Coordinated Research Projects of the IAEA Atomic and Molecular Data Unit

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Braams, B. J.; Chung, H.-K.

2011-05-01

The IAEA Atomic and Molecular Data Unit is dedicated to the provision of databases for atomic, molecular and plasma-material interaction (AM/PMI) data that are relevant for nuclear fusion research. IAEA Coordinated Research Projects (CRPs) are the principal mechanism by which the Unit encourages data evaluation and the production of new data. Ongoing and planned CRPs on AM/PMI data are briefly described here.

Coordinated Research Projects of the IAEA Atomic and Molecular Data Unit

International Nuclear Information System (INIS)

Braams, B. J.; Chung, H.-K.

2011-01-01

The IAEA Atomic and Molecular Data Unit is dedicated to the provision of databases for atomic, molecular and plasma-material interaction (AM/PMI) data that are relevant for nuclear fusion research. IAEA Coordinated Research Projects (CRPs) are the principal mechanism by which the Unit encourages data evaluation and the production of new data. Ongoing and planned CRPs on AM/PMI data are briefly described here.

Overview of the consortium of hospitals advancing research on tobacco (chart

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Riley William T

2012-08-01

Full Text Available Abstract Background The Consortium of Hospitals Advancing Research on Tobacco (CHART is a network of six projects and a research coordinating unit funded by the National Heart, Lung, and Blood Institute, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institutes of Health (NIH Office of Behavioral and Social Science Research. The CHART projects will assess the effectiveness and cost-effectiveness of smoking cessation interventions initiated during hospitalization and continued post-discharge. Methods/design Along with a seventh project funded previously under the NIH Challenge grants, the CHART projects will assess smoking cessation strategies delivered to approximately 10,000 hospitalized smokers across a geographically diverse group of nearly 20 private, public, academic, and community hospitals. The CHART research coordinating unit at Kaiser Permanente Center for Health Research provides organizational and data coordination support, facilitating the development of common measures for combining data from multiple CHART projects. Discussion The targeted enrollment in CHART, if achieved, will represent the largest, most diverse pooled dataset of hospitalized smokers receiving smoking cessation assistance, and is designed to contribute to the dissemination and implementation of smoking cessation interventions provided by hospital systems.

Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?

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Than, Thet Mon; Saw, Yu Mon; Khaing, Moe; Win, Ei Mon; Cho, Su Myat; Kariya, Tetsuyoshi; Yamamoto, Eiko; Hamajima, Nobuyuki

2017-09-19

Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately. A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015-2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010. The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals. The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the

Numbers and Measuring, Learning With TOR: MINNEMAST Coordinated Mathematics - Science Series, Unit 16.

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Vogt, Elaine E., Ed.

This volume is the sixteenth in a series of 29 coordinated MINNEMAST units in mathematics and science for kindergarten and the primary grades. Intended for use by second-grade teachers, this unit guide provides a summary and overview of the unit, a list of materials needed, and descriptions of five groups of lessons. The purposes and procedures…

[Monitoring evaluation system for high-specialty hospitals].

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Fajardo Dolci, Germán; Aguirre Gas, Héctor G; Robledo Galván, Héctor

2011-01-01

Hospital evaluation is a fundamental process to identify medical units' objective compliance, to analyze efficiency of resource use and allocation, institutional values and mission alignment, patient safety and quality standards, contributions to research and medical education, and the degree of coordination among medical units and the health system as a whole. We propose an evaluation system for highly specialized regional hospitals through the monitoring of performance indicators. The following are established as base thematic elements in the construction of indicators: safe facilities and equipment, financial situation, human resources management, policy management, organizational climate, clinical activity, quality and patient safety, continuity of care, patients' and providers' rights and obligations, teaching, research, social responsibility, coordination mechanisms. Monitoring refers to the planned and systematic evaluation of valid and reliable indicators, aimed at identifying problems and opportunity areas. Moreover, evaluation is a powerful tool to strengthen decision-making and accountability in medical units.

Cross Selling Implementation From Outpatient Unit to Radiology Unit in Semen Gresik Hospital

OpenAIRE

Rochmah, Thinni Nurul; Faradisa, Mutiara Ayu

2013-01-01

Thelow visitingnumberinhospital€™sunitarecloselyrelatedtomarketingactivities,includinginternal marketing which consistsof cross sellingfromother units.Thisstudy aims toanalyze crossselling implementation from Outpatient Unit to Radiology Unit in Semen Gresik Hospital. This study was a cross sectional analytic design. Samplewastakenbysimple random samplingwithsamplesize25respondents.Independentvariableswere marketing policy,employee commitment,perception, motivation,andreadiness ofcross sellin...

Exposure measurement in the neighboring hospital beds during an x-ray procedure in hospitalization unit

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Goto, Rafael E.; Capeleti, Felipe F.; Cabete, Henrique V., E-mail: rafael.goto@fcmsantacasasp.edu.br, E-mail: felipe.capeleti@fcmsantacasasp.edu.br, E-mail: henrique@gmpbrasil.com.br [Faculdade de Ciencias Medicas da Santa Casa Sao Paulo, SP (Brazil); GMP Consultoria em Radioprotecao e Fisica Medica e Assessoria LTDA, Sao Paulo, SP (Brazil)

2017-11-01

There are lots of discussion about the exposure in hospitalization units in Brazil, especially around labor legislation and economic advantages of unhealthiness. With the attention focused on hospitalized patients, there were measured the exposure in neighboring beds of the patient submitted to an X-ray procedure with a mobile X-ray system that could be used to illustrate the discussion with consistent values. The most common X-ray procedure made in hospitalization units are chests images with techniques between 70 to 120 kV and 5 to 20 mAs. The measurement was made during routine exposure and simulations using a scattering phantom with Radcal AccuPro electrometer and 1800cc ionization chamber in a private hospital and a philanthropic hospital, both in Sao Paulo, Brazil. The ionization chambers are placed at 2 meters distance of the patient exposed of both sides during the routine procedure. During the simulation, a nylon phantom of 20 centimeters thick and 30 x 30 cm² size was placed on the bed, a typical exposure technique was used and the exposure was measured surrounding the phantom at 0.6, 1.0 and 2.0 meters distance for scattered radiation characterization. Initial results showed that the neighboring exposure at about 2 meters distance from the exposed patient bed have low values, even when exposure is integrated during the length of hospital stay. Therefore, the exposure in hospitalization units are very low compared to the exams doses. (author). (author)

Job satisfaction and importance for intensive care unit research coordinators: results from binational survey.

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Rickard, Claire M; Roberts, Brigit L; Foote, Jonathon; McGrail, Matthew R

2007-09-01

To measure Intensive Care Unit Research coordinator job satisfaction and importance and to identify priorities for role development. Research coordinator numbers are growing internationally in response to increasing clinical research activity. In Australia, 1% of registered nurses work principally in research, many as Research coordinators. Internationally, the Association of Clinical Research Professionals currently has 6536 certified Research coordinators in 13 countries, with likely additional large numbers practicing without the voluntary certification. Research coordinators are almost always nurses, but little is know about this emerging specialty. Design. Cross-sectional study using anonymous self-report questionnaire. After ethics approval, the McCloskey-Mueller Satisfaction Scale and McCloskey-Mueller Importance Scale were administered via the Internet. The sample was 49 (response rate 71%) Research coordinators from the Australia and New Zealand Intensive Care Unit Research coordinators' Interest Group. Research coordinators were satisfied with structural aspects of the position working business hours; flexibility of working hours; high levels of responsibility and control over their work. Dissatisfaction was expressed regarding: remuneration and recognition; compensation for weekend work; salary package; career advancement opportunities; and childcare facilities. High priorities for role development are those rated highly important but with much lower satisfaction. These are: compensation for weekend call-out work; salary and remuneration package; recognition by management and clinicians; career advancement opportunities; departmental research processes; encouragement and feedback; and number of working hours. Increasing numbers of nurses have been attracted to this clinically based research position. These data contribute to the understanding and development of the role.

[Complexity of care and organizational effectiveness: a survey among medical care units in nine Lombardy region hospitals].

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Pasquali, Sara; Capitoni, Enrica; Tiraboschi, Giuseppina; Alborghetti, Adriana; De Luca, Giuseppe; Di Mauro, Stefania

2017-01-01

Eleven medical care units of nine Lombardy Region hospitals organized by levels of care model or by the traditional departmental model have been analyzed, in order to evaluate if methods for complexity of patient-care evaluation represent an index factor of nursing organizational effectiveness. Survey with nine Nurses in managerial position was conducted between Nov. 2013-Jan. 2014. The following factors have been described: context and nursing care model, staffing, complexity evaluation, patient satisfaction, staff well-being. Data were processed through Microsoft Excel. Among Units analysed ,all Units in levels of care and one organized by the departmental model systematically evaluate nursing complexity. Registered Nurses (RN) and Health Care Assistants (HCA) are on average numerically higher in Units that measure complexity (0.55/ 0.49 RN, 0.38/0.23 HCA - ratio per bed). Adopted measures in relation to changes in complexity are:rewarding systems, supporting interventions, such as moving personnel within different Units or additional required working hours; reduction in number of beds is adopted when no other solution is available. Patient satisfaction is evaluated through Customer Satisfaction questionnaires. Turnover, stress and rate of absenteeism data are not available in all Units. Complexity evaluation through appropriate methods is carried out in all hospitals organized in levels of care with personalized nursing care models, though complexity is detected with different methods. No significant differences in applied managerial strategies are present. Patient's satisfaction is evaluated everywhere. Data on staffing wellbeing is scarcely available. Coordinated regional actions are recommended in order to gather comparable data for research, improve decision making and effectiveness of Nursing care.

Hospital Mortality in the United States following Acute Kidney Injury

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Jeremiah R. Brown

2016-01-01

Full Text Available Acute kidney injury (AKI is a common reason for hospital admission and complication of many inpatient procedures. The temporal incidence of AKI and the association of AKI admissions with in-hospital mortality are a growing problem in the world today. In this review, we discuss the epidemiology of AKI and its association with in-hospital mortality in the United States. AKI has been growing at a rate of 14% per year since 2001. However, the in-hospital mortality associated with AKI has been on the decline starting with 21.9% in 2001 to 9.1 in 2011, even though the number of AKI-related in-hospital deaths increased almost twofold from 147,943 to 285,768 deaths. We discuss the importance of the 71% reduction in AKI-related mortality among hospitalized patients in the United States and draw on the discussion of whether or not this is a phenomenon of hospital billing (coding or improvements to the management of AKI.

Hospital librarianship in the United States: at the crossroads.

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Wolf, Diane G; Chastain-Warheit, Christine C; Easterby-Gannett, Sharon; Chayes, Marion C; Long, Bradley A

2002-01-01

This paper examines recent developments in hospital librarianship in the United States, including the current status of hospital-based clinical library services. Several examples of hospital library services are presented that demonstrate some characteristics of struggling and thriving services. The implications of the informationist concept are considered. The continuation of the hospital librarian's primary role in support of patient care is explored, as core competencies are reexamined for relevancy in the new millennium.

Evaluation of the timing and coordination of prandial insulin administration in the hospital.

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Alwan, Dhuha; Chipps, Esther; Yen, Po-Yin; Dungan, Kathleen

2017-09-01

The objective of this study was to examine the relationship between measures of coordinated insulin delivery and capillary blood glucose (CBG) levels among hospitalized patients and to assess nurse perceptions of insulin administration. Hospitalized patients (n=451) receiving rapid acting insulin analog (RAIA) using carbohydrate counting were retrospectively analyzed. Nurses (n=35) were asked to complete an 18-item anonymous survey assessing perception of RAIA dosing. The median time from breakfast CBG to RAIA dose was 93 (IQR 57-138) min. There was no association between timeliness measures and mean CBG at lunch or dinner. Hypoglycemia was rare (N=2). More than half (54%) of nurses were confident all of the time in determining the correct dose of RAIA, though none were confident in administering it on time. The majority of nurses perceived an electronic dosing calculator and a patient reminder to notify the nurse at the end of the meal favorably. The data demonstrate suboptimal coordination of CBG monitoring and insulin doses using a flexible meal insulin dosing strategy, though there was minimal impact on glycemic control. Nurses reported high confidence in the ability to calculate the correct insulin dose but not in the ability to administer it on time. Copyright © 2017 Elsevier B.V. All rights reserved.

The role of hospitals in bridging the care continuum: a systematic review of coordination of care and follow-up for adults with chronic conditions.

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De Regge, Melissa; De Pourcq, Kaat; Meijboom, Bert; Trybou, Jeroen; Mortier, Eric; Eeckloo, Kristof

2017-08-09

Multiple studies have investigated the outcome of integrated care programs for chronically ill patients. However, few studies have addressed the specific role hospitals can play in the downstream collaboration for chronic disease management. Our objective here is to provide a comprehensive overview of the role of the hospitals by synthesizing the advantages and disadvantages of hospital interference in the chronic discourse for chronically ill patients found in published empirical studies. Systematic literature review. Two reviewers independently investigated relevant studies using a standardized search strategy. Thirty-two articles were included in the systematic review. Overall, the quality of the included studies is high. Four important themes were identified: the impact of transitional care interventions initiated from the hospital's side, the role of specialized care settings, the comparison of inpatient and outpatient care, and the effect of chronic care coordination on the experience of patients. Our results show that hospitals can play an important role in transitional care interventions and the coordination of chronic care with better outcomes for the patients by taking a leading role in integrated care programs. Above that, the patient experiences are positively influenced by the coordinating role of a specialist. Specialized care settings, as components of the hospital, facilitate the coordination of the care processes. In the future, specialized care centers and primary care could play a more extensive role in care for chronic patients by collaborating.

[The construction process of managerial profile competencies for nurse coordinators in the hospital field].

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Manenti, Simone Alexandra; Ciampone, Maria Helena Trench; Mira, Vera Lucia; Minami, Lígia Fumiko; Soares, Jaqueline Maria Sousa

2012-06-01

The objective of this study was to construct a profile of managerial competencies, based on the consensus of nurse coordinators in the field. This study was developed in a philanthropic hospital in São Paulo, following the research-action model, and included 13 nurse coordinators as participants. The data collection was performed using the focal group technique. Data analysis was performed using the theoretical frameworks related to the working process and managerial competencies. The results identified the greater emphasis assigned to the competencies related to the mentor, coordinator and director roles. It was, therefore, possible to construct a professional development plan that is based on competencies in the technical, ethical-political, and communicative domains, as well as the development of citizenship. The analysis of the managerial working process and the study of the competencies within the managerial environment were shown to be important, because they highlighted the professionals' need to improve, thus fulfilling personal, professional, and organizational demands.

Women's experiences of nurse case management on a gynaecological oncology unit in a Swiss tertiary hospital. A thematic analysis.

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Grob, Silvia; Bläuer, Cornelia; Frei, Irena Anna

2017-12-01

Women with gynaecological cancer face various physical, social and emotional challenges concerning their health. Existing research shows that case management can improve patient satisfaction and reduce readmission rates. Although nurse case management was introduced on a gynaecological oncology unit in a Swiss university hospital in 2013, little is known about the experiences of female patients on a unit that uses this model of care. The aims were to explore women's experiences and to gain deeper understanding about hospital-based nurse case management on a gynaecological oncology unit and to qualitatively evaluate the concept of nurse case management. Sound research knowledge suggests that experiences are best explored with a qualitative research design. Ten participant interviews were conducted and inductively analysed between September 2014 and May 2015 as described by the thematic analysis method. Ethical approval was obtained, and the women signed a consent form. The first theme was named continuous relationship, with the nurse case manager as contact person and trusted partner. Study participants explained that friendliness and being present were essential qualities of nurse case management. Secondly, an essential support for women dealing with the situation of gynaecological cancer was described in the theme sharing information. The organisation of rehabilitation and other services by the nurse case management defined the third theme coordinating care. Trust was seen as the basis of the continuous relationship, marked by friendliness and presence of the nurse case manager. The helpful approach of persons practicing nurse case management made dealing with the situation of illness easier for women with gynaecological cancer. Coordination of information between the nurse case management and other healthcare services could be improved. Further evaluation is suggested to explore effects of the concept on family members. © 2017 Nordic College of Caring Science.

Development and Monitoring the Key Performance Indicators of the Quality of Care for Patients with Cleft Lips/Palates at Srinagarind Hospital.

