International Bibliography of the Social Sciences (IBSS). We included studies of SEP and indicators of subjective health and well-being (self-rated health; life satisfaction; quality of life) conducted since 1991 using population-based samples of older people in Europe and published 1995–2013. Results: A total of 71 studies were identified. Poorer SEP was associated with poorer subjective health and well-being. Associations varied somewhat depending on the SEP measure and subjective health and well-being outcome used. Associations were weaker when social support and health-related behaviours were adjusted for suggesting that these factors mediate the relationship between SEP and subjective health and well-being. Associations tended to be weaker in the oldest age groups. The patterns of associations by gender were not consistent and tended to diminish after adjusting for indicators of health and life circumstances. Conclusion: The results of this systematic narrative review of the literature demonstrate the importance of social influences on later life subjective health and well-being and indicate areas which need further investigation, such as more studies from Eastern Europe, more longitudinal studies and more research on the role of mediating factors. PMID:25806655
Scollo, M; Lal, A; Hyland, A; Glantz, S
To compare the quality and funding source of studies concluding a negative economic impact of smoke-free policies in the hospitality industry to studies concluding no such negative impact. Researchers sought all studies produced before 31 August 2002. Articles published in scientific journals were located with Medline, Science Citation Index, Social Sciences Citation Index, Current Contents, PsychInfo, Econlit, and Healthstar. Unpublished studies were located from tobacco company websites and through internet searches. 97 studies that made statements about economic impact were included. 93% of the studies located met the selection criteria as determined by consensus between multiple reviewers. Findings and characteristics of studies (apart from funding source) were classified independently by two researchers. A third assessor blind to both the objective of the present study and to funding source also classified each study. In studies concluding a negative impact, the odds of using a subjective outcome measure was 4.0 times (95% confidence interval (CI) 1.4 to 9.6; p = 0.007) and the odds of not being peer reviewed was 20 times (95% CI 2.6 to 166.7; p = 0.004) that of studies concluding no such negative impact. All of the studies concluding a negative impact were supported by the tobacco industry. 94% of the tobacco industry supported studies concluded a negative economic impact compared to none of the non-industry supported studies. All of the best designed studies report no impact or a positive impact of smoke-free restaurant and bar laws on sales or employment. Policymakers can act to protect workers and patrons from the toxins in secondhand smoke confident in rejecting industry claims that there will be an adverse economic impact.
Sani, M U; Adamu, B; Mijinyawa, M S; Abdu, A; Karaye, K M; Maiyaki, M B; Borodo, M M
Socio-economic changes and rural urban migration have led to emergence of non-communicable disease including ischaemic heart disease (IHD) and many others. The actual prevalence of IHD in Nigeria is not known. The non communicable disease (NCD) survey sought to determine the prevalence of major risk factors, rather than the prevalence of the disease itself. The prevalence is generally considered low in Nigeria but the current impression about its importance stems mostly from anecdotal reports. We therefore set out to describe the prevalence as well as the spectrum of IHD at Aminu Kano Teaching Hospital, Kano. Between July 2000 and June 2005, we reviewed the prevalence as well as the spectrum of presentation of IHD in Aminu Kano Teaching Hospital. Information was obtained from the medical records of patients in the medical unit of the hospital. Age, sex, diagnosis, risk factors for IHD, other relevant clinical and laboratory data and outcome of patients for myocardial infarction (MI) were extracted from the records. Data was analyzed using SPSS version 10.0 software. There were 5124 medical patients admitted over the period under review, out of which 1347 had cardiovascular diseases. Forty six patients were diagnosed to have IHD giving it a prevalence of 0.9% of medical conditions and 3.4% of all cardiovascular cases. There were 33 males and 13 females (M : F = 2.5:1). Twenty two patients (47.8%) had myocardial infarction, 14 (30.4%) had ischemic cardiomyopathy and 10 (21.7%) had angina. The patients consist of 41 (89.1%) Nigerians, 3 (6.5%) Lebanese, 1 (2.2%) Indian and 1 (2.2%) Pakistani. The risk factors found were Hypertension in 37 (80.4%) of patients, diabetes in 16 (34.8%), and Dyslipidaemia in 20 (43.5%). Others were cigarette smoking and obesity. IHD is an important cause of morbidity and mortality in our population. There is need for us to be on the alert and prepare ourselves to manage these cases. Focus should be on preventive cardiology.
Addresses the skills debate in hospitality in four key areas: the nature of work and skills in hospitality, considering skills in terms of personal attributes, job requirements, and work settings; deskilling within the hospitality workplace; the technical/generic skills debate; and the education/training process in hospitality. Concludes that…
Kai-Yang, Lv; Zhao-Fan, Xia; Luo-Man, Zhang; Yi-Tao, Jia; Tao, Tan; Wei, Wei; Bing, Ma; Jie, Xiong; Yu, Wang; Yu, Sun
This review was an effort to systematically examine the nationwide data available on pediatric burns requiring hospitalization to reveal burn epidemiology and guide future education and prevention. The China Biomedical Disk Database, Chongqing VIP Database, and China Journal Full-Text Database were searched for articles reporting data on children and their burns from January 2000 through December 2005. Studies were included that systematically investigated the epidemiology of pediatric burns requiring hospitalization in China. Twenty-eight articles met the inclusion criteria, all of which were retrospective analyses. For each study included, 2 investigators independently abstracted the data related to the population description by using a standard form and included the percentage of patients with burn injury who were burn; anatomical sites of burn; severity of burn; and mortality and cause of death. These data were extracted, and a retrospective statistical description was performed with SPSS11.0 (SPSS Inc, Chicago, IL). Of the pediatric patients studied, the proportion of children with burn injury ranged from 22.50% to 54.66%, and the male/female ratio ranged from 1.25:1 to 4.42:1. The ratio of children aged 3 years was 0.19:1 to 4.18:1. The rural/urban ratio was 1.60:1 to 12.94:1. The ratio of those who were burned indoors versus outdoors was 1.62 to 17.00, and there were no effective hints on the distribution of seasons and anatomical sites of burn that could be found. The peak hours of pediatric burn were between 17:00 and 20:00. Most articles reported the sequence of reasons as hot liquid > flame > electricity > chemical, and scalding was, by far, the most predominant reason for burn. The majority of the studies reported the highest proportion involved in moderate burn, and the lowest proportion was for critical burn. The mortality rate ranged from 0.49% to 9.08%, and infection, shock, and multiple organ dysfunction syndrome were the most common causes of
Moore Peter J
Full Text Available Abstract Background Wound infections are a common complication of surgery that add significantly to the morbidity of patients and costs of treatment. The global trend towards reducing length of hospital stay post-surgery and the increase in day case surgery means that surgical site infections (SSI will increasingly occur after hospital discharge. Surveillance of SSIs is important because rates of SSI are viewed as a measure of hospital performance, however accurate detection of SSIs post-hospital discharge is not straightforward. Methods We conducted a systematic review of methods of post discharge surveillance for surgical wound infection and undertook a national audit of methods of post-discharge surveillance for surgical site infection currently used within United Kingdom NHS Trusts. Results Seven reports of six comparative studies which examined the validity of post-discharge surveillance methods were located; these involved different comparisons and some had methodological limitations, making it difficult to identify an optimal method. Several studies evaluated automated screening of electronic records and found this to be a useful strategy for the identification of SSIs that occurred post discharge. The audit identified a wide range of relevant post-discharge surveillance programmes in England, Scotland and Wales and Northern Ireland; however, these programmes used varying approaches for which there is little supporting evidence of validity and/or reliability. Conclusion In order to establish robust methods of surveillance for those surgical site infections that occur post discharge, there is a need to develop a method of case ascertainment that is valid and reliable post discharge. Existing research has not identified a valid and reliable method. A standardised definition of wound infection (e.g. that of the Centres for Disease Control should be used as a basis for developing a feasible, valid and reliable approach to defining post
Janssen, T L; van Dijk, M; Al Malki, I; van As, A B
The reason for this review is the lack of data on the management of physical abused children in Africa. The primary goal of the first part is to outline the management of physical child abuse in (South) Africa and provide suggestions for other governments in Africa on which to base their management of physical child abuse, at both governmental and hospital management level. The main aim of the second part is to outline the extent of the problem as seen at the Red Cross Memorial Children's Hospital (RCH) in Cape Town. The National Library of Medicine's PubMed database was searched for articles specifically about the management of physical child abuse. Hospital data were analysed in two phases: one addressed various types of assault in order to assess the number of patients admitted to the trauma unit of RCH between 1991 and 2009, and the other to identify all children with suspected non-accidental injury (NAI) presenting to the trauma unit at RCH from January 2008 until December 2010. Information on physical abuse of children in Africa in the English scientific literature remains disappointing with only two articles focusing on its management. RCH data for the period 1991-2009 recorded a total number of 6415 children hospitalised with injuries following assault, who accounted for 4.2% of all trauma admissions. Types of abuse included assault with a blunt or sharp instrument, rape/sexual assault and human bite wounds. Over the last 2 decades, there has been a minor decline in the number of cases of severe abuse requiring admission; admissions for other injuries have remained stable. More detailed analysis of hospital data for 2008-2010, found that boys were far more commonly assaulted than girls (70.5% vs 29.5%). Physical abuse appeared to be the most common cause of abuse; 89.9% of all boys and 60.5% of all girls presented after physical abuse. In order to eradicate child abuse, awareness of it as to be promoted in the community at large. Because the types of child
Desalu, Olufemi O; Wahab, Kolawole W; Fawale, Bimbo; Olarenwaju, Timothy O; Busari, Olusegun A; Adekoya, Adebowale O; Afolayan, Joshua Oluwafemi
Stroke is a common neurological disorder and is the third leading cause of death and a major cause of long-term disability. The disease is expected to increase in low- and middle-income countries like Nigeria. There is no information on stroke in rural Nigeria. To review the clinical patterns, risk-factors, and outcome of stroke in a tertiary hospital in rural Nigeria and examine the rural-urban variation of stroke hospitalization in Nigeria. We carried out a retrospective study of patients who had a clinical diagnosis of stroke at the Federal Medical Centre, Ido-Ekiti, South-western Nigeria between November 2006 and October 2009. A total of 101 patients who had stroke were admitted during this review period, accounting for 4.5% of medical admission and 1.3% of total hospital admission. Women accounted 52.5% of cases, with a male to female ratio of 1 : 1.1. Their mean age was 68 ± 12 years. Stroke occurrences increased with age, as almost half (49.5%) of the cases were aged ≥70 years and majority (84.2%) of them were in low socioeconomic class. The mean hospital stay for stroke treatment was 12 ± 9 days, Glasgow coma score on admission was 11 ± 4. Ischemic stroke was 64.4%; hemorrhagic stroke, 34.7%; and indeterminate, 1.0%. Hypertension (85.2%), diabetes mellitus (23.8%), and tobacco smoking (22.8%) were the common identifiable risk factors for stroke. Of all the patients, 69% had ≥2 risk factors for stroke. Thirty-day case fatality was 23.8%; it increases with age and was higher among men than women (29.2 vs 18.9%) and in patients with diagnosis of hemorrhagic stroke (34.3 vs 18.5%). The numbers of identifiable risk factors of stroke has no effect on the 30-day case fatality. When compared with stroke in urban areas of Nigeria, we found no differences in frequency of hospitalization (1.3 vs 0.9 - 4%) and the major risk factor (hypertension). Hemorrhagic stroke was more common in urban than in the rural community (45.2 - 51 vs 34.7%) and the 30-day case
Petit Dit Dariel, Odessa; Regnaux, Jean-Phillipe
The Magnet model proposes an accreditation for hospitals having demonstrated a healthy work environment and, as a result, positive staff and patient outcomes. Yet there are conflicting findings surrounding the actual impact of Magnet's organizational model on these outcomes, as well as a wide range of designs influencing the quality of these results. To conduct a systematic review that explores the effect of Magnet accreditation on objective nurse and patient outcomes. Magnet and non-Magnet accredited hospitals matched according to their similarity (e.g. size, type [urban or rural], level of acuity, location, etc.). Hospitals could be either university based or non-teaching hospitals and in any geographical location. As the focus of the study was outcomes specific to Magnet accreditation, studies reporting on "reputational Magnets" (the original hospitals), Magnet-aspiring and non-Magnet hospitals alone were excluded from the review. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: Exposure to Magnet accreditation. A Magnet hospital is defined as a hospital with American Nursing Credentialing Center -designated Magnet status at the time of study and having received this accreditation in the last four years, as this is the length of time for which the accreditation is valid, after which the hospital must reapply for another four-year accreditation. TYPES OF STUDIES: This review considered any quantitative study comparing nurse and patient outcomes in Magnet accredited hospitals with those in non-Magnet hospitals. Controlled clinical trials, controlled before and after and interrupted time series were considered first. When these were not available, case-controlled, descriptive comparative and descriptive correlational designs were considered. All studies presenting a "case study" with no comparison and other studies reporting on interviews and other qualitative data were excluded. TYPES OF OUTCOMES: The outcomes of interest were nurse outcomes related to turnover and
Normand, Charles; Morrison, R. Sean
Abstract Background: Maintaining the recent expansion of palliative care access in the United States is a recognized public health concern. Economic evaluation is essential to validate current provision and assess the case for new programs. Previous economic reviews in palliative care reported on programs across settings and systems; none has examined specifically the hospital consultative model, the dominant model of provision in the United States. Objectives: To review systematically the economic evidence on specialist palliative care consultation teams in the hospital setting, to appraise this evidence critically, and to identify areas for future research in this field. Data Sources: A meta-review (“a review of existing reviews”) was conducted of eight published systematic reviews and one relevant nonsystematic review. To identify articles published outside of the timeframe of these reviews, systematic searches were performed on the PubMed, CINAHL, and EconLit databases. Study Selection: Articles were included if they compared the costs and/or cost effectiveness of a specialist hospital inpatient palliative care consultation for adult patients with those of a comparator. Results: Ten studies were included and these demonstrate a clear pattern of cost-saving impact from inpatient consultation programs. Nevertheless, knowledge gaps still exist regarding the economic effects of these programs. Current evidence has been generated from the hospital perspective; health system costs, patient and caregiver costs, and health outcomes are typically not included. Conclusions: Inpatient palliative care consultation programs have been shown to save hospitals money and to provide improved care to patients with serious illness. With a clear pattern of cost-saving using current methodology, it is timely to begin expanding the scope of economic evaluation in this field. Future research must address the measurement of both costs and outcomes to understand more fully the role
Prince, Rebecca M; Atenafu, Eshetu G; Krzyzanowska, Monika K
Understanding the risk of hospitalization due to treatment-related toxic effects is essential for patients, their clinicians, and health systems. Unplanned hospitalizations represent potential gaps in patient care; definition of these gaps allows characterization and identification of areas for quality improvement. To compare the rates of hospitalization in patients with metastatic non-small-cell lung cancer (mNSCLC) receiving chemotherapy in the "real world" vs clinical trial settings and to identify factors associated with hospitalization. A systematic review of Medline and EMBASE was conducted for records dating from database inception (1946 and 1974, respectively) through December 2014 to identify articles reporting rates of hospitalization during chemotherapy in patients with cancer. Both observational studies and clinical trials were eligible. This report focuses on patients with mNSCLC receiving chemotherapy because data were available for this clinical scenario in both the clinical trial and observational setting, allowing comparison. Summary statistics were used to describe results, and the χ2 test was used to compare hospitalization rates. Of the 74 articles reporting hospitalization rates during chemotherapy, 10 studies, all published after 2004, examined chemotherapy in mNSCLC, 5 randomized clinical trials (3962 patients) and 5 observational studies (8624 patients). Chemotherapy regimens included doublet therapy, single-agent therapy, or chemotherapy type unspecified. The real world cohort was older (71 vs 63 years). All real world studies reported on comorbidities, while clinical trials reported performance status. The aggregate hospitalization rate among real world patients was significantly higher than among trial patients (51% vs 16%) (odds ratio, 7.7; 95% CI, 7.0-8.4; P chemotherapy were associated with hospitalization during chemotherapy in clinical trials, while type of chemotherapy was a risk factor in observational studies. Clinical trials in
Laird, Elizabeth A; Coates, Vivien; Chaney, David
This article presents the results of a systematic review of descriptive cohort studies on the dynamics of glycaemia among adults admitted to hospital with acute stroke. Hyperglycaemia is common among adults admitted to hospital with stroke. Systematic review. A search for descriptive cohort studies published between January 1996-June 2011, was conducted in MEDLINE, PubMed and Embase electronic databases. The search was performed using the terms 'stroke', 'hyperglycaemia' and/or 'glucose' combined and limited to adults and English language publications. Searching of citations from identified studies supplemented the electronic searches. A systematic review was conducted of eight studies, meeting the criteria of: (1) descriptive cohort studies; (2) adults admitted to hospital with acute stroke; and (3) glycaemic status monitored over at least two consecutive days from admission to hospital. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis standards. The dynamics of glycaemia after stroke has been investigated in seven prospective cohort studies and one retrospective study. The patterns that emerged were persisting normoglycaemia, transient hyperglycaemia, persisting hyperglycaemia and delayed hyperglycaemia. Surges in glycaemia are likely on days 2 and 3 and some adults will not exhibit hyperglycaemia till day 7. Further large cohort studies are required to explore the dynamic of glycaemia after stroke for at least 1 week duration. The timing of formal screening for diabetes mellitus is important, as early screening may overestimate detection rates. © 2012 Blackwell Publishing Ltd.
End-users should be able to identify the most relevant scientific and technical information resources. They must understand database structure, query techniques, controlled dictionaries, terminology and indexing schemes. In the present article, we review principal characteristics of the following information systems: bibliographic databases (Agricola, Agris, Cab Abstracts (CABI), Compendex, Inspec, Iconda, statistical collections Eurostat and Faostat, and technical standards and patents ISO a...
Full Text Available Rasaaq Ayodele Adebayo,1 Patience Olayinka Akinwusi,2 Michael Olabode Balogun,1 Anthony Olubunmi Akintomide,1 Victor Oladeji Adeyeye,1 Olugbenga Olusola Abiodun,1 Luqman Adeleke Bisiriyu,3 Suraj Adefabi Ogunyemi,1 Ebenezer Adekunle Ajayi,4 Olufemi Eyitayo Ajayi,1 Adebayo Tolulope Oyedeji5 1Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, 2Cardiology Unit, Department of Medicine, Osun State University, Osogbo, Osun State, 3Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Osun State, 4Cardiology Unit, Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, 5Cardiology Unit, Department of Medicine, LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria Background: Echocardiography remains a key noninvasive cardiac investigative tool in the management of patients, especially in a developing economy like Nigeria. In this study, we investigated the indications for transthoracic echocardiography and spectrum of cardiac disease found in patients referred to our cardiac unit for echocardiography. Methods: A prospective two-dimensional, pulsed, continuous, and color-flow Doppler echocardiographic evaluation was done using the transthoracic approach in 2501 patients over an eight-year period. Univariate data analysis was performed for mean age, gender, clinical indications, and diagnoses. Results: The subject age range was less than 12 months to 97 years (mean 52.39 years. There were 1352 (54.06% males and 1149 (45.94% females. The most common indication for echocardiography was hypertension (52.1% followed by congestive cardiac failure (13.9%. Others were for screening (6.1%, arrhythmias (5%, cerebrovascular disease (5%, chest pain (3.3%, chronic kidney disease (3.2%, congenital heart disease (2.6%, cardiomyopathy (1.8%, rheumatic heart disease (1.7%, diabetes mellitus (1.3%, thyrocardiac disease (1.2%, ischemic heart
United States foreign policy is tied extensively to health initiatives, many related to the use of military assets. Despite substantial resource investment by the US Department of Defense (DoD) in hospital ship humanitarian assistance and disaster response missions, the impact of this investment is unclear. A systematic literature review of both peer-reviewed and grey literature using eight databases representing the international community and multiple sectors was conducted. Data on the characteristics of missions directly related to US Navy hospital ship humanitarian assistance and disaster response from 2004-2012 were extracted and documented. Of the 1445 sources reviewed, a total of 43 publications met criteria for review. Six (13.9%) met empirical documentation criteria and 37 (86.0%) were considered nonempirical expert opinions and anecdotal accounts that were primarily descriptive in nature. Overall, disaster response accounted for 67.4% (29/43) and humanitarian assistance 25.6% (11/43). Public and private sector participants produced 79.0% (34/43) and 20.9% (9/43) of the publications respectively. Of private sector publications, 88.9% (8/9) focused on disaster response compared to 61.8% (21/34) from the public sector. Of all publications meeting inclusion criteria, 81.4% (35/43) focused on medical care, 9.3% (4/43) discussed partnerships, 4.7% (2/43) training, and 4.7% (2/43) medical ethics and strategic utilization. No primary author publications from the diplomatic, development, or participating host nations were identified. One (2.3%) of the 43 publications was from a partner nation participant. Discussion Without rigorous research methods yielding valid and reliable data-based information pertaining to Navy hospital ship mission impact, policy makers are left with anecdotal reports to influence their decision-making processes. This is inadequate considering the frequency of hospital ship deployments used as a foreign policy tool and the considerable
Background Integrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland and train AM in PGMT. We performed the first quality evaluation of the subjectively perceived quality of this PGMT. Methods An anonymous full survey of all 214 trainers (TR) and 240 trainees (TE) in all 15 AM hospitals in Germany and Switzerland, using the ETHZ questionnaire for annual national PGMT assessments in Switzerland (CH) and Germany (D), complemented by a module for AM. Data analysis included Cronbach’s alpha to assess internal consistency questionnaire scales, 2-tailed Pearson correlation of specific quality dimensions of PGMT and department size, 2-tailed Wilcoxon Matched-Pair test for dependent variables and 2-tailed Mann–Whitney U-test for independent variables to calculate group differences. The level of significance was set at p 0.8 or >0.9, and >0.7 to >0.5 for TR scales. Swiss hospitals surpassed German ones significantly in Global Satisfaction with AM (TR and TE); Clinical Competency training in CON (TE) and AM (TE, TR), Error Management, Culture of Decision Making, Evidence-based Medicine, and Clinical Competency in internal medicine CON and AM (TE). When the comparison was restricted to departments of comparable size, differences remained significant for Clinical Competencies in AM (TE, TR), and Culture of Decision Making (TE). CON received better grades than AM in Global Satisfaction and Clinical Competency. Quality of PGMT depended on department size, working conditions and structural training features. Conclusion The lower quality of PGMT in
Heusser, Peter; Eberhard, Sabine; Berger, Bettina; Weinzirl, Johannes; Orlow, Pascale
Integrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland and train AM in PGMT. We performed the first quality evaluation of the subjectively perceived quality of this PGMT. An anonymous full survey of all 214 trainers (TR) and 240 trainees (TE) in all 15 AM hospitals in Germany and Switzerland, using the ETHZ questionnaire for annual national PGMT assessments in Switzerland (CH) and Germany (D), complemented by a module for AM. Data analysis included Cronbach's alpha to assess internal consistency questionnaire scales, 2-tailed Pearson correlation of specific quality dimensions of PGMT and department size, 2-tailed Wilcoxon Matched-Pair test for dependent variables and 2-tailed Mann-Whitney U-test for independent variables to calculate group differences. The level of significance was set at p 0.8 or >0.9, and >0.7 to >0.5 for TR scales. Swiss hospitals surpassed German ones significantly in Global Satisfaction with AM (TR and TE); Clinical Competency training in CON (TE) and AM (TE, TR), Error Management, Culture of Decision Making, Evidence-based Medicine, and Clinical Competency in internal medicine CON and AM (TE). When the comparison was restricted to departments of comparable size, differences remained significant for Clinical Competencies in AM (TE, TR), and Culture of Decision Making (TE). CON received better grades than AM in Global Satisfaction and Clinical Competency. Quality of PGMT depended on department size, working conditions and structural training features. The lower quality of PGMT in German hospitals can be attributed to
Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals. Final rule.