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Mongkhonthawornchai, Siriporn; Pradubwong, Suteera; Augsornwan, Darawan; Pathumwiwatana, Pornpen; Sroyhin, Waranya; Pongpagatip, Sumalee; Wongkham, Jamras; Wachirapakorn, Jantira; Lao-unka, Kesorn; Mucnamporn, Tippawan; Chowchuen, Bowornsilp

2015-08-01

Congenital deformities, such as cleft lips and/or cleft palates (CLP), have high incidences in the Northeast of Thailand. These birth defects can affect patient's quality of life. CLP patients need crucial and long-term treatments by a multidisciplinary team starting from prenatal stage to late adulthood. Patients and their families should involve in their own care, and their care objectives should correspond with healthcare providers. Besides the clinical outcome of interdisciplinary team, key performance indicators (KPIs) need to be developed in the hospital service unit in order to improve quality of care and treatment outcomes. 1) to establish KPIs in hospital service units, and 2) to develop the information system to collect, analysis and improve the quality of CLP care. A nurse coordinator was appointed in the Tawanchai Center to coordinate care. The three periods were conducted for the nurse coordinator to work with nine service units in Srinagarind Hospital for consensus on both qualitative and quantitative data to be used as service unit quality measurement. Thirty one KPIs from nine service units were established, collected and analyzed during a four-month period in 2014. The 20 KPIs achieved the unit targets. Two PKIs of the rates of complication with anesthesia during/after surgery in the first 24 hours and the rates of patient/caregiver's satisfaction in acquiring information from the officer were improving. There were 11 KPIs that did not achieve the targets. The coordinator nurse of the Tawanchai Center discussed with the service unit for the cause and how to improve the outcome. The monitoring KPIs will lead to improvement of outcome for better patient quality as well as benchmarking with other hospitals of Cleft Center. The KPIs from hospital service units with the monitoring and analysis of information by the nurse coordinator will enhance and lead to improvement of the quality of the patients and family centered care process.

The Need for a United Nations Global Counter-Terrorism Coordinator

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Howard Stoffer

2013-08-01

Full Text Available The case for a high level United Nations (UN Counter-Terrorism Coordinator position within the UN system has become increasingly urgent in 2013. This need has diluted some Member State reticence to creating a new Assistant Secretary-General position that would supervise and manage the existing counter-terrorism structures in the UN system. A Coordinator would have a basic responsibility to keep track of all of the activities of many formal inter-governmental organisations operating at the international, regional and sub-regional level and would also work closely with national counter-terrorism focal points. In this Policy Brief, Dr. Howard Stoffer reviews the debate among Security Council and Fifth Committee members about the efficacy of establishing a senior UN Global Counter-Terrorism Coordinator. He argues that the creation of such a position could lead to a restructuring of the UN counter-terrorism architecture as well as its funding within the UN budget and among donors. The position would eventually make the UN overall counter-terrorism effort, under the UN Global Counter-Terrorism Strategy, a stronger, more effective and more efficient process with measurable impact on the ground among Member States.

Recent Trends in Out-of-Hospital Births in the United States.

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

2013-01-01

Although out-of-hospital births are still relatively rare in the United States, it is important to monitor trends in these births, as they can affect patterns of facility usage, clinician training, and resource allocation, as well as health care costs. Trends and characteristics of home and birth center births are analyzed to more completely profile contemporary out-of-hospital births in the United States. National birth certificate data were used to examine a recent increase in out-of-hospital births. After a gradual decline from 1990 to 2004, the number of out-of-hospital births increased from 35,578 in 2004 to 47,028 in 2010. In 2010, 1 in 85 US infants (1.18%) was born outside a hospital; about two-thirds of these were born at home, and most of the rest were born in birth centers. The proportion of home births increased by 41%, from 0.56% in 2004 to 0.79% in 2010, with 10% of that increase occurring in the last year. The proportion of birth center births increased by 43%, from 0.23% in 2004 to 0.33% in 2010, with 14% of the increase in the last year. About 90% of the total increase in out-of hospital births from 2004 to 2010 was a result of increases among non-Hispanic white women, and 1 in 57 births to non-Hispanic white women (1.75%) in 2010 was an out-of-hospital birth. Most home and birth center births were attended by midwives. Home and birth center births in the United States are increasing, and the rate of out-of-hospital births is now at the highest level since 1978. There has been a decline in the risk profile of out-of-hospital births, with a smaller proportion of out-of-hospital births in 2010 than in 2004 occurring to adolescents and unmarried women and fewer preterm, low-birth-weight, and multiple births. © 2013 This article is a U.S. Government work and is in the public domain in the United States.

Vertical and horizontal control dilemmas in public hospitals.

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Pettersen, Inger Johanne; Solstad, Elsa

2015-01-01

The hospital sector in Norway has been continuously reorganized since 2002 and the reforms have created organizations that are functionally/vertically controlled, whereas the production lines are coordinated on a process or a lateral basis. The purpose of this paper is to focus on both the perceived functional vertical control and horizontal controls within and between the local hospitals and the regional administrative levels. A national survey study, complemented with interviews of some key informants and document studies. The study shows that the functional and vertical lines of management control are perceived to be operating according to the traditional views of management control. The study indicates that the horizontal tasks are not very well implemented, and we did not find interactive and lateral uses of management control systems for managerial purposes. New control problems arise when services are to be coordinated between autonomous units. The paper focuses on the control problems found within the horizontal, flat relationship between production units in hospitals; new organizational structures have emerged where lateral relations are important, but traditional control practices follow functional, vertical lines.

Current status of in-hospital donation coordinators in Japan: nationwide survey.

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Konaka, S; Shimizu, S; Iizawa, M; Ohkawara, H; Kato, O; Ashikari, J; Fukushima, N

2013-05-01

When the Japanese Organ Transplantation Act was issued, the Japanese Organ Transplantation Network (JOT) was established in 1997. JOT lists recipients, assesses and manages organ donors, and educates publics and headquarters for organ donations. JOT procurement transplant coordinators (PTC) play roles in obtaining consent from relatives for organ donation, donor evaluation and management, organ recovery management, organ transport, and care of donor families during and after donation. Every prefecture has at least one PTC who is mainly working in public education and hospital development. They also help the JOT PTC at the time of organ procurement. Most prefectures commission hospital staff in the procurement hospital to be an in-hospital PTC (In-Hp PTC), who make their hospital staff aware of organ donation and support organ procurement. Although the Act was revised in 2010 with brain-dead organ donation increased from 13 to 44 cases yearly, the number was still extremely smaller than other developed countries. In these circumstances, In-Hp PTC may play greater roles to increase donation and smooth procurement procedures Our primary aim was to describe the current status of In-Hp PTC in Japan. Between December 15, 2011, and January 31, 2012, we invited 1889 In-Hp PTC to complete a letter survey using a self-designed questionnaire. In all, 56 In-Hp PTC (40%) completed and returned it. The occupation of the respondents was nurse (66%), physician (18%), or other (16%). Although 52% of respondents belonged to the hospital, which was designated for brain-death organ donation by the government, only 46% had any experience with a cadaveric donor. Only 2% were full-time In-Hp PTC. They mainly played a role in preparing their own manual for organ procurement (57%), providing in-hospital lectures (44%) or their own simulation exercise (29%), as well as coordinating donation cases. Although 77% had attended seminar about organ donation provided by JOT or the prefecture PTC

Unit cost of medical services at different hospitals in India.

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Susmita Chatterjee

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

Unit Cost of Medical Services at Different Hospitals in India

Science.gov (United States)

Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

2013-01-01

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

Epidemiology of Hospitalizations Associated with Invasive Candidiasis, United States, 2002-20121.

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Strollo, Sara; Lionakis, Michail S; Adjemian, Jennifer; Steiner, Claudia A; Prevots, D Rebecca

2016-01-01

Invasive candidiasis is a major nosocomial fungal disease in the United States associated with high rates of illness and death. We analyzed inpatient hospitalization records from the Healthcare Cost and Utilization Project to estimate incidence of invasive candidiasis-associated hospitalizations in the United States. We extracted data for 33 states for 2002-2012 by using codes from the International Classification of Diseases, 9th Revision, Clinical Modification, for invasive candidiasis; we excluded neonatal cases. The overall age-adjusted average annual rate was 5.3 hospitalizations/100,000 population. Highest risk was for adults >65 years of age, particularly men. Median length of hospitalization was 21 days; 22% of patients died during hospitalization. Median unadjusted associated cost for inpatient care was $46,684. Age-adjusted annual rates decreased during 2005-2012 for men (annual change -3.9%) and women (annual change -4.5%) and across nearly all age groups. We report a high mortality rate and decreasing incidence of hospitalizations for this disease.

DRUG MANAGEMENT REVIEWS IN DISTRICT DRUG MANAGEMENT UNIT AND GENERAL HOSPITAL

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Max Joseph Herman

2009-12-01

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

The impact of the Family Communication Coordinator (FCC) Protocol on the role stress of hospital chaplains.

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Dodd-McCue, Diane; Tartaglia, Alexander

2005-01-01

The Family Communication Coordinator (FCC) Protocol was implemented to provide early family intervention and to facilitate effective communications during potential organ donation cases. Previous studies found the Protocol associated with improved donor outcome measures and with reduced role stress for ICU nurses caring for potential donors. The present study examines the impact of the Protocol on the perceived role stress of hospital chaplains serving as FCCs. All hospital chaplains serving as FCCs at an academic teaching hospital were surveyed. Their perceptions of job dimensions, role stress, job satisfaction, and commitment were measured; interviews and secondary data supplemented the surveys. The findings demonstrate that the FCC Protocol is associated with improved role stress, specifically role ambiguity and role conflict, among hospital chaplains serving as FCCs. Additionally, the findings suggest that satisfaction with the Protocol may be associated with experience with the Protocol.

Coordinating health care: lessons from Norway

Directory of Open Access Journals (Sweden)

Trond Tjerbo

2005-11-01

Full Text Available Objective: What influences the coordination of care between general practitioners and hospitals? In this paper, general practitioner satisfaction with hospital—GP interaction is revealed, and related to several background variables. Method: A questionnaire was sent to all general practitioners in Norway (3388, asking their opinion on the interaction and coordination of health care in their district. A second questionnaire was sent to all the somatic hospitals in Norway (59 regarding formal routines and structures. The results were analysed using ordinary least squares regression. Results: General practitioners tend to be less satisfied with the coordination of care when their primary hospital is large and cost-effective with a high share of elderly patients. Together with the degree to which the general practitioner is involved in arenas where hospital physicians and general practitioners interact, these factors turned out to be good predictors of general practitioner satisfaction. Implication: To improve coordination between general practitioners and specialists, one should focus upon the structural traits within the hospitals in different regions as well as creating common arenas where the physicians can interact.

Severe Maternal Morbidity and Hospital Cost among Hospitalized Deliveries in the United States.

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Chen, Han-Yang; Chauhan, Suneet P; Blackwell, Sean C

2018-05-03

 The objective of this study was to estimate the contemporary national rate of severe maternal morbidity (SMM) and its associated hospital cost during delivery hospitalization.  We conducted a retrospective study identifying all delivery hospitalizations in the United States between 2011 and 2012. We used data from the National (Nationwide) Inpatient sample of the Healthcare Cost and Utilization Project. The delivery hospitalizations with SMM were identified by having at least one of the 25 previously established list of diagnosis and procedure codes. Aggregate and mean hospital costs were estimated. A generalized linear regression model was used to examine the association between SMM and hospital costs.  Of 7,438,946 delivery hospitalizations identified, the rate of SMM was 154 per 10,000 delivery hospitalizations. Without any SMM, the mean hospital cost was $4,300 and with any SMM, the mean hospital cost was $11,000. After adjustment, comparing to those without any SMM, the mean cost of delivery hospitalizations with any SMM was 2.1 (95% confidence interval: 2.1-2.2) times higher, and this ratio increases from 1.7-fold in those with only one SMM to 10.3-fold in those with five or more concurrent SMM.  The hospital cost with any SMM was 2.1 times higher than those without any SMM. Our findings highlight the need to identify interventions and guide research efforts to mitigate the rate of SMM and its economic burden. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[Management of malnutrition in geriatric hospital units in Germany].

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Smoliner, C; Volkert, D; Wirth, R

2013-01-01

Elderly hospitalized patients have a high risk for developing malnutrition. The causes for an impaired nutritional status in old age are various and the impact is far-reaching. Malnutrition is a comorbidity that is well treatable and various studies show the favorable effect of nutrition therapy on nutritional status and prognosis. In the past few years, several guidelines have been developed to improve nutritional management and to ensure standardized procedures to identify patients at nutritional risk who will benefit from nutrition therapy. However, it is still not clear to what extent nutrition management has been implemented in geriatric wards in Germany. This survey is intended to give an overview on the situation of the current diagnosis and therapy of malnutrition and nutritional management in geriatric hospital units for acute and rehabilitative care. In 2011, the task force of the German Geriatric Society ("Deutsche Gesellschaft für Geriatrie", DGG) developed a questionnaire which was sent out to 272 directors of geriatric hospital and rehabilitational units. Included were questions regarding the size and staffing of the hospital and wards, food provision, diagnosis and therapy of malnutrition, as well as communication of malnutrition and nutrition therapy in the doctor's letter. A total of 38% of the questioned units answered. The following information was compiled: 31% of the geriatric facilities employed a doctor with training in clinical nutrition, 42% employ dieticians or nutritional scientists, and 90% speech and language pathologists. In 36% of the wards, a so-called geriatric menu is offered (small portions, rich in energy and/or protein, easy to chew). In 89% of the wards, snacks are available between meals. Diagnosis of malnutrition is mainly done by evaluation of weight and BMI. Validated and established screening tools are only used in 40% of the geriatric wards. Food records are carried out in 64% of the units when needed. Diagnosed

Shopping around for hospital services: a comparison of the United States and Canada.

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Bell, C M; Crystal, M; Detsky, A S; Redelmeier, D A

1998-04-01

Historical comparisons indicate that US hospitals are more expensive than Canadian hospitals, but health care system reform might have changed the relative costs and timeliness of health care in the 2 countries. To estimate the price and convenience of selected hospital services in the United States and Canada for patients in 1997 had they paid out-of-pocket. Cross-sectional telephone survey conducted May 1996 to April 1997. The 2 largest acute care general hospitals from every city in the United States and Canada with a population greater than 500000. Each hospital was telephoned and asked their price and waiting time for 7 services: magnetic resonance imaging of the head without gadolinium; a screening mammogram; a 12-lead electrocardiogram; a prothrombin time measurement; a session of hemodialysis; a screening colonoscopy; and a total knee replacement. Waiting times were measured in days until earliest appointment and charges were converted to American currency. Overall, 48 US and 18 Canadian hospitals were surveyed. Median waiting times were significantly shorter in American hospitals for 4 services, particularly a magnetic resonance imaging of the head (3 days vs 150 days; Preplacement ($26805 vs $10651; Preplacement in the United States. US hospitals still provide higher prices and faster care than Canadian hospitals for patients who pay out-of-pocket.

[Activity-based costing methodology to manage resources in intensive care units].

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Alvear V, Sandra; Canteros G, Jorge; Jara M, Juan; Rodríguez C, Patricia

2013-11-01

An accurate estimation of resources use by individual patients is crucial in hospital management. To measure financial costs of health care actions in intensive care units of two public regional hospitals in Chile. Prospective follow up of 716 patients admitted to two intensive care units during 2011. The financial costs of health care activities was calculated using the Activity-Based Costing methodology. The main activities recorded were procedures and treatments, monitoring, response to patient needs, patient maintenance and coordination. Activity-Based Costs, including human resources and assorted indirect costs correspond to 81 to 88% of costs per disease in one hospital and 69 to 80% in the other. The costs associated to procedures and treatments are the most significant and are approximately $100,000 (Chilean pesos) per day of hospitalization. The second most significant cost corresponds to coordination activities, which fluctuates between $86,000 and 122,000 (Chilean pesos). There are significant differences in resources use between the two hospitals studied. Therefore cost estimation methodologies should be incorporated in the management of these clinical services.

Salmonellosis Hospitalizations in the United States: Associated Chronic Conditions, Costs, and Hospital Outcomes, 2011, Trends 2000-2011.

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Cummings, Patricia L; Kuo, Tony; Javanbakht, Marjan; Shafir, Shira; Wang, May; Sorvillo, Frank

2016-01-01

Hospitalized salmonellosis patients with concurrent chronic conditions may be at increased risk for adverse outcomes, increasing the costs associated with hospitalization. Identifying important modifiable risk factors for this predominantly foodborne illness may assist hospitals, physicians, and public health authorities to improve management of these patients. The objectives of this study were to (1) quantify the burden of salmonellosis hospitalizations in the United States, (2) describe hospitalization characteristics among salmonellosis patients with concurrent chronic conditions, and (3) examine the relationships between salmonellosis and comorbidities by four hospital-related outcomes. A retrospective analysis of salmonellosis discharges was conducted using the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample for 2011. A supplemental trend analysis was performed for the period 2000-2011. Hospitalization characteristics were examined using multivariable regression modeling, with a focus on four outcome measures: in-hospital death, total amount billed by hospitals for services, length of stay, and disease severity. In 2011, there were 11,032 total salmonellosis diagnoses; 7496 were listed as the primary diagnosis, with 86 deaths (case-fatality rate = 1.2%). Multivariable regression analyses revealed a greater number of chronic conditions (≥4) among salmonellosis patients was associated with higher mean total amount billed by hospitals for services, longer length of stay, and greater disease severity (p ≤ 0.05). From 2000 to 2011, hospital discharges for salmonellosis increased by 27.2%, and the mean total amount billed by hospitals increased nearly threefold: $9,777 (2000) to $29,690 (2011). Observed increases in hospitalizations indicate the burden of salmonellosis remains substantial in the United States. The positive association between increased number of chronic conditions and the four hospital-related outcomes affirms

Optimal coordinated scheduling of combined heat and power fuel cell, wind, and photovoltaic units in micro grids considering uncertainties

International Nuclear Information System (INIS)

Bornapour, Mosayeb; Hooshmand, Rahmat-Allah; Khodabakhshian, Amin; Parastegari, Moein

2016-01-01

In this paper, a stochastic model is proposed for coordinated scheduling of combined heat and power units in micro grid considering wind turbine and photovoltaic units. Uncertainties of electrical market price; the speed of wind and solar radiation are considered using a scenario-based method. In the method, scenarios are generated using roulette wheel mechanism based on probability distribution functions of input random variables. Using this method, the probabilistic specifics of the problem are distributed and the problem is converted to a deterministic one. The type of the objective function, coordinated scheduling of combined heat and power, wind turbine, and photovoltaic units change this problem to a mixed integer nonlinear one. Therefore to solve this problem modified particle swarm optimization algorithm is employed. The mentioned uncertainties lead to an increase in profit. Moreover, the optimal coordinated scheduling of renewable energy resources and thermal units in micro grids increase the total profit. In order to evaluate the performance of the proposed method, its performance is executed on modified 33 bus distributed system as a micro grid. - Highlights: • Stochastic model is proposed for coordinated scheduling of renewable energy sources. • The effect of combined heat and power is considered. • Maximizing profits of micro grid is considered as objective function. • Considering the uncertainties of problem lead to profit increasing. • Optimal scheduling of renewable energy sources and thermal units increases profit.

Development of a hospital-based care coordination program for children with special health care needs.

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Petitgout, Janine M; Pelzer, Daniel E; McConkey, Stacy A; Hanrahan, Kirsten

2013-01-01

A hospital-based Continuity of Care program for children with special health care needs is described. A family-centered team approach provides care coordination and a medical home. The program has grown during the past 10 years to include inpatients and outpatients from multiple services and outreach clinics. Improved outcomes, including decreased length of stay, decreased cost, and high family satisfaction, are demonstrated by participants in the program. Pediatric nurse practitioners play an important role in the medical home, collaborating with primary care providers, hospital-based specialists, community services, and social workers to provide services to children with special health care needs. Copyright © 2013 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

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

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

2014-10-22

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

The relationship between hospital unit culture and nurses' quality of work life.

Science.gov (United States)

Gifford, Blair D; Zammuto, Raymond F; Goodman, Eric A

2002-01-01

Turnover rates for hospital nurses have been increasing in recent years, which is partially a result of increasing pressure on nurses from higher productivity expectations in a managed care environment. Improving nurse retention is a difficult challenge to managers since the bureaucratic cultural norm of hospitals, with its hierarchical structures, rules, and regulations, and heavy emphasis on measurement of outcomes and costs, may not be the culture most conducive to enhancing nurses' job satisfaction and commitment. Accordingly, this study investigates the relationships between unit organizational culture and several important job-related variables for nurse retention in the labor and delivery units of seven hospitals. Data analysis shows that unit organizational culture does affect nurses' quality of work life factors and that human relations cultural values are positively related to organizational commitment, job involvement, empowerment, and job satisfaction, and negatively related to intent to turnover. These findings suggest that although increasing recruitment of nurses and improved compensation and benefits strategies may offset hospital nurse shortages in the short term, improving quality of work life may be a more practical and long-term approach to improving hospital nurse retention.

Surgical referral coordination from a first-level hospital: a prospective case study from rural Nepal.

Science.gov (United States)

Fleming, Matthew; King, Caroline; Rajeev, Sindhya; Baruwal, Ashma; Schwarz, Dan; Schwarz, Ryan; Khadka, Nirajan; Pande, Sami; Khanal, Sumesh; Acharya, Bibhav; Benton, Adia; Rogers, Selwyn O; Panizales, Maria; Gyorki, David; McGee, Heather; Shaye, David; Maru, Duncan

2017-09-25

Patients in isolated rural communities typically lack access to surgical care. It is not feasible for most rural first-level hospitals to provide a full suite of surgical specialty services. Comprehensive surgical care thus depends on referral systems. There is minimal literature, however, on the functioning of such systems. We undertook a prospective case study of the referral and care coordination process for cardiac, orthopedic, plastic, gynecologic, and general surgical conditions at a district hospital in rural Nepal from 2012 to 2014. We assessed the referral process using the World Health Organization's Health Systems Framework. We followed the initial 292 patients referred for surgical services in the program. 152 patients (52%) received surgery and four (1%) suffered a complication (three deaths and one patient reported complication). The three most common types of surgery performed were: orthopedics (43%), general (32%), and plastics (10%). The average direct and indirect cost per patient referred, including food, transportation, lodging, medications, diagnostic examinations, treatments, and human resources was US$840, which was over 1.5 times the local district's per capita income. We identified and mapped challenges according to the World Health Organization's Health Systems Framework. Given the requirement of intensive human capital, poor quality control of surgical services, and the overall costs of the program, hospital leadership decided to terminate the referral coordination program and continue to build local surgical capacity. The results of our case study provide some context into the challenges of rural surgical referral systems. The high relative costs to the system and challenges in accountability rendered the program untenable for the implementing organization.

[Children's medically complex diseases unit. A model required in all our hospitals].

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Climent Alcalá, Francisco José; García Fernández de Villalta, Marta; Escosa García, Luis; Rodríguez Alonso, Aroa; Albajara Velasco, Luis Adolfo

2018-01-01

The increase in survival of children with severe diseases has led to the rise of children with chronic diseases, sometimes with lifelong disabilities. In 2008, a unit for the specific care of medically complex children (MCC) was created in Hospital La Paz. To describe the work and care activities of this Unit. Patients and methods An analysis was performed on all discharge reports of the Unit between January 2014 and July 2016. The MCC Unit has 6 beds and daily outpatient clinic. A total of 1,027 patients have been treated since the creation of the unit, with 243 from 2014. The median age was 24.2 months (IQ: 10.21-84.25). The large majority (92.59%) have multiple diseases, the most frequent chronic conditions observed were neurological (76.95%), gastrointestinal (63.78%), and respiratory diseases (61.72%). More than two-thirds (69.54%) of MCC are dependent on technology, 53.49% on respiratory support, and 35.80% on nutritional support. Hospital admission rates have increased annually. There have been 403 admissions since 2014, of which 8.93% were re-admissions within 30 days of hospital discharge. The median stay during 2014-2016 was 6 days (IQ: 3-14). The occupancy rate has been above 100% for this period. Currently, 210 patients remain on follow-up (86.42%), and 11 children (4.53%) were discharged to their referral hospitals. The mortality rate is 9.05% (22 deaths). The main condition of these 22 patients was neurological (9 patients). Infectious diseases were the leading cause of death. MCC should be treated in specialized units in tertiary or high-level hospitals. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative.

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Dückers, Michel La; Wagner, Cordula; Vos, Leti; Groenewegen, Peter P

2011-03-09

Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.

Development of certified environmental management in hospital and outpatient haemodialysis units.

Science.gov (United States)

García Vicente, Sergio; Morales Suárez-Varela, María; Martí Monrós, Anna; Llopis González, Agustín

2015-01-01

The environmental impact of haemodialysis is very high. Institutional activity in this sense is important, even in the production of references. Voluntary environmental management systems (EMS), environmental management and auditing systems (EMAS) and the International Organization for Standardization standards (ISO 14001) are important tools for environmental protection, together with legislation, taxation and tax benefits. To determine the degree of implementation of EMS in hospital units and outpatient haemodialysis in the Spanish National Health System to provide a group of reference centres in environmental management in this healthcare activity. Development of a list by autonomous communities showing hospital and outpatient dialysis units using an EMAS and/or ISO 14001 in 2012-2013. The sources of information were the Spanish National Catalogue of Hospitals, Spanish Registry of Healthcare Certification and Accreditation, European and regional EMAS records, world ISO registrations, dialysis centre lists from scientific societies and patients, responses from accredited entities in Spain for environmental certification and the institutional website of each haemodialysis centre identified. Of the 210 hospitals with a dialysis unit, 53 (25%) have the ISO 14001 and 15 of these also have an EMAS). This constitutes 30% of all hospital dialysis chairs in Spain: 1,291 (of 4,298). Only 11 outpatient clinics are recorded, all with the ISO 14001. There is no official documentation of the implementation of EMS in dialysis units. Making this list provides an approach to the situation, with special reference to haemodialysis because of its significant environmental impact. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Improving the smoking patterns in a general hospital psychiatric unit

Directory of Open Access Journals (Sweden)

Celso Iglesias García

2009-01-01

Full Text Available Objectives: The purpose of the present paper is to evaluate the effects of a smoking ban in a general hospital psychiatric unit. Methods: We study the effects of smoking ban in 40 consecutive psychiatric inpatients. The staff registered socio-demographic and tobacco-related variables. We also registered any kind of behavioral effects of smoking ban.Results: The patients were willing to stop smoking during their hospital stay (with or without nicotine replacement with two mild behavioural incidences registered throughout the study. Conclusions: The benefits of non-smoking policy in a psychiatric unit can be significant. The introduction of smoking bans in psychiatric inpatients settings is possible and safe.

Two Zn coordination polymers with meso-helical chains based on mononuclear or dinuclear cluster units

Energy Technology Data Exchange (ETDEWEB)

Qin, Ling, E-mail: qinling@hfut.edu.cn [Department of Chemical Engineering and Food Processing, Xuancheng Campus, Hefei University of Technology, Xuancheng 242000, Anhui (China); Jiangsu Engineering Technology Research Center of Environmental Cleaning Materials (CEM), School of Environmental Sciences and Engineering, Nanjing University of Information Science and Technology (China); State Key Laboratory of Coordination Chemistry, School of Chemistry and Chemical Engineering, Nanjing National Laboratory of Microstructures, Nanjing University, Nanjing 210093 (China); Qiao, Wen-Cheng; Zuo, Wei-Juan; Zeng, Si-Ying; Mei, Cao; Liu, Chang-Jiang [Department of Chemical Engineering and Food Processing, Xuancheng Campus, Hefei University of Technology, Xuancheng 242000, Anhui (China)

2016-07-15

Two zinc coordination polymers {[Zn_2(TPPBDA)(oba)_2]·DMF·1.5H_2O}{sub n} (1), {[Zn(TPPBDA)_1_/_2(tpdc)]·DMF}{sub n} (2) have been synthesized by zinc metal salt, nanosized tetradentate pyridine ligand with flexible or rigid V-shaped carboxylate co-ligands. These complexes were characterized by elemental analyses and X-ray single-crystal diffraction analyses. Compound 1 is a 2-fold interpenetrated 3D framework with [Zn{sub 2}(CO{sub 2}){sub 4}] clusters. Compound 2 can be defined as a five folded interpenetrating bbf topology with mononuclear Zn{sup 2+}. These mononuclear or dinuclear cluster units are linked by mix-ligands, resulting in various degrees of interpenetration. In addition, the photoluminescent properties for TPPBDA ligand under different state and coordination polymers have been investigated in detail. - Graphical abstract: Two zinc coordination polymers have been synthesized by zinc metal salt, nanosized tetradentate pyridine ligand with flexible or rigid V-shaped carboxylate co-ligands. Compound 1 is a 2-fold interpenetrated 3D framework with [Zn{sub 2}(CO{sub 2}){sub 4}] clusters. Compound 2 can be defined as a five folded interpenetrating bbf topology with mononuclear Zn{sup 2+}. In addition, the photoluminescent properties for TPPBDA ligand under different status and coordination polymers have been investigated in detail. Display Omitted - Highlights: • Two Zn coordination polymers based on mononuclear or dinuclear cluster units have been synthesized. • Compound 1 is a 2-fold interpenetrated 3D framework with [Zn{sub 2}(CO{sub 2}){sub 4}] clusters. • Compound 2 is a five folded interpenetrating bbf topology with mononuclear Zn{sup 2+}. • The photoluminescent properties for TPPBDA with different state and two coordination polymers have been investigated.

Risk factors predictive of endogenous endophthalmitis among hospitalized patients with hematogenous infections in the United States.

Science.gov (United States)

Vaziri, Kamyar; Pershing, Suzann; Albini, Thomas A; Moshfeghi, Darius M; Moshfeghi, Andrew A

2015-03-01

To identify potential risk factors associated with endogenous endophthalmitis among hospitalized patients with hematogenous infections. Retrospective cross-sectional study. MarketScan Commercial Claims and Encounters, and Medicare Supplemental and Coordination of Benefit inpatient databases from the years 2007-2011 were obtained. Utilizing ICD-9 codes, logistic regression was used to identify potential predictors/comorbidities for developing endophthalmitis in patients with hematogenous infections. Among inpatients with hematogenous infections, the overall incidence rate of presumed endogenous endophthalmitis was 0.05%-0.4% among patients with fungemia and 0.04% among patients with bacteremia. Comorbid human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) (OR = 4.27; CI, 1.55-11.8; P = .005), tuberculosis (OR = 8.5; CI, 1.2-61.5; P = .03), endocarditis (OR = 8.3; CI, 4.9-13.9; P endogenous endophthalmitis. Patients aged 0-17 years (OR = 2.61; CI, 1.2-5.7; P = .02), 45-54 years (OR = 3.4; CI, 2.0-5.4; P endogenous endophthalmitis. Endogenous endophthalmitis is rare among hospitalized patients in the United States. Among patients with hematogenous infections, odds of endogenous endophthalmitis were higher for children and middle-aged patients, and for patients with endocarditis, bacterial meningitis, lymphoma/leukemia, HIV/AIDS, internal organ abscess, diabetes with ophthalmic manifestations, skin cellulitis/abscess, pyogenic arthritis, tuberculosis, longer hospital stays, and/or ICU/NICU admission. Published by Elsevier Inc.

Multiple intra-hospital transports during relocation to a new critical care unit.

Science.gov (United States)

O'Leary, R-A; Conrick-Martin, I; O'Loughlin, C; Curran, M-R; Marsh, B

2017-11-01

Intra-hospital transport (IHT) of critically ill patients is associated with morbidity and mortality. Mass transfer of patients, as happens with unit relocation, is poorly described. We outline the process and adverse events associated with the relocation of a critical care unit. Extensive planning of the relocation targeted patient and equipment transfer, reduction in clinical pressure prior to the event and patient care during the relocation phase. The setting was a 30-bed, tertiary referral, combined medical and surgical critical care unit, located in a 570-bed hospital that serves as the national referral centre for cardiothoracic surgery and spinal injuries. All stakeholders relevant to the critical care unit relocation were involved, including nursing and medical staff, porters, information technology services, laboratory staff, project development managers, pharmacy staff and building contractors. Mortality at discharge from critical care unit and discharge from hospital were the main outcome measures. A wide range of adverse events were prospectively recorded, as were transfer times. Twenty-one patients underwent IHT, with a median transfer time of 10 min. Two transfers were complicated by equipment failure and three patients experienced an episode of hypotension requiring intervention. There were no cases of central venous or arterial catheter or endotracheal tube dislodgement, and hospital mortality at 30 days was 14%. Although IHT is associated with morbidity and mortality, careful logistical planning allows for efficient transfer with low complication rates.

Decreased mortality in patients hospitalized due to respiratory diseases after installation of an intensive care unit in a secondary hospital in the interior of Brazil.

Science.gov (United States)

Diogo, Luciano Passamani; Bahlis, Laura Fuchs; Wajner, André; Waldemar, Fernando Starosta

2015-01-01

To evaluate the association between the in-hospital mortality of patients hospitalized due to respiratory diseases and the availability of intensive care units. This retrospective cohort study evaluated a database from a hospital medicine service involving patients hospitalized due to respiratory non-terminal diseases. Data on clinical characteristics and risk factors associated with mortality, such as Charlson score and length of hospital stay, were collected. The following analyses were performed: univariate analysis with simple stratification using the Mantel Haenszel test, chi squared test, Student's t test, Mann-Whitney test, and logistic regression. Three hundred thirteen patients were selected, including 98 (31.3%) before installation of the intensive care unit and 215 (68.7%) after installation of the intensive care unit. No significant differences in the clinical and anthropometric characteristics or risk factors were observed between the groups. The mortality rate was 18/95 (18.9%) before the installation of the intensive care unit and 21/206 (10.2%) after the installation of the intensive care unit. Logistic regression analysis indicated that the probability of death after the installation of the intensive care unit decreased by 58% (OR: 0.42; 95%CI 0.205 -0.879; p = 0.021). Considering the limitations of the study, the results suggest a benefit, with a decrease of one death per every 11 patients treated for respiratory diseases after the installation of an intensive care unit in our hospital. The results corroborate the benefits of the implementation of intensive care units in secondary hospitals.

Stroke treatment outcomes in hospitals with and without Stroke Units.

Science.gov (United States)

Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I M

2017-10-23

Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Emergency response planning in hospitals, United States: 2003-2004.