We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. We also are providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2017. In addition, we are making changes relating to direct graduate medical education (GME) and indirect medical education payments; establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities), including related provisions for eligible hospitals and critical access hospitals (CAHs) participating in the Electronic Health Record Incentive Program; updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program; implementing statutory provisions that require hospitals and CAHs to furnish notification to Medicare beneficiaries, including Medicare Advantage enrollees, when the beneficiaries receive outpatient observation services for more than 24 hours; announcing the implementation of the Frontier Community Health Integration Project Demonstration; and
Noreña-Herrera, Camilo; Rojas, Carlos Alberto; Cruz-Jiménez, Lizeth
The aim of this review was to describe HIV prevalence in children and youth living on the street and subject to commercial sexual exploitation, and the studies' characteristics in terms of place, time, population, and sample design. This was a systematic review, not a meta-analysis, based on an article search in 10 electronic databases: Science Direct, MEDLINE, OVID, LILACS, Wiley InterScience, MD Consult, Springer Link, Embase, Web of Science, and Ebsco. A complementary search was also performed in the libraries of schools of public health and webpages of U.N. agencies, besides the reference lists from the selected articles. We selected observational studies focused on children and youth living on the street and subject to commercial sexual exploitation, ranging in age from 10 to 20 years, with the results for HIV prevalence rates. A total of 9,829 references were retrieved, of which 15 met the inclusion criteria and comprise this descriptive summary. Of these 15 articles, 12 were conducted in children and youth living on the street and three in children subject to commercial sexual exploitation. All 15 were cross-sectional studies. HIV prevalence in children and youth living on the street ranged from 0% in Dallas, USA and Cochabamba, Bolivia to 37.4% in St. Petersburg, Russia. In children and youth living subject to commercial sexual exploitation, prevalence ranged from 2% in Toronto, Canada to 20% in Kolkata, India. In conclusion, HIV infection is present in children and youth living on the street and subject to commercial sexual exploitation. Measures are needed for prevention, diagnosis, and treatment as a public health priority and an ethical responsibility on the part of governments and society.
Mizer, Adam; Bachmann, Alexa; Gibson, Jessie; Donaldson, Megan Burrowbridge
Rising healthcare costs and inherent risks with over-utilizing diagnostic imaging require a quality subjective examination to improve effectiveness and time management of physical examinations. This systematic review investigates the diagnostic accuracy of subjective history and self-report items to determine if there is significant alteration in the probability of identifying specific painful neck conditions. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. 1) Written in the English language 2) Cervical pain with/without referred upper extremity or head pain 3) Subjective history or self-report items 4) Study designs that reported diagnostic statistics or allowed calculation of sensitivities, specificities, diagnostic odds ratios, and likelihood ratios 5) used a reference standard that has a sensitivity or specificity ≥75% or a diagnostic tool that is strongly supported in the literature where this data is not available. Quality Assessment of Studies of Diagnostic Accuracy II was performed to evaluate risk of bias. Five studies with 830 total patients met the inclusion criteria. Conditions commonly reported in the literature included: cervical radiculopathy, cervical myelopathy, degenerative joint disease, and cervicogenic headache. Individual history questions show minimal diagnostic value in identifying cervical conditions without the physical examination. The value of the subjective history report is important and requires further investigation for specific neck conditions. Clustering symptoms may provide more insight than individual history items in future studies. The diagnostic value of history for neck conditions may be underrepresented due to the lack of studies that isolate subjective examination from the physical examination. 3a. Copyright © 2017 Elsevier Ltd. All rights reserved.
The hospital is a tertiary care facility in competition with a large number of private hospitals with different levels of competence. Objective: The objective of the study is to review the outcome of the surgical management of acute appendicitis in our hospital. Method: A retrospective study of subjects who had appendectomy for ...
Hammad, Eman A; Bale, Amanda; Wright, David J; Bhattacharya, Debi
Transition of patients care between settings presents an increased opportunity for errors and preventable morbidity. A number of studies outlined that pharmacy-led medicine reconciliation (MR) might facilitate safer information transfer and medication use. MR practice is not well standardized and often delivered in combination with other health care activities. The question regarding the effects and costs of pharmacy-led MR and the optimum MR practice is warranted of value. To review the evidence for the effects and costs/cost-effectiveness of complete pharmacy-led MR in hospital settings. A systematic review searching the following database was conducted up to the 13th December 2015; EMBASE & MEDLINE Ovid, CINAHL and the Cochrane library. Studies evaluating pharmacy-led MR performed fully from admission till discharges were included. Studies evaluated non-pharmacy-led MR at only one end of patient care or transfer was not included. Articles were screened and extracted independently by two investigators. Studies were divided into those in which: MR was the primary element of the intervention and labeled as "primarily MR" studies, or MR combined with non-MR care activities and labeled as "supplemented MR" studies. Quality assessment of studies was performed by independent reviewers using a pre-defined and validated tool. The literature search identified 4065 citations, of which 13 implemented complete MR. The lack of evidence precluded addressing the effects and costs of MR. The composite of optimum MR practice is not widely standardized and requires discussion among health professions and key organizations. Research focused on evaluating cost-effectiveness of pharmacy-led MR is lacking. Copyright © 2016 Elsevier Inc. All rights reserved.
Aims The aim of this paper was to conduct a systematic review of the published literature to address the question: “In pre-hospital adult cardiac arrest (asystole, pulseless electrical activity, pulseless Ventricular Tachycardia and Ventricular Fibrillation), does the use of mechanical Cardio-Pulmonary Resuscitation (CPR) devices compared to manual CPR during Out-of-Hospital Cardiac Arrest and ambulance transport, improve outcomes (e.g. Quality of CPR, Return Of Spontaneous Circulation, Survival)”. Methods Databases including PubMed, Cochrane Library (including Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials), Embase, and AHA EndNote Master Library were systematically searched. Further references were gathered from cross-references from articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review included manikin and human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were review articles, case series and case reports. Results Out of 88 articles identified, only 10 studies met the inclusion criteria for further review. Of these 10 articles, 1 was Level of Evidence (LOE) 1, 4 LOE 2, 3 LOE 3, 0 LOE 4, 2 LOE 5. 4 studies evaluated the quality of CPR in terms of compression adequacy while the remaining six studies evaluated on clinical outcomes in terms of return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and Cerebral Performance Categories (CPC). 7 studies were supporting the clinical question, 1 neutral and 2 opposing. Conclusion In this review, we found insufficient evidence to support or refute the use of mechanical CPR devices in settings of out-of-hospital cardiac arrest and during ambulance transport. While there is some low quality evidence suggesting that mechanical CPR can improve consistency and reduce interruptions in chest compressions, there is no evidence that
Gupta, Shailvi; Wong, Evan G; Mahmood, Umbareen; Charles, Anthony G; Nwomeh, Benedict C; Kushner, Adam L
More than 90% of thermal injury-related deaths occur in low-resource settings. While baseline assessment of burn management capabilities is necessary to guide capacity building strategies, limited data exist from low and middle-income countries (LMICs). The objective of our review is to assess burn management capacity in LMICs. A PubMed literature review was performed based on studies assessing baseline surgical capacity in individual LMICs. Seven criteria were used to assess burn management capabilities: presence of surgeon, presence of anesthesiologist, basic resuscitation capabilities, acute burn management, management of burn complications, endotracheal intubation and skin grafts. Fourteen studies were reviewed using data from 458 hospitals in fourteen countries. Of these, 82.3% (284/345) of hospitals had the capacity to provide basic resuscitation and 84.9% (275/324) were capable of providing acute burn management. Endotracheal intubation was only available at 38.3% (51/133) of hospitals. Moreover, only 35.6% (111/312) and 37.9% (120/317) of hospitals were able to provide skin grafts and treat burn complications, respectively. Many hospitals in LMICs are capable of initial burn management and basic resuscitation. However, deficiencies still exist in the capacity to systematically provide advanced burn care. Efforts should be made to better document resources in order to guide burn management resource allocation. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Pooler, Alison; Beech, Roger
Exacerbations of chronic obstructive pulmonary disease (COPD) are the third largest cause of emergency hospital admissions in the UK. This systematic literature review explored the relationship between the hospitalization rates and the COPD comorbidities, anxiety, and depression. The Centre for Research Dissemination's framework for systematic reviews was followed using search terms relating to COPD, anxiety, depression, and hospital admission. Papers identified were assessed for relevance and quality, using a suitable Critical Appraisal Skills Programme tool and Mixed Methods Assessment Tool. Twenty quantitative studies indicated that anxiety and depression led to a statistically significant increase in the likelihood of COPD patients being hospitalized. These comorbidities also led to an increased length of stay and a greater risk of mortality postdischarge. Other significant factors included lower Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise scores, female gender, lower socioeconomic status, poorer patient perceived quality of life, increased severity of lung function, and less improvement in dyspnea from admission to discharge. It was also highlighted that only 27%-33% of those with depression were being treated for it. Four qualitative studies revealed that patients saw anxiety and depression as a major factor that affected their ability to cope with and self-manage their condition. Findings from the systematic review have highlighted a need for better recognition and treatment of anxiety and depression amongst individuals with COPD. Ongoing research will develop and test strategies for promoting better management and self-management as a means of reducing hospital admissions.
Lattari, Eduardo; Portugal, Eduardo; Moraes, Helena; Machado, Sérgio; Santos, Tony M; Deslandes, Andrea C
Electroencephalography has been used to establish the relationship among cortical activity, exercise and mood, such as asymmetry, absolute and relative power. The purpose of this study was to systematically review the influence of cortical activity on mood state induced by exercise. The Preferred Reporting Items in Systematic reviews and Meta-Analyses was followed in this study. The studies were retrieved from MEDLINE/PubMed, ISI Web of Knowledge and SciELO. Search was conducted in all databases using the following terms: EEG asymmetry, sLORETA, exercise, with affect, mood and emotions. Based on the defined criteria, a total of 727 articles were found in the search conducted in the literature (666 in Pubmed, 54 in ISI Web of Science, 2 in SciELO and 5 in other data sources). Total of 11 studies were selected which properly met the criteria for this review. Nine out of 11 studies used the frontal asymmetry, four used absolute and relative power and one used sLORETA. With regard to changes in cortical activity and mood induced by exercise, six studies attributed this result to different intensities, one to duration, one to type of exercise and one to fitness level. In general, EEG measures showed contradictory evidence of its ability to predict or modulate psychological mood states through exercise intervention.
Motivated by many design considerations, several conceptual designs for advanced reactors have proposed that the entire reactor building and a significant portion of the steam generator building will be either partially or completely embedded below grade. For the analysis of seismic events, the soil-structure interaction (SSI) effect and passive earth pressure for these types of deeply embedded structures will have a significant influence on the predicted seismic response. Sponsored by the US Nuclear Regulatory Commission (NRC), Brookhaven National Laboratory (BNL) is carrying out a research program to assess the significance of these proposed design features for advanced reactors, and to evaluate the existing analytical methods to determine their applicability and adequacy in capturing the seismic behavior of the proposed designs. This paper summarizes a literature review performed by BNL to determine the state of knowledge and practice for seismic analyses of deeply embedded and/or buried (DEB) nuclear containment type structures. Included in the paper is BNL's review of the open literature of existing standards, tests, and practices that have been used in the design and analysis of DEB structures. The paper also provides BNL's evaluation of available codes and guidelines with respect to seismic design practice of DEB structures. Based on BNL's review, a discussion is provided to highlight the applicability of the existing technologies for seismic analyses of DEB structures and to identify gaps that may exist in knowledge and potential issues that may require better understanding and further research.
Anthony O. Etyang
Full Text Available Background: Despite the publication of several studies on the subject, there is significant uncertainty regarding the burden of disease among adults in sub-Saharan Africa (sSA. Objectives: To describe the breadth of available data regarding causes of admission to hospital, to systematically analyze the methodological quality of these studies, and to provide recommendations for future research. Design: We performed a systematic online and hand-based search for articles describing patterns of medical illnesses in patients admitted to hospitals in sSA between 1950 and 2010. Diseases were grouped into bodily systems using International Classification of Disease (ICD guidelines. We compared the proportions of admissions and deaths by diagnostic category using χ2. Results: Thirty articles, describing 86,307 admissions and 9,695 deaths, met the inclusion criteria. The leading causes of admission were infectious and parasitic diseases (19.8%, 95% confidence interval [CI] 19.6–20.1, respiratory (16.2%, 95% CI 16.0–16.5 and circulatory (11.3%, 95% CI 11.1–11.5 illnesses. The leading causes of death were infectious and parasitic (17.1%, 95% CI 16.4–17.9, circulatory (16%, 95% CI 15.3–16.8 and digestive (16.2%, 95% CI 15.4–16.9. Circulatory diseases increased from 3.9% of all admissions in 1950–59 to 19.9% in 2000–2010 (RR 5.1, 95% CI 4.5–5.8, test for trend p<0.00005. The most prevalent methodological deficiencies, present in two-thirds of studies, were failures to use standardized case definitions and ICD guidelines for classifying illnesses. Conclusions: Cardiovascular and infectious diseases are currently the leading causes of admissions and in-hospital deaths in sSA. Methodological deficiencies have limited the usefulness of previous studies in defining national patterns of disease in adults. As African countries pass through demographic and health transition, they need to significantly invest in clinical research capacity to provide
Ambriz Murillo, Yesenia; Menor Almagro, Raul; Campos-González, Israel David; Cardiel, Mario H
Chronic diseases have a great impact in the morbidity and mortality and in the health-related quality of life (HRQoL) of patients around the world. The impact of rheumatic diseases has not been fully recognized. We conducted a comparative study to evaluate the HRQoL in different chronic diseases. The aim of the present study was to assess the HRQoL and identify specific areas affected in patients with rheumatoid arthritis (RA), osteoarthritis (OA), diabetes mellitus, end-stage renal disease, geriatric subjects and a control group. We conducted a cross-sectional study, in a General Hospital in Morelia, Mexico. All patients met classification criteria for RA, OA, diabetes mellitus, end-stage renal disease; the geriatric subjects group was≥65 years, and the control group≥30 years. Demographic characteristics were recorded, different instruments were applied: SF-36, visual analogue scale for pain, patient's and physician's global assessments, Beck Depression Inventory and specific instruments (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] and Kidney Disease Questionnaire of Life [KDQOL]). Biochemical measures: erythrocyte sedimentation rate, blood count, glucose, HbA1C, serum creatinine and urea. We evaluated 290 subjects (control group: 100; geriatric subjects: 30 and 160 for the rest of groups). Differences were detected in baseline characteristics (P<.0001). The SF-36 scores were different between control group and others groups (P=0.007). The worst HRQoL was in end-stage renal disease group (±SD: 48.06±18.84 x/SD). The general health was the principal affected area in RA. The pain was higher in rheumatic diseases: OA (5.2±2.4) and RA (5.1±3). HAQ was higher in OA compared to RA (1.12±0.76 vs 0.82±0.82, respectively; P=.001). Forty five percent of all subjects had depression. The HRQoL in RA patients is poor and comparable to other chronic diseases (end-stage renal disease and diabetes mellitus). Rheumatic diseases should be considered high impact
Ricardo de Amorim Cini
Full Text Available The use of the term vulnerability in the discussion of bioethics, either as a concept or as a reality, has become increasingly recurrent. The first, and also most important use of this term is to protect subjects participating in experiments, but its use has been expanded to other situations. The aim of this research was to identify the subjects or realities that are classified as vulnerable. We used the descriptors “bioethics” and “vulnerability” to search for literature in Scielo.BR, Scielo.ORG and Lilacs, and analyzed 79 articles. Furthermore, in these articles we identified four categories of vulnerability that can be grouped as vulnerability in:  stages of life and gender;  health, disease and research;  socioeconomic and cultural exclusion;  and environment. This categorization demonstrates that the bioethical reflection on the vulnerability of life is still predominantly anthropocentric, which makes the protection of the dignity of life as a whole a challenge that is still to be faced by bioethical discussion.
Little, Charles M; McStay, Christopher; Oeth, Justin; Koehler, April; Bookman, Kelly
The use of after-action reviews (AARs) following major emergency events, such as a disaster, is common and mandated for hospitals and similar organizations. There is a recurrent challenge of identified problems not being resolved and repeated in subsequent events. A process improvement technique called a rapid improvement event (RIE) was used to conduct an AAR following a complete information technology (IT) outage at a large urban hospital. Using RIE methodology to conduct the AAR allowed for the rapid development and implementation of major process improvements to prepare for future IT downtime events. Thus, process improvement methodology, particularly the RIE, is suited for conducting AARs following disasters and holds promise for improving outcomes in emergency management. Little CM , McStay C , Oeth J , Koehler A , Bookman K . Using rapid improvement events for disaster after-action reviews: experience in a hospital information technology outage and response. Prehosp Disaster Med. 2018;33(1):98-100.
Full Text Available Abstract Background Pneumonia is one of the leading hospital-acquired infections worldwide and has an important impact. Although preventive measures for ventilator-associated pneumonia (VAP are well known, less is known about appropriate measures for prevention of hospital-acquired pneumonia (HAP. Aim The purpose of this narrative review is to provide an overview of the current standards for preventing HAP in non-ventilated adult patients. Methods A search of the literature up to May 2015 was conducted using Medline for guidelines published by national professional societies or professional medical associations. In addition, a comprehensive search for the following preventive measures was performed: hand hygiene, oral care, bed position, mobilization, diagnosis and treatment of dysphagia, aspiration prevention, viral infections and stress bleeding prophylaxis. Findings Regarding international guidelines, several measures were recommended for VAP, whilst no specific recommendations for HAP prevention in non-ventilated patients are available. There is reasonable evidence available that oral care is associated with a reduction in HAP. Early mobilization interventions, swift diagnosis and treatment of dysphagia, and multimodal programmes for the prevention of nosocomial influenza cross-infection, have a positive impact on HAP reduction. The impact of bed position and stress bleeding prophylaxis remains uncertain. Systematic antibiotic prophylaxis for HAP prevention should be avoided. Conclusion Scant literature and little guidance is available for the prevention of HAP among non-ventilated adult patients. In addition, the criteria used for the diagnosis of HAP and the populations targeted in the studies selected are heterogeneous. Oral care was the most studied measure and was commonly associated with a decrease in HAP rate, although a broad range of interventions are proposed. No robust evidence is available for other measures. Further high
Vatanpour H, Soltani M,
Full Text Available Persistent pain continues to be a common problem among patients undergoing cardiac operations and the need for controlling such pain is believed to be as a prime necessity in terms of the patient’s well being, health care costs and avoiding negative consequences provoked by the pain itself. Regarding to the newly established guidelines, opioid analgesic agents are considered as the mainstay of moderate to severe acute pain. Nonetheless, the underutilization of opioids for pain relief is still a persisting huge challenge. This survey, applying as a concurrent Drug Utilization Review using ATC/DDD system provided and recommended by the DUR group of the World Health Organization, conducted on 108 inpatients who received opioid drugs by parenteral route during 9 months from February to November 2013 at the post-ICU ward of Shahid Modarres Cardiovascular Hospital, affiliated to Shahid Beheshti University of Medical Science, in Tehran. Our findings revealed that morphine was the most commonly prescribed parenteral opioid in the hospitalized patients and pethidine usage was in the lowest level for the geriatric patients, resulting in satisfaction with the analgesic procedure among most of the cases in our study. Both of the mentioned drugs were prescribed by intramuscular route, regarding PRN way of injecting as well. Comparative results of our study with the literature revealed relatively moderate and roughly rational consumption of morphine (10.282 DDD/100bed-days and pethidine (0.013 DDD/100bed-days. Applying multivariate conditional regression modeling on the question of determining independent predictors for opioid usage, disclosed a direct correlation between the patient’s weight and daily dose of parenteral opioid consumption.
Gorman, Todd E; Ahern, Stéphane P; Wiseman, Jeffrey; Skrobik, Yoanna
The authors performed a structured literature review to understand residents' experiences with end-of-life (EOL) decision making with adult hospitalized patients, specifically regarding decisions to withhold or withdraw advanced life-support measures. An Ovid-based strategy was used to search Medline, ERIC, PsychINFO, and CINHAL databases for articles published between 1966 and February 2005, combining the domains of "resuscitation orders," "decision making," and "internship and residency." All quantitative and qualitative studies examining residents' EOL decision making with adult hospitalized patients were included. The authors developed and applied a scoring system for relevance and quality, performed data abstraction and quality assessment independently and in duplicate, then met to collate findings and identify factors in residents' EOL decision making. The searches yielded 884 articles, of which 26 were included. Variable methodologies precluded meta-analysis. In these studies, residents felt unprepared to handle patient EOL decision making, although exposure to EOL discussions helped them gain confidence. Residents' attitudes, skills, and knowledge were key determinants of whether EOL decisions were addressed. Many misinterpreted the terms "DNR" and "futility." Residents' understanding of the patient EOL decision-making process could be extremely variable, and their do-not-resuscitate discussions suboptimal. Residents' lived practice experience of the patient EOL decision-making process was often at odds with what they were taught in formal curricula. Educational strategies aimed at changing residents' knowledge, skills and attitude should address the hidden curriculum for the patient EOL decision-making process that is part of the experienced culture of every day practice. Future studies of this experienced culture would inform specific educational interventions.
Turner, Conor D A; Lockey, David J; Rehn, Marius
Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice. Systematic literature searches of PubMed, Cochrane Database of Systematic Reviews and Scopus were conducted in conjunction with simple searches of non-indexed databases; Web of Science, OpenDOAR and Evidence Search. The searches were last carried out on 20 April 2016 and only identified those papers published after the 1 January 1980. Included documents had to contain descriptions, discussions or experiences of the pre-hospital management of civilian mass shootings. From the 494 identified manuscripts, 73 were selected on abstract and title and after full text reading 47 were selected for inclusion in analysis. The search yielded reports of 17 mass shooting events, the majority from the USA with additions from France, Norway, the UK and Kenya. Between 1994 and 2015 the shooting of 1649 people with 578 deaths at 17 separate events are described. Quality appraisal demonstrated considerable heterogeneity in reporting and revealed limited data on mass shootings globally. Key themes were identified to improve future practice: tactical emergency medical support may harmonise inner cordon interventions, a need for inter-service education on effective haemorrhage control, the value of senior triage operators and the need for regular mass casualty incident simulation.