Science.gov (United States)

Niska, Richard W; Burt, Catharine W

2007-08-20

This study presents baseline data to determine which hospital characteristics are associated with preparedness for terrorism and natural disaster in the areas of emergency response planning and availability of equipment and specialized care units. Information from the Bioterrorism and Mass Casualty Preparedness Supplements to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in hospital emergency response plans and resources by residency and medical school affiliation, hospital size, ownership, metropolitan statistical area status, and Joint Commission accreditation. Of 874 sampled hospitals with emergency or outpatient departments, 739 responded for an 84.6 percent response rate. Estimates are presented with 95 percent confidence intervals. About 92 percent of hospitals had revised their emergency response plans since September 11, 2001, but only about 63 percent had addressed natural disasters and biological, chemical, radiological, and explosive terrorism in those plans. Only about 9 percent of hospitals had provided for all 10 of the response plan components studied. Hospitals had a mean of about 14 personal protective suits, 21 critical care beds, 12 mechanical ventilators, 7 negative pressure isolation rooms, and 2 decontamination showers each. Hospital bed capacity was the factor most consistently associated with emergency response planning and availability of resources.

A Bi-Level Particle Swarm Optimization Algorithm for Solving Unit Commitment Problems with Wind-EVs Coordinated Dispatch

Science.gov (United States)

Song, Lei; Zhang, Bo

2017-07-01

Nowadays, the grid faces much more challenges caused by wind power and the accessing of electric vehicles (EVs). Based on the potentiality of coordinated dispatch, a model of wind-EVs coordinated dispatch was developed. Then, A bi-level particle swarm optimization algorithm for solving the model was proposed in this paper. The application of this algorithm to 10-unit test system carried out that coordinated dispatch can benefit the power system from the following aspects: (1) Reducing operating costs; (2) Improving the utilization of wind power; (3) Stabilizing the peak-valley difference.

GUIDING PRINCIPLES FOR GOOD PRACTICES IN HOSPITAL-BASED HEALTH TECHNOLOGY ASSESSMENT UNITS.

Science.gov (United States)

Sampietro-Colom, Laura; Lach, Krzysztof; Pasternack, Iris; Wasserfallen, Jean-Blaise; Cicchetti, Americo; Marchetti, Marco; Kidholm, Kristian; Arentz-Hansen, Helene; Rosenmöller, Magdalene; Wild, Claudia; Kahveci, Rabia; Ulst, Margus

2015-01-01

Health technology assessment (HTA) carried out for policy decision making has well-established principles unlike hospital-based HTA (HB-HTA), which differs from the former in the context characteristics and ways of operation. This study proposes principles for good practices in HB-HTA units. A framework for good practice criteria was built inspired by the EFQM excellence business model and information from six literature reviews, 107 face-to-face interviews, forty case studies, large-scale survey, focus group, Delphi survey, as well as local and international validation. In total, 385 people from twenty countries have participated in defining the principles for good practices in HB-HTA units. Fifteen guiding principles for good practices in HB-HTA units are grouped in four dimensions. Dimension 1 deals with principles of the assessment process aimed at providing contextualized information for hospital decision makers. Dimension 2 describes leadership, strategy and partnerships of HB-HTA units which govern and facilitate the assessment process. Dimension 3 focuses on adequate resources that ensure the operation of HB-HTA units. Dimension 4 deals with measuring the short- and long-term impact of the overall performance of HB-HTA units. Finally, nine core guiding principles were selected as essential requirements for HB-HTA units based on the expertise of the HB-HTA units participating in the project. Guiding principles for good practices set up a benchmark for HB-HTA because they represent the ideal performance of HB-HTA units; nevertheless, when performing HTA at hospital level, context also matters; therefore, they should be adapted to ensure their applicability in the local context.

Epidemiology of Hospitalizations Associated with Invasive Candidiasis, United States, 2002–20121

Science.gov (United States)

Strollo, Sara; Lionakis, Michail S.; Adjemian, Jennifer; Steiner, Claudia A.

2017-01-01

Invasive candidiasis is a major nosocomial fungal disease in the United States associated with high rates of illness and death. We analyzed inpatient hospitalization records from the Healthcare Cost and Utilization Project to estimate incidence of invasive candidiasis–associated hospitalizations in the United States. We extracted data for 33 states for 2002–2012 by using codes from the International Classification of Diseases, 9th Revision, Clinical Modification, for invasive candidiasis; we excluded neonatal cases. The overall age-adjusted average annual rate was 5.3 hospitalizations/100,000 population. Highest risk was for adults >65 years of age, particularly men. Median length of hospitalization was 21 days; 22% of patients died during hospitalization. Median unadjusted associated cost for inpatient care was $46,684. Age-adjusted annual rates decreased during 2005–2012 for men (annual change –3.9%) and women (annual change –4.5%) and across nearly all age groups. We report a high mortality rate and decreasing incidence of hospitalizations for this disease. PMID:27983497

[Work setting, satisfaction and burnout of the nurses in critical care units and hospitalization units. RN4CAST-Spain project].

Science.gov (United States)

Fuentelsaz-Gallego, C; Moreno-Casbas, T; Gómez-García, T; González-María, E

2013-01-01

To know if there are differences between the critical care units and the medical-surgical care units regarding the perception of the nurses working in National Health System hospitals about their work environment, burnout level and job satisfaction. A cross-sectional study was conducted with 6,417 nurses from the medical-surgical care units and with 1,122 nurses from critical care units of 59 Spanish hospitals with more than 150 beds. Socio-demographic, job satisfaction, perception of work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI questionnaire]) and burnout measured with the Maslach Burnout Inventory (MBI) data were collected. The PES-NWI showed differences in 4 out of its 5 factors. It showed better values in medical-surgical units in all the factors, except for Staffing and resource adequacy (P<.001), where critical care units showed a mean level of agreement of 2.41 versus 2.19 for the medical-surgical units. Regarding burnout, this was higher in the medical-surgical care units (P=.039) where 23% (952) of the nurses had high levels. Job satisfaction was lower in the critical care units (P=.044) with 70% (578) of nurses being very or strongly satisfied. The opinion of the nurses, working in critical care units about their hospital is unfavorable. They showed lower levels of burnout than those working in medical-surgical units. Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.

Implementation of a large-scale hospital information infrastructure for multi-unit health-care services.

Science.gov (United States)

Yoo, Sun K; Kim, Dong Keun; Kim, Jung C; Park, Youn Jung; Chang, Byung Chul

2008-01-01

With the increase in demand for high quality medical services, the need for an innovative hospital information system has become essential. An improved system has been implemented in all hospital units of the Yonsei University Health System. Interoperability between multi-units required appropriate hardware infrastructure and software architecture. This large-scale hospital information system encompassed PACS (Picture Archiving and Communications Systems), EMR (Electronic Medical Records) and ERP (Enterprise Resource Planning). It involved two tertiary hospitals and 50 community hospitals. The monthly data production rate by the integrated hospital information system is about 1.8 TByte and the total quantity of data produced so far is about 60 TByte. Large scale information exchange and sharing will be particularly useful for telemedicine applications.

Transplant Procurement Management Model Training: Marked Improvement in the Mindset of In-Hospital Procurement Coordinators at Hyogo Prefecture, Japan.

Science.gov (United States)

Yoshikawa, M; Yoshinaga, K; Imamura, Y; Hayashi, T; Osako, T; Takahashi, K; Kaneko, M; Fujisawa, M; Kamidono, S

2016-09-01

The organ donation rate in Japan is much lower than that in other developed countries for several reasons. An advanced educational program for in-hospital procurement coordinators is a possible solution for this. We introduced a Transplant Procurement Management (TPM) educational program at Hyogo Prefecture, Japan. Ten healthcare professionals at Hyogo Prefecture participated in the Advanced International TPM course to educate themselves on TPM and held 2 TPM Model Organ Procurement Training Workshops at Hyogo Prefecture for in-hospital procurement coordinators. Furthermore, we held 2 workshops outside Hyogo Prefecture and at the same time undertook a pre-workshop questionnaire survey to evaluate the ability and motivation with respect to organ donation. To evaluate the effectiveness of the workshops, we conducted post-workshop and 3-months-after workshop questionnaire surveys. The results of the pre-workshop survey revealed that in-hospital procurement coordinators lacked the knowledge regarding the entire organ donation process, the current status of organ donation in Japan, and the definition of brain death. Moreover, they did not completely understand the meaning of "organ donation." The results of the post-workshop questionnaire survey showed that the educational program was effective to improve the knowledge and skills of organ donation and motivated behavioral changes among the participants. The survey results showed that our TPM model educational program offered sufficient knowledge and skills to increase organ donation at Hyogo Prefecture. We will continue this program and make an effort to further contribute to the Japanese organ donation activities. Copyright © 2016 Elsevier Inc. All rights reserved.

Estimating the unit costs of public hospitals and primary healthcare centers.

Science.gov (United States)

Younis, Mustafa Z; Jaber, Samer; Mawson, Anthony R; Hartmann, Michael

2013-01-01

Many factors have affected the rise of health expenditures, such as high-cost medical technologies, changes in disease patterns and increasing demand for health services. All countries allocate a significant portion of resources to the health sector. In 2008, the gross domestic product of Palestine was estimated to be at $6.108bn (current price) or about $1697 per capita. Health expenditures are estimated at 15.6% of the gross domestic product, almost as much as those of Germany, Japan and other developed countries. The numbers of hospitals, hospital beds and primary healthcare centers in the country have all increased. The Ministry of Health (MOH) currently operates 27 of 76 hospitals, with a total of 3074 beds, which represent 61% of total beds of all hospitals in the Palestinian Authorities area. Also, the MOH is operating 453 of 706 Primary Health Care facilities. By 2007, about 40 000 people were employed in different sectors of the health system, with 33% employed by the MOH. This purpose of this study was to develop a financing strategy to help cover some or all of the costs involved in operating such institutions and to estimate the unit cost of primary and secondary programs and departments. A retrospective study was carried out on data from government hospitals and primary healthcare centers to identify and analyze the costs and output (patient-related services) and to estimate the unit cost of health services provided by hospitals and PHCs during the year 2008. All operating costs are assigned and allocated to the departments at MOH hospitals and primary health care centers (PPHCs) and are identified as overhead departments, intermediate-service and final-service departments. Intermediate-service departments provide procedures and services to patients in the final-service departments. The costs of the overhead departments are distributed to the intermediate-service and final-service departments through a step-down method, according to allocation

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative

Directory of Open Access Journals (Sweden)

Wagner Cordula

2011-03-01

Full Text Available Abstract Background Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC comprised of (a a leadership programme for hospital executives, (b six quality-improvement collaboratives (QICs for healthcare professionals and other staff, and (c an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. Methods The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. Results MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. Conclusions It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative

Science.gov (United States)

2011-01-01

Background Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. Methods The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. Results MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. Conclusions It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects. PMID:21385467

The need for economic policy coordination between Europe, Japan, and the United States: Policy recommendations for the 1990s

NARCIS (Netherlands)

A. Knoester (Anthonie); A. Kolodziejak (André)

1994-01-01

textabstractBetter policy coordination between Europe, Japan, and the United States is urgently needed in order to restore economic growth and to diminish mutual trade imbalances. Using the EC Compact model it is shown how coordinated fiscal policies can contribute to reaching these goals in the

[Medico-economic assessment of the Pontoise Hospital stroke unit].

Science.gov (United States)

Yekhlef, F; Decup, D; Niclot, P; Servan, J; Descombes, S; Richecoeur, J; Ollivier, A

2010-11-01

Annually, approximately 120,000 people in France have a stroke. Various controlled studies have pointed out the benefits of treatment in a stroke unit (SU). The objective of this study was to evaluate, from a medical point of view, the economic impact of the Pontoise Hospital SU. Based on the national cost study (NCS [étude nationale des coûts: ENC]) we analyzed data of five diagnosis related groups (DRG) which have a principle diagnosis in relation with stroke. This work was limited to strokes and transient ischemic events in adults and excluded sub-arachnoid hemorrhage. Medical and economic parameters were collected over the period from January to October 2006 and compared with those of the same period in 2005, that is to say before the opening of the SU. Three hundred and twenty-three hospital stays occurred between January 1st and October 31st, 2006 and 216 during the same time period before the opening of the SU, an increase of approximately 50% of all stroke-related admissions in our hospital. The number of stays carried out in the neurology unit increased by 29%. There was no significant difference between the two periods regarding age (median 69 versus 70 years) and sex- ratio. Average length of stay (ALS) was the same (9 days). There were no significant differences concerning the death rate (5.6% versus 6.2%) and that of discharge to home (44.6% versus 44.4%). The cost by stay in 2006 was 3534 euros [median; min 664-max 57,542] versus 3541 euros in 2005 [681-35,149] (p=0.57). Analysis by DRG highlighted an increase in the cost for serious strokes, cerebral infarctions and hemorrhages. For transitory ischemic events, the cost and the ALS decreased. After the opening of the SU, there was an increase in the activity without an increase in the total cost. This could be related in part to the limited means allocated to the stroke unit at its opening (in particular medical staff). The NCS can be used to evaluate the activity of a stroke unit. This work could

The crisis in United States hospital emergency services.

Science.gov (United States)

Harrison, Jeffrey P; Ferguson, Emily D

2011-01-01

Emergency services are critical for high-quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (U.S.) acute care hospital staffs ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers. Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities. U.S. acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, U.S. emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staffs ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state-of-the-art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement. This research uses the AHA annual surveys,which represent self-reported data by individual hospital staff. However, the AHA expendssignificant resources to validate reported information and the annual survey data are widely used for hospital research. The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure. This article has important information on US emergency service availability in the hospital industry.

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

Science.gov (United States)

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

2010-04-30

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

Homo- and heterodinuclear coordination polymers based on a tritopic cyclam bis-terpyridine unit: Structure and rheological properties

Energy Technology Data Exchange (ETDEWEB)

Qu, Li; Fan, Jiangxia; Ren, Yong; Xiong, Kun [State Key Laboratory Cultivation Base for Nonmetal Composites and Functional Materials, School of Materials Science and Engineering, Southwest University of Science and Technology, Mianyang 621010 (China); Yan, Minhao, E-mail: yanminhao@swust.edu.cn [State Key Laboratory Cultivation Base for Nonmetal Composites and Functional Materials, School of Materials Science and Engineering, Southwest University of Science and Technology, Mianyang 621010 (China); Tuo, Xianguo, E-mail: tuoxg@swust.edu.cn [Laboratory of National Defense for Radioactive Waste and Environmental Security, Southwest University of Science and Technology, Mianyang 621010 (China); Terech, Pierre [SPrAM, UMR CEA/CNRS/UJF-Grenoble 1, INAC, Grenoble F-38054 (France); Royal, Guy [Université Joseph Fourier Grenoble I, Département de Chimie Moléculaire, UMR CNRS-5250, Institut de Chimie Moléculaire de Grenoble, FR CNRS-2607, BP 53, 38041 Grenoble Cedex 9 (France)

2015-03-01

An innovative coordination polymer based on a tritopic ligand having the bis-terpyridine cyclam (CHTT) unit is explored. Homo- or heteronuclear 1D coordination polymers can be formed with bivalent metal ions such as Co(II) and Ni(II) in solvent DMF. Creep-recovery curves of the (Co{sup II}){sub 2}CHTT gels formed from 1D coordination polymers were analyzed with the Burgers model and demonstrated an original self-healing property, unusual in the class of molecular gels. The influence of the metal type was studied through the structural features using small-angle neutron scattering (SANS) experiments. In gels, the corresponding network involves genuine fibers (R ≈ 35 Å), bundles of these fibers and also a fraction of finite size aggregates (rods with aspect ratio f ≈ 3–5). We found that the distribution of these latter structural components is sensitive to the metal ions type. Such tritopic 1D coordination polymers exhibit a range of original structural features and a facile control of the developed structures in solutions and gels by tuning their thermodynamic parameters. The versatility associated to the intrinsic dynamic ability of the systems should pave the way to original properties for molecular devices. - Graphical abstract: A tritopic ligand with a bis-terpyridine cyclam (CHTT) unit can form homo- and heterobinuclear coordination polymers with bivalent metal ions in DMF. Gels exhibit a remarkable self-healing property while structures of solutions and gels are studied by small-angle neutron scattering. - Highlights: • Homo- and heteronuclear coordination polymers based on innovative tritopic ligand. • The gels formed from the coordination polymers demonstrated self-healing property. • Influence of the metal type was studied through the structural properties by SANS. • Versatility of the singular system present original properties for molecular device.

An analysis of acute admissions to a general hospital psychiatric unit

African Journals Online (AJOL)

Rapid turnover of patients in a general hospital psychiatric unit demands stabilization and discharge as soon as possible. It is likely that patients are being prematurely discharged because of this pressure. Aim: The study sought to analyse admissions to an acute psychiatric unit with a view to determining the demographic ...

The role of leader behaviors in hospital-based emergency departments' unit performance and employee work satisfaction.

Science.gov (United States)

Lin, Blossom Yen-Ju; Hsu, Chung-Ping C; Juan, Chi-Wen; Lin, Cheng-Chieh; Lin, Hung-Jung; Chen, Jih-Chang

2011-01-01

The role of the leader of a medical unit has evolved over time to expand from simply a medical role to a more managerial one. This study aimed to explore how the behavior of a hospital-based emergency department's (ED's) leader might be related to ED unit performance and ED employees' work satisfaction. One hundred and twelve hospital-based EDs in Taiwan were studied: 10 in medical centers, 32 in regional hospitals, and 70 in district hospitals. Three instruments were designed to assess leader behaviors, unit performance and employee satisfaction in these hospital-based EDs. A mail survey revealed that task-oriented leader behavior was positively related to ED unit performance. Both task- and employee-oriented leader behaviors were found to be positively related to ED nurses' work satisfaction. However, leader behaviors were not shown to be related to ED physicians' work satisfaction at a statistically significant level. Some ED organizational characteristics, however, namely departmentalization and hospital accreditation level, were found to be related to ED physicians' work satisfaction. Copyright © 2010 Elsevier Ltd. All rights reserved.

Observation-status patients in children's hospitals with and without dedicated observation units in 2011.

Science.gov (United States)

Macy, Michelle L; Hall, Matthew; Alpern, Elizabeth R; Fieldston, Evan S; Shanley, Leticia A; Hronek, Carla; Hain, Paul D; Shah, Samir S

2015-06-01

Pediatric observation units (OUs) have demonstrated reductions in lengths of stay (LOS) and costs of care. Hospital-level outcomes across all observation-status stays have not been evaluated in relation to the presence of a dedicated OU in the hospital. To compare observation-status stay outcomes in hospitals with and without a dedicated OU. Cross-sectional analysis of hospital administrative data. Observation-status stay outcomes were compared in hospitals with and without a dedicated OU across 4 categories: (1) LOS, (2) standardized costs, (3) conversion to inpatient status, and (4) return care. Observation-status stays in 31 free-standing children's hospitals contributing observation patient data to the Pediatric Health Information System database, 2011. Fifty-one percent of the 136,239 observation-status stays in 2011 occurred in 14 hospitals with a dedicated OU; the remainder were in 17 hospitals without. The percentage of observation-status same-day discharges was higher in hospitals with a dedicated OU compared with hospitals without (23.8 vs 22.1, P hospitals with a dedicated OU (11.06%) compared with hospitals without (9.63%, P hospital-level outcomes. Inclusion of location of care (eg, dedicated OU, inpatient unit, emergency department) in hospital administrative datasets would allow for more meaningful comparisons of models of hospital care. © 2015 Society of Hospital Medicine.

Coordination chemistry of gadolinium complexes having pyridine carboxylate units in relation with the medical imagery

International Nuclear Information System (INIS)

Gateau, C.; Chatterton, N.; Nonat, A.; Mazzanti, M.; Pecaut, J.; Borel, A.; Merbach, A.; Heim, L.

2005-01-01

In order to study the influence of the coordination sphere on the properties which govern the relaxivity, ligands containing pyridine carboxylates units have been particularly studied. It has been shown that the tripodal ligand tpaa forms with gadolinium (III) a neutral complex having a relaxivity (r1p=13.3 mM -1 at 298 K and 60 MHz) which is three times superior to the contrast agents currently used in NMR Imaging. To explain this remarkably relaxivity, two new ligands analogous to the tpaa: the tpatcn and the bpeda containing pyridine carboxylate units bound to one or several aliphatic nitrogen have been studied in modulating the number of coordination sites and the symmetry degree. The study of the relaxivity of the corresponding gadolinium (III) complexes gives precious data on the understanding of the results in the case of the complex [Gd(tpaa)]. The synthesis and the properties of these gadolinium (III) complexes will be presented during this conference. (O.M.)

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

Directory of Open Access Journals (Sweden)

Tom E.F. Abbott

2018-03-01

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

Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital

Science.gov (United States)

Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

2016-01-01

Background: Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. Objective: This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran. Methods: This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS. Results: The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. Conclusion: By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department. PMID:26234974

Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital.

Science.gov (United States)

Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

2015-05-17

Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran.‎ This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS.‎ The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department.

Hospitalization for esophageal achalasia in the United States.

Science.gov (United States)

Molena, Daniela; Mungo, Benedetto; Stem, Miloslawa; Lidor, Anne O

2015-09-25

To assess the outcome of different treatments in patients admitted for esophageal achalasia in the United States. This is a retrospective analysis using the Nationwide Inpatient Sample over an 8-year period (2003-2010). Patients admitted with a primary diagnosis of achalasia were divided into 3 groups based on their treatment: (1) Group 1: patients who underwent Heller myotomy during their hospital stay; (2) Group 2: patients who underwent esophagectomy; and (3) Group 3: patients not undergoing surgical treatment. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), discharge destination and total hospital charges. Among 27141 patients admitted with achalasia, nearly half (48.5%) underwent Heller myotomy, 2.5% underwent esophagectomy and 49.0% had endoscopic or other treatment. Patients in group 1 were younger, healthier, and had the lowest mortality when compared with the other two groups. Group 2 had the highest LOS and hospital charges among all groups. Group 3 had the highest mortality (1.2%, P achalasia carries exceedingly low mortality in the modern era; however, in complicated patients, even less invasive treatments are burdened by significant mortality and morbidity.

Role of communication systems in coordinating supervising anesthesiologists' activities outside of operating rooms.

Science.gov (United States)

Smallman, Bettina; Dexter, Franklin; Masursky, Danielle; Li, Fenghua; Gorji, Reza; George, Dave; Epstein, Richard H

2013-04-01

Theoretically, communication systems have the potential to increase the productivity of anesthesiologists supervising anesthesia providers. We evaluated the maximal potential of communication systems to increase the productivity of anesthesia care by enhancing anesthesiologists' coordination of care (activities) among operating rooms (ORs). At hospital A, data for 13,368 pages were obtained from files recorded in the internal alphanumeric text paging system. Pages from the postanesthesia care unit were processed through a numeric paging system and thus not included. At hospital B, in a different US state, 3 of the authors categorized each of 898 calls received using the internal wireless audio system (Vocera(®)). Lower and upper 95% confidence limits for percentages are the values reported. At least 45% of pages originated from outside the ORs (e.g., 20% from holding area) at hospital A and at least 56% of calls (e.g., 30% administrative) at hospital B. In contrast, requests from ORs for urgent presence of the anesthesiologist were at most 0.2% of pages at hospital A and 1.8% of calls at hospital B. Approximately half of messages to supervising anesthesiologists are for activity originating outside the ORs being supervised. To use communication tools to increase anesthesia productivity on the day of surgery, their use should include a focus on care coordination outside ORs (e.g., holding area) and among ORs (e.g., at the control desk).

A medical admission unit reduces duration of hospital stay and number of readmissions

DEFF Research Database (Denmark)

Vork, Jan C; Brabrand, Mikkel; Folkestad, Lars

2011-01-01

Political initiatives promoting a more efficient emergency admission process have triggered a reorganisation of the Danish health system with a view to creating fewer and larger admission units counting more experienced physicians. At our hospital, a medical admission unit (MAU) was established. ...... present the effect of this on the length of hospital stay, mortality rates and the number of readmissions for the last year with the previous structure and the first year of the new MAU structure....

CORRELATION BETWEEN COORDINATION AND PERSONALITY TRAITS OF SOLDIERS IN BATTLE UNIT OF SLOVENIAN ARMED FORCES

Directory of Open Access Journals (Sweden)

Maja Pori

2009-11-01

Full Text Available The aim of the study was to investigate the correlation between motor ability of coordination and personality traits of Slovenian soldiers. The subject sample consisted of 94 soldiers in a battle unit of Slovenian Armed Forces (SAF who were serving in the first brigade (age 26,5 ± 3,4 years. Motor ability of coordination was assessed with two motor tasks (polygon bac- kwards and figure 8 duck test. The structure of personality traits was measured with a FPI (Freiburg Personality Inventory included 114 items and measured 9 personality traits of order I (neuroticism, impulsivity, depression, irritability, sociability, calmness, dominance, suppression, sincerity and 3 personality traits of order II (extroversion, emotional istability, masculinity. The correlation between coordination and personality traits was estimated by the Pearson’s correlation coefficient. The results show that soldiers who did worse in motor test polygon backwards were more neurotic, suppressed, and impulsive. They also tend to be more sociable. The correlation between second test of coordination shows that better soldiers in this test are more extrovert or less introvert.

[Incidence of multi-resistant bacteria in Intensive Care Units of Chilean hospitals].

Science.gov (United States)

Acuña, M Paz; Cifuentes, Marcela; Silva, Francisco; Rojas, Álvaro; Cerda, Jaime; Labarca, Jaime

2017-12-01

Incidence of multi-resistant bacteria is an indicator that permits better estimation of the magnitude of bacterial resistance in hospitals. To evaluate the incidence of relevant multi-drug resistant bacteria in intensive care units (ICUs) of Chile. Participating hospitals submitted information about the number of isolates from infected or colonized patients with 7 epidemiologically relevant multi-resistant bacteria in adult and pediatric ICUs between January 1, 2014 and October 31, 2015 and the number of bed days occupied in these units in the same period was requested. With these data incidence was calculated per 1,000 patient days for each unit. Information from 20 adults and 9 pediatric ICUs was reviewed. In adult ICUs the bacteria with the highest incidence were K. pneumoniae ESBL [4.72 × 1,000 patient day (1.21-13.89)] and oxacillin -resistant S. aureus [3.85 (0.71-12.66)]. In the pediatric units the incidence was lower, highlighting K. pneumoniae ESBL [2.71 (0-7.11)] and carbapenem -resistant P. aeruginosa [1.61 (0.31-9.25)]. Important differences between hospitals in the incidence of these bacteria were observed. Incidence of multi-resistant bacteria in adult ICU was significantly higher than in pediatric ICU for most of the studied bacterias.

The Role of Equivalence and Order Relations in the Development and Coordination of the Concepts of Unit Size and Number of Units in Selected Conservation Type Measurement Problems.

Science.gov (United States)

Carpenter, Thomas P.

The major purpose of this study was 1) to investigate the development of the concept of a unit of measure and the coordination of unit size and the number of units 2) to relate this development to the development of conservation and 3) to determine the role of equivalence and nonequivalence relations in certain conservation and measurement…

Impact of stroke unit in a public hospital on length of hospitalization and rate of early mortality of ischemic stroke patients

Directory of Open Access Journals (Sweden)

Maria Sheila G. Rocha

2013-10-01

Full Text Available We ascertained whether a public health stroke unit reduces the length of hospitalization, the rate of inpatient fatality, and the mortality rate 30 days after the stroke. Methods We compared a cohort of stroke patients managed on a general neurology/medical ward with a similar cohort of stroke patients managed in a str oke unit. The in-patient fatality rates and 30-day mortality rates were analyzed. Results 729 patients were managed in the general ward and 344 were treated at a comprehensive stroke unit. The in-patient fatality rates were 14.7% for the general ward group and 6.9% for the stroke unit group (p<0.001. The overall mortality rate 30 days after stroke was 20.9% for general ward patients and 14.2% for stroke unit patients (p=0.005. Conclusions We observed reduced in-patient fatalities and 30-day mortality rates in patients managed in the stroke unit. There was no impact on the length of hospitalization.

[Hospital pharmaceutical practice in prison].

Science.gov (United States)

Harcouët, L

2010-09-01

Since 1994, hospital pharmaceutical teams have been in charge of pharmaceutical tasks in "unités de consultation et de soins ambulatoires" (UCSA), which are hospital consulting care units in French prisons. In 2008, pharmaceutical team in Parisian prisons received 6500 prescriptions and prepared 85,000 nominative bags containing drugs. Prisoners were 1.3% to receive treatments against HIV, 8.2% cardiovascular drugs, 7.2% opioid substitution treatments, and 52.9% psychoactive drugs, including 39.3% hypnotics, 40.5% anxiolytics, 11.3% antidepressants and 12.2% neuroleptics. In prison, the dichotomy between somatic and mental care is marked, attitudes of prisoners about their medicines are complex (important claims, embezzlement, etc.) and it is difficult for law defendants to maintain treatment confidentiality and to prepare prison outing in terms of health. To attenuate the heterogeneity of drug distribution systems in French prisons, we propose pharmaceutical analysis of prescriptions and nominative dispensation, computerization in UCSA in coordination with hospitals, a better contribution of prison medical and pharmaceutical staff in hospital "drug committees" and the redaction of pharmaceutical guidelines. Acting in concert with multidisciplinary medical staff in UCSA, pharmaceutical teams have to develop epidemiological studies to improve knowledge in prisoner's health and also prevention and health care in prison. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Critical diversity: Divided or united states of social coordination.

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Mengsen Zhang

Full Text Available Much of our knowledge of coordination comes from studies of simple, dyadic systems or systems containing large numbers of components. The huge gap 'in between' is seldom addressed, empirically or theoretically. We introduce a new paradigm to study the coordination dynamics of such intermediate-sized ensembles with the goal of identifying key mechanisms of interaction. Rhythmic coordination was studied in ensembles of eight people, with differences in movement frequency ('diversity' manipulated within the ensemble. Quantitative change in diversity led to qualitative changes in coordination, a critical value separating régimes of integration and segregation between groups. Metastable and multifrequency coordination between participants enabled communication across segregated groups within the ensemble, without destroying overall order. These novel findings reveal key factors underlying coordination in ensemble sizes previously considered too complicated or 'messy' for systematic study and supply future theoretical/computational models with new empirical checkpoints.

Accounting for the Invisible Work of Hospital Orderlies

DEFF Research Database (Denmark)

Stisen, Allan; Verdezoto, Nervo; Blunck, Henrik

2016-01-01

the coordination changes in orderlies’ work practices in connection to the implementation of a workflow application at the hospital. By applying a mixed methods approach (both qualitative and quantitative studies), this paper calls for attention to the changes in orderlies’ coordination activities while moving......The cooperative, invisible non-clinical work of hospital orderlies is often overlooked. It consists foremost of transferring patients between hospital departments. As the overall efficiency of the hospital is highly dependent on the coordination of the work of orderlies, this study investigates...... coordination. We also present design recommendations for future design of coordination tools to support orderlies’ work practices....

Pressure ulcers and prevention among acute care hospitals in the United States.

Science.gov (United States)

Bergquist-Beringer, Sandra; Dong, Lei; He, Jianghua; Dunton, Nancy

2013-09-01

Most pressure ulcers can be prevented with evidence-based practice. Many studies describe the implementation of a pressure ulcer prevention program but few report the effect on outcomes across acute care facilities. Data on hospital-acquired pressure ulcers and prevention from the National Database of Nursing Quality Indicators 2010 Pressure Ulcer Surveys were linked to hospital characteristics and nurse staffing measures within the data set. The sample consisted of 1,419 hospitals from across the United States and 710,626 patients who had been surveyed for pressure ulcers in adult critical care, step-down, medical, surgical, and medical/surgical units. Hierarchical logistic regression analysis was performed to identify study variables associated with hospital-acquired pressure ulcers among patients at risk for these ulcers. The rate of hospital-acquired pressure ulcers was 3.6% across all surveyed patients and 7.9% among those at risk. Patients who received a skin and pressure ulcer risk assessment on admission were less likely to develop a pressure ulcer. Additional study variables associated with lower hospital-acquired pressure ulcer rates included a recent reassessment of pressure ulcer risk, higher Braden Scale scores, a recent skin assessment, routine repositioning, and Magnet or Magnet-applicant designation. Variables associated with a higher likelihood of hospital-acquired pressure ulcers included nutritional support, moisture management, larger hospital size, and academic medical center status. Results provide empirical support for pressure ulcer prevention guideline recommendations on skin assessment, pressure ulcer risk assessment, and routine repositioning, but the 7.9% rate of hospital-acquired pressure ulcers among at-risk patients suggests room for improvement in pressure ulcer prevention practice.

Hospitalized poisonings after renal transplantation in the United States

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Viola Rebecca A

2002-11-01

Full Text Available Abstract Background The national incidence of and risk factors for hospitalized poisonings in renal transplant recipients has not been reported. Methods Historical cohort study of 39,628 renal transplant recipients in the United States Renal Data System between 1 July 1994 and 30 June 1998. Associations with time to hospitalizations for a primary diagnosis of poisonings (ICD-9 codes 960.x-989.x within three years after renal transplant were assessed by Cox Regression. Results The incidence of hospitalized poisonings was 2.3 patients per 1000 person years. The most frequent causes of poisonings were immunosuppressive agents (25.3%, analgesics/antipyretics (14.1%, psychotropic agents (10.0%, and insulin/antidiabetic agents (7.1%. In Cox Regression analysis, low body mass index (BMI, 28.3 kg/m2, adjusted hazard ratio (AHR, 3.02, 95% CI, 1.45–6.28, and allograft rejection, AHR 1.83, 95% CI, 1.15–2.89, were the only factors independently associated with hospitalized poisonings. Hospitalized poisonings were independently associated with increased mortality (AHR, 1.54, 95% CI 1.22–1.92, p = 0.002. Conclusions Hospitalized poisonings were associated with increased mortality after renal transplantation. However, almost all reported poisonings in renal transplant recipients were due to the use of prescribed medications. Allograft rejection and low BMI were the only independent risk factors for poisonings identified in this population.