Full Text Available Objective: A prospective medicine usage evaluation based on prescription monitoring was conducted in the medicine OPD of our university teaching hospital to know prescribing trends of different categories of medicines. Materials and Methods: A total of 600 patients were included in the study comprising of 339 (56.5% males and 261 (43.5% females. The data were recorded within the OPD by a registered pharmacist on a medicine usage evaluation form, approved by The University Institutional Review Board (IRB. Results: A total of 2365 medicines were prescribed to 600 patients during the 3 months study period. The mean number of medicines per prescription were found to be 3.94. Medicines were most frequently prescribed as solid dosage forms (85.62%, especially tablets (70.82%, and liquid formulations (14.12%. Oral route (96.17% was the most preferred mode of administration, followed by topical (2.11% and parenteral (1.60% routes. Combination therapy (94.33% was more prevalent than monotherapy (5.66%. An overwhelming tendency for prescribing medicines by brand names (99% was observed by the physicians. The most frequently prescribed class of medicines were antimicrobials > analgesics > cardiovascular > gastrointestinal agents. The most prescribed individual medicines among various therapeutic classes included isoniazid (antimicrobial, amlodipine (cardiovascular, metformin (hypoglycemic, cetirizine (antiallergic, rabeprazole (GI medicine, atorvastatin (hypolipidemic, dextromethorphan (respiratory medicine, alprazolam (sedative-hypnotic, paracetamol (analgesic. Conclusions: There is a considerable scope of improvement in the existing prescribing practice, especially prescribing by generic names, needs to be encouraged and a hospital formulary has to be developed for the purpose. The number of medicines to be included per prescription should be judged rationally and polypharmacy ought to be curbed. Use of antimicrobial also needs to be rationalized as over
Norsa' adah, Bachok; Nur-Zafira, Azemi; Knight, Aishah
Pancreatic cancer is usually detected late and has a high mortality rate. Since little is known about this cancer in Malaysia, a review of all cases admitted to Universiti Sains Malaysia Hospital was conducted to identify the epidemiological distribution and assess survival. A list of pancreatic cancer patients in 2001-2008 was obtained from the Hospital Record Department. Only cases confirmed by radio-imaging or histo-pathology examination were included. We excluded those with incomplete medical records. Kaplan-Meier and Cox proportional hazard approaches were used for data analysis. Only 56 cases were included with a mean (SD) age of 49.6 (16.0) years, with 60.7% males and 82.1% of Malay ethnicity. Previous history included cholelithiasis in 23.2%, diabetes mellitus in 16.1%, previous laparotomy in 10.7%, chronic pancreatitis in 7.1%, alcohol drinking in 5.4% and positive family history in 3.6%. The common presenting history included 67.9% loss of appetite, 66.1% loss of weight, 58.9% jaundice and 46.4% abdominal pain. Tumour staging was: 21.5% stage l, 17.8% stage ll, 3.6% stage lll and 57.1% stage lV. The median (95% CI) survival time was 3.4 (0.5, 6.3) months and significant prognostic factors were duration of symptoms (HR 0.97; 95% CI: 0.95, 0.99; p value 0.013), ascites (HR 2.64; 95% CI: 1.28, 5.44; p value 0.008) and Whipple surgery (HR 4.20; 95% CI: 2.27, 7.76; p value <0.001). The history of presenting complaints was short and the majority presented at late stages of the disease, thus the median survival time was very poor.
Jeddi, Fatemeh Rangraz; Gilasi, Hamidreza; Khademi, Sahar
Hospital websites are important tools in establishing communication and exchanging information between patients and staff, and thus should enjoy an acceptable level of quality. The aim of this study was to identify proper models and criteria to evaluate the quality of hospital websites. This research was a systematic review study. The international databases such as Science Direct, Google Scholar, PubMed, Proquest, Ovid, Elsevier, Springer, and EBSCO together with regional database such as Magiran, Scientific Information Database, Persian Journal Citation Report (PJCR) and IranMedex were searched. Suitable keywords including website, evaluation, and quality of website were used. Full text papers related to the research were included. The criteria and sub criteria of the evaluation of website quality were extracted and classified. To evaluate the quality of the websites, various models and criteria were presented. The WEB-Q-IM, Mile, Minerva, Seruni Luci, and Web-Qual models were the designed models. The criteria of accessibility, content and apparent features of the websites, the design procedure, the graphics applied in the website, and the page's attractions have been mentioned in the majority of studies. The criteria of accessibility, content, design method, security, and confidentiality of personal information are the essential criteria in the evaluation of all websites. It is suggested that the ease of use, graphics, attractiveness and other apparent properties of websites are considered as the user-friendliness sub criteria. Further, the criteria of speed and accessibility of the website should be considered as sub criterion of efficiency. When determining the evaluation criteria of the quality of websites, attention to major differences in the specific features of any website is essential.
Clyburn, Terry A; Heydemann, John A
Falls in the elderly are a significant problem both in and out of the hospital. The Deficit Reduction Act of 2005 and the Fiscal Year 2009 Inpatient Prospective Payment System Final Rule, as outlined by the Centers for Medicare & Medicaid Services, placed on hospitals the financial burden of fall prevention for falls (ie, hospital-acquired conditions) that could have been prevented by following evidence-based guidelines. Multifaceted and individualized programs have been created to prevent falls in the elderly. Many of these interventions are based on expert opinion and statistical trends. Our review of the literature revealed that the risk of fall is only slightly greater in the hospital environment than in the home and that there is no medical evidence that evidence-based guidelines are effective in fall prevention.
Dewing, Jan; Dijk, Saskia
This paper summarises a literature review focusing on the literature directly pertaining to the acute care of older people with dementia in general hospitals from 2007 onwards. Following thematic analysis, one overarching theme emerged: the consequences of being in hospital with seven related subthemes. Significantly, this review highlights that overall there remains mostly negative consequences and outcomes for people with dementia when they go into general hospitals. Although not admitted to hospital directly due to dementia, there are usually negative effects on the dementia condition from hospitalisation. The review suggests this is primarily because there is a tension between prioritisation of acute care for existing co-morbidities and person-centred dementia care. This is complicated by insufficient understanding of what constitutes person-centred care in an acute care context and a lack of the requisite knowledge and skills set in health care practitioners. The review also reveals a worrying lack of evidence for the effectiveness of mental health liaison posts and dementia care specialist posts in nursing. Finally, although specialist posts such as liaison and clinical nurse specialists and specialist units/shared care wards can enhance quality of care and reduce adverse consequences of hospitalisation (they do not significantly) impact on reducing length of stay or the cost of care. © The Author(s) 2014.
Full Text Available Alison Pooler,1,2 Roger Beech21School of Nursing and Midwifery, Clinical Education Centre, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK; 2Health Services Research, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK Objectives: Exacerbations of chronic obstructive pulmonary disease (COPD are the third largest cause of emergency hospital admissions in the UK. This systematic literature review explored the relationship between the hospitalization rates and the COPD comorbidities, anxiety, and depression.Methods: The Centre for Research Dissemination's framework for systematic reviews was followed using search terms relating to COPD, anxiety, depression, and hospital admission. Papers identified were assessed for relevance and quality, using a suitable Critical Appraisal Skills Programme tool and Mixed Methods Assessment Tool.Results: Twenty quantitative studies indicated that anxiety and depression led to a statistically significant increase in the likelihood of COPD patients being hospitalized. These comorbidities also led to an increased length of stay and a greater risk of mortality postdischarge. Other significant factors included lower Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise scores, female gender, lower socioeconomic status, poorer patient perceived quality of life, increased severity of lung function, and less improvement in dyspnea from admission to discharge. It was also highlighted that only 27%–33% of those with depression were being treated for it. Four qualitative studies revealed that patients saw anxiety and depression as a major factor that affected their ability to cope with and self-manage their condition.Implications: Findings from the systematic review have highlighted a need for better recognition and treatment of anxiety and depression amongst individuals with COPD. Ongoing research will develop and test strategies for promoting better management
Mekonnen, Alemayehu B; Alhawassi, Tariq M; McLachlan, Andrew J; Brien, Jo-Anne E
Medication errors and adverse drug events are universal problems contributing to patient harm but the magnitude of these problems in Africa remains unclear. The objective of this study was to systematically investigate the literature on the extent of medication errors and adverse drug events, and the factors contributing to medication errors in African hospitals. We searched PubMed, MEDLINE, EMBASE, Web of Science and Global Health databases from inception to 31 August, 2017 and hand searched the reference lists of included studies. Original research studies of any design published in English that investigated adverse drug events and/or medication errors in any patient population in the hospital setting in Africa were included. Descriptive statistics including median and interquartile range were presented. Fifty-one studies were included; of these, 33 focused on medication errors, 15 on adverse drug events, and three studies focused on medication errors and adverse drug events. These studies were conducted in nine (of the 54) African countries. In any patient population, the median (interquartile range) percentage of patients reported to have experienced any suspected adverse drug event at hospital admission was 8.4% (4.5-20.1%), while adverse drug events causing admission were reported in 2.8% (0.7-6.4%) of patients but it was reported that a median of 43.5% (20.0-47.0%) of the adverse drug events were deemed preventable. Similarly, the median mortality rate attributed to adverse drug events was reported to be 0.1% (interquartile range 0.0-0.3%). The most commonly reported types of medication errors were prescribing errors, occurring in a median of 57.4% (interquartile range 22.8-72.8%) of all prescriptions and a median of 15.5% (interquartile range 7.5-50.6%) of the prescriptions evaluated had dosing problems. Major contributing factors for medication errors reported in these studies were individual practitioner factors (e.g. fatigue and inadequate knowledge
Almeida, Dejanira; Cristovam, Elisabete; Caldeira, Daniel; Ferreira, Joaquim J; Marques, Teresa
Legionnaires' disease (LD) is recognized as an important hospital-acquired disease. Despite the several methods available, the optimal method to control hospital-acquired LD is not well established and their overall efficacy requires further evaluation. To systematically review all controlled trials evaluating the efficacy of interventions to prevent hospital-acquired LD in patients at high risk of developing the disease and its effects on environmental colonization. A database search was performed through PubMed and the Cochrane Central Register of Controlled Trials (inception-November 2014). Eligible studies included all controlled studies evaluating interventions to prevent hospital-acquired LD in patients at high risk or evaluating the effect on environmental colonization. Both individual and pooled risk estimates were reported using risk ratio (RR) and 95% confidence intervals (95% CIs). There were no studies evaluating the risk reduction in hospital-acquired LD, but 4 studies evaluated the influence of copper-silver ionization and ultraviolet light in the reduction of environmental reservoirs of Legionella. The meta-analysis showed a significant 95% risk reduction of Legionella positivity in environmental samples using copper-silver ionization (RR, 0.05; 95% CI, 0.01-0.17) and 97% risk reduction with ultraviolet light (RR, 0.03; 95% CI, 0.002-0.41). The best available evidence suggests that copper-silver ionization and ultraviolet light are effective in reducing Legionella positivity in environmental samples. Nevertheless, the low quality of evidence weakens the robustness of conclusions. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Tully, Mary P; Ashcroft, Darren M; Dornan, Tim; Lewis, Penny J; Taylor, David; Wass, Val
Prescribing errors are common, they result in adverse events and harm to patients and it is unclear how best to prevent them because recommendations are more often based on surmized rather than empirically collected data. The aim of this systematic review was to identify all informative published evidence concerning the causes of and factors associated with prescribing errors in specialist and non-specialist hospitals, collate it, analyse it qualitatively and synthesize conclusions from it. Seven electronic databases were searched for articles published between 1985-July 2008. The reference lists of all informative studies were searched for additional citations. To be included, a study had to be of handwritten prescriptions for adult or child inpatients that reported empirically collected data on the causes of or factors associated with errors. Publications in languages other than English and studies that evaluated errors for only one disease, one route of administration or one type of prescribing error were excluded. Seventeen papers reporting 16 studies, selected from 1268 papers identified by the search, were included in the review. Studies from the US and the UK in university-affiliated hospitals predominated (10/16 [62%]). The definition of a prescribing error varied widely and the included studies were highly heterogeneous. Causes were grouped according to Reason's model of accident causation into active failures, error-provoking conditions and latent conditions. The active failure most frequently cited was a mistake due to inadequate knowledge of the drug or the patient. Skills-based slips and memory lapses were also common. Where error-provoking conditions were reported, there was at least one per error. These included lack of training or experience, fatigue, stress, high workload for the prescriber and inadequate communication between healthcare professionals. Latent conditions included reluctance to question senior colleagues and inadequate provision of
Smith, M E Beth; Chiovaro, Joseph C; O'Neil, Maya; Kansagara, Devan; Quiñones, Ana R; Freeman, Michele; Motu'apuaka, Makalapua L; Slatore, Christopher G
Early warning system (EWS) scores are used by hospital care teams to recognize early signs of clinical deterioration and trigger more intensive care. To systematically review the evidence on the ability of early warning system scores to predict a patient's risk of clinical deterioration and the impact of early warning system implementation on health outcomes and resource utilization. We searched the MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials databases through May 2014. We included English-language studies of early warning system scores used with adults admitted to medical or surgical wards. We abstracted study characteristics, including population, setting, sample size, duration, and criteria used for early warning system scoring. For predictive ability, the primary outcomes were modeled for discrimination on 48-hour mortality, cardiac arrest, or pulmonary arrest. Outcomes for the impact of early warning system implementation included 30-day mortality, cardiovascular events, use of vasopressors, respiratory failure, days on ventilator, and resource utilization. We assessed study quality using a modified Quality in Prognosis Studies assessment tool where applicable. Of 11,183 citations studies reviewed, one controlled trial and 20 observational studies of 13 unique models met our inclusion criteria. In eight studies, researchers addressed the predictive ability of early warning system tools and found a strong predictive value for death (area under the receiver operating characteristic curve [AUROC], 0.88-0.93) and cardiac arrest (AUROC, 0.74-0.86) within 48 hours. In 13 studies (one controlled trial and 12 pre-post observational studies), researchers addressed the impact on health outcomes and resource utilization and had mixed results. The one controlled trial was of good quality, and the researchers found no difference in mortality, transfers to the ICU, or length of hospital stay. The pre-post designs of the remaining studies have
Snider, Karen T; Snider, Eric J; DeGooyer, Brett R; Bukowski, Allison M; Fleming, Regina K; Johnson, Jane C
In the first half of the 20th century, nearly all osteopathic physicians used osteopathic manipulative medicine (OMM) in the care of hospitalized patients. Over the past few decades, however, inpatient OMM care has declined and is more commonly provided by OMM specialists. To retrospectively evaluate the details of a specialty-level OMM inpatient consultation service. Inpatient OMM consultations that took place at Northeast Regional Medical Center in Kirksville, Missouri, between July 1998 and March 2008 were identified from billing records. Consultations were reviewed for demographic information, admission location, postoperative status, intensive care unit and mechanical ventilation usage, admission and discharge diagnoses, consultation reasons and final diagnoses, areas of somatic dysfunction treated and types of osteopathic manipulative treatment (OMT) techniques used, and hospital length of stay (LOS). A total of 1509 OMM consultations were identified (580 for male patients [38%]; 929 for female patients [62%]; mean [SD] age, 54  years [range, 0-99 years]), representing 11% of all inpatient consultations. Of these, 1372 consultations (91%) were initiated in the inpatient acute care facility, 87 (6%) in the inpatient acute rehabilitation facility, and 50 (3%) in the skilled nursing facility. Further, 265 consultations (18%) were for postoperative patients, 187 (12%) were for patients in the intensive care unit, and 54 (4%) were for patients receiving mechanical ventilation at the time of the consultation. The most common admission diagnoses were hypertension, routine newborn care, lower respiratory infection, chronic obstructive pulmonary disease, and gastrointestinal symptoms. The most common reasons for OMM consultation were chest/rib pain, spinal pain, lower respiratory infection (adjunctive treatment), cranial asymmetry, and infant feeding disorder. The most common types of OMT techniques used were myofascial release, balanced ligamentous tension
Mendes, Vivian; Dos Santos, Gustavo Oliveira; Moraschini, Vittorio
The aim of this systematic review (SR) is to evaluate the association between asthma and periodontal parameters. An electronic search without date or language restrictions was carried out in MEDLINE, Cochrane, Web of Science, and LILACS until May 2017. In addition, manual search and in the grey literature were also conducted. The search process, data analysis, and quality assessment were performed by two independent reviewing authors. Eligibility criteria included prospective and retrospective cohort studies, case-controls, and randomized clinical trials. For the meta-analysis, the inverse variance method was used in fixed or random effect models, which were chosen according to heterogeneity. The estimates of the intervention effects were expressed as the mean differences. The search and selection process yielded 21 studies, published between 1979 and 2017. The meta-analysis showed a statistically significant difference for the parameters of gingival bleeding, plaque index, and gingival index for asthmatic participants with P<0.0001, P<0.0001, and P=0.0005, respectively. The data from this SR suggest that asthmatic patients may be more susceptible to negative periodontal changes, althought further high-quality research wuold be welcome. Copyright © 2017 Elsevier Ltd. All rights reserved.
Objectives: To review the spectrum of thyroid pathology diagnoses likely to be encountered by surgeons working in East African hospitals. Design: A retrospective review of all thyroidectomies performed over a three year period. Setting: A rural church based hospital in Kenya. Subjects: Two hundred and twenty two patients ...
Lameijer, Heleen; Immink, Rosa S.; Broekema, Josien J.; Ter Maaten, Jan C.
With increasing rates of in-hospital cardiac arrest, improving resuscitation outcomes is essential. Mechanical chest compressors seem to be related to improved outcome in out-of hospital cardiac arrest; however, the literature on its use in in-hospital cardiac arrest is scarce. We used the Medline
URINARY TRACT INFECTIONS IN A TERTIARY HOSPITAL IN ABUJA, NIGERIA. Iregbu KC*,Nwajiobi-Princewill PI. Department of Medical Microbiology and Parasitology, National Hospital Abuja, P.M.B 425, Nigeria. *Corresponding Author: Iregbu KC, Department of Medical Microbiology, National Hospital, Abuja. Nigeria.
Knorr, Ulla; Kessing, Lars Vedel; Knorr, Ulla
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) show antidepressant properties in many patients with a diagnosis of depression. An understanding of the underlying mechanisms of the effect of SSRIs in healthy patients may lead to an understanding of the yet unclear pathophysiology...... of depression. Recent reviews of studies investigating the effect of SSRIs in healthy persons conclude that the results are inconsistent and that--in relation to a wide range of outcomes--the effect of SSRIs is limited; however, reasons for the inconsistencies are poorly studied. AIMS AND METHODS...... of SSRIs in healthy persons may lead to an understanding of the pathophysiology of depression, since the present evidence is divergent and may be severely influenced by a number of methodological drawbacks....
Fabbricotti, Isabelle N.; Buljac-Samardžić, Martina; Hilders, Carina G. J. M.
Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal–and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal ‘leaders’ in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care. PMID:28910335
Berghout, Mathilde A; Fabbricotti, Isabelle N; Buljac-Samardžić, Martina; Hilders, Carina G J M
Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal-and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal 'leaders' in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.
Bianconi, Maria Inés; Otero, Silvina; Moscheni, Oriana; Alvarez, Lucia; Storino, Claudio; Jankilevich, Gustavo
To analyze the clinical trends of gestational trophoblastic disease (GTD) in a public hospital of Buenos Aires, Argentina. A review of the clinical records of 358 patients with a diagnosis of GTD admitted to Durand Trophoblastic Disease Center between 1990 and February 2011 was performed. Features of diagnosis, treatment and follow-up were analyzed. A total of 358 cases of GTD were reviewed. Hydatidiform mole was diagnosed in 340 patients; of those 223 (66%) experienced spontaneous remission after evacuation. Of the 135 patients with persistent gestational trophoblastic neoplasia (GTN), 99 (73%) had low-risk GTN, 32 (26%) had high-risk GTN and 4 had either placental site trophoblastic disease or epithelioid trophoblastic tumor. In the low-risk group the first-line treatment was methotrexate and the second-line treatment was actinomycin D, etoposide, cytoxan, and oncovin (EMA/CO), with a complete response rate of 100%. High-risk patients whose WHO prognostic scores were 7-13 were treated initially with EMA/CO. Patients whose scores were >13 were treated with EMA/PE, where platinum and etoposide replaced oncovin and cytoxan. Salvage therapy in patients with relapse or resistant disease were treated with a wide variety of chemotherapy regimens. The complete response rate was 98.2%. Compliance was 100%. Three patients died. In all cases the outcome was related with inadequate initial treatment. This protocol is in agreement with international consensus. It was useful, safe and feasible in our population. The compliance with international guidelines allows reach a successful treatment and follow-up in one Latin-American population.
Mathilde A Berghout
Full Text Available Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal-and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal 'leaders' in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.
Norcross, J.R.; Stroud, L.C.; Klein, J.; Desantis, L.; Gernhardt, M.L.
Crewmembers will perform a variety of exploration and construction activities on the lunar surface. These activities will be performed while inside an extravehicular activity (EVA) spacesuit. In most cases, human performance is compromised while inside an EVA suit as compared to a crewmember s unsuited performance baseline. Subjects completed different EVA type tasks, ranging from ambulation to geology and construction activities, in different lunar analog environments including overhead suspension, underwater and 1-g lunar-like terrain, in both suited and unsuited conditions. In the suited condition, the Mark III (MKIII) EVA technology demonstrator suit was used and suit pressure and suit weight were parameters tested. In the unsuited conditions, weight, mass, center of gravity (CG), terrain type and navigation were the parameters. To the extent possible, one parameter was varied while all others were held constant. Tests were not fully crossed, but rather one parameter was varied while all others were left in the most nominal setting. Oxygen consumption (VO2), modified Cooper-Harper (CH) ratings of operator compensation and ratings of perceived exertion (RPE) were measured for each trial. For each variable, a lower value correlates to more efficient task performance. Due to a low sample size, statistical significance was not attainable. Initial findings indicate that suit weight, CG and the operational environment can have a large impact on human performance during EVA. Systematic, prospective testing series such as those performed to date will enable a better understanding of the crucial interactions of the human and the EVA suit system and their environment. However, work remains to be done to confirm these findings. These data have been collected using only unsuited subjects and one EVA suit prototype that is known to fit poorly on a large demographic of the astronaut population. Key findings need to be retested using an EVA suit prototype better suited to a
Full Text Available Background: Electroconvulsive therapy (ECT is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014, and it was observed that 23 elderly patients (aged ≥60 years had received ECT. Results: The patients received modified bitemporal ECT using a brief pulse ECT machine and had no major complications. A total of 184 ECT treatments were administered at an average of 8 treatments per case. The major diagnoses of patients were schizophrenia and major depression. The main indications of ECT were intolerance to medication, suicidal behavior and aggression. Out of the 23 elderly patients, 18 (78.26% showed a good response to ECT. The only complication noted was memory loss and confusion in 3 cases. Patients with medical illnesses like hypertension, diabetes and both together received ECT without any complications. Conclusions: This study adds to the scarce database on the use of ECT in elderly patients in India and adds evidence to the fact that ECT is a safe and effective treatment in the elderly.