[Stress in parents of hospitalized newborns in a neonatal intensive care unit].

Science.gov (United States)

Palma I, Elisa; Von Wussow K, Fernanda; Morales B, Ignacia; Cifuentes R, Javier; Ambiado T, Sergio

2017-06-01

The birth of a child that requires hospitalization in a Neonatal Intensive Care Unit (NICU) can be very stressful for parents. To determine the stress level of parents of newborns (NB) hospitalized in a level III NICU in Santiago, and its association with clinical and sociodemographic variables. Descriptive cross-sectional study. 373 admissions were evaluated. The sampling was non-probabilistic and included parents of RN admitted to the UPCN between 7 and 21 days of hospitalization. Only parents which have visited the RN at least three times were included. i) Questionnaire to obtain data which could not be obtained from the medical record; ii) Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU) which measures the perception of parents about stressors from the physical and psychological environment of the UPCN. 100 parents of 59 hospitalized NB participated in the study. The average parental stress was 2.87±0.69. The subscale scores got higher was “Relationship with the baby and parental role”. Complications in pregnancy, prenatal diagnosis or prenatal hospitalization, did not affect the stress level or the presence of prematurity, respiratory diseases, congenital malformations, genopathies or requirement of mechanical ventilation. Stress levels presented in parents are unrelated to gender and to the studied clinical variables.

10 CFR 455.141 - Grant awards for units of local government, public care institutions, and coordinating agencies.

Science.gov (United States)

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Grant awards for units of local government, public care... CONSERVATION GRANT PROGRAMS FOR SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS Grant Awards § 455.141 Grant awards for units of local government, public care...

The use of irradiated food for immunosuppressed hospital patients in the United Kingdom

International Nuclear Information System (INIS)

Pryke, D.C.; Taylor, R.R.

1995-01-01

Irradiation has been recommended as a method for preparing foods for hospital patients requiring sterile diets as a result of intensive therapy or disease that has resulted in suppression of the immune system. It has a number of advantages over other methods and in recognition of this, in the United Kingdom, the use of irradiated foods for hospital patients has been specifically exempted from regulatory control. Due to a number of factors there is a move away from keeping patients in a sterile environment; however, irradiation may still have a role to play for vulnerable and high-risk patients. This paper summarizes the use of radiation-sterilized foods in hospitals in the United Kingdom and discusses the future potential for both radiation-sterilized and ‘radiation-pasturized’ foods

Hospitals: Soft Target for Terrorism?

Science.gov (United States)

De Cauwer, Harald; Somville, Francis; Sabbe, Marc; Mortelmans, Luc J

2017-02-01

In recent years, the world has been rocked repeatedly by terrorist attacks. Arguably, the most remarkable were: the series of four coordinated suicide plane attacks on September 11, 2001 on buildings in New York, Virginia, and Pennsylvania, USA; and the recent series of two coordinated attacks in Brussels (Belgium), on March 22, 2016, involving two bombings at the departure hall of Brussels International Airport and a bombing at Maalbeek Metro Station located near the European Commission headquarters in the center of Brussels. This statement paper deals with different aspects of hospital policy and disaster response planning that interface with terrorism. Research shows that the availability of necessary equipment and facilities (eg, personal protective clothing, decontamination rooms, antidotes, and anti-viral drugs) in hospitals clearly is insufficient. Emergency teams are insufficiently prepared: adequate and repetitive training remain necessary. Unfortunately, there are many examples of health care workers and physicians or hospitals being targeted in both political or religious conflicts and wars. Many health workers were kidnapped and/or killed by insurgents of various ideology. Attacks on hospitals also could cause long-term effects: hospital units could be unavailable for a long time and replacing staff could take several months, further compounding hospital operations. Both physical and psychological (eg, posttraumatic stress disorder [PTSD]) after-effects of a terrorist attack can be detrimental to health care services. On the other hand, physicians and other hospital employees have shown to be involved in terrorism. As data show that some offenders had a previous history with the location of the terror incident, the possibility of hospitals or other health care services being targeted by insiders is discussed. The purpose of this report was to consider how past terrorist incidents can inform current hospital preparedness and disaster response planning

The impact of the hospitalization process on the caregiver of a chronic critical patient hospitalized in a Semi-Intensive Care Unit

OpenAIRE

Neves, Letícia; Gondim, Andressa Alencar; Soares, Sara Costa Martins Rodrigues; Coelho, Denis Pontes; Pinheiro, Joana Angélica Marques

2018-01-01

Abstract Objective: To understand the impact of the hospitalization process on the family companion of critical patients admitted to a Semi-Intensive Care Unit (SICU). Method: Exploratory research with a qualitative approach, conducted in the months of April to July of 2016 through a semi-structured interview applied to relatives who were accompanying patients hospitalized in an SICU of a high complexity care hospital in Fortaleza. The interviews were submitted to content analysis. Results...

First-year results of the Global Influenza Hospital Surveillance Network: 2012–2013 Northern hemisphere influenza season

Science.gov (United States)

2014-01-01

Background The Global Influenza Hospital Surveillance Network (GIHSN) was developed to improve understanding of severe influenza infection, as represented by hospitalized cases. The GIHSN is composed of coordinating sites, mainly affiliated with health authorities, each of which supervises and compiles data from one to seven hospitals. This report describes the distribution of influenza viruses A(H1N1), A(H3N2), B/Victoria, and B/Yamagata resulting in hospitalization during 2012–2013, the network’s first year. Methods In 2012–2013, the GIHSN included 21 hospitals (five in Spain, five in France, four in the Russian Federation, and seven in Turkey). All hospitals used a reference protocol and core questionnaire to collect data, and data were consolidated at five coordinating sites. Influenza infection was confirmed by reverse-transcription polymerase chain reaction. Hospitalized patients admitted within 7 days of onset of influenza-like illness were included in the analysis. Results Of 5034 patients included with polymerase chain reaction results, 1545 (30.7%) were positive for influenza. Influenza A(H1N1), A(H3N2), and both B lineages co-circulated, although distributions varied greatly between coordinating sites and over time. All age groups were affected. A(H1N1) was the most common influenza strain isolated among hospitalized adults 18–64 years of age at four of five coordinating sites, whereas A(H3N2) and B viruses were isolated more often than A(H1N1) in adults ≥65 years of age at all five coordinating sites. A total of 16 deaths and 20 intensive care unit admissions were recorded among patients with influenza. Conclusions Influenza strains resulting in hospitalization varied greatly between coordinating sites and over time. These first-year results of the GIHSN are relevant, useful, and timely. Due to its broad regional representativeness and sustainable framework, this growing network should contribute substantially to understanding the

[Emotional climate and internal communication in a clinical management unit compared with two traditional hospital services].

Science.gov (United States)

Alonso, E; Rubio, A; March, J C; Danet, A

2011-01-01

The aim of this study is to compare the emotional climate, quality of communication and performance indicators in a clinical management unit and two traditional hospital services. Quantitative study. questionnaire of 94 questions. 83 health professionals (63 responders) from the clinical management unit of breast pathology and the hospital services of medical oncology and radiation oncology. descriptive statistics, comparison of means, correlation and linear regression models. The clinical management unit reaches higher values compared with the hospital services about: performance indicators, emotional climate, internal communication and evaluation of the leadership. An important gap between existing and desired sources, channels, media and subjects of communication appear, in both clinical management unit and traditional services. The clinical management organization promotes better internal communication and interpersonal relations, leading to improved performance indicators. Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.

The role of programmed and emergent mechanisms of coordination

DEFF Research Database (Denmark)

Prætorius, Thim

Hospitals face substantial coordination challenges. To meet this hospitals more and more use standardized work processes such as care pathways. By drawing on recent coordination theory that increasingly emphasizes the role of lateral and emergent interactions alongside traditional, programmed...... mechanisms of coordination, this paper finds that standardized work processes such as care pathways should be considered as a bundle of coordination mechanisms—plans and rules, objects, routines, roles and proximity—rather than a mechanism of its own. The bundle builds the accountability, predictability...... and common understanding needed to coordinate standardized care tasks. The analysis lends theoretical insights to the traditional view that see standardized work processes as programmed processes. For health care workers who design, implement and use care pathways to solve care tasks, the analysis calls...

Rural model dedicated education unit: partnership between college and hospital.

Science.gov (United States)

Harmon, Lisa M

2013-02-01

This article describes the pilot project development of a rural model Dedicated Education Unit (DEU) by a rural college nursing program and a rural hospital to increase student nurses' confidence and proficiency and improve recruitment of prepared rural staff nurses. Traditionally, for economies of scale, most student clinical rotations occurred in urban settings with the number of students per clinical instructor allowed by the state board of nursing. College budget constraints negated the placement of fewer than this mandated maximum number of students in a rural hospital with a clinical instructor; moreover, rural hospitals could not accommodate 10 students at one time. Rural nursing students were anxious in the urban settings, and this anxiety precluded learning in many instances. Rural hospitals face higher registered nurse vacancies than urban centers. Of the nurses applying for open positions, many were not prepared for the demands of rural nursing, resulting in increased turnover and high orientation costs. The rural model DEU addressed issues of both the nursing program and the hospital. The design and development of the rural model DEU and the advantages of the partnership for the college nursing program and the hospital are discussed. Initial outcomes and serendipitous findings from the pilot project are also discussed. Copyright 2013, SLACK Incorporated.

[Civilian-military coordination].

Science.gov (United States)

de Montravel, G

2002-01-01

Current humanitarian emergencies create complex, mutidimensional situations that stimulate simultaneous responses from a wide variety of sources including governments, non-governmental organizations (NGO), United Nations agencies, and private individuals. As a result, it has become essential to establish a coherent framework in which each actor can contribute promptly and effectively to the overall effort. This is the role of the United Nations Office for the Coordination of Humanitarian Affairs. Regardless of the circumstances and level of coordination, cooperation and collaboration between humanitarian and military personnel, it is necessary to bear in mind their objectives. The purpose of humanitarian action is to reduce human suffering. The purpose of military intervention is to stop warfare. The author of this article will discuss the three major obstacles to civilian-military coordination (strategic, tactical, and operational). Operations cannot be conducted smoothly and differences cannot be ironed out without mutual respect between the two parties, an explicit definition of their respective duties and responsibilities, a clear understanding of their cultural differences, and the presence of an organization and facilities for coordination and arbitrage by a neutral referee.

Deterioro funcional en ancianos ingresados en un hospital sin unidades geriátricas Functional impairment in elderly inpatients in a hospital without geriatric units

Directory of Open Access Journals (Sweden)

Alfonso Jesús Cruz Lendínez

2010-03-01

ás influyen en la variación de la capacidad funcional durante la hospitalización. La hospitalización de ancianos en un hospital sin unidad geriátrica supone peores resultados en la capacidad funcional de los pacientes frente a los hospitales que cuentan con unidad de hospitalización geriátrica.Introduction: Increased population of elderly people is becoming more frequent admission to hospitals of people older than 65 years. Hospital stay in conventional units can lead to functional worsening in the elderly. Aim: To identify the profile of elderly patients treated in the Internal Medicine Hospital of Jaén. To analyze variation in functional ability of elderly people following admission to inpatient units of a public hospital. To identify variables that influence the changes in the functional ability of elderly inpatients in hospitals without geriatric units. Methods: Prospective observational study in 3 units of internal medicine units in a hospital belonging to the Andalusian Health Service. A sample of 190 hospitalized elderly patients has been included. Variables related to demographic, hospitalization and functional ability using Barthel Index, were reported. Results: Hospitalization in internal medicine units did not help to improve functional ability in older people; rather, they had a negative effect, promoting functional worsening in an important group of these patients. Depending on the age, among patients studied (65-85 and over, younger patients got better results on functional recovery at discharge, while those above 85 years got worst results. 16% under 85 years and 67.5% of those over 85 lose functional capacity. Conclusions: Most important factors affecting functional ability change during hospitalization were age, functional ability at admission, functional ability at discharge, the presence of companions during hospitalization and discharge destination. Hospitalization of elderly in a nongeriatric inpatient unit at hospital assumes no worse results in

[Evaluation of the activity of a urological emergency unit in university hospital].

Science.gov (United States)

Martin, L; Pillot, P; Bardonnaud, N; Lillaz, J; Chabannes, E; Bernardini, S; Guichard, G; Bittard, H; Kleinclauss, F

2014-01-01

To determine the epidemiology of urological emergencies in a university hospital and the interest of a dedicated urological emergency unit. In 2008, a dedicated urological emergency unit was individualized in our department of urology. We conducted a retrospective study including all patients consulting in this unit in 2009 with epidemiological, clinical and therapeutic data. During 2009, 1257 patients consulted in this unit. Main diagnoses were acute urinary retention (303, 24.11%), renal colic (219, 17.42%), urinary infections (278, 22.11%), postoperative complications (141, 11.22%), symptomatic benign prostate hyperplasia (65, 5.17%), genitourinary cancers (61, 4.85%), trauma of urinary apparel (41, 3.26%), and spermatic cords torsion (10, 0.8%). In 99 cases (7.88%) diagnosis did not involved the urinary system. The treatment was surgical in 213 (17.7%) cases, technical procedure under local anesthesia in 368 (29.3%) and a medical treatment in 675 (53.7%) cases. Six hundred and sixty (52.5%) patients were managed ambulatory whereas 596 (47.5%) needed hospitalization. The opening of a dedicated urological emergency unit lead to 1257 emergency consultations. Frequent etiologies were acute urinary retention, renal colic and urinary infection. The creation of this unit allowed to register and to valorize this emergency activity through the ATU emergency amount. Copyright © 2013. Published by Elsevier Masson SAS.

Nurses' Use and Perception of an Information and Communication Technology System for Improving Coordination During Hospital Discharges: A Survey in Swedish Primary Healthcare.

Science.gov (United States)

Christiansen, Line; Fagerström, Cecilia; Nilsson, Lina

2017-07-01

To facilitate communications between care levels and improve coordination during hospital discharges, there is great potential in using information and communication technology systems, because they can significantly help to deter unnecessary readmissions. However, there is still a lack of knowledge about how often nurses use information and communication technology and the indicators related to its use. The aims of this study were to describe the indicators related to nurses' use of an information and communication technology system for collaboration between care levels and to estimate whether the level of use can be related to nurses' perceptions of the information and communication technology system's contribution to improve coordination during hospital discharges. A quantitative survey of 37 nurses from 11 primary healthcare centers was performed in a county in southern Sweden. The data were analyzed using descriptive and comparative analyses. The results showed that perceptions concerning the information and communication technology system's usability and time consumption differed between nurses who used the system and those who did not. Simultaneously, the nurses were rather unaware of the ability of the information and communication technology system to improve coordination during patient discharges.

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

Science.gov (United States)

Andrews, Hannah; Singh, Yogen

2016-03-01

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

Maternal Coping with Baby Hospitalization at a Neonatal Intensive Care Unit

Directory of Open Access Journals (Sweden)

Fabiana Pinheiro Ramos

Full Text Available Abstract: Coping is defined by actions of self-regulation of emotions, cognitions, behaviors, and motivational orientation under stress. This study analyzed the maternal coping with hospitalization of premature and low birth weight infants at the Neonatal Intensive Care Unit (NICU, using the Motivational Theory of Coping. A questionnaire, a scale and an interview were applied to 25 mothers three times between birth and hospital discharge. The results showed that the mothers’ first visit to the NICU had strong emotional impact; longer hospitalization periods were linked to the decrease in Delegation coping strategies. There was more Support Seeking after the hospital discharge. Multiparous mothers and those who had a job appeared to be more vulnerable to stress. Predominantly adaptive coping responses were identified, even among two mothers whose babies had died, including Self-Reliance strategies, which were mediated by religious beliefs.

Occupational stressors among nurses working in urgent and emergency care units

Directory of Open Access Journals (Sweden)

Denyson Santana PEREIRA

Full Text Available The study aimed to assess occupational stressors among nurses working in urgent and emergency care facilities. It is a descriptive research developed in two public hospitals of different complexity degrees, with 49 nurses. Data were collected from June to September 2011. The Bianchi's Stress Scale, which is composed of six domains: Relationship, Unit functioning, Staff management, Nursing care, Unit coordination, and Work conditions was used to assess occupational stressors based on the regular activities performed by nurses. Data were analyzed by using descriptive statistics and Mann Whitney-U test. For the nurses working in the high complexity healthcare facility - hospital A the most stressful domain was Nursing care, while for those professionals working in the medium complexity healthcare facility - hospital B, Staff management was the most stressful domain. The nurses from hospital A perceived care-related activities as more stressful, while for those in hospital B administrative activities were considered more stressful.

No Exit: Identifying Avoidable Terminal Oncology Intensive Care Unit Hospitalizations

Science.gov (United States)

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

2016-01-01

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

Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units

Directory of Open Access Journals (Sweden)

Raymond M Khan

2017-01-01

Full Text Available Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs. Earlier initiatives used the concept of ventilator care bundles (sets of interventions, with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization. The approach of the Comprehensive Unit-based Safety Program (CUSP was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs (a total of 271 beds in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia.

Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study

Directory of Open Access Journals (Sweden)

T B Singh

2013-01-01

Full Text Available Acute kidney injury (AKI is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years of either gender who developed AKI based on RIFLE criteria (using serum creatinine, 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively ( P < 0.0001. There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward ( P = 0.001. RIFLE-R was the most common AKI in medical (39.2% and ICU (50% wards but in the surgical ward, it was RIFLE-F that was most common (52.6%. Acute tubular necrosis was more common in ICU ( P = 0.043. Most common etiology of HAAKI in medical unit was drug induced (39.2%, whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively. Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively ( P = 0.003. Length of hospital stay in surgical, ICU and medical units were different ( P = 0.007. This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.

A taxonomy and cultural analysis of intra-hospital patient transfers.

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Rosenberg, Alana; Campbell Britton, Meredith; Feder, Shelli; Minges, Karl; Hodshon, Beth; Chaudhry, Sarwat I; Jenq, Grace Y; Emerson, Beth L

2018-05-02

Existing research on intra-hospital patient transitions focuses chiefly on handoffs, or exchanges of information, between clinicians. Less is known about patient transfers within hospitals, which include but extend beyond the exchange of information. Using participant observations and interviews at a 1,541-bed, academic, tertiary medical center, we explored the ways in which staff define and understand patient transfers between units. We conducted observations of staff (n = 16) working in four hospital departments and interviewed staff (n = 29) involved in transfers to general medicine floors from either the Emergency Department or the Medical Intensive Care Unit between February and September 2015. The collected data allowed us to understand transfers in the context of several hospital cultural microsystems. Decisions were made through the lens of the specific unit identity to which staff felt they belonged; staff actively strategized to manage workload; and empty beds were treated as a scarce commodity. Staff concepts informed the development of a taxonomy of intra-hospital transfers that includes five categories of activity: disposition, or determining the right floor and bed for the patient; notification to sending and receiving staff of patient assignment, departure and arrival; preparation to send and receive the patient; communication between sending and receiving units; and coordination to ensure that transfer components occur in a timely and seamless manner. This taxonomy widens the study of intra-hospital patient transfers from a communication activity to a complex cultural phenomenon with several categories of activity and views them as part of multidimensional hospital culture, as constructed and understood by staff. © 2018 Wiley Periodicals, Inc.

An international investigation into O red blood cell unit administration in hospitals: the GRoup O Utilization Patterns (GROUP) study.

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Zeller, Michelle P; Barty, Rebecca; Aandahl, Astrid; Apelseth, Torunn O; Callum, Jeannie; Dunbar, Nancy M; Elahie, Allahna; Garritsen, Henk; Hancock, Helen; Kutner, José Mauro; Manukian, Belinda; Mizuta, Shuichi; Okuda, Makoto; Pagano, Monica B; Pogłód, Ryszard; Rushford, Kylie; Selleng, Kathleen; Sørensen, Claess Henning; Sprogøe, Ulrik; Staves, Julie; Weiland, Thorsten; Wendel, Silvano; Wood, Erica M; van de Watering, Leo; van Wordragen-Vlaswinkel, Maria; Ziman, Alyssa; Jan Zwaginga, Jaap; Murphy, Michael F; Heddle, Nancy M; Yazer, Mark H

2017-10-01

Transfusion of group O blood to non-O recipients, or transfusion of D- blood to D+ recipients, can result in shortages of group O or D- blood, respectively. This study investigated RBC utilization patterns at hospitals around the world and explored the context and policies that guide ABO blood group and D type selection practices. This was a retrospective study on transfusion data from the 2013 calendar year. This study included a survey component that asked about hospital RBC selection and transfusion practices and a data collection component where participants submitted information on RBC unit disposition including blood group and D type of unit and recipient. Units administered to recipients of unknown ABO or D group were excluded. Thirty-eight hospitals in 11 countries responded to the survey, 30 of which provided specific RBC unit disposition data. Overall, 11.1% (21,235/191,397) of group O units were transfused to non-O recipients; 22.6% (8777/38,911) of group O D- RBC units were transfused to O D+ recipients, and 43.2% (16,800/38,911) of group O D- RBC units were transfused to recipients that were not group O D-. Disposition of units and hospital transfusion policy varied within and across hospitals of different sizes, with transfusion of group O D- units to non-group O D- patients ranging from 0% to 33%. A significant proportion of group O and D- RBC units were transfused to compatible, nonidentical recipients, although the frequency of this practice varied across sites. © 2017 AABB.

Competition or coordination in hospital markets with unionised labour.

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Brekke, Kurt R

2004-03-01

This paper study labour market responses to hospital mergers. The market consists of two hospitals providing horizontally and vertically differentiated services. Hospitals compete either in price and quality or just in quality (non-price competition). To provide medical care, hospitals employ health care workers (e.g., physicians, nurses). The workers collectively bargain wages either at a central level, firm level or plant level. Anticipating wage responses, hospitals decide whether or not to merge. The main finding is that the bargaining structure, the nature of competition and the patient copayment rate have a crucial impact on the profitability of hospital mergers.

Hospital-based shootings in the United States: 2000 to 2011.

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Kelen, Gabor D; Catlett, Christina L; Kubit, Joshua G; Hsieh, Yu-Hsiang

2012-12-01

Workplace violence in health care settings is a frequent occurrence. Emergency departments (EDs) are considered particularly vulnerable. Gunfire in hospitals is of particular concern; however, information about such workplace violence is limited. Therefore, we characterize US hospital-based shootings from 2000 to 2011. Using LexisNexis, Google, Netscape, PubMed, and ScienceDirect, we searched reports for acute care hospital shooting events in the United States for 2000 through 2011. All hospital-based shootings with at least 1 injured victim were analyzed. Of 9,360 search "hits," 154 hospital-related shootings were identified, 91 (59%) inside the hospital and 63 (41%) outside on hospital grounds. Shootings occurred in 40 states, with 235 injured or dead victims. Perpetrators were overwhelmingly men (91%) but represented all adult age groups. The ED environs were the most common site (29%), followed by the parking lot (23%) and patient rooms (19%). Most events involved a determined shooter with a strong motive as defined by grudge (27%), suicide (21%), "euthanizing" an ill relative (14%), and prisoner escape (11%). Ambient society violence (9%) and mentally unstable patients (4%) were comparatively infrequent. The most common victim was the perpetrator (45%). Hospital employees composed 20% of victims; physician (3%) and nurse (5%) victims were relatively infrequent. Event characteristics that distinguished the ED from other sites included younger perpetrator, more likely in custody, and unlikely to have a personal relationship with the victim (ill relative, grudge, coworker). In 23% of shootings within the ED, the weapon was a security officer's gun taken by the perpetrator. Case fatality inside the hospital was much lower in the ED setting (19%) than other sites (73%). Although it is likely that not every hospital-based shooting was identified, such events are relatively rare compared with other forms of workplace violence. The unpredictable nature of this type of

Nosocomial infections in hospitalized patients in the burn unit of Hospital Universitario San José, Popayán - Colombia

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Yeni Arroyave

2014-08-01

Full Text Available Objective. To determine the prevalence and microbiological behavior of the infections in hospitalized patients in the burn unit of the University Hospital San José ( HUSJ at Popayan, Colombia, 2010-2011. Methods: A retrospective cross-sectional study was conducted in patients admitted to the burn unit of HUSJ between the years 2010–2011. Patients were characterized sociodemographic and clinically. The prevalence of nosocomial infections was estimated. Frequency and antibiotic resistance of microorganisms isolated was described. Data were analyzed using SPSS version 15. Results. 113 patients was enrolled, the average age was 17.7 years and male gender predominated (55.8%. Hot liquids (64.6% were the principal cause, the average of body surface area burned was 11.3% and the average hospital stay was 19.8 days. 13.3% of the patients had some nosocomial infection. The most frequently diagnosed infections were sepsis (24%, urinary tract infection (20% and pneumonia (20%. Staphylococcus aureus was the most frequent bacteria (41.7% followed by Staphylococcus epidermidis, mostly meticilino-resistant. The mean length of hospital stay and burned surface area (BSA in patients with diagnosis of infection was 36.6 days and 17.3% respectively. Conclusions. The prevalence of infection is similar to that reported in Colombia. The resistance of the isolates was high. The meticilinoresistance of Staphylococcus was associated with clindamicina resistance.

Does a specialist unit improve outcomes for hospitalized patients with Parkinson's disease?

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Skelly, Rob; Brown, Lisa; Fakis, Apostolos; Kimber, Lindsey; Downes, Charlotte; Lindop, Fiona; Johnson, Clare; Bartliff, Caroline; Bajaj, Nin

2014-01-01

Objective Suboptimal management of Parkinson's disease (PD) medication in hospital may lead to avoidable complications. We introduced an in-patient PD unit for those admitted urgently with general medical problems. We explored the effect of the unit on medication management, length of stay and patient experience. Methods We conducted a single-center prospective feasibility study. The unit's core features were defined following consultation with patients and professionals: specially trained staff, ready availability of PD drugs, guidelines, and care led by a geriatrician with specialty PD training. Mandatory staff training comprised four 1 h sessions: PD symptoms; medications; therapy; communication and swallowing. Most medication was prescribed using an electronic Prescribing and Administration system (iSOFT) which provided accurate data on time of administration. We compared patient outcomes before and after introduction of the unit. Results The general ward care (n = 20) and the Specialist Parkinson's Unit care (n = 24) groups had similar baseline characteristics. On the specialist unit: less Parkinson's medication was omitted (13% vs 20%, p < 0.001); of the medication that was given, more was given on time (64% vs 50%, p < 0.001); median length of stay was shorter (9 days vs 13 days, p = 0.043) and patients' experience of care was better (p = 0.01). Discussion If replicated and generalizable to other hospitals, reductions in length of stay would lead to significant cost savings. The apparent improved outcomes with Parkinson's unit care merit further investigation. We hope to test the hypothesis that specialized units are cost-effective and improve patient care using a randomized controlled trial design. PMID:25264022

Experience of family members as a result of children's hospitalization at the Intensive Care Unit

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Maria Virginia Martins Faria Faddul Alves

2013-07-01

Full Text Available Objective. To describe the experience of family members as a result of children's hospitalization at the Intensive Care Unit (ICU. Methodology. Descriptive and cross-sectional study. A structured interview was held with 20 relatives of patients hospitalized at two clinics of the Botucatu Medical School at Universidade Estadual Paulista 'Júlio de Mesquita Filho'. Information was collected between July and September 2010. Results. The main characteristics of the participating relatives were: 80% mothers of the children; 70% low education level and 70% married. Sixty percent of the children were hospitalized at the ICU for the first time. Eighty percent of the interviewees believe that the children's behavior changes inside the unit and 85% consider that visiting hours are sufficient. The predominant negative feelings are fear (50% and insecurity (20%, while the predominant positive feelings are hope (50% and the expectation of discharge (25%. The professional who most supported the relatives was the nurse (35%. Conclusion. The family members' experience as a result of the children's hospitalization at the ICU involves positive and negative aspects, which also affect the child's behavior at the unit.

Comparison of Patient Costs in Internal Medicine and Anaesthesiology Intensive Care Units in a Tertiary University Hospital.

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Kara, İskender; Yıldırım, Fatma; Başak, Dilek Yumuş; Küçük, Hamit; Türkoğlu, Melda; Aygencel, Gülbin; Katı, İsmail; Karabıyık, Lale

2015-06-01

The allocation of the Gross Domestic Product (GDP) to health is limited, therefore it has made a need for professional management of health business. Hospital managers as well as employees are required to have sufficient knowledge about the hospital costs. Hospital facilities like intensive care units that require specialization and advanced technology have an important part in costs. For this purpose, cost analysis studies should be done in the general health business and special units separately. In this study we aimed to compare the costs of anaesthesiology and internal medicine intensive care units (ICU) roughly. After approval of this study by Gazi University Faculty of Medicine Ethics Committee, the costs of 855 patients that were hospitalized, examined and treated for at least 24 hours in internal medicine and anaesthesiology ICUs between January 2012-August 2013 (20 months period) were taken and analyzed from chief staff of the Department of Information Technology, Gazi University Hospital. At the end of the study, we observed clear differences between internal medicine and anaesthesiology ICUs arising from transactions and patient characteristics of units. We stated that these differences should be considered by Social Security Institution (SSI) for the reimbursement of the services. Further, we revealed that SSI payments do not meet the intensive care expenditure.

How unit level nursing responsibilities are structured in US hospitals.

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Minnick, Ann F; Mion, Lorraine C; Johnson, Mary E; Catrambone, Cathy

2007-10-01

To describe (1) the extent to which acute and intensive care units use the elements of nursing models (team, functional, primary, total patient care, patient-focused care, case management) and (2) the deployment of non-unit-based personnel resources. The lack of current data-based behavioral descriptions of the extent to which elements of nursing models are implemented makes it difficult to determine how work models may influence outcomes. Nurse managers of 56 intensive care units and 80 acute care adult units from 40 randomly selected US hospitals participated in a structured interview regarding (1) day-shift use of patient assignment behaviors associated with nursing models and (2) the availability and consistency of assignment of non-unit-based support personnel. No model was implemented fully. Almost all intensive care units reported similar assignment behaviors except in the consistency of patient assignment. Non-intensive care units demonstrated wide variation in assignment patterns. Patterns differed intra-institutionally. There were large differences in the availability and deployment of non-unit-based supportive resources. Administrators must recognize the differences in work models within their institutions as a part of any quality improvement effort. Attempts to test new work models must be rigorous in the measurement of their implementation.

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

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

2016-07-01

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

Child and Adolescent Inpatient Unit in General Hospital “Tzaneio”

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E. Tseva

2017-01-01

Full Text Available The Child and Adolescent Psychiatry Inpatient Service offers comprehensive diagnostic evaluation and treatment of children and adolescents (typical age ranges from 3-16 years old with a variety of emotional and behavioral problems including mood disorders, anxiety disorders, psychotic disorders, severe disruptive behavior, and suicide attempts. Treatment Team. The inpatient treatment team includes psychiatrists, psychologists, registered nurses, special education teacher, social worker, speech and occupational therapists. In addition, pediatricians from a full range of medical subspecialties are available for consultations. The multi-disciplinary staff emphasizes a family-oriented approach and parents and care-givers are encouraged to be active participants in the treatment team throughout a child’s stay. Treatment Program. The program offers developmentally appropriate therapeutic activities in a closely supervised environment. Extensive opportunities for observation, assessment, and intervention are possible in this intensive setting. Specialized assessments including neuropsychological testing, speech and language testing, and occupational therapy assessments are all available. Treatment plans typically include a combination of individual psychotherapy, behavior management, family counseling and medications. Staff members develop an individualized treatment plan emphasizing safety for each patient during the hospital stay. The plan is closely coordinated with families, outpatient providers, and resource programs to coordinate aftercare plans and facilitate a smooth transition to home.

The process of implementation of emergency care units in Brazil.

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O'Dwyer, Gisele; Konder, Mariana Teixeira; Reciputti, Luciano Pereira; Lopes, Mônica Guimarães Macau; Agostinho, Danielle Fernandes; Alves, Gabriel Farias

2017-12-11

To analyze the process of implementation of emergency care units in Brazil. We have carried out a documentary analysis, with interviews with twenty-four state urgency coordinators and a panel of experts. We have analyzed issues related to policy background and trajectory, players involved in the implementation, expansion process, advances, limits, and implementation difficulties, and state coordination capacity. We have used the theoretical framework of the analysis of the strategic conduct of the Giddens theory of structuration. Emergency care units have been implemented after 2007, initially in the Southeast region, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620 emergency care units are under construction, which indicates expectation of expansion. Federal funding was a strong driver for the implementation. The states have planned their emergency care units, but the existence of direct negotiation between municipalities and the Union has contributed with the significant number of emergency care units that have been built but that do not work. In relation to the urgency network, there is tension with the hospital because of the lack of beds in the country, which generates hospitalizations in the emergency care unit. The management of emergency care units is predominantly municipal, and most of the emergency care units are located outside the capitals and classified as Size III. The main challenges identified were: under-funding and difficulty in recruiting physicians. The emergency care unit has the merit of having technological resources and being architecturally differentiated, but it will only succeed within an urgency network. Federal induction has generated contradictory responses, since not all states consider the emergency care unit a priority. The strengthening of the state management has been identified as a challenge for the implementation of the urgency network.