Khambhiphant, Bharkbhum; Srisuwanwattana, Wisara
To report the characteristics and the success rate of treatment of newly diagnosed amblyopia at Department of Ophthalmology, King Chulalongkorn Memorial Hospital between January 2007 and December 2007. The authors performed retrospective chart reviews of 16 newly diagnosed amblyopic literate patients. Successful treatment was defined as having best corrected visual acuity (BCVA) > or = 3 Snellen lines improvement or > or = 20/30 in the amblyopic eye. Of 16 patients, the mean age was 8.62 +/- 3.07 years old. The causes o amblyopia were 12 refractive error (75%), three strabismus (18.75%), and one visual deprivation (6.25%). The mean BCVA, before treatment, of amblyopic eyes was 0.74 +/- 0.4 LogMAR and after treatment, BCVA was 0.41 +/- 0.33 LogMAR. Seven (43.75%) patients were treated successfully whereas nine (56.25%) patients were not. No significant association was found between presenting age (p-value 0.92) (95% CI -3.59 to 3.72), cause of amblyopia (p-value 0.22) (95% CI -0.74 to 0.07), degree of refractive error (p-value 0.71) (95% CI -8.27 to 0.68) and treatment outcome. Refractive amblyopia was the major cause of amblyopia in our clinic. Combined refractive correction and patching were the effective treatments of choice. Early diagnosis and prompt initiation of treatments will help achieve the optimal therapeutic outcome.
Full Text Available Resuscitation plans (RP are an important clinical indicator relating to care at the end of life in paediatrics. A retrospective review of the medical records of children who had been referred to the Royal Children’s Hospital, Brisbane, Australia who died in the calendar year 2011 was performed. Of 62 records available, 40 patients (65% had a life limiting condition and 43 medical records (69% contained a documented RP. This study demonstrated that both the underlying condition (life-limiting or life-threatening and the setting of care (Pediatric Intensive Care Unit or home influenced the development of resuscitation plans. Patients referred to the paediatric palliative care (PPC service had a significantly longer time interval from documentation of a resuscitation plan to death and were more likely to die at home. All of the patients who died in the paediatric intensive care unit (PICU had a RP that was documented within the last 48 h of life. Most RPs were not easy to locate. Documentation of discussions related to resuscitation planning should accommodate patient and family centered care based on individual needs. With varied diagnoses and settings of care, it is important that there is inter-professional collaboration, particularly involving PICU and PPC services, in developing protocols of how to manage this difficult but inevitable clinical scenario.
Ahmad Hatib, Nur Adila; Chong, Chia Yin; Thoon, Koh Cheng; Tee, Nancy Ws; Krishnamoorthy, Subramania S; Tan, Natalie Wh
Enteric fever is a multisystemic infection which largely affects children. This study aimed to analyse the epidemiology, clinical presentation, treatment and outcome of paediatric enteric fever in Singapore. A retrospective review of children diagnosed with enteric fever in a tertiary paediatric hospital in Singapore was conducted from January 2006 to January 2012. Patients with positive blood cultures for Salmonella typhi or paratyphi were identified from the microbiology laboratory information system. Data was extracted from their case records. Of 50 enteric fever cases, 86% were due to Salmonella typhi, with 16.3% being multidrug resistant (MDR) strains. Sixty-two percent of S. typhi isolates were of decreased ciprofloxacin susceptibility (DCS). Five cases were both MDR and DCS. The remaining 14% were Salmonella paratyphi A. There were only 3 indigenous cases. Ninety-four percent had travelled to typhoid-endemic countries, 70.2% to the Indian subcontinent and the rest to Indonesia and Malaysia. All patients infected with MDR strains had travelled to the Indian subcontinent. Anaemia was a significant finding in children with typhoid, as compared to paratyphoid fever (P = 0.04). Although all children were previously well, 14% suffered severe complications including shock, pericardial effusion and enterocolitis. None had typhoid vaccination prior to their travel to developing countries. Enteric fever is largely an imported disease in Singapore and has contributed to significant morbidity in children. The use of typhoid vaccine, as well as education on food and water hygiene to children travelling to developing countries, needs to be emphasised.
Liu, I-Ting; Kao, Shu-Ching; Wang, An-Guor; Tsai, Chieh-Chih; Liang, Chih-Kai; Hsu, Wen-Ming
Preseptal and orbital cellulitis range in severity from minor to potentially severe complications. The purpose of this study is to describe the clinical features of patients with preseptal or orbital cellulitis in one medical center in Taiwan, and to assess the effectiveness of treatments and the complications. Patients admitted between 1996 and 2005 to Taipei Veterans General Hospital under the diagnosis of preseptal or orbital cellulitis were retrospectively reviewed. The demographics, administrative history, past history, clinical presentations, treatments, and complications were analyzed. In total, 94 patients fulfilling the diagnostic criteria for preseptal or orbital cellulitis were identified (67 had preseptal cellulitis, 27 had orbital cellulitis). While paranasal sinus disease was the most common predisposing cause in orbital cases, skin lesions in children and dacryocystitis in adults were the most common in preseptal cases. Microbiologic investigations showed variable results, but the most common pathogen isolated was Staphylococcus aureus. Cultures from eye swabs and local abscesses gave the highest positive yield. Blood cultures were taken in some patients, but the positive rate was extremely low. Treatments included intravenous antibiotics alone, or intravenous antibiotics combined with surgical drainage. Only one case had permanent ocular motility impairment after removal of the orbital foreign body. Despite the past history of potential morbidity and even mortality from orbital cellulitis, early diagnosis and prompt treatment with proper antibiotics and/or surgical intervention can achieve a good prognosis.
Gutiérrez Valencia, M; Martínez Velilla, N; Lacalle Fabo, E; Beobide Telleria, I; Larrayoz Sola, B; Tosato, M
To summarise the evidence on interventions aimed at optimising the drug treatment of hospitalised elderly patients. We conducted a search in the main medical literature databases, selecting prospective studies of hospitalised patients older than 65 years who underwent interventions aimed at optimising drug treatment, decreasing polypharmacy and improving the medication appropriateness, health outcomes and exploitation of the healthcare system. We selected 18 studies whose interventions consisted of medication reviews, detection of predefined drugs as potentially inappropriate for the elderly, counselling from a specialised geriatric team, the use of a computer support system for prescriptions and specific training for the nursing team. Up to 14 studies assessed the medication appropriateness, 13 of which showed an improvement in one or more of the parameters. Seven studies measured the impact of the intervention on polypharmacy, but only one improved the outcomes compared with the control. Seven other studies analysed mortality, but none of them showed a reduction in that rate. Only 1 of 6 studies showed a reduction in the number of hospital readmissions, and 1 of 4 studies showed a reduction in the number of emergency department visits. Despite the heterogeneity of the analysed interventions and variables, we obtained better results in the process variables (especially in medication appropriateness) than in those that measured health outcomes, which had greater variability. Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.
Abdul-Warith Olaitan Akinshipo
Full Text Available Context: Head and neck cancers (HNCs display variable biological and geographical variations even within the same country. Aims: This study aims to determine the histopathologic pattern of HNCs in three Northwestern states of Kebbi, Sokoto, and Zamfara in Nigeria. Settings and Design: This was an hospital-based descriptive retrospective study carried out at Federal Medical Centre, Birnin Kebbi; Federal Medical Centre, Gusau; and Usmanu Danfodio Teaching Hospital, Sokoto. Subjects and Methods: Medical and histopathologic records of all HNCs seen at these centers between January 2006 and December 2013, were reviewed, and data on time of presentation, sociodemographic, anatomic site, and histology were collected and analyzed using the Statistical Package for the Social Sciences (version 20 (SPSS Inc., Chicago, IL, USA statistical software. Quantitative data were summarized using simple descriptive statistics of means and standard deviation (SD. Chi-square tests were used to analyze the nonparametric variables. Statistical significance was inferred at P ≤ 0.05. Results: Three hundred and eighty-one malignant HNCs were seen over a period of 8 years with an annual frequency of 47 cases. There was a male to female ratio of 1.2:1, and the mean age was 39.5 ± 19.2 (±SD. About 70.3% of cases were carcinomas, 15.0% were sarcomas, and 8.7% were lymphomas. Squamous cell carcinoma (34.9% was the highest carcinomas while non-Hodgkin's lymphomas (6.6% and rhabdomyosarcoma (4.2% were the most common lymphomas and sarcomas observed, respectively. The most common sites were those of the lips, oral cavity, and pharynx International Statistical Classification of Diseases-10 (C00–C14. Conclusions: This present study demonstrates the rising trend of HNCs in these regions and highlights the urgent need for adoption of grass root policies that would incorporate public participation especially those under 40 years, in the awareness on the harmful use of
There is a literature base about the care of children in hospital in developed nations, but little from, or about, developing countries. The aim of this review was to critically examine publications relating to the effect of hospitalization on children and their parents. 'Parents', in this context, were considered as the child's natural or adoptive parents, step-parents or any other context of parent-child relationship, in other words, the primary care-giver to the child. Most of the work reviewed from developed countries was sourced from the nursing literature, while in developing countries, the available literature was largely from medicine. Conclusions from developed countries indicated that parents should be allowed to stay in hospital with their child, and that care must be developmental-stage appropriate. Furthermore, staff need to be educated about special needs of children, children should be prepared for hospital admission (if possible) and parents' needs met. In developing countries, the meagre literature available suggested that recognition of the important role parents play in a child's hospitalization is starting to become recognized.
Abraham, S B; Rubino, D; Sinaii, N; Ramsey, S; Nieman, L K
Circulating cortisol and psychosocial stress may contribute to the pathogenesis of obesity and metabolic syndrome (MS). To evaluate these relationships, a cross-sectional study of 369 overweight and obese subjects and 60 healthy volunteers was performed and reviewed the previous literature. Overweight and obese subjects had at least two other features of Cushing's syndrome. They underwent measurements representing cortisol dynamics (24 h urine cortisol excretion (UFC), bedtime salivary cortisol, 1 mg dexamethasone suppression test) and metabolic parameters (BMI, blood pressure (BP); fasting serum triglycerides, HDL, insulin, and glucose). Subjects also completed the Perceived Stress Scale (PSS). UFC, salivary cortisol, and weight from 60 healthy volunteers were analyzed. No subject had Cushing's syndrome. UFC and dexamethasone responses were not associated with BMI or weight. However, salivary cortisol showed a trend to increase as BMI increased (P < 0.0001), and correlated with waist circumference (WC) in men (rs = 0.28, P = 0.02) and systolic BP in women (rs = 0.24, P = 0.0008). Post-dexamethasone cortisol levels were weak to moderately correlated with fasting insulin (rs = -0.31, P = 0.01) and HOMA-IR (rs = -0.31, P = 0.01) in men and systolic (rs = 0.18, P = 0.02) and diastolic BP (rs = 0.20, P = 0.009) in women. PSS results were higher in obese subjects than controls, but were not associated with cortisol or metabolic parameters. As expected, WC correlated with fasting insulin, HOMA-IR, and systolic BP (adjusted for BMI and gender; P < 0.01). Literature showed inconsistent relationships between cortisol and metabolic parameters. Taken together, these data do not support a strong relationship between systemic cortisol or stress and obesity or MS. Copyright © 2013 The Obesity Society.
Morihisa, Robert; Eskew, Jared; McNamara, Anna; Young, Jodi
Trigger points, which have been defined as highly localized, hyperirritable locations in a palpable taut band of skeletal muscle fibers, have been identified with a variety of musculoskeletal conditions. The incidence of trigger point pain is high, with studies showing them as the primary source of pain in 30-85% of patients presenting in a primary care setting or pain clinic. Dry needling has emerged as a possible intervention for trigger points, but its effectiveness has not yet fully been determined. To assess and provide a summary on the current literature for the use of dry needling as an intervention for lower quarter trigger points in patients with various orthopedic conditions. Systematic review. CINAHL, NCBI-PubMed, PEDro, SPORTDiscus, Cochrane Library, and APTA's PTNow were searched to identify relevant randomized controlled trials. Six studies meeting the inclusion criteria were analyzed using the PEDro scale. Four of the studies assessed by the PEDro scale were deemed 'high' quality and two were 'fair' quality. Each of the six included studies reported statistically significant improvements with dry needling for the reduction of pain intensity in the short-term. Only one study reported a statistically significant improvement in short-term functional outcomes; however, there was no maintenance of improved function at long-term follow-up. Furthermore, none of the studies reported statistically significant changes regarding the effect of dry needling on quality of life, depression, range of motion, or strength. A review of current literature suggests that dry needling is effective in reducing pain associated with lower quarter trigger points in the short-term. However, the findings suggest that dry needling does not have a positive effect on function, quality of life, depression, range of motion, or strength. Further high quality research with long-term follow-up investigating the effect of dry needling in comparison to and in conjunction with other
Castle, Nicholas G; Brown, Julie; Hepner, Kimberly A; Hays, Ron D
Objective To review the existing literature (1980–2003) on survey instruments used to collect data on patients' perceptions of hospital care. Study Design Eight literature databases were searched (PubMED, MEDLINE Pro, MEDSCAPE, MEDLINEplus, MDX Health, CINAHL, ERIC, and JSTOR). We undertook 51 searches with each of the eight databases, for a total of 408 searches. The abstracts for each of the identified publications were examined to determine their applicability for review. Methods of Analysis For each instrument used to collect information on patient perceptions of hospital care we provide descriptive information, instrument content, implementation characteristics, and psychometric performance characteristics. Principal Findings The number of institutional settings and patients used in evaluating patient perceptions of hospital care varied greatly. The majority of survey instruments were administered by mail. Response rates varied widely from very low to relatively high. Most studies provided limited information on the psychometric properties of the instruments. Conclusions Our review reveals a diversity of survey instruments used in assessing patient perceptions of hospital care. We conclude that it would be beneficial to use a standardized survey instrument, along with standardization of the sampling, administration protocol, and mode of administration. PMID:16316435
van Sluis, Klaske E; van der Molen, Lisette; van Son, Rob J J H; Hilgers, Frans J M; Bhairosing, Patrick A; van den Brekel, Michiel W M
Esophageal speech (ES), tracheoesophageal speech (TES) and/or electrolarynx speech (ELS) are three speech rehabilitation methods which are commonly provided after total laryngectomy (TL). A systematic review of the literature was conducted to evaluate comparative acoustic, perceptual, and patient-reported outcomes for ES, TES, ELS and healthy speakers. Twenty-six articles could be included. In most studies, methodological quality was low. It is likely that an inclusion bias exists, many studies only included exceptional speakers. Significant better outcomes are reported for TES compared to ES for the acoustic parameters, fundamental frequency, maximum phonation time and intensity. Perceptually, TES is rated with a significant better voice quality and intelligibility than ES and ELS. None of the speech rehabilitation groups reported clearly better outcomes in patient-reported outcomes. Studies on speech outcomes after TL are flawed in design and represent weak levels of evidence. There is an urge for standardized measurement tools for evaluations of substitute voice speakers. TES is the favorable speech rehabilitation method according to acoustic and perceptual outcomes. All speaker groups after TL report a degree of voice handicap. Knowledge of caretakers and differences in health care and insurance systems play a role in the speech rehabilitation options that can be offered.
Keers, Richard N; Williams, Steven D; Cooke, Jonathan; Ashcroft, Darren M
Underlying systems factors have been seen to be crucial contributors to the occurrence of medication errors. By understanding the causes of these errors, the most appropriate interventions can be designed and implemented to minimise their occurrence. This study aimed to systematically review and appraise empirical evidence relating to the causes of medication administration errors (MAEs) in hospital settings. Nine electronic databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts, ASSIA, PsycINFO, British Nursing Index, CINAHL, Health Management Information Consortium and Social Science Citations Index) were searched between 1985 and May 2013. Inclusion and exclusion criteria were applied to identify eligible publications through title analysis followed by abstract and then full text examination. English language publications reporting empirical data on causes of MAEs were included. Reference lists of included articles and relevant review papers were hand searched for additional studies. Studies were excluded if they did not report data on specific MAEs, used accounts from individuals not directly involved in the MAE concerned or were presented as conference abstracts with insufficient detail. A total of 54 unique studies were included. Causes of MAEs were categorised according to Reason's model of accident causation. Studies were assessed to determine relevance to the research question and how likely the results were to reflect the potential underlying causes of MAEs based on the method(s) used. Slips and lapses were the most commonly reported unsafe acts, followed by knowledge-based mistakes and deliberate violations. Error-provoking conditions influencing administration errors included inadequate written communication (prescriptions, documentation, transcription), problems with medicines supply and storage (pharmacy dispensing errors and ward stock management), high perceived workload, problems with ward-based equipment (access, functionality
Aluísio Henrique Rodrigues Lima
Full Text Available The objective of this study was to systematically review the literature on blood pressure response after strength training in hypertensive subjects, trying to identify the effect of failure in this response. We performed a literature search in SciELO, LILACS, PubMed / MedLine databases. Out of 9377 studies, only six met the inclusion criteria and were included in the review. Five studies (83.3% reported a reduction in systolic or diastolic blood pressure. Regarding failure, 66.7% (n = 4 of the studies performed the sets until failure while 33.3% (n = 2 interrupted exercise before failure. Out of the four studies that used protocols until failure, 75% (n=3 observed a reduction in blood pressure, and the two studies who discontinued before the series also showed a reduction of failure. The magnitude of blood pressure reduction was similar among studies that employed both protocols. Thus, the results indicated that the reduction in blood pressure after strength training in subjects with hypertension is independent of the occurrence of failure.
Millar, Ross; Mannion, Russell; Freeman, Tim; Davies, Huw T O
Recurring problems with patient safety have led to a growing interest in helping hospitals' governing bodies provide more effective oversight of the quality and safety of their services. National directives and initiatives emphasize the importance of action by boards, but the empirical basis for informing effective hospital board oversight has yet to receive full and careful review. This article presents a narrative review of empirical research to inform the debate about hospital boards' oversight of quality and patient safety. A systematic and comprehensive search identified 122 papers for detailed review. Much of the empirical work appeared in the last ten years, is from the United States, and employs cross-sectional survey methods. Recent empirical studies linking board composition and processes with patient outcomes have found clear differences between high- and low-performing hospitals, highlighting the importance of strong and committed leadership that prioritizes quality and safety and sets clear and measurable goals for improvement. Effective oversight is also associated with well-informed and skilled board members. External factors (such as regulatory regimes and the publication of performance data) might also have a role in influencing boards, but detailed empirical work on these is scant. Health policy debates recognize the important role of hospital boards in overseeing patient quality and safety, and a growing body of empirical research has sought to elucidate that role. This review finds a number of areas of guidance that have some empirical support, but it also exposes the relatively inchoate nature of the field. Greater theoretical and methodological development is required if we are to secure more evidence-informed governance systems and practices that can contribute to safer care. © 2013 Milbank Memorial Fund.
Longacre, Margaret L; Wong, Yu-Ning; Fang, Carolyn Y
This integrative review involved studies conducted in the United States that assessed hospitalizations of older adults receiving family care and the psychological health of their family caregivers. The primary objectives were to (a) summarize findings between caregiver psychological health and older care recipient hospitalizations, and (b) describe how caregiver psychological health has been measured with regard to older care recipient hospitalizations. Online databases were searched for articles assessing caregiver psychological health (e.g., burden, strain, depressive or anxious symptoms) and older care recipient hospitalizations in the United States. According to the findings, few studies in the United States have assessed hospitalization characteristics of older care recipients and the psychological health of their family caregivers. All analyses incorporated a measure of depression; however, the measurement of other psychological health constructs (e.g., anxious symptoms, perceived burden) was limited or absent. Findings note the potential importance of focusing on readmission rates in light of caregiver psychological health. Findings also note the benefit of caregiver emotional and instrumental support toward reducing hospitalizations among older adults receiving family care. Copyright 2014, SLACK Incorporated.
Full Text Available Abstract Background Drug utilization review (DUR programs are being conducted in Canadian hospitals with the aim of improving the appropriateness of prescriptions. However, there is little evidence of their effectiveness. The objective of this study was to assess the impact of both a retrospective and a concurrent DUR programs on the quality of in-hospital prescribing. Methods We conducted an interrupted time series quasi-experimental study. Using explicit criteria for quality of prescribing, the natural history of cisapride prescription was established retrospectively in three university-affiliated hospitals. A retrospective DUR was implemented in one of the hospitals, a concurrent DUR in another, whereas the third hospital served as a control. An archivist abstracted records of all patients who were prescribed cisapride during the observation period. The effect of DURs relative to the control hospital was determined by comparing estimated regression coefficients from the time series models and by testing the statistical significance using a 2-tailed Student's t test. Results The concurrent DUR program significantly improved the appropriateness of prescriptions for the indication for use whereas the retrospective DUR brought about no significant effect on the quality of prescribing. Conclusion Results suggest a retrospective DUR approach may not be sufficient to improve the quality of prescribing. However, a concurrent DUR strategy, with direct feedback to prescribers seems effective and should be tested in other settings with other drugs.
Mousazadeh, Yalda; Jannati, Ali; Jabbari Beiramy, Hossein; AsghariJafarabadi, Mohammad; Ebadi, Ali
Background: Hospitals as key actors in health systems face growing pressures especially cost cutting and search for costeffective ways to resources management. Downsizing is one of these ways. This study was conducted to identify advantages and disadvantages of different methods of hospital' downsizing. Methods:The search was conducted in databases of Medlib, SID, Pub Med, Science Direct and Google Scholar Meta search engine by keywords of Downsizing, Hospital Downsizing, Hospital Rightsizing, Hospital Restructuring, Staff Downsizing, Hospital Merging, Hospital Reorganization and the Persian equivalents. Resulted 815 articles were studied and refined step by step. Finally, 27 articles were selected for analysis. Results: Five hospital downsizing methods were identified during searching. These methods were reducing the number of employees and beds, outsourcing, integration of hospital units, and the combination of these methods. The most important benefits were cost reduction, increasing patient satisfaction, increasing home care and outpatient services. The most important disadvantage included reducing access, reducing the rate of hospital admissions and increasing employees’ workload and dissatisfaction. Conclusion: Each downsizing method has strengths and weaknesses. Using different methods of downsizing, according to circumstances and applying appropriate interventions after implementation, is necessary for promotion. PMID:24688978
Full Text Available Background:Hospitals as key actors in health systems face growing pressures especially cost cutting and search for cost-effective ways to resources management. Downsizing is one of these ways. This study was conducted to identify advantages and disadvantages of different methods of hospital' downsizing. Methods: The search was conducted in databases of Medlib, SID, Pub Med, Science Direct and Google Scholar Meta search engine by keywords of Downsizing, Hospital Downsizing, Hospital Rightsizing, Hospital Restructuring, Staff Downsizing, Hospital Merging, Hospital Reorganization and the Persian equivalents. Resulted 815 articles were studied and refined step by step. Finally, 27 articles were selected for analysis. Results: Five hospital downsizing methods were identified during searching. These methods were reducing the number of employees and beds, outsourcing, integration of hospital units, and the combination of these methods. The most important benefits were cost reduction, increasing patient satisfaction, increasing home care and outpatient services. The most important disadvantage included reducing access, reducing the rate of hospital admissions and increasing employees’ workload and dissatisfaction. Conclusion: Each downsizing method has strengths and weaknesses. Using different methods of downsizing, according to circumstances and applying appropriate interventions after implementation, is necessary for promotion.
Mousazadeh, Yalda; Jannati, Ali; Jabbari Beiramy, Hossein; Asgharijafarabadi, Mohammad; Ebadi, Ali
Hospitals as key actors in health systems face growing pres-sures especially cost cutting and search for costeffective ways to resources management. Downsizing is one of these ways. This study was conducted to identify advantages and disadvantages of different methods of hospital' downsizing. The search was conducted in databases of Medlib, SID, Pub Med, Science Direct and Google Scholar Meta search engine by keywords of Downsizing, Hospital Downsizing, Hospital Rightsizing, Hospital Restructuring, Staff Downsizing, Hospital Merging, Hospital Reorganization and the Persian equivalents. Resulted 815 articles were studied and refined step by step. Finally, 27 articles were selected for analysis. Five hospital downsizing methods were identified during searching. These methods were reducing the number of employees and beds, outsourcing, integration of hospital units, and the combination of these methods. The most important benefits were cost reduction, increasing patient satisfaction, increasing home care and outpatient services. The most important disadvantage included reducing access, reducing the rate of hospital admissions and increasing employees' workload and dissatisfaction. Each downsizing method has strengths and weaknesses. Using different methods of downsizing, according to circumstances and applying appropriate interventions after implementation, is necessary for promotion.
Battleday, R M; Brem, A-K
Modafinil is an FDA-approved eugeroic that directly increases cortical catecholamine levels, indirectly upregulates cerebral serotonin, glutamate, orexin, and histamine levels, and indirectly decreases cerebral gamma-amino-butrytic acid levels. In addition to its approved use treating excessive somnolence, modafinil is thought to be used widely off-prescription for cognitive enhancement. However, despite this popularity, there has been little consensus on the extent and nature of the cognitive effects of modafinil in healthy, non-sleep-deprived humans. This problem is compounded by methodological discrepancies within the literature, and reliance on psychometric tests designed to detect cognitive effects in ill rather than healthy populations. In order to provide an up-to-date systematic evaluation that addresses these concerns, we searched MEDLINE with the terms "modafinil" and "cognitive", and reviewed all resultant primary studies in English from January 1990 until December 2014 investigating the cognitive actions of modafinil in healthy non-sleep-deprived humans. We found that whilst most studies employing basic testing paradigms show that modafinil intake enhances executive function, only half show improvements in attention and learning and memory, and a few even report impairments in divergent creative thinking. In contrast, when more complex assessments are used, modafinil appears to consistently engender enhancement of attention, executive functions, and learning. Importantly, we did not observe any preponderances for side effects or mood changes. Finally, in light of the methodological discrepancies encountered within this literature, we conclude with a series of recommendations on how to optimally detect valid, robust, and consistent effects in healthy populations that should aid future assessment of neuroenhancement. Copyright © 2015 Elsevier B.V. and ECNP. All rights reserved.
Benson, Sarah; Verster, Joris C; Alford, Chris; Scholey, Andrew
It has been suggested that mixing alcohol with energy drinks or other caffeinated beverages may alter the awareness of (or 'mask') intoxication. The proposed reduction in subjective intoxication may have serious consequences by increasing the likelihood of engaging in potentially dangerous activities while intoxicated. A literature search was conducted to collect all studies measuring subjective intoxication after administration of alcohol with energy drinks, or with other caffeinated alcoholic drinks compared with alcohol alone. The studies were critically reviewed and, where possible, included in a meta-analysis in order to determine whether masking exists after mixing alcohol with caffeinated beverages. Sixteen articles were identified, of which nine could be used for the meta-analysis. When including the higher caffeine dose studies, the meta-analysis revealed no significant masking effect (p=0.404). Similarly, when including the lower caffeine dose studies, no significant masking effect was found (p=0.406). Despite the large range of caffeine doses (2.0-5.5 mg/kg resulting in absolute levels of 46-383 mg) and alcohol levels 0.29-1.068 g/kg (resulting in blood alcohol concentration (BAC) from 0.032 to 0.12%) investigated, caffeine had no effect on the judgement of subjective intoxication. Copyright © 2014 Elsevier Ltd. All rights reserved.
Madhusudhan A/L Paramananda
Full Text Available AIM: To identify the aetiology of open globe injuries at Hospital Universiti Sains Malaysia over a period of 10y and the prognostic factors for visual outcome.METHODS:Retrospective review of medical records of open globe injury cases that presented from January 2000 to December 2009. Classification of open globe injury was based on the Birmingham Eye Trauma Terminology (BETT. Records were obtained with hospital permission via the in-house electronic patient management system, and the case notes of all patients with a diagnosis of open globe injury were scrutinised. Patients with prior ocular trauma, pre-existing ocular conditions affecting the visual acuity, contrast sensitivity, central vision or corneal thickness, as well as those with a history of previous intraocular or refractive surgery were excluded. Analysis of data was with SPSS version 20.0. Ordinal logistic regression analysis was used to examine the association between prognostic factors and visual outcome.RESULTS: This study involved 220 patients (n=222 eyes. The most common place of injury was the home (51.8%, followed by the workplace (23.4%. Among children aged less than 16y of age, domestic-related injury was the predominant cause (54.6%, while in those aged 16y and above, occupational injuries were the most common cause (40.0%. Most eyes (76.5% had an initial visual acuity worse than 3/60, and in half of these, the visual acuity improved. The visual outcome was found to be significantly associated with the initial visual acuity (P<0.005, posterior extent of wound (P<0.001, length of wound (P<0.001, presence of hyphaema (P<0.001 and presence of vitreous prolapse ((P<0.005.CONCLUSION:The most common causes of open globe injury are domestic accidents and occupational injuries. Significant prognostic factors for final visual outcome in patients with open globe injury are initial visual acuity, posterior extent and length of wound, presence of hyphaema and presence of vitreous
Keers, Richard N; Williams, Steven D; Cooke, Jonathan; Walsh, Tanya; Ashcroft, Darren M
There is a need to identify effective interventions to minimize the threat posed by medication administration errors (MAEs). Our objective was to review and critically appraise interventions designed to reduce MAEs in the hospital setting. Ten electronic databases were searched between 1985 and November 2013. Randomized controlled trials (RCTs) and controlled trials (CTs) reporting rates of MAEs or related adverse drug events between an intervention group and a comparator group were included. Data from each study were independently extracted and assessed for potential risk of bias by two authors. Risk ratios (RRs, with 95 % confidence intervals [CIs]) were used to examine the effect of an intervention. Six RCTs and seven CTs were included. Types of interventions clustered around four main themes: medication use technology (n = 4); nurse education and training (n = 3); changing practice in anesthesia (n = 2); and ward system changes (n = 4). Reductions in MAE rates were reported by five studies; these included automated drug dispensing (RR 0.72, 95 % CI 0.53-1.00), computerized physician order entry (RR 0.51, 95 % 0.40-0.66), barcode-assisted medication administration with electronic administration records (RR 0.71, 95 % CI 0.53-0.95), nursing education/training using simulation (RR 0.17, 95 % CI 0.08-0.38), and clinical pharmacist-led training (RR 0.76, 95 % CI 0.67-0.87). Increased or equivocal outcome rates were found for the remaining studies. Weaknesses in the internal or external validity were apparent for most included studies. Theses and conference proceedings were excluded and data produced outside commercial publishing were not searched. There is emerging evidence of the impact of specific interventions to reduce MAEs in hospitals, which warrant further investigation using rigorous and standardized study designs. Theory-driven efforts to understand the underlying causes of MAEs may lead to more effective interventions in the future.
Rampatige, Rasika; Mikkelsen, Lene; Hernandez, Bernardo; Riley, Ian; Lopez, Alan D
To systematically review the reliability of hospital data on cause of death and encourage periodic reviews of these data using a standard method. We searched Google Scholar, Pubmed and Biblioteca Virtual de la Salud for articles in English, Spanish and Portuguese that reported validation studies of data on cause of death. We analysed the results of 199 studies that had used medical record reviews to validate the cause of death reported on death certificates or by the vital registration system. The screened studies had been published between 1983 and 2013 and their results had been reported in English (n = 124), Portuguese (n = 25) or Spanish (n = 50). Only 29 of the studies met our inclusion criteria. Of these, 13 had examined cause of death patterns at the population level - with a view to correcting cause-specific mortality fractions - while the other 16 had been undertaken to identify discrepancies in the diagnosis for specific diseases before and after medical record review. Most of the selected studies reported substantial misdiagnosis of causes of death in hospitals. There was wide variation in study methodologies. Many studies did not describe the methods used in sufficient detail to be able to assess the reproducibility or comparability of their results. The assumption that causes of death are being accurately reported in hospitals is unfounded. To improve the reliability and usefulness of reported causes of death, national governments should do periodic medical record reviews to validate the quality of their hospital cause of death data, using a standard.
Parkinson, John; Tsasis, Peter; Porporato, Marcela
For Ontario hospitals in Canada, the Financial Performance and Condition measures in the Ontario hospital balanced scorecard are especially of interest since in the foreseeable future, they may be linked to provincial government funding decisions. However, we find that these measures lack valuable information on key attributes that affect organizational performance. We suggest changes that focus on key drivers of performance and reflect the operational realities of Ontario hospitals.
Sive, Jonathan; Ardeshna, Kirit M; Cheesman, Simon; le Grange, Franel; Morris, Stephen; Nicholas, Claire; Peggs, Karl; Statham, Paula; Goldstone, Anthony H
Since 2005, University College London Hospital (UCLH) has operated a hotel-based Ambulatory Care Unit (ACU) for hematology and oncology patients requiring intensive chemotherapy regimens and hematopoietic stem cell transplants. Between January 2005 and 2011 there were 1443 patient episodes, totaling 9126 patient days, with increasing use over the 6-year period. These were predominantly for hematological malignancy (82%) and sarcoma (17%). Median length of stay was 5 days (range 1-42), varying according to treatment. Clinical review and treatment was provided in the ACU, with patients staying in a local hotel at the hospital's expense. Admission to the inpatient ward was arranged as required, and there was close liaison with the inpatient team to preempt emergency admissions. Of the 523 unscheduled admissions, 87% occurred during working hours. An ACU/hotel-based treatment model can be safely used for a wide variety of cancers and treatments, expanding hospital treatment capacity, and freeing up inpatient beds for those patients requiring them.
Pai, Yogesh P; Chary, Satyanarayana T
The purpose of this paper is to review the service quality dimensions established in various studies conducted across the world specifically applied to health care. Studies conducted on quality of care selected from literature databases - Ebsco, Emerald Insight, ABI/Inform - was subjected to a comprehensive in-depth content analysis. Service quality has been extensively studied with considerable efforts taken to develop survey instruments for measuring purposes. The number of dimensional structure varies across the studies. Self-administered questionnaire dominates in terms of mode of administration adopted in the studies, with respondents ranging from 18 to 85 years. Target sample size ranged from 84-2,000 respondents in self-administered questionnaires and for mail administration ranged from 300-2,600 respondents. Studies vary in terms of the scores used ranging from four to ten-point scale. A total of 27 of the studies have used EFA, 11 studies have used structural equation modelling and eight studies used gap scores. Cronbach's alpha is the most commonly used measure of scale reliability. There is variation in terms of measuring the content, criteria and construct validation among the studies. The literature offers dimensions used in assessing patient perceived service quality. The review reveals diversity and a plethora of dimensions and methodology to develop the construct discussed. The reported study describes and contrasts a large number of service-quality measurement constructs and highlights the usage of dimensions. The findings are valuable to academics in terms of dimensions and methodology used, approach for analysis; whereas findings are of value to practitioners in terms of the dimensions found in the research and to identify the gap in their setting.
Jusela, Cheryl; Struble, Laura; Gallagher, Nancy Ambrose; Redman, Richard W; Ziemba, Rosemary A
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review" found on pages 19-28, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 29, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Discuss problematic barriers during care transitions
Chen, L L; Liu, Y L
The aims of this study were to (1) examine the presence of nursing information on 50 hospital websites across five countries; (2) describe the accessibility, range and depth of nursing information provided; and (3) compare the characteristics of nursing web information across the countries. Providing information on hospital website is an increasingly popular strategy for marketing hospital services, and it has been playing unique and important roles for nursing. So far, the nursing information offered via hospital websites is not uncommon worldwide, but the amount, content and form of such information presented by the institutions of different countries have not been examined systematically. Objective sampling was employed to select 50 top hospital websites from five countries, with ten for each geographical region, namely, Australia (Oceania), China (Asia), South Africa (Africa), UK (Europe) and the USA (North America). A self-developed checklist was used to examine the presence of nursing information on the above-mentioned hospital websites. The most frequently presented information on the hospital websites was nursing employment (job placement), nursing education, and news and events concerning the nursing profession, but information about other aspects of nursing was relatively lacking. The hospital websites in the USA and Australia provided more information as compared with those in China and the UK. Nursing information was almost unavailable on hospital websites in South Africa. Although the accessibility of nursing-related information has been improved, the presence of nursing information was not strong on the hospital websites across the five countries. The nursing information presented on hospital websites varied with different countries. Efforts have to be made to improve the presence and accessibility of nursing information. Information about the nursing services, professional image of nurses and nursing employment should be enhanced.
Dang, Gregory T T; Barros, Nirmalla; Higgins, Sheila A; Langley, Ricky L; Lipton, David
Asbestosis and silicosis are debilitating pulmonary conditions resulting from inhalation of asbestos fibers or silica dust. We provide a descriptive analysis of asbestosis and silicosis hospitalizations in North Carolina to assess trends over a 10-year period. Events were defined as inpatient hospital discharges during the period 2002-2011 with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of 501 or 502. Using statewide discharge data for 2002-2011, we calculated asbestosis and silicosis hospitalization rates in North Carolina (by demographics, hospital length of stay, cost, and payment type) and compared them with national rates. In North Carolina, average annual age-standardized hospitalization rates for asbestosis and silicosis were 71.2 hospitalizations per 1 million residents and 6.2 hospitalizations per 1 million residents, respectively. Rates for asbestosis and silicosis decreased significantly (less than .01 for both conditions) between 2002 and 2011, by 46% and 67%, respectively. Men had significantly higher rates than women (less than .01), more than half of hospitalizations were among persons aged 65-84 years, and Medicare was the predominant payment source. The highest silicosis rates by county were clustered in Western North Carolina; no geographic patterns were observed for asbestosis. The estimated average annual cost statewide for these hospitalizations was $10,170,417 for asbestosis and $886,143 for silicosis. ICD-9-CM misclassification and duplicate hospitalization records may have biased the observed rates of asbestosis and silicosis. Decreases in hospitalization rates in North Carolina may be due to misdiagnosis, underreporting, or the declining use of asbestos in industries. Obtaining complete exposure histories at diagnosis is useful for continued public health surveillance.
Marilza Vieira Cunha Rudge
Full Text Available CONTEXT AND OBJECTIVE: Pregnancies complicated by diabetes are associated with increased neonatal and maternal complications. The most serious maternal complication is the risk of developing type 2 diabetes, 10-12 years after the delivery. For rigorous control over blood glucose, pregnant women are treated through ambulatory management or hospitalization. The aim of this study was to evaluate the effectiveness of ambulatory management versus hospitalization in pregnancies complicated by diabetes or hyperglycemia. DESIGN AND SETTING: Systematic review conducted in a public university hospital. METHODS: A systematic review of the literature was performed and the main electronic databases were searched. The date of the most recent search was September 4, 2011. Two authors independently selected relevant clinical trials, assessed their methodological quality and extracted data. RESULTS: Only three studies were selected, with small sample sizes. There was no statistically significance different between ambulatory management and hospitalization, regarding mortality in any of the subcategories analyzed: perinatal and neonatal deaths (relative risk [RR] 0.65; 95% confidential interval [CI]: 0.11 to 3.84; P = 0.63; neonatal deaths (RR 0.29; 95% CI: 0.01 to 6.07; P = 0.43; and infant deaths (RR 0.29; 95% CI: 0.01 to 6.07; P = 0.43. CONCLUSIONS: This review, based on studies with high or moderate risk of bias, showed that there was no statistically significant difference between ambulatory management and hospital care, regarding reduction of mortality rates in pregnancies complicated by diabetes or hyperglycemia. It also suggested that there is a need for further randomized controlled trials on this issue.
Psychodynamic-oriented psychological assessment predicts evolution to schizophrenia at 8-year follow-up in adolescents hospitalized for a manic/mixed episode: interest of an overall subjective rating.
Louët, Estelle; Consoli, Angèle; Lucanto, Raffaella; Duplant, Nicole; Bailly-Salin, Marie-José; Lemoigne, Annie; Martin, Michèle; Mayer, Charlotte; Thompson, Caroline; Gollier-Briant, Fanny; Laurent, Claudine; Brunelle, Julie; Bodeau, Nicolas; Cohen, David
Little is known concerning the prognostic significance of manic/mixed episodes in adolescents. In particular, whether the use of psychodynamic-oriented projective psychological testing predicts evolution to schizophrenia at follow-up has not been established. Eighty subjects, aged 12-20years old, consecutively hospitalized for a manic or mixed episode between 1994 and 2003 were recruited. All patients were contacted in 2005-2006 for a follow-up assessment. For the subgroup of adolescents (N=40) who had psychodynamic-oriented psychological testing (Rorschach and TAT), two scores regarding psychosocial risk and schizophrenia risk were computed using the clinical global impression (CGI) assessment based on an overall subjective rating given by a panel of expert psychologists who reviewed all protocols. At follow-up (average 8years), 25 (62.5%) patients, 16 females and nine males, were assessed: 14 still had a diagnosis of bipolar disorder; eight changed to schizo-affective disorder and three to schizophrenia. Inter-rater reliability of both CGI-risk scores (psychosocial risk and schizophrenia risk) showed good clinical consensus with intraclass correlation and Kappa scores ranging from 0.53 to 0.75. Univariate analysis showed that CGI-psychosocial risk score (p=0.017), type of index episode (p=0.049) and CGI-schizophrenia risk score (p=0.09) were associated with transition to schizophrenia spectrum disorder at follow-up. Age, sex, socioeconomic status, duration of stay and the presence of psychotic features at index episode were not associated with the transition. We conclude that the CGI assessment appears to be valid to score risk of poor outcome using psychodynamic-oriented psychological testing and that these scores may predict, in part, the transition to schizophrenia in adolescents with a history of manic/mixed episode. Copyright © 2010 Elsevier Ltd. All rights reserved.
Jakimowicz, Samantha; Stirling, Christine; Duddle, Maree
To systematically review the qualitative evidence on factors that affect the experience of patients attending nurse-led clinics and compare with key elements of person-centred care. As the number of nurse-led clinics increases in response to health system needs, evaluation has focused on clinical outcomes and cost. Patient experiences are less researched and yet, they are an important influence on clinical outcomes and an indicator of person-centred care. A detailed review of existing research in this area is needed. A systematic review of primary, qualitative literature was conducted using the Joanna Briggs Institute methodology of meta-aggregation. Published research from 1990-2012 was located using CINAHL, PubMed, Medline and PsycINFO. Reference lists were searched and analysed. Two reviewers assessed the papers for methodological quality using instruments from the Joanna Briggs Institute to critically appraise, extract data and meta-aggregate findings. Eleven studies met all inclusion criteria. Three meta-synthesis statements were derived from 46 findings aggregated to nine categories. The key themes relating to establishment of a therapeutic relationship, effective communication, and clinical skills and collaboration mapped closely to the person-centred care framework. Concepts central to person-centred care proved to be factors impacting patients' subjective experience. Further research is warranted to meet the challenge to transform the key concepts of the person-centred care model into everyday nursing practice. Knowledge of patients' feelings and the importance of person-centred, individualised care may contribute to development of future training and re-training programs in basic nursing skills. This is significant in that it contributes to future positive patient experience. © 2014 John Wiley & Sons Ltd.
Tei-Tominaga, Maki; Miki, Akiko; Fujimura, Kazumi
This study was performed to examine job stressors, job readiness, and subjective health status as factors associated with intentions to leave among newly graduated nurses (NGNs) in advanced treatment hospitals in Japan. From June to August 2007, anonymous self-administered questionnaires were distributed to all NGNs in nine advanced treatment hospitals. The questionnaire items addressed individual attributes, employment characteristics, organizational characteristics, the 22-item Job Content Questionnaire, a novel job readiness scale, and scales for subjective health status (cumulative fatigue and psychological distress) and intentions to leave. The response rate was 73% (n=414), and 377 completed questionnaire data sets from eight hospitals were analyzed. A hierarchical multiple regression analysis was performed to investigate the factors associated with intentions to leave and subjective health status. The results of hierarchical multiple regression analysis showed 55% of the variance in intentions to leave. "orientation as nurse", subjective health status influenced by psychological job demand, and "supervisor support" were important independent factors of intentions to leave. Psychological job demand and job readiness were also important factors of subjective health status. To intervene in early resignation of NGNs, job stressors should be minimized to improve subjective health status; while simultaneously raising job readiness.
Patricia Carvalho de Jesus
Full Text Available Abstract Objective To identify the impact of training in breastfeeding on knowledge, skills, and professional and hospital practices. Data source The systematic review search was carried out through the MEDLINE, Scopus, and LILACS databases. Reviews, studies with qualitative methodology, those without control group, those conducted in primary care, with specific populations, studies that had a belief and/or professional attitude as outcome, or those with focus on the post-discharge period were excluded. There was no limitation of period or language. The quality of the studies was assessed by the adapted criteria of Downs and Black. Summary of data The literature search identified 276 articles, of which 37 were selected for reading, 26 were excluded, and six were included through reference search. In total, 17 intervention articles were included, three of them with good internal validity. The studies were performed between 1992 and 2010 in countries from five continents; four of them were conducted in Brazil. The training target populations were nursing practitioners, doctors, midwives, and home visitors. Many kinds of training courses were applied. Five interventions employed the theoretical and practical training of the Baby-Friendly Hospital Initiative. All kinds of training courses showed at least one positive result on knowledge, skills, and/or professional/hospital practices, most of them with statistical significance. Conclusions Training of hospital health professionals has been effective in improving knowledge, skills, and practices.
de Jesus, Patricia Carvalho; de Oliveira, Maria Inês Couto; Fonseca, Sandra Costa
To identify the impact of training in breastfeeding on knowledge, skills, and professional and hospital practices. The systematic review search was carried out through the MEDLINE, Scopus, and LILACS databases. Reviews, studies with qualitative methodology, those without control group, those conducted in primary care, with specific populations, studies that had a belief and/or professional attitude as outcome, or those with focus on the post-discharge period were excluded. There was no limitation of period or language. The quality of the studies was assessed by the adapted criteria of Downs and Black. The literature search identified 276 articles, of which 37 were selected for reading, 26 were excluded, and six were included through reference search. In total, 17 intervention articles were included, three of them with good internal validity. The studies were performed between 1992 and 2010 in countries from five continents; four of them were conducted in Brazil. The training target populations were nursing practitioners, doctors, midwives, and home visitors. Many kinds of training courses were applied. Five interventions employed the theoretical and practical training of the Baby-Friendly Hospital Initiative. All kinds of training courses showed at least one positive result on knowledge, skills, and/or professional/hospital practices, most of them with statistical significance. Training of hospital health professionals has been effective in improving knowledge, skills, and practices. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
Wolters, R.J.; Braspenning, J.C.C.; Wensing, M.
High-quality primary care for diabetes patients may be related to lowered hospital admissions. A systematic search was performed to assess the impact of structure, process, and outcome of primary diabetes care on hospital admission rates, considering patient characteristics. Studies on diabetes
This study has identified that age-specific feeding of infants and young children is not recognised in state hospitals, due to the inadequate frequency of ... shortages coupled with the lack of support groups in facilities or at the community level have ... these hospitals were accredited as “mother and baby friendly”, implying that ...
The relevancy of program curricula in tourism and hospitality education has been called into question by key stakeholders in light of ongoing changes in the multifaceted tourism and hospitality industry. Various program models have been identified. Program content and quality of student preparedness have been debated. Balance and areas of emphasis…
Outpatient attendance and inpatient admission records were examined to assess malaria situation in ten hospitals in Mbeya and Iringa Regions in southern highlands of Tanzania for a period of fifteen years from 1986-2000. Generally, records were deficient, some hospitals with entire annual records missing for one or ...
Viereck, Søren; Møller, Thea Palsgaard; Rothman, Josephine Philip; Folke, Fredrik; Lippert, Freddy Knudsen
BACKGROUND: The medical dispatcher plays an essential role as part of the first link in the Chain of Survival, by recognising the out-of-hospital cardiac arrest (OHCA) during the emergency call, dispatching the appropriate first responder or emergency medical services response, performing dispatcher assisted cardiopulmonary resuscitation, and referring to the nearest automated external defibrillator. The objective of this systematic review was to evaluate and compare studies reporting recogni...
Full Text Available We reviewed the literature on interventions that aimed to improve hospital-to-school reintegration for children and youth with acquired brain injury (ABI. ABI is the leading cause of disability among children and youth. A successful hospital-to-school reintegration process is essential to the rehabilitative process. However, little is known about the effective components of of such interventions.Our research team conducted a systematic review, completing comprehensive searches of seven databases and selected reference lists for relevant articles published in a peer-reviewed journal between 1989 and June 2014. We selected articles for inclusion that report on studies involving: a clinical population with ABI; sample had an average age of 20 years or younger; an intentional structured intervention affecting hospital-to-school transitions or related components; an experimental design; and a statistically evaluated health outcome. Two independent reviewers applied our inclusion criteria, extracted data, and rated study quality. A meta-analysis was not feasible due to the heterogeneity of the studies reported. Of the 6933 articles identified in our initial search, 17 articles (reporting on 350 preadolescents and adolescents, aged 4-19, (average age 11.5 years, SD: 2.21 met our inclusion criteria. They reported on interventions varying in number of sessions (one to 119 and session length (20 minutes to 4 hours. The majority of interventions involved multiple one-to-one sessions conducted by a trained clinician or educator, homework activities, and parental involvement. The interventions were delivered through different settings and media, including hospitals, schools, and online. Although outcomes varied (with effect sizes ranging from small to large, 14 of the articles reported at least one significant improvement in cognitive, social, psychological, or behavioral functioning or knowledge of ABI.Cognitive, behavioral, and problem
Lindsay, Sally; Hartman, Laura R; Reed, Nick; Gan, Caron; Thomson, Nicole; Solomon, Beverely
We reviewed the literature on interventions that aimed to improve hospital-to-school reintegration for children and youth with acquired brain injury (ABI). ABI is the leading cause of disability among children and youth. A successful hospital-to-school reintegration process is essential to the rehabilitative process. However, little is known about the effective components of of such interventions. Our research team conducted a systematic review, completing comprehensive searches of seven databases and selected reference lists for relevant articles published in a peer-reviewed journal between 1989 and June 2014. We selected articles for inclusion that report on studies involving: a clinical population with ABI; sample had an average age of 20 years or younger; an intentional structured intervention affecting hospital-to-school transitions or related components; an experimental design; and a statistically evaluated health outcome. Two independent reviewers applied our inclusion criteria, extracted data, and rated study quality. A meta-analysis was not feasible due to the heterogeneity of the studies reported. Of the 6933 articles identified in our initial search, 17 articles (reporting on 350 preadolescents and adolescents, aged 4-19, (average age 11.5 years, SD: 2.21) met our inclusion criteria. They reported on interventions varying in number of sessions (one to 119) and session length (20 minutes to 4 hours). The majority of interventions involved multiple one-to-one sessions conducted by a trained clinician or educator, homework activities, and parental involvement. The interventions were delivered through different settings and media, including hospitals, schools, and online. Although outcomes varied (with effect sizes ranging from small to large), 14 of the articles reported at least one significant improvement in cognitive, social, psychological, or behavioral functioning or knowledge of ABI. Cognitive, behavioral, and problem-solving interventions have the
Huang, Neng-Chyan; Wann, Shue-Ren; Chang, Hong-Tai; Lin, Shoa-Lin; Wang, Jyh-Seng; Guo, How-Ran
Hepatic angiosarcoma (HAS) is a rare type of liver cancer that is often fatal, and arsenic and vinyl chloride monomer (VCM) are two major causal agents. Whereas Taiwan is an endemic area of liver cancer, epidemiologic data on HAS are limited. We reviewed the cases observed at a teaching hospital to evaluate the roles of VCM, arsenic, and viral hepatitis in the occurrence of HAS. We reviewed the medical records of patients with pathological proof of HAS from January 2000 to August 2010 at a teaching hospital which is adjacent to the major VCM processing area in Taiwan and nearby an endemic area of arsenic exposure from drinking water. We also conducted a literature review and included all patients of HAS reported in Taiwan. Six male and three female cases aged from 56 to 83 years (64.6 ± 8.2 years) were identified at the hospital. The differences in clinical features between men and women were not statistically significant. None of them had exposure to VCM or arsenic in drinking water. Two had evidence of hepatitis C infection, but none had evidence of hepatitis B infection. Five male and four female cases aged 30 to 82 years (58.6 ± 15.5 years) were identified in the literature, including two with arsenic exposure and one with chronic hepatitis B infection. HAS is rare in Taiwan, and we found no evidence supporting a major role of VCM, arsenic in drinking water, or viral hepatitis in its occurrence.
Cole, Linda C; LoBiondo-Wood, Geri
The objective of this review is to evaluate the evidence regarding the use of music as an adjuvant therapy for pain control in hospitalized adults. The search terms music, music therapy, pain, adults, inpatient, and hospitalized were used to search the Cochrane Library, Cinahl, Medline, Natural Standard, and Scopus databases from January 2005 to March 2011. (A systematic review conducted by the Cochrane Collaboration has extensively covered the time frame from 1966 to 2004.) Seventeen randomized controlled trials met criteria for review and inclusion. Seven of the research studies were conducted with surgical patients, three with medical patients, one with medical-surgical patients, four with intensive care patients, and two with pregnant patients. The combined findings of these studies provide support for the use of music as an adjuvant approach to pain control in hospitalized adults. The use of music is safe, inexpensive, and an independent nursing function that can be easily incorporated into the routine care of patients. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Salomé, F; Boyer, P; Fayol, M
The aim of this survey is to present an overview of research into psychopharmacology as regards the effects of different psychoactive drugs and neuroleptics (NL) on language in normal subjects and schizophrenic patients. Eighteen studies that have investigated the effects of different drugs (alcohol, amphetamines, secobarbital, L-dopa, psilocybin, ketamine, fenfluramine) and neuroleptics (conventional and atypical) on language are reviewed. There are no studies concerning the effects of neuroleptics on language in healthy subjects. The results of the effects of other molecules indicate that language production can be increased (alcohol, amphetamine, secobarbital), rendered more complex (d-amphetamine), more focused (L-dopa) or more unfocused (psilocybin) and clearly impaired (ketamine). For schizophrenic patients, most studies show that conventional neuroleptic treatments, at a therapeutic dosage and in acute or chronic mode, reduce language disorders at all levels (clinic, linguistic, psycholinguistic). In conjunction with other molecules, the classical NL, when administered at a moderate dosage and in chronic mode, modify language in schizophrenia, either by improving the verbal flow and reducing pauses and positive thought disorder (NL + amphetamine) or by inducing an impairment in the language measurements (NL + fenfluramine). Clinical, methodological and theoretical considerations of results are debated in the framework of schizophrenic language disorders.
Zhu, Liqiang; Zhang, Yanqi; Liu, Ling; Jiang, Jingcheng; Liu, Yong; Shi, Fusheng; Yi, Dong
Retrospective surveys of all hospitalized pediatric burns under the age of 15 years were conducted in 18 hospitals from 5 provinces and municipal cities of North China between 2001 and 2010. A total of 17,770 patients were included in this study. The epidemiological characteristics of hospitalized pediatric burns and influencing factors of length of hospital stay and hospitalization cost were analyzed. In this study, children accounted for 43.57% of all hospitalized burns, with a gradually increasing trend (P=0.003). Among children hospitalized burns, the percentage of children younger than three years was 69.9%, with an upward trend (Pburns accounted for 89.79% and 71.54% had burns of burned surface area, surgery and treatment outcome. Children under three years of age, boys and children with a small area of mild scald burns should be made the focus of childhood burn prevention. Improving the medical insurance system for children is urgently needed. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.
Croker, Curtis; Redelings, Matthew; Reporter, Roshan; Sorvillo, Frank; Mascola, Laurene; Wilkins, Patricia
To assess the burden of neurocysticercosis (NCC) in California we examined statewide hospital discharge data for 2009. There were 304 cases hospitalized with NCC identified (incidence = 0.8 per 100,000). Cases were mostly Latino (84.9%), slightly more likely to be male than female (men 57.6%, women 42.4%) with an average age of 43.5 years. A majority of cases were hospitalized in Southern California (72.1%) and many were hospitalized in Los Angeles County (44.7%). Men were more likely than women to have severe disease including hydrocephalus (29.7% vs. 18.6%, p = 0.027), resulting in longer hospitalizations (>4 days, 48.0% vs. 32.6%, p = 0.007) that were more costly (charge>$40 thousand men = 46.9% vs. woman = 4.1%, p = 0.026). Six deaths were recorded (2.0%). The total of NCC-related hospital charges exceeded $17 million; estimated hospital costs exceeded $5 million. Neurocysticercosis causes appreciable disease and exacts a considerable economic burden in California. PMID:22292097
Max Joseph Herman
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.
Markazi-Moghaddam, Nader; Arab, Mohammad; Ravaghi, Hamid; Rashidian, Arash; Khatibi, Toktam; Zargar Balaye Jame, Sanaz
Performance is a multi-dimensional and dynamic concept. During the past 2 decades, considerable studies were performed in developing the hospital performance concept. To know literature key concepts on hospital performance, the knowledge visualization based on co-word analysis and social network analysis has been used. Documents were identified through "PubMed" searching from 1945 to 2014 and 2350 papers entered the study after omitting unrelated articles, the duplicates, and articles without abstract. After pre-processing and preparing articles, the key words were extracted and terms were weighted by TF-IDF weighting schema. Support as an interestingness measure, which considers the co-occurrence of the extracted keywords and "hospital performance" phrase was calculated. Keywords having high support with "hospital performance" are selected. Term-term matrix of these selected keywords is calculated and the graph is extracted. The most high frequency words after "Hospital Performance" were "mortality" and "efficiency". The major knowledge structure of hospital performance literature during these years shows that the keyword "mortality" had the highest support with hospital performance followed by "quality of care", "quality improvement", "discharge", "length of stay" and "clinical outcome". The strongest relationship is seen between "electronic medical record" and "readmission rate". Some dimensions of hospital performance are more important such as "efficiency", "effectiveness", "quality" and "safety" and some indicators are more highlighted such as "mortality", "length of stay", "readmission rate" and "patient satisfaction". In the last decade, some concepts became more significant in hospital performance literature such as "mortality", "quality of care" and "quality improvement".
Ágh, Tamás; Dömötör, Péterné; Bártfai, Zoltán; Inotai, András; Fujsz, Eszter; Mészáros, Ágnes
Various aspects of medication adherence and health-related quality of life (HRQOL) have been studied in subjects with COPD. Nevertheless, little is known about the association between these factors. The aim of this study was to undertake a systematic review of the published literature focusing on the relationship between medication adherence and HRQOL in COPD. A systematic literature search of English language articles was conducted in April 2013 using MEDLINE. No publication date limits were defined. All of the included studies were assessed for quality. Seven studies were included in the review. Three of the assessed studies found no correlation, and 3 studies described positive and 2 studies reported negative associations between medication adherence and HRQOL. The results indicate that an improved HRQOL may be a trigger for non-adherence in patients with COPD. The relationship between medication adherence and HRQOL may be dual. The effect of medication adherence on HRQOL might be a consequence of the effectiveness of therapy and the negative effects (ie, side effects, daily life limitation of therapy, social stigma) that it can generate. HRQOL might also influence the patterns of patients' drug use, as an increased HRQOL might trigger non-adherence. The dynamics between adherence and HRQOL might differ over time, as the negative effects of medication non-adherence might become dominant in the long term. Copyright © 2015 by Daedalus Enterprises.
Nieri, Michele; Tofani, Elena; Defraia, Efisio; Giuntini, Veronica; Franchi, Lorenzo
The aim of this systematic review was to compare the presence of enamel defects and aphthous stomatitis between celiac patients and healthy controls. A systematic review of articles selected from MEDLINE, EMBASE and Google Scholar was performed by two independent operators. Additional studies hand-searched and found in the principal dental and gastroenterology journals were included. Only controlled studies on celiac patients compared to healthy subjects were included. Independent extraction of articles by 2 authors using predefined data fields, including study quality indicators. In total, the celiac patients had greater frequency of enamel defects (odds ratio=5.69, 95%CI from 3.47 to 9.33, Pceliac patients had greater frequency of aphthous stomatitis (odds ratio=3.79, 95%CI from 2.67 to 5.39, Pceliac disease was associated with both enamel defects and aphthous stomatitis. The odds ratio estimates, however, should be interpreted with caution due to the high risk of bias showed by all the studies. In adults, the association between celiac disease and enamel defects or aphthous stomatitis was unclear because very few studies were performed on this population. The presence of enamel defects and/or aphthous stomatitis in a child affected by other typical or atypical symptoms of celiac disease represents an indication for further diagnostic exams for celiac disease. Copyright © 2017 Elsevier Ltd. All rights reserved.
Hut-Mossel, Lisanne; Welker, Gera; Ahaus, Kees; Gans, Rijk
Introduction Many types of audits are commonly used in hospital care to promote quality improvements. However, the evidence on the effectiveness of audits is mixed. The objectives of this proposed realist review are (1) to understand how and why audits might, or might not, work in terms of delivering the intended outcome of improved quality of hospital care and (2) to examine under what circumstances audits could potentially be effective. This protocol will provide the rationale for using a realist review approach and outline the method. Methods and analysis This review will be conducted using an iterative four-stage approach. The first and second steps have already been executed. The first step was to develop an initial programme theory based on the literature that explains how audits are supposed to work. Second, a systematic literature search was conducted using relevant databases. Third, data will be extracted and coded for concepts relating to context, outcomes and their interrelatedness. Finally, the data will be synthesised in a five-step process: (1) organising the extracted data into evidence tables, (2) theming, (3) formulating chains of inference from the identified themes, (4) linking the chains of inference and formulating CMO configurations and (5) refining the initial programme theory. The reporting of the review will follow the ‘Realist and Meta-Review Evidence Synthesis: Evolving Standards’ (RAMESES) publication standards. Ethics and dissemination This review does not require formal ethical approval. A better understanding of how and why these audits work, and how context impacts their effectiveness, will inform stakeholders in deciding how to tailor and implement audits within their local context. We will use a range of dissemination strategies to ensure that findings from this realist review are broadly disseminated to academic and non-academic audiences. PROSPERO registration number CRD42016039882. PMID:28615270
. Olusegun A. Busari1, Adebowale O. Adekoya2, Joshua Oluwafemi Afolayan1. Department of Medicine, University of Ilorin Teaching Hospital Ilorin, 1Department of Medicine, Federal Medical. Centre Ido- Ekiti, 2Department of ...
Full Text Available Background: Van der Woude syndrome (VWS, an autosomal dominant condition associated with clefts of the lip and/or palate and lower lip pits and is caused by mutations in interferon regulatory factor six gene. It is reported to be the most common syndromic cleft world-wide. Non-penetrance for the lip pit phenotype is found in at least 10% of affected individuals and those without the pits are phenocopies for non-syndromic clefting. The aim of this study is to present the phenotypic characteristic of VWS seen at the Lagos University Teaching Hospital (LUTH cleft clinic. Materials and Methods: A review of cases of patients with VWS that attended the cleft lip and palate clinic at the LUTH Idi-Araba, Lagos, from January 2007 to December 2012 was conducted. Data analyses included sex of affected patients, types of cleft, presence of lower lip pits and history of lower lip pits/cleft in the family. Results: A total of 11 cases were seen during the period (male = 4; female = 7. Age at presentation ranged between 1 week and 12 years, with majority (n = 10 less than 2 years of age. Bilateral cleft lip and palate (BCLP was seen in six patients, isolated soft palatal cleft (n = 3 and unilateral cleft lip and alveolus (n = 1 and cleft of hard and soft palate (n = 1. Bilateral lower lips were presented in 10 out of the 11 cases. The mother of the only patient without lip pits presented with bilateral lower lip pits. No family history of cleft/lip pits was elicited in 10 other cases. Conclusion: Most of the cases of VWS presented with BCLP and lower lip pits. Non-penetrance for the lip pits was seen in one out of 11 cases. Our study emphasizes the need to screen family members in all cleft cases, especially clinically diagnosed non-syndromic cases who may be VWS with no lip pits. Future studies are required to investigate the genetic causes of this syndrome in our population.
Okuyama, Ayako; Wagner, Cordula; Bijnen, Bart
Speaking up is important for patient safety, but often, health care professionals hesitate to voice concerns. Understanding the influencing factors can help to improve speaking-up behaviour and team communication. This review focused on health care professionals' speaking-up behaviour for patient safety and aimed at (1) assessing the effectiveness of speaking up, (2) evaluating the effectiveness of speaking-up training, (3) identifying the factors influencing speaking-up behaviour, and (4) developing a model for speaking-up behaviour. Five databases (PubMed, MEDLINE, CINAHL, Web of Science, and the Cochrane Library) were searched for English articles describing health care professionals' speaking-up behaviour as well as those evaluating the relationship between speaking up and patient safety. Influencing factors were identified and then integrated into a model of voicing behaviour. In total, 26 studies were identified in 27 articles. Some indicated that hesitancy to speak up can be an important contributing factor in communication errors and that training can improve speaking-up behaviour. Many influencing factors were found: (1) the motivation to speak up, such as the perceived risk for patients, and the ambiguity or clarity of the clinical situation; (2) contextual factors, such as hospital administrative support, interdisciplinary policy-making, team work and relationship between other team members, and attitude of leaders/superiors; (3) individual factors, such as job satisfaction, responsibility toward patients, responsibility as professionals, confidence based on experience, communication skills, and educational background; (4) the perceived efficacy of speaking up, such as lack of impact and personal control; (5) the perceived safety of speaking up, such as fear for the responses of others and conflict and concerns over appearing incompetent; and (6) tactics and targets, such as collecting facts, showing positive intent, and selecting the person who has
Polyzos, Nicholas M
In order to verify the efficiency level of Greek public hospitals, this paper evaluates the most recent indicators. Relevant data were collected from the two following databases: (a) hospitals' utilisation data generally and per clinical speciality [Ministry of Health, Athens, (Data based) 1995]; (b) Patients' and hospitals' characteristics per diagnosis [National Statistical Office, Athens, (Data based) 1993]. As explanatory variables, the study examines supply and demand factors following case mix classifications. Firstly, average length of stay (ALOS) and secondly, cost per case were regressed as dependent variables. The study highlights the extent of variability across hospitals for different groups of patients with the same condition. The results specify the most important factors that affect ALOS and cost pertaining to efficiency. Per speciality analysis shows occupancy, size-type of the hospital, beds and doctors per speciality, access and use of outpatient services, and surgical operations, etc. as the most significant factors. Per disease-diagnosis analysis shows age of over 65 years, gender, residence, marital status, surgical operation and insurance as the most important factors. General cost analysis in all National Health Systems (NHS) hospitals shows that economies of scale appear in: (a) district and/or specialised hospitals of 250-400 beds; (b) regional and/or teaching hospitals of over but near to 400 beds. Consequently, the author determines the 'Greek' Diagnostic Related Groups (DRGs), based on the cost per clinical speciality in the nine basic specialities and on the cost per diagnosis of the top 15 diagnoses. Further to the scientific results, such studies will enhance much necessary discussions on the organisation of service delivery and financing, by following case mix classification. Copyright 2002 Elsevier Science Ireland Ltd.
Whyman, Robin A; Mahoney, Erin K; Morrison, David; Stanley, James
To describe the prevalence of admissions to New Zealand public hospitals for dental care and associated time trends for people of all ages during the 20-year period 1990-2009. The New Zealand Ministry of Health National Minimum Data Set (NMDS), a collection that covers all publicly funded hospital discharges, was the primary data source for this study. Data over a 20-year period from 1 January 1990 to 31 December 2009 were included, and a subset of ICD 10 codes (K02-K09 and K12 and K13) were selected to identify potentially preventable or ambulatory care sensitive conditions (ACSC) leading to admission to hospital. Volumes, proportions and rates of admission are presented to describe the patterns of admission to hospital. There were 120,046 admissions to public hospitals in New Zealand between 1990 and 2009 for which the provision of dental care was the primary reason for admission. The rate of admission to hospital for dental care increased from 0.92 per 1000 population in the period 1990-1994 to 2.15 per 1000 population in 2005-2009. Dental admission rates were greatest in the 3- to 4-year-old age group, for Maori and Pacific people and for people in the most deprived quintile of the NZDep 2006 index. Almost one-third of people aged 18-34 years who were admitted to hospital primarily for dental care were acute admissions. Both the volume and the rate of admission to New Zealand public hospitals for dental care have increased over the period of this study. A continued focus on strategies to reduce the impact of dental disease, particularly in the early childhood population and on ensuring accessible primary dental care for the adult population, is required. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Tâche, Frédéric; Pantet, Olivier; Joly, Céleste; Pasquier, Mathieu; Maillard-Dewarrat, Géraldine; Méan, Marie; Cosma-Rochat, Monica; Deriaz, Sandra; Donzé, Jacques; Pasche, Antoine; Burnier, Coralie; Stadelmann, Raphaël
Internists must regularly adjust their patients care according to recent relevant publications. The chief residents from the Department of Internal Medicine of a university hospital present some major themes of internal medicine treated during the year 2009. Emphasis will be placed primarily on changes in the daily hospital practice induced by these recent studies. This variety of topics illustrates both the broad spectrum of the current internal medicine, and the many uncertainties associated with modern medical practice based on evidence.
Khanna, Sankalp; Boyle, Justin; Good, Norm; Lind, James
Introduced with a promise to reduce overcrowding in the Emergency Department (ED) and the associated morbidity and mortality linked to bed access difficulties, the National Emergency Access Target (NEAT) is now over halfway through transitionary arrangements towards a target of 90% of patients that visit a hospital ED being admitted or discharged within 4 hours. Facilitation and reward funding has ensured hospitals around the country are remodelling workflows to ensure compliance. Recent reports however show that the majority of hospitals are still far from being able to meet this target. We investigate the NEAT journey of 30 Queensland hospitals over the past two years and compare this performance to a previous study that investigated the 4 hour ED discharge performance of these hospitals at various times of day and under varying occupancy conditions. Our findings reveal that, while most hospitals have made significant improvements to their 4 hour discharge performance in 2013, the underlying flow patterns and periods of poor NEAT compliance remain largely unchanged. The work identifies areas for targeted improvement to inform system redesign and workflow planning.
Warren, Sam A; Huszti, Ella; Bradley, Steven M; Chan, Paul S; Bryson, Chris L; Fitzpatrick, Annette L; Nichol, Graham
Expert guidelines for treatment of cardiac arrest recommend administration of adrenaline (epinephrine) every three to five minutes. However, the effects of different dosing periods of epinephrine remain unclear. We sought to evaluate the association between epinephrine average dosing period and survival to hospital discharge in adults with an in-hospital cardiac arrest (IHCA). We performed a retrospective review of prospectively collected data on 20,909 IHCA events from 505 hospitals participating in the Get With The Guidelines-Resuscitation (GWTG-R) quality improvement registry. Epinephrine average dosing period was defined as the time between the first epinephrine dose and the resuscitation endpoint, divided by the total number of epinephrine doses received subsequent to the first epinephrine dose. Associations with survival to hospital discharge were assessed by using generalized estimating equations to construct multivariable logistic regression models. Compared to a referent epinephrine average dosing period of 4 to <5 min per dose, survival to hospital discharge was significantly higher in patients with the following epinephrine average dosing periods: for 6 to <7 min/dose, adjusted odds ratio [OR], 1.41 (95%CI: 1.12, 1.78); for 7 to <8 min/dose, adjusted OR, 1.30 (95%CI: 1.02, 1.65); for 8 to <9 min/dose, adjusted OR, 1.79 (95%CI: 1.38, 2.32); for 9 to <10 min/dose, adjusted OR, 2.17 (95%CI: 1.62, 2.92). This pattern was consistent for both shockable and non-shockable cardiac arrest rhythms. Less frequent average epinephrine dosing than recommended by consensus guidelines was associated with improved survival of in-hospital cardiac arrest. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Domingo, Grace Rita R; Reyes, Flordelis C; Thompson, Fay V; Johnson, Pauline M; Shortridge-Baggett, Lillie M
Hospital readmission soon after discharge is common and costly. To date, published studies of effectiveness of structured discharge process addressing reduction of hospital readmission have focused on patients with chronic conditions and complex needs, but not in adult patients with community acquired pneumonia. To examine and synthesise the best available evidence related to effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia. This review considered studies that included hospitalised adult patients diagnosed with community acquired pneumonia regardless of gender, ethnicity, severity, and co-morbidities.Structured discharge process related to early patient engagement, patient-caregiver dyad intervention, transitional care, coordinated care, and multidisciplinary team approach.The outcome measures included in this review were hospital readmission, emergency room visits, and unscheduled visits to healthcare provider.Randomised controlled trials (RCTs) and quasi-experimental studies were considered for inclusion. The search strategy aimed to find both published and unpublished studies in English language without date limits. A search of PubMed/MEDLINE, CINAHL, CINAHL Plus, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Academic Search Premier, Health Source Nursing/Academic Edition and seven other databases was conducted. Studies were critically appraised by two independent reviewers using the Joanna Briggs Institute's standardised critical appraisal tool. Data were extracted using the standardised Joanna Briggs Institute's data extraction instruments. Statistical pooling in meta-analysis was not appropriate. Findings are presented in a narrative form. Three articles were included in the review, two RCTs and one pseudo-randomised controlled clinical trial. Structured discharge process did not have a positive impact in reducing hospital readmission at 30, 90, and
Hirose, Maki; Gilio, Alfredo Elias; Ferronato, Angela Esposito; Ragazzi, Selma Lopes Betta
to describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. we identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination) in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or) "hospitalization". Publications in English published between January 1995 and May 2015 were included. 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4% -99.2% reduction in hospitalization rates in children younger than four years after 6-14 years after the onset of universal vaccination (1995), with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1-4 years) in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1-4 years) in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1-4 years) in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1-4 years) in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years) in four years, coverage of 77.2% and Italy 69.7% -73.8% decrease (general population), coverage of 60%-95%. The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between data. Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por
Strupeit, Steve; Buss, Arne; Dassen, Theo
Nurse-delivered education is a crucial part of nursing practice; however, evidence regarding its impact on quality of life is lacking. To our knowledge, no systematic review has addressed the effects of nurse-delivered education interventions on the quality of life in a general elderly inpatient population. To evaluate the effectiveness of nurse-delivered education interventions compared to usual care with regard to the quality of life in elders in the hospital. A systematic review was performed to identify randomized controlled trials examining the effects of nurse-delivered educational interventions on the quality of life in elders in the hospital. The search was performed in December 2012 in the MEDLINE (via PubMed), EMBASE (via Ovid), and CINAHL (via EBSCO) databases and was limited with regard to publication time and language. The studies were appraised according to methodological quality, and p-values were extracted to determine the effectiveness of the interventions. Four studies were included in the review. One study testing multicomponent interventions showed positive effects on quality of life. Two studies showed no effect, and one study showed a negative effect of the intervention on quality of life. Methodological appraisal revealed single biases in most of the studies. Because of the scarcity of positive findings, methodological issues, and heterogeneity between studies, this review could not provide evidence of the effectiveness of nurse-delivered education interventions in elders in the hospital for improving quality of life. Nurse-delivered education may be more effective as a part of multifactorial interventions. Further studies should examine interventions that focus on quality of life using validated measures. Copyright © 2016 Elsevier Inc. All rights reserved.
Di Lorito, Claudio; Castelletti, Luca; Lega, Ilaria; Gualco, Barbara; Scarpa, Franco; Vӧllm, Birgit
Italy is the only country in the world to have closed forensic psychiatric hospitals and converted to fully-residential services. The international interest around this reform has not been matched by research. This scoping review aims to report the determinants of the reform, the most updated information on how the system operates, its benefits and its challenges. We further aim to discuss the implications for policy, research and practice. 1. Selection of relevant sources through electronic search on four databases, Google, relevant printed materials and personal communication with practitioners currently working in REMS. 2. Study quality monitoring. 3. Data extraction onto NVivo 4. Data synthesis through content analysis. 43 papers were selected for inclusion in our review. Two main themes were identified: 1. Historical chronology of the closure of forensic psychiatric hospitals; 2. The current model of residential forensic psychiatric care. The closing down of Italian forensic psychiatric hospitals represented a fundamental step for human rights. Further work is required to improve the current service, including potential reforming of the penal code, improved referral/admission processes and consistent monitoring to reduce service inequality across regions. Further research is crucial to test the effectiveness of the Italian model of care against traditional ones. Copyright © 2017 Elsevier Ltd. All rights reserved.
Husebø, Sissel Eikeland; Akerjordet, Kristin
To evaluate the impact of multi-professional teamwork (MPTW) and leadership training interventions on patient outcomes in acute hospital settings. Although investigations of teamwork and leadership training in acute hospital settings indicate that such programs can optimize patient outcomes, evidence-based recommendations on the content, duration and frequency of training programs associated with clinical evidence are still absent. Quantitative systematic review. A search was conducted for relevant papers published during the period from 2000-February 2014. Twelve studies met the inclusion criteria and were appraised for quality and a risk-of-bias assessment was conducted. The review used a structured approach for literature search, data evaluation, analysis and presentation. A narrative summary was used to report results. Two MPTW and leadership interventions in stroke units have the greatest impact on patient outcomes in acute hospital settings. The interventions' impact on patient outcomes, explored in the ten remaining studies, is associated with great uncertainty due to several alternative explanations of the findings. Research designs that test such interventions must be improved before recommendations on the ultimate program can be made. This can be achieved by strengthening the design, methodology and descriptions of interventions and the use of more consistent patient outcomes. Building a safety culture adjacent to implementing teamwork and leadership training interventions is essential for improving patient outcomes. © 2016 John Wiley & Sons Ltd.
Yusoff, N. A.; Shafii, H.; Omar, R.
In late December 2014, the flood was most significant and largest recorded specifically in the Kelantan, Malaysia. It was considered to be a “tsunami like disaster” in which 202,000 victims were displaced and causing widespread collapse of public infrastructure. Flooding of hospital results in interruption of business, loss of infrastructure, such as electrical power and water supplies, increased difficulty in providing routine medical and increased patient admissions and nursing care for patients with chronic diseases, such as renal failure, diabetes, cancer, cystic fibrosis and mental illness. The aimed of this paper to identify the best of measures for reduce the risk of flood in hospital. Method of this paper uses the previous study result. Several related previous study can be used as measures to mitigation flood risk in Malaysian hospitals. Early stage research of related studies hope to help add more information to assist researchers in reducing the risk of flooding in hospital. The findings with proper pre-event preparation framework for mitigation flood risk of hospitals, the continuing medical services can be provided to patient especially during emergency.
Full Text Available OBJECTIVE: To describe the quantitative treatment outcomes of patients undergoing acoustic coordinated reset (CR neuromodulation at a single independent audiology practice over a 22 – 26 week period as part of an open label, non-randomized, non-controlled observational study.Methods: Sixty six patients with subjective tonal tinnitus were treated with acoustic CR Neuromodulation with a retrospective review of patient records being performed in order to identify changes of visual analogue scale (VAS, n=66 and in the score of the Tinnitus Handicap Questionnaire (THQ, n =51. Patients had their tinnitus severity recorded prior to the initiation of therapy using the Tinnitus Handicap Inventory (THI in order to categorize patients into slight up to catastrophic impact categories. THQ and VAS for tinnitus loudness / annoyance were obtained at the patient’s initial visit, at 10-14 weeks and 22-26 weeks. RESULTS: VAS scores were significantly improved, demonstrating a 25.8% mean reduction in tinnitus loudness and a 32% mean reduction in tinnitus annoyance with a clinically significant reduction in percept loudness and annoyance being recorded in 59.1% and 72.7% of the patient group. THQ scores were significantly improved by 19.4% after 22-26 weeks of therapy compared to baseline. CONCLUSION: Acoustic CR neuromodulation therapy appears to be a practical and promising treatment for subjective tonal tinnitus. However, due to the lack of a control group it is difficult to reach an absolute conclusion regarding to what extent the observed effects are related directly to the acoustic CR neuromodulation therapy. Also as the observed patient group was made up of paying clients it is unknown as to whether this could have caused any additional placebo like effects to influence the final results.
Fasugba, Oyebola; Gardner, Anne; Mitchell, Brett G..; Mnatzaganian, George
Background During the last decade the resistance rate of urinary Escherichia coli (E. coli) to fluoroquinolones such as ciprofloxacin has increased. Systematic reviews of studies investigating ciprofloxacin resistance in community- and hospital-acquired E. coli urinary tract infections (UTI) are absent. This study systematically reviewed the literature and where appropriate, meta-analysed studies investigating ciprofloxacin resistance in community- and hospital-acquired E. coli UTIs. Methods ...
Risks for patients and consumers can be minimized depending on how they are provided appropriate drug information. Therefore, from the viewpoint of hospital pharmacists, I would like to report on how information should be provided in order to minimize patient risk. For example, there is an ongoing opinion that the provision of easy-to-understand drug information to patients and consumers "does not appear necessary". The reasons for this include the following: Because the level of understanding varies greatly among patients, it is difficult to define what "easy-to-understand" information entails; rather, it may cause misunderstanding. These problems occur repeatedly if they are resolved by individual institutions. Therefore, it is essential to standardize the drug information provided to patients, that is, to establish a system to transmit drug information to patients and consumers. Regardless of whether the development of a hospital information system is in progress or not, it can be said that the development of such information systems is gradually spreading outside of hospitals and the situation is changing. From the viewpoint of patients, medical services are not limited to those from hospitals. Patient-centered collaboration between hospitals/clinics and pharmacies (but not the collaboration between hospital pharmacists and community pharmacists (why not?)) can provide good medical services only if patient information is shared. It is essential to establish a system for providing a drug guide for patients, in order to have patients understand drug information. The preparation of Drug Information for Patients would provide health care specialists a communication tool that helps minimize patient risk.
Yousefinezhadi, Taraneh; Mohamadi, Efat; Safari Palangi, Hossein; Akbari Sari, Ali
This study aimed to explore the effect of the International Organization for Standardization (ISO) ISO 9001 standard and the European foundation for quality management (EFQM) model on improving hospital performance. PubMed, Embase and the Cochrane Library databases were searched. In addition, Elsevier and Springer were searched as main publishers in the field of health sciences. We included empirical studies with any design that had used ISO 9001 or the EFQM model to improve the quality of healthcare. Data were collected and tabulated into a data extraction sheet that was specifically designed for this study. The collected data included authors' names, country, year of publication, intervention, improvement aims, setting, length of program, study design, and outcomes. Seven out of the 121 studies that were retrieved met the inclusion criteria. Three studies assessed the EFQM model and four studies assessed the ISO 9001 standard. Use of the EFQM model increased the degree of patient satisfaction and the number of hospital admissions and reduced the average length of stay, the delay on the surgical waiting list, and the number of emergency re-admissions. ISO 9001 also increased the degree of patient satisfaction and patient safety, increased cost-effectiveness, improved the hospital admissions process, and reduced the percentage of unscheduled returns to the hospital. Generally, there is a lack of robust and high quality empirical evidence regarding the effects of ISO 9001 and the EFQM model on the quality care provided by and the performance of hospitals. However, the limited evidence shows that ISO 9001 and the EFQM model might improve hospital performance.
McGuckin, Maryanne; Govednik, John
Healthcare-associated infections (HAIs) in U.S. acute care hospitals lead to a burden of $96-$147 billion annually on the U.S. health system and affect 1 in 20 hospital patients (Marchetti & Rossiter, 2013). Hospital managers are charged with reducing and eliminating HAIs to cut costs and improve patient outcomes. Healthcare worker (HCW) hand hygiene (HH) practice is the most effective means of preventing the spread of HAIs, but compliance is at or below 50% (McGuckin, Waterman, & Govednik, 2009). For managers to increase the frequency of HCW HH occurrences and improve the quality of HH performance, companies have introduced electronic technologies to assist managers in training, supervising, and gathering data in the patient care setting. Although these technologies offer valuable feedback regarding compliance, little is known in terms of capabilities in the clinical setting. Less is known about HCW or patient attitudes if the system allows feedback to be shared. Early-adopting managers have begun to examine their experiences with HH technologies and publish their findings. We review peer-reviewed research on infection prevention that focused on the capabilities of these electronic systems, as well as the related research on HCW and patient interactions with electronic HH systems. Research suggests that these systems are capable of collecting data, but the results are mixed regarding their impact on HH compliance, reducing HAIs, or both and their costs. Research also indicates that HCWs and patients may not regard the technology as positively as industry or healthcare managers may have intended. When considering the adoption of electronic HH monitoring systems, hospital administrators should proceed with caution.
Tetreault, Lindsay A.; Karadimas, Spyridon; Wilson, Jefferson R.; Arnold, Paul M.; Kurpad, Shekar; Dettori, Joseph R.
Study Method: Systematic review (update). Objective: Degenerative cervical myelopathy (DCM) is a degenerative spine disease and the most common cause of spinal cord dysfunction in adults worldwide. The objective of this study is to determine the natural history of DCM by updating the systematic review by Karadimas et al. The specific aims of this review were (1) to describe the natural history of DCM and (2) to determine potential risk factors of disease progression. Method: An updated search based on a previous protocol was conducted in PubMed and the Cochrane Collaboration library for studies published between November 2012 and February 15, 2015. Results: The updated search yielded 3 additional citations that met inclusion criteria and reported the incidence of spinal cord injury and severe disability in patients with DCM. Based on 2 retrospective cohort studies, the incidence rate of hospitalization for spinal cord injury is 13.9 per 1000 person-years in patients with cervical spondylotic myelopathy and 4.8 per 1000 person-years in patients with myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL). In a third small prospective study, the risk of being wheelchair bound or bedridden was 66.7% in DCM patients with OPLL. Conclusion: The overall level of evidence for these estimated rates of hospitalization following spinal cord injury was rated as low. PMID:29164030
Kinsella, Rita; Pizzari, Tania
Subacromial pain syndrome (SPS) is a common cause of shoulder pain and muscle activity deficits are postulated to contribute to the development and progression of the disorder. The purpose of this systematic review was to definitively determine whether evidence exists of differences in electromyography (EMG) characteristics between subjects with and without SPS. Six key databases were searched: MEDLINE, EMBASE, CINAHL, SPORTdiscus, PEDro and The Cochrane Library (inception to May 2016). The search yielded 1414 records using terms relating to shoulder impingement, EMG, scapular and rotator cuff muscles. Twenty-two papers remained once duplicates were removed and selection criteria applied. Data extraction, quality assessment and data synthesis were performed. Effect sizes and 95% confidence intervals were calculated. There was limited evidence that serratus anterior has lower amplitude, delayed activation and earlier termination in SPS participants. For the majority of muscles, regardless of task, load or arm position, significant differences were not demonstrated or results were contradictory. The understanding of SPS is changing and EMG appears unable to capture the complexities associated with this condition. Addressing aberrant movement patterns and facilitating balanced activation of all shoulder muscles may be a more appropriate treatment direction for the future.
Izquierdo, Yojhan Edilberto; Calvo Páramo, Enrique; Castañeda, Luisa María; Gómez, Sandra Viviana; Zambrano, Fernán Santiago
To determine abnormal plain radiograph findings of the distal phalanx tuft of the hand (DPTH) associated with systemic sclerosis in adults. A systematic review was developed following the parameters of the PRISMA guidelines in databases: MEDLINE, EMBASE, BIREME, Scielo, Google Scholar and others including as primary outcomes alterations of DPTH (erosions, resorption, sclerosis and proliferation) detected by simple radiography in subjects with systemic sclerosis. The prevalence of radiographic findings was synthesized using the fixed effects model. The statistical associations were expressed in terms of relative risk or odds ratio with their respective confidence intervals and p values. Twenty-two observational studies were included; the prevalence of DPTH resorption was 28.3% (95% CI: 0.256-0.312; p < .001); I(2)=80.4%, the prevalence of calcinosis was 15.6% (95% CI: 0.113-0.210; p < .001); I(2)=0%. No study reported proliferation or erosions and only one study described sclerosis of DPTH in 5 individuals. Resorption and calcinosis of DPTH are the characteristic radiographic findings in patients with systemic sclerosis. However, new studies with greater methodological strength are needed to establish associations between these phenomena and their presence in other connective tissue diseases. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.
Castro, Verônica Moreira Ferreira de; Melo, Angelita Cristine de; Belo, Vinícius Silva; Chaves, Valéria Ernestânia
Although uric acid is not part of any definition of metabolic syndrome, a number of studies have shown strong associations between the concentration of uric acid and metabolic syndrome or its components. The purpose of this systematic review with meta-analysis was to evaluate, using prospective interventional studies, the effects of allopurinol therapy and uric acid normalization on serum concentrations of triacylglycerol, total-cholesterol, LDL-cholesterol and HDL-cholesterol in hyperuricemic subjects. A systematic search of the PubMed and Scopus databases was performed following the guidelines described in the PRISMA statement. Seven studies were included in the meta-analysis, including six randomized controlled trials and one controlled before-and-after study. Despite differences in the follow-up periods (4, 12 and 24weeks) and allopurinol dose (100-300mg/day), all the studies showed decreases in the mean serum uric acid level (95% confidence interval: -2.61 to -1.55 (4weeks), -2.94 to -1.09 (12weeks) and -2.59 to -1.22 (24weeks); plipid levels, although larger and longer trials of higher quality are needed to confirm this. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
Penm, Jonathan; Chaar, Betty; Moles, Rebekah J
The Basel statements of the International Pharmaceutical Federation, which provide the first global, unified vision for the hospital pharmacy profession, have recently been revised. Originally released in 2008, the Basel statements have since been made available in 21 languages, and thus have the potential for great impact around the world. To conduct a scoping review to examine the extent and nature of research activity related to the Basel statements. Google Scholar, PubMed, and International Pharmaceutical Abstracts were searched using the key term "Basel statements" for relevant research articles. From each included study, data were extracted on geographic location, study design, study outcomes, and use of the Basel statements. The search strategy generated 113 results. Further refinement resulted in 14 English-language articles that met the inclusion criteria. Four of these articles focused on adapting the Basel statements to European practice, an initiative of the European Association of Hospital Pharmacists that led to development of the European statements of Hospital Pharmacy. Six studies focused on monitoring hospital pharmacy practice in Uganda, the Pacific island countries, and the Western Pacific Region. These studies provide valuable baseline data to measure and track the development of hospital pharmacy practices in their respective countries and regions. The remaining 4 studies used qualitative methods to explore the barriers to and facilitators of implementation of the Basel statements in South Africa, China, and Australia. The Basel statements have led to multiple initiatives around the world, involving more than 70 countries. The European and Western Pacific regions have been the most active. Current initiatives should be continued to ensure identification and resolution of issues related to sustaining their use over time.
Penm, Jonathan; Chaar, Betty; Moles, Rebekah J
Background: The Basel statements of the International Pharmaceutical Federation, which provide the first global, unified vision for the hospital pharmacy profession, have recently been revised. Originally released in 2008, the Basel statements have since been made available in 21 languages, and thus have the potential for great impact around the world. Objective: To conduct a scoping review to examine the extent and nature of research activity related to the Basel statements. Methods: Google Scholar, PubMed, and International Pharmaceutical Abstracts were searched using the key term “Basel statements” for relevant research articles. From each included study, data were extracted on geographic location, study design, study outcomes, and use of the Basel statements. Results: The search strategy generated 113 results. Further refinement resulted in 14 English-language articles that met the inclusion criteria. Four of these articles focused on adapting the Basel statements to European practice, an initiative of the European Association of Hospital Pharmacists that led to development of the European statements of Hospital Pharmacy. Six studies focused on monitoring hospital pharmacy practice in Uganda, the Pacific island countries, and the Western Pacific Region. These studies provide valuable baseline data to measure and track the development of hospital pharmacy practices in their respective countries and regions. The remaining 4 studies used qualitative methods to explore the barriers to and facilitators of implementation of the Basel statements in South Africa, China, and Australia. Conclusion: The Basel statements have led to multiple initiatives around the world, involving more than 70 countries. The European and Western Pacific regions have been the most active. Current initiatives should be continued to ensure identification and resolution of issues related to sustaining their use over time. PMID:27168634
Mohammadzadeh, Zeinab; Ghazisaeedi, Marjan; Nahvijou, Azin; Rostam Niakan Kalhori, Sharareh; Davoodi, Somayeh; Zendehdel, Kazem
Introduction: Incidence and mortality rate of cancer is increasing in all countries including low and middle-income countries. Hospital based cancer registry (HBCR) is an important tool for administration purpose and improvement of the quality of care. It is also important resource for population based cancer registries. In this study we reviewed HBCRs in different countries. Methods: We searched the published literature using the MEDLINE (PubMed), Google scholar, Scopus, ProQuest and Google. We also reviewed websites of the HBCRs in different countries. The search was carried out based on proper keywords in English for all motor engines including “hospital-based”, “clinical” and “data quality” combined with “registry”, “cancer” and “tumor” including all subheadings. We reviewed objectives, developer institutions, minimum datasets, data sources, quality control indicators and processes. Results: In total we found 163 papers in the first step. After screening of the titles, abstracts and the full texts, 14 papers remained for analysis. Analysis of the 14 papers showed that the improvement of the quality of the care were the most important objectives among the registries. HBCRs collect information about patients, tumor diagnosis, treatment and follow-up. Generally, indicators such as completeness and validity were used for quality control. Conclusion: Because of the increases in cancer burden in the world, more attention is needed to be paid on cancer surveillance systems, including HBCRs. We evaluated and highlighted the importance and characteristics HBCRs and believe that this paper would help the hospitals and policy makers for planning and establishment of new HBCRs. We suggest the establishment of a worldwide network for coordination and collaboration between HBCRs. Creative Commons Attribution License
Full Text Available Abstract Background Hepatic angiosarcoma (HAS is a rare type of liver cancer that is often fatal, and arsenic and vinyl chloride monomer (VCM are two major causal agents. Whereas Taiwan is an endemic area of liver cancer, epidemiologic data on HAS are limited. We reviewed the cases observed at a teaching hospital to evaluate the roles of VCM, arsenic, and viral hepatitis in the occurrence of HAS. Methods We reviewed the medical records of patients with pathological proof of HAS from January 2000 to August 2010 at a teaching hospital which is adjacent to the major VCM processing area in Taiwan and nearby an endemic area of arsenic exposure from drinking water. We also conducted a literature review and included all patients of HAS reported in Taiwan. Results Six male and three female cases aged from 56 to 83 years (64.6 ± 8.2 years were identified at the hospital. The differences in clinical features between men and women were not statistically significant. None of them had exposure to VCM or arsenic in drinking water. Two had evidence of hepatitis C infection, but none had evidence of hepatitis B infection. Five male and four female cases aged 30 to 82 years (58.6 ± 15.5 years were identified in the literature, including two with arsenic exposure and one with chronic hepatitis B infection. Conclusions HAS is rare in Taiwan, and we found no evidence supporting a major role of VCM, arsenic in drinking water, or viral hepatitis in its occurrence.
Perry, R J; McLaughlin, E A; Rice, P J
This article reports a project that was undertaken to determine current UK dental hospital policy with regard to the management of patients taking therapeutic doses of corticosteroids receiving dental treatment under local anaesthesia. There is variation in the medical management of this patient group, and whether practice should be standardized by means of a national policy document warrants consideration.
Aim/Objectives: The objective of this study was to present the descriptive characteristics of non-neonatal tetanus cases seen in a teaching hospital in Northwestern Nigeria over a 10-year period and to discuss the implications of the study findings for anti-tetanus vaccination policy and implementation in developing countries.
Aims: To study the causes and incidence of deaths in patients who died in the ward after discharge from the intensive care unit (ICU) of the University of Nigeria Teaching Hospital, Enugu, Nigeria, from January 1998 to December 2002. Methods: This is a retrospective study. The medical records of those who died in the ...
Hugtenburg, J. G.; Borgsteede, S. D.; Beckeringh, J. J.
AIMS: In 2001, the Association of Amsterdam Community Pharmacists adopted a programme to improve the pharmaceutical care of patients who were discharged from hospital with five or more drug prescriptions. A comprehensive protocol for pharmaceutical care at discharge (IBOM-1) was developed. The aim
Objective: To determine the mortality among admitted patients in the study centre, a pioneer psychiatric facility in the West African sub-region. Design: A detailed retrospective study of the records of all deaths among the inpatients during the ten-year period of January, 1991 to December, 2000. Setting: Psychiatric Hospital ...
Background: The ovary is a frequent site for the occurrence of neoplastic tumours that could be either benign or malignant. Method: A prospective study of ovarian cyst at a General Hospital in northern Nigeria from October 2005 to November 2006. Clinical case notes of patients diagnosed of ovarian cyst were kept and ...
Genuini, Mathieu; Prot-Labarthe, Sonia; Bourdon, Olivier; Doit, Catherine; Aujard, Yannick; Naudin, Jérôme; Lorrot, Mathie
Numerous studies have shown that the tolerance of children to fluoroquinolones (FQs) is satisfactory, and some indications have been recently agreed upon. However, vigilance is required when prescribing FQ to children. The aim of our study was to describe the prescription of FQs to children hospitalized in our hospital. This is a chart retrospective observational study at the Robert-Debré teaching Hospital between January 2009 and December 2010. Data was collected about patients (name, sex, weight, age) and prescribed treatments (indication, international nonproprietary names, dose, number of doses per day, administration route). Quality of collected data was assessed by analyzing the clinical files of 32 randomly selected patients. We analyzed data for 397 patients (3 days - 18 years old and 640 g - 115 kg). Ciprofloxacin was prescribed for 382 patients (96%), ofloxacin for 10 patients (3%), and levofloxacin for 5 patients (1%). Febrile neutropenia was the most common indication (108 patients, i.e., 27%), followed by inflammatory bowel disease (50 patients, 13%). Doses conformed to recommendations for 88% of the patients. Analysis of the 32 cases indicated an overall compliance percentage of 94.4%. This is the first study to collect so much data on FQ prescriptions for hospitalized children. Use in practice went beyond the licensed indication. Doses were consistent with those for recommended indications.
Dubois, S; Barbier, A; Thibault, M; Atkinson, S; Bussières, J-F
The main objective of this study was to compare the responses of pharmacy residents regarding critical steps for medication order review, in the presence or absence of clinical pharmacists on patient care units, to describe the sequence of these steps and to compare them to an optimal sequence. The secondary objectives were to test this sequence in a simulation and to assess the residents' level of agreement on medication order review. Twenty-two validation steps were selected from guidelines. A simulation on order review was organized in three steps: selecting elements judged to be necessary or not for the order review critical path, then organizing this sequence in chronological order, implementation of this critical path on two simulated practical cases, resident perceptions about order review in their training. Forty-one residents participated in the activity. Responses were heterogeneous regarding the elements' sequence and the time required for the review of a simulated case (3-13minutes). A majority of residents considered that their training was insufficient (29/41), that pharmacists validated differently (27/41), and that it was impossible to review the 22 proposed items for each prescription (30/41). This article highlights heterogeneous medication order review practices among pharmacy residents, due to a lack of training in their curriculum according to them. It is essential to acquire medication order review standard both locally and nationally. Copyright © 2016 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.
Ray, Sumantra; Laur, Celia; Golubic, Rajna
One in four hospital patients in the UK are estimated to be affected by 'hospital malnutrition' (under-nutrition). There is a need for robust epidemiological data relating to the frequency, distribution and determinants of this clinical problem of public health importance. This review aims to undertake a narrative synthesis of data on the descriptive epidemiology of under-nutrition, and to address some of the methodological limitations. A methodical review of literature was undertaken, tracking the reported prevalence and incidence of under-nutrition in hospital, in the UK, since 1994. The 16 articles retrieved and reviewed demonstrate that nutrition in hospital is a long standing problem in UK hospitals and care homes. The existing literature is comprised mainly of cross-sectional surveys describing the prevalence of under-nutrition in hospital which ranges from 11 to 45%. There is considerable heterogeneity in the published literature on hospital malnutrition (under-nutrition) and very few studies either measure or have estimated incidence. Under-nutrition in hospital continues to be under-addressed, yet a major public health problem in the UK. Defining the descriptive epidemiology of this problem is one of the first steps towards understanding its aetiology or planning and evaluating appropriate prevention or treatment strategies. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
M.J.E. Van Der Heijden (Marianne J. E.); S.O. Araghi (Sadaf Oliai); J. Jeekel (Hans); I.K.M. Reiss (Irwin); M.G.M. Hunink (Myriam); M. Van Dijk (Monique)
textabstractObjective: Neonatal intensive care units (NICU) around the world increasingly use music interventions. The most recent systematic review of randomized controlled trials (RCT) dates from 2009. Since then, 15 new RCTs have been published. We provide an updated systematic review on the
Her Majesty's Inspectorate of Education, 2010
The HM Inspectorate of Education publication, "External quality arrangements for Scotland's colleges, September 2008," specifies that HMIE will produce a number of subject aspect reports over the four years 2008-12. These reports complement in a subject specific context the generic evaluations of learning and teaching in HMIE's reports…
Al-Shaqsi, Sultan; Al-Kashmiri, Ammar; Al-Bulushi, Taimoor
The aim of this study was to describe the epidemiology of burns admitted to the National Burns Unit (NBU) in the Sultanate of Oman between 1987 and 2011. This is a retrospective review of burn patients admitted to Oman's National Burns Unit (NBU) between 1987 and 2011. The data extracted from the national burn registry. The study describes the admission rate by gender and age groups, occupation, causes of burns, time-to-admission, length of stay and in-hospital mortality of burns between 1987 and 2011. During a 25-year from 1987 to 2011, there were 3531 burn patients admitted to the National Burns Unit in Oman. The average admission rate to NBU is 7.02 per 100,000 persons per year. On average, males were more likely to be admitted to the NBU than females during the study period (P value burns. About half of all patients admitted to the NBU have burns to more than 11% of total body surface area (TBSA). The average stay in hospital was estimated to be 15.3 days per patient. The average in-hospital mortality rate was estimated to be 8.2% per year (range 1.9-22%). Burns are significant public health issue in the Sultanate of Oman. Children are disproportionately over-represented in this study. Prevention programmes are urgently needed to address this "silent and costly epidemic." Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.
Degrie, Liesbet; Gastmans, Chris; Mahieu, Lieslot; Dierckx de Casterlé, Bernadette; Denier, Yvonne
In our globalizing world, caregivers are increasingly being confronted with the challenges of providing intercultural healthcare, trying to find a dignified answer to the vulnerable situation of ethnic minority patients. Until now, international literature lacks insight in the intercultural care process as experienced by the ethnic minority patients themselves. We aim to fill this gap by analysing qualitative literature on the intercultural care encounter in the hospital setting, as experienced by ethnic minority patients. A systematic search was conducted for papers published between 2000 and 2015. Analysis and synthesis were guided by the critical interpretive synthesis approach. Fifty one articles were included. Four dimensions emerged, describing the intercultural care encounter as (1) a meeting of two different cultural contexts of care, (2) in a dynamic and circular process of (3) balancing between the two cultural contexts, which is (4) influenced by mediators as concepts of being human, communication, family members and the hospital's organizational culture. This review provides in-depth insight in the dynamic process of establishing intercultural care relationships in the hospital. We call for a broader perspective towards cultural sensitive care in which patients are cared for in a holistic and dignity-enhancing way.
Drake, Gareth; de C Williams, Amanda C
The objective of this review was to examine the effects of nursing education interventions on clinical outcomes for acute pain management in hospital settings, relating interventions to health care behavior change theory. Three databases were searched for nursing education interventions from 2002 to 2015 in acute hospital settings with clinical outcomes reported. Methodological quality was rated as strong, moderate, or weak using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies. The 12 eligible studies used varied didactic and interactive teaching methods. Several studies had weaknesses attributable to selection biases, uncontrolled confounders, and lack of blinding of outcome assessors. No studies made reference to behavior change theory in their design. Eight of the 12 studies investigated nursing documentation of pain assessment as the main outcome, with the majority reporting positive effects of education interventions on nursing pain assessment. Of the remaining studies, two reported mixed findings on patient self-report of pain scores as the key measure, one reported improvements in patient satisfaction with pain management after a nursing intervention, and one study found an increase in nurses' delivery of a relaxation treatment following an intervention. Improvements in design and evaluation of nursing education interventions are suggested, drawing on behavior change theory and emphasizing the relational, contextual, and emotionally demanding nature of nursing pain management in hospital settings. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.
Haffey, Faye; Brady, Richard R W; Maxwell, Simon
Junior doctors write the majority of hospital prescriptions but many indicate they feel underprepared to assume this responsibility and around 10% of prescriptions contain errors. Medical smartphone apps are now widely used in clinical practice and present an opportunity to provide support to inexperienced prescribers. This study assesses the contemporary range of smartphone apps with prescribing or related content. Six smartphone app stores were searched for apps aimed at the healthcare prof...
Chandir, Subhash; Chandir, Subash; Hussain, Hamidah; Salahuddin, Naseem; Amir, Mohammad; Ali, Farheen; Lotia, Ismat; Khan, Amir Javed
To describe the types and treatment outcomes of the extra-pulmonary tuberculosis (EPTB) cases in a tertiary care hospital in a high burden tuberculosis country. A retrospective case series study was conducted at Liaquat National Hospital (LNH), the largest private tertiary care hospital in Karachi, Pakistan. All cases diagnosed and treated as EPTB between November 2005 and February 2007 were included. Data was retrieved from medical records on demographics, clinical, laboratory, and outcome status. A total of 194 patients treated for EPTB were identified. Mean age of patients was 34 +/- 16.4 years, and 75% of patients were female. Lymph nodes and spine were the most common sites involved (60%). The cure rate was 40.7%. There was no difference in cure rate of males and females (p=0.99). EPTB is an important clinical problem in Pakistan. Due to lack of guidelines for diagnosis and duration of treatment in EPTB most physicians in Pakistan treat patients based on clinical symptoms and for prolonged duration of 12, to even as long as 24 months. The National TB Program, and chest and infectious disease societies must develop standardized guidelines for the diagnosis and treatment of EPTB.
Carpenter, Joan G
Although palliative care consultation teams are common in U.S. hospitals, follow up and outcomes of consultations for frail older adults discharged to nursing facilities are unclear. To summarize and critique research on the care of patients discharged to nursing facilities following a hospital-based palliative care consult, a systematic search of PubMed, CINAHL, Ageline, and PsycINFO was conducted in February 2016. Data from the articles (N = 12) were abstracted and analyzed. The results of 12 articles reflecting research conducted in five countries are presented in narrative form. Two studies focused on nurse perceptions only, three described patient/family/caregiver experiences and needs, and seven described patient-focused outcomes. Collectively, these articles demonstrate that disruption in palliative care service on hospital discharge and nursing facility admission may result in high symptom burden, poor communication, and inadequate coordination of care. High mortality was also noted. [Res Gerontol Nurs. 2017; 10(1):25-34.]. Copyright 2017, SLACK Incorporated.
Bladh, Marie; Carstensen, John; Josefsson, Ann; Finnström, Orvar; Sydsjö, Gunilla
Children born with non-optimal birth characteristics - that is, are small for gestational age and/or preterm - have an increased risk for several long-term effects such as neurological sequelae and chronic disease. The purpose of this study was to examine whether twins exhibited a different outcome, compared with singletons, in terms of hospitalization during adolescence and early adulthood, and to what extent differences remain when considering the divergence in birth characteristics between singletons and twins. Persons born between 1973 and 1983 in Sweden and surviving until age 13 were included and followed until the end of 2006. Data on birth characteristics, parental socio-demographic factors, and hospitalizations were collected from national registers. Adjusting for parental socio-demographic factors, twins had a higher risk of being hospitalized than singletons (odds ratio, OR = 1.17, 95% confidence interval, CI = 1.10-1.25) and more often due to 'Congenital anomalies' (OR = 1.18, 95% CI = 1.06-1.28), 'Infections' (OR = 1.14; 95% CI = 1.08-1.20), 'External causes of illness' (OR = 1.10, 95% CI = 1.06-1.15), and 'Diseases of the nervous system' (OR = 1.18, 95% CI = 1.10-1.26). Stratifying for birth characteristics, this difference diminishes, and for some diagnoses non-optimal twins seem to do slightly better than non-optimal singletons. Thus, twins with non-optimal birth characteristics had a lower risk of hospitalization than non-optimal singletons on, for example, 'Congenital anomalies' and 'Diseases of the nervous system' (OR = 0.86, 95% CI = 0.77-0.96; OR = 0.88, 95% CI = 0.81-0.97, respectively) and Total (any) hospitalization (OR = 0.87, 95% CI = 0.83-0.92). Among those with optimal birth characteristics, twins had an increased hospitalization due to 'External causes of illness' (OR = 1.07, 95% CI = 1.02-1.13) compared with optimal singletons. Twins have higher hospitalization rates than singletons. In stratifying for birth characteristics, this
Stalpers, Dewi; de Brouwer, Brigitte J M; Kaljouw, Marian J.; Schuurmans, Marieke J.
Objective: To systematically review the literature on relationships between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals. Data sources: The search was performed in Medline (PubMed), Cochrane, Embase, and CINAHL. Review methods: Included were
A.J. Leendertse (Anne); F.H.P. de Koning (Fred); A.N. Goudswaard (Alex); A.R. Jonkhoff (Andries); S.C.A. van den Bogert; H.J. de Gier (Han); T.C.G. Egberts (Toine); P.M.L.A. van den Bemt (Patricia)
textabstractBackground: Medication can be effective but can also be harmful and even cause hospital admissions. Medication review or pharmacotherapy review has often been proposed as a solution to prevent these admissions and to improve the effectiveness and safety of pharmacotherapy. However, most
Leendertse, Anne J.; de Koning, Fred H. P.; Goudswaard, Alex N.; Jonkhoff, Andries R.; van den Bogert, Sander C. A.; de Gier, Han J.; Egberts, Toine C. G.; van den Bemt, Patricia M. L. A.
Background: Medication can be effective but can also be harmful and even cause hospital admissions. Medication review or pharmacotherapy review has often been proposed as a solution to prevent these admissions and to improve the effectiveness and safety of pharmacotherapy. However, most published
Stalpers, D.; Brouwer, B.J.M. de; Kaljouw, M.J.; Schuurmans, M.J.
OBJECTIVE: To systematically review the literature on relationships between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals. DATA SOURCES: The search was performed in Medline (PubMed), Cochrane, Embase, and CINAHL. REVIEW METHODS: Included were
Akakpo, Patrick K; Awuku, Yaw A; Derkyi-Kwarteng, Leonard; Gyamera, Kelvin A; Eliason, Sebastian
Reliable mortality statistics are useful in determining national policies on preventive and interventional medicine. This study reviews, completed medical certificates of cause of death at the Cape Coast Teaching Hospital, in order to determine their accuracy and reliability. A one-year review of Medical Certificates of Cause of Death (MCCD) signed between 01-01-2013 and 31-12-2013 in the medical, pediatric, surgical and obstetrics/gynecology departments of Cape Coast Teaching Hospital were done, analyzing for errors using the WHO/ICD-10 guidelines as the standard. The errors were grouped into minor and major errors. In all, 337 medical certificates of cause of death were audited. Majority, 212(62.9%) were issued in the internal medicine and therapeutics department. 30.86% (104) MCCDs were completed by specialists while 69.14% (233) were completed by non-specialist medical officers. Over half (56.68%) of the MCCDs had major errors while all (100%) had at least one minor error. Our study showed significant errors in MCCD records, with the errors more likely in certificates issued by non-specialist medical officers. All the certificates audited had at least one minor error. Training of doctors on proper completion of MCCDs is strongly advocated. None of the authors received any financial support for this study.
Full Text Available BACKGROUND: Retrospective and prospective randomized studies have compared general and locoregional anesthesia for carotid endarterectomy, but without definitive results.OBJECTIVES: Evaluate the incidence of complications (medical, surgical, neurological, and hospital mortality in a tertiary center in Portugal and review the literature.METHODS: Retrospective analysis of patients undergoing endarterectomy between 2000 and 2011, using a software for hospital consultation.RESULTS: A total of 750 patients were identified, and locoregional anesthesia had to be converted to general anesthesia in 13 patients. Thus, a total of 737 patients were included in this analysis: 74% underwent locoregional anesthesia and 26% underwent general anesthesia. There was no statistically significant difference between the two groups regarding per operative variables. The use of shunt was more common in patients undergoing general anesthesia, a statistically significant difference. The difference between groups of strokes and mortality was not statistically significant. The average length of stay was shorter in patients undergoing locoregional anesthesia with a statistically significant difference.CONCLUSIONS: We found that our data are overlaid with the literature data. After reviewing the literature, we found that the number of studies comparing locoregional and general anesthesia and its impact on delirium, cognitive impairment, and decreased quality of life after surgery is still very small and can provide important data to compare the two techniques. Thus, some questions remain open, which indicates the need for randomized studies with larger number of patients and in new centers.
Pumar-Méndez, María J; Attree, Moira; Wakefield, Ann
A thematic literature review was undertaken to identify methodological aspects in the assessment of safety culture and critically examine how these have been addressed in hospital-based studies of safety culture, for the period 1999-2012. The literature search included an electronic database search (BNI, CINAHL, EMBASE, MEDLINE and PsycINFO), access to websites of organizations dedicated to the enhancement of patient safety, and a manual search of reference lists of the papers included. The analysis of the 43 records included in the review revealed that discussion regarding the measurement of safety culture in the hospital setting revolves around three methodological areas, namely: research approaches; survey tools for data collection; and levels of data aggregation. To advance these discussions, robust research is needed to clarify what dimensions belong to the core of safety culture and what the main sources of safety culture variability are. Studies using a mixed methods approach to assess safety culture would be useful, since they permit the in-depth research necessary to depict the multiple components of this construct. © 2014.