The process of implementation of emergency care units in Brazil

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Gisele O'Dwyer

2017-12-01

Full Text Available ABSTRACT OBJECTIVE To analyze the process of implementation of emergency care units in Brazil. METHODS We have carried out a documentary analysis, with interviews with twenty-four state urgency coordinators and a panel of experts. We have analyzed issues related to policy background and trajectory, players involved in the implementation, expansion process, advances, limits, and implementation difficulties, and state coordination capacity. We have used the theoretical framework of the analysis of the strategic conduct of the Giddens theory of structuration. RESULTS Emergency care units have been implemented after 2007, initially in the Southeast region, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620 emergency care units are under construction, which indicates expectation of expansion. Federal funding was a strong driver for the implementation. The states have planned their emergency care units, but the existence of direct negotiation between municipalities and the Union has contributed with the significant number of emergency care units that have been built but that do not work. In relation to the urgency network, there is tension with the hospital because of the lack of beds in the country, which generates hospitalizations in the emergency care unit. The management of emergency care units is predominantly municipal, and most of the emergency care units are located outside the capitals and classified as Size III. The main challenges identified were: under-funding and difficulty in recruiting physicians. CONCLUSIONS The emergency care unit has the merit of having technological resources and being architecturally differentiated, but it will only succeed within an urgency network. Federal induction has generated contradictory responses, since not all states consider the emergency care unit a priority. The strengthening of the state management has been identified as a challenge for the implementation of the

A Performance Evaluation of Diagnostic X-ray Unit Depends on the Hospitals Size

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Park, Ju Hun [Kaya University, Gimhae (Korea, Republic of); Im, In Chul [Gwangju Health College University, Gwangju (Korea, Republic of); Dong, Kyung Rae [Chosun University, Gwangju (Korea, Republic of); Kang, Se Sik [College of Health Science, Catholic University of Pusan, Busan (Korea, Republic of)

2009-03-15

The purpose of this study is to measure the tube voltage, the tube current/volume, exposure time and exposure dose of diagnostic X-ray unit in each doctor offices, hospitals and general hospitals for evaluating the performance of such device, to learn the method and technology of its measurement and to suggest its importance. Research subjects were total 30 X-ray units and divided into groups of 10 X-ray units each. The tube voltage, the tube current/volume, exposure time and exposure dose were measured using percentage average error, and then reproducibility of exposure dose was measured through calculating coefficient of variation. The results are like followings; The tube voltage correctness examination showed that incongruent devices among total 30 X-ray units were 5 devices (16.7%). The tube current correctness examination showed that incongruent X-ray units were 3 devices (10.0%). The tube current volume correctness examination showed that incongruent X-ray units were 4 devices (13.3%). Finally, according to exposure time correctness examination, incongruent X-ray units were 5 devices (16.7%) and according to reproducibility examination of exposure dose, incongruent X-ray units were 7 devices (23.3%). Above results showed serious problem in performance management based on management regulation of diagnostic X-ray unit; it means that regular checkout and safety management are required, and as doing so, patients will be able to receive good quality of medical service by the reduction of radiation exposure time, image quality administration, unnecessary retake and etc. Therefore, this study suggests that the performance of diagnostic X-ray units should be checked regularly

A Performance Evaluation of Diagnostic X-ray Unit Depends on the Hospitals Size

International Nuclear Information System (INIS)

Park, Ju Hun; Im, In Chul; Dong, Kyung Rae; Kang, Se Sik

2009-01-01

The purpose of this study is to measure the tube voltage, the tube current/volume, exposure time and exposure dose of diagnostic X-ray unit in each doctor offices, hospitals and general hospitals for evaluating the performance of such device, to learn the method and technology of its measurement and to suggest its importance. Research subjects were total 30 X-ray units and divided into groups of 10 X-ray units each. The tube voltage, the tube current/volume, exposure time and exposure dose were measured using percentage average error, and then reproducibility of exposure dose was measured through calculating coefficient of variation. The results are like followings; The tube voltage correctness examination showed that incongruent devices among total 30 X-ray units were 5 devices (16.7%). The tube current correctness examination showed that incongruent X-ray units were 3 devices (10.0%). The tube current volume correctness examination showed that incongruent X-ray units were 4 devices (13.3%). Finally, according to exposure time correctness examination, incongruent X-ray units were 5 devices (16.7%) and according to reproducibility examination of exposure dose, incongruent X-ray units were 7 devices (23.3%). Above results showed serious problem in performance management based on management regulation of diagnostic X-ray unit; it means that regular checkout and safety management are required, and as doing so, patients will be able to receive good quality of medical service by the reduction of radiation exposure time, image quality administration, unnecessary retake and etc. Therefore, this study suggests that the performance of diagnostic X-ray units should be checked regularly

Healthy hospital food initiatives in the United States: time to ban sugar sweetened beverages to reduce childhood obesity

OpenAIRE

Wojcicki, Janet M

2013-01-01

While childhood obesity is a global problem, the extent and severity of the problem in United States, has resulted in a number of new initiatives, including recent hospital initiatives to limit the sale of sweetened beverages and other high calorie drinks in hospital vending machines and cafeterias. These proposed policy changes are not unique to United States, but are more comprehensive in the number of proposed hospitals that they will impact. Meanwhile, however, it is advised, that these i...

Relationship between leadership styles of hospital pharmacists and perceptions of work-unit effectiveness.

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Bennett, C R; Grussing, P G; Hutchinson, R A; Stewart, J E

1988-08-01

Relationships between hospital pharmacists' perceptions of their own and their immediate supervisors' leadership styles and their perceptions of the effectiveness of their work units were examined. Pharmacists practicing in 12 large Chicago-area hospitals were asked to complete a four-part questionnaire that consisted of demographic questions, the LEADSelf instrument, the LEADOther instrument, and a measure of perceived work unit effectiveness. Respondents' primary, secondary, and combination leadership styles and their degree of style adaptability were determined and compared with the primary, secondary, and combination leadership styles and style adaptability of their immediate supervisors and with their perceptions of the effectiveness of their work units. Pharmacists involved in providing clinical or drug information services and pharmacists responsible for purchasing activities perceived their work units to be most and least effective, respectively. Most respondents perceived their primary leadership style to be high task-high relationship, but only 32% perceived their immediate supervisors to exhibit this style. Pharmacists who perceived their immediate supervisors to have high relationship leadership styles (based on primary and combination style classifications) had significantly more favorable perceptions of the effectiveness of their work units than did pharmacists who perceived their supervisors to exhibit low relationship styles. Respondents' perceptions of their supervisors' style adaptability were positively and significantly correlated with their perceptions of work-unit effectiveness. Respondents who thought their supervisors' leadership styles were more adaptable than their own had the most favorable perceptions of work-unit effectiveness.(ABSTRACT TRUNCATED AT 250 WORDS)

The disposal of redundant teletherapy units from NHS hospitals

International Nuclear Information System (INIS)

Gaffka, A.P.; Ord, M.A.

1994-01-01

The removal/disposal of redundant teletherapy units from NHS hospitals is described, detailing the operational procedures and the transport package background. The Harwell section of the Transport Technology Department has been carrying out these operations since 1991, where initially the service was just offered to the NHS; however, today their specialist transport service has significantly widened and is now offered to other business sectors. Due to the level of radioactivity found in each teletherapy unit, it was necessary to design a special transport packaging to meet the requirements for shipment of these units. Approval was sought from the Department of Transport to adapt a standard Type B package as no other packaging could be found to comply with the necessary requirements. All work undertaken on the removal and disposal of these units complied with an approved scheme of work and was carried out in accordance with a Quality Assurance workplan. However, to keep abreast of modern standards in a manner which is cost effective to customers and acceptable to the general public, the full development of a new Type B packaging is taking place, which is specifically designed to undertake these removal/disposal duties. (author)

Individual units rather than entire hospital as the basis for improvement: the example of two Methicillin resistant Staphylococcus aureus cohort studies

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Gastmeier Petra

2012-02-01

Full Text Available Abstract Background Two MRSA surveillance components exist within the German national nosocomial infection surveillance system KISS: one for the whole hospital (i.e. only hospital based data and no rates for individual units and one for ICU-based data (rates for each individual ICU. The objective of this study was to analyze which surveillance system (a hospital based or a unit based leads to a greater decrease in incidence density of nosocomial MRSA Methods Two cohort studies of surveillance data were used: Data from a total of 224 hospitals and 359 ICUs in the period from 2004 to 2009. Development over time was described first for both surveillance systems. In a second step only data were analyzed from those hospitals/ICUs with continuous participation for at least four years. Incidence rate ratios (IRR with 95% confidence intervals were calculated to compare incidence densities between different time intervals. Results In the baseline year the mean MRSA incidence density of hospital acquired MRSA cases was 0.25 and the mean incidence density of ICU-acquired MRSA was 1.25 per 1000 patient days. No decrease in hospital-acquired MRSA rates was found in a total of 111 hospitals with continuous participation in the hospital- based system. However, in 159 ICUs with continuous participation in the unit-based system, a significant decrease of 29% in ICU-acquired MRSA was identified. Conclusions A unit-based approach of surveillance and feedback seems to be more successful in decreasing nosocomial MRSA rates, compared to a hospital-based approach. Therefore each surveillance system should provide unit-based data to stimulate activities on the unit level.

Factors associated with variations in hospital expenditures for acute heart failure in the United States.

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Ziaeian, Boback; Sharma, Puza P; Yu, Tzy-Chyi; Johnson, Katherine Waltman; Fonarow, Gregg C

2015-02-01

Relatively little contemporary data are available that describe differences in acute heart failure (AHF) hospitalization expenditures as a function of patient and hospital characteristics, especially from a population-based investigation. This study aimed to evaluate factors associated with variations in hospital expenditures for AHF in the United States. A cross-sectional analysis using discharge data from the 2011 Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, was conducted. Discharges with primary International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes for AHF in adults were included. Costs were estimated by converting Nationwide Inpatient Sample charge data using the Healthcare Cost and Utilization Project Cost-to-Charge Ratio File. Discharges with highest (≥80th percentile) versus lowest (≤20th percentile) costs were compared for patient characteristics, hospital characteristics, utilization of procedures, and outcomes. Of the estimated 1 million AHF hospital discharges, the mean cost estimates were $10,775 per episode. Younger age, higher percentage of obesity, atrial fibrillation, pulmonary disease, fluid/electrolyte disturbances, renal insufficiency, and greater number of cardiac/noncardiac procedures were observed in stays with highest versus lowest costs. Highest-cost discharges were more likely to be observed in urban and teaching hospitals. Highest-cost AHF discharges also had 5 times longer length of stay, were 9 times more costly, and had higher in-hospital mortality (5.6% vs 3.5%) compared with discharges with lowest costs (all P heart failure hospitalizations are costly. Expenditures vary markedly among AHF hospitalizations in the United States, with substantial differences in patient and hospital characteristics, procedures, and in-hospital outcomes among discharges with highest compared with lowest costs. Copyright © 2014 Elsevier Inc. All rights reserved.

Profile of nursing diagnoses of hospitalized patients in an infectious disease unit

OpenAIRE

Souza Neto, Vinicius Lino de; Andrade, Lidiane Lima de; Agra, Glenda; Costa, Marta Miriam Lopes; Silva, Richardson Augusto Rosendo da

2015-01-01

Objective: To define the profile of nursing diagnoses of hospitalized patients at an infectious diseases unit.Methods: This is a descriptive study based on the quantitative approach conducted at an infectious diseases unit in Paraiba, Brazil, from January to February 2014. The data collection instrument was based on the Theory of Basic Human Needs by Wanda de Aguiar Horta, followed by the classification system CIPE(r) version 2.0 to construct the diagnoses.Results: Data analysis resulted in 3...

Risk Management in Csr Unit of Shams Hospital Using FMEA Technique -Tabriz

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Mohammad Saadati

2015-08-01

Full Text Available Background and Objectives : Since one of the effective ways to prevent infections is the proper sterilization of instruments, CSR is one of the most important units in hospitals. Thus, risk management has a high priority in CSR. The aim of this study was to identify and prevent potential risks in CSR unit in Shams Hospital using FMEA technique. Material and Methods : This is a descriptive and interventional study. Using FMEA technique, potential risks were identified. Risks were prioritized and corrective interventions were implemented to reduce risks. Results : The current study identified 69 risks that 10 risks were marked as high priority. Corrective activities were suggested by risk management teams which were applied. Conclusion : The results showed that flaws in safety policies, equipment and physical conditions were the most important risk factors. Implementing risk management plan and clear safety policies could be useful. ​

A 37-year-old man trying to choose a high-quality hospital: review of hospital quality indicators.

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Howell, Michael D

2009-12-02

Mr A, a previously healthy 37-year-old man, was diagnosed as having Prinzmetal angina and a hypercoagulable state 3 years ago after an ST-elevation myocardial infarction. Now, his cardiologist is moving and Mr A must select a new physician and health system. Geographic relocation, insurance changes, and other events force millions in the United States to change physicians and hospitals every year. Mr A should begin by choosing a primary care physician, since continuity and coordination of care improves outcomes. Evidence for evaluating specific physicians is less robust, though a variety of sources are available. A broad range of detailed quality information, such as Medicare's Hospital Compare (http://www.hospitalcompare.hhs.gov/), is available for selecting a hospital. However, the relationship of these metrics to patient outcomes is variable, and different Web sites provide meaningfully different rankings and data interpretations. For Mr A in particular, a warfarin management team, the hospital's location, and a cardiologist with whom he feels comfortable and who can communicate with his primary care physician are important factors. Nevertheless, hospital quality information and metrics are an important component of the strategy Mr A should take to solve this challenging problem.

The evaluation of primary care unit of Mahasarakham Hospital.

Science.gov (United States)

Asavatanabodee, Paibool

2010-02-01

To evaluate the one-year performance outcome of Community Medical Care Unit (CMU) in Mahasarakham Hospital. This cross-sectional descriptive study used the CIPP model. The target population was divided into two groups. The first group consisted of the executive committee of Mahasarakham Hospital including one director, five Vice-directors, and 16 CMU paramedical personnel and public health administrators. The second group consisted of 281 randomized people in the service area of CMU, Mahasarakham Hospital. The overall outcome evaluation of both groups was high with mean of 3.53 and 3.86, respectively. The evaluation of context, input, and output was ranked high in both groups while the process ranking was moderate in the first group and high in the other group. The present study proposed that project guidelines be explicit policies, improvement in behavioral service, appropriate workload, adequate parking lot, and network sharing of hospital data bank. The quality and efficiency of CMU project are dependent upon explicit policy, well-planned structure of organization, efficient-informative systems, good development plan, and adequate manpower. The personnel should plan the project process and continuously improve the system. CMU project would be neither successful nor beneficial for the development ofpublic health care system if it lacked the participation of the people in the community and associated networks. The results of the present study might be the useful data for improving and developing the pattern of community healthcare service in urban area.

Quality Control in Radiological Unit of Three Hospitals in Makurdi, Benue State

International Nuclear Information System (INIS)

Akaagerger, N.B.

2013-01-01

Quality Control in Radiological units of three hospitals in Makurdi, Benue State, designed A, B and C, was done using beam alignment and collimator test tool on single phase diagnostic X-ray machines. The collimator and beam alignment tests were used to measure the degree of misalignment of the target point. The results of this work shows that the misalignment falls within the acceptable limit. Hospital A (Federal Medical Center, Makurdi), has a misalignment of 0.2cm at 60KVp, 10mAs, 100cm FFD, film size of 10 x 8cm square. Hospital B (Bishop Murray Medical Center, Makurdi) has a misalignment of 0.6cm at 60KVp, 25mAs, 81cm FFD and a film size of 10 x 8cm square and Hospital C (Hemko Hospital, Makurdi) has a misalignment of 0.8cm at 60KVp, 20mA s, 88cm FFD and a film size of 10 x 8cm-square. These show that Hospital A has the least misalignment, followed by B, with C as the highest. These results also show the misalignment fall within 2.0cm as recommended by ICRP.

Optimal stochastic coordinated scheduling of proton exchange membrane fuel cell-combined heat and power, wind and photovoltaic units in micro grids considering hydrogen storage

International Nuclear Information System (INIS)

Bornapour, Mosayeb; Hooshmand, Rahmat-Allah; Khodabakhshian, Amin; Parastegari, Moein

2017-01-01

Highlights: •Stochastic model is proposed for coordinated scheduling of renewable energy sources. •The effect of combined heat and power is considered. •Hydrogen storage is considered for fuel cells. •Maximizing profits of micro grid is considered as objective function. •Considering the uncertainties of problem lead to profit increasing. -- Abstract: Nowadays, renewable energy sources and combined heat and power units are extremely used in micro grids, so it is necessary to schedule these units to improve the performance of the system. In this regard, a stochastic model is proposed in this paper to schedule proton exchange membrane fuel cell-combined heat and power, wind turbines, and photovoltaic units coordinately in a micro grid while considering hydrogen storage. Hydrogen storage strategy is considered for the operation of proton exchange membrane fuel cell-combined heat and power units. To consider stochastic generation of renewable energy source units in this paper, a scenario-based method is used. In this method, the uncertainties of electrical market price, the wind speed, and solar irradiance are considered. This stochastic scheduling problem is a mixed integer- nonlinear programming which considers the proposed objective function and variables of coordinated scheduling of PEMFC-CHP, wind turbines and photovoltaic units. It also considers hydrogen storage strategy and converts it to a mixed integer nonlinear problem. In this study a modified firefly algorithm is used to solve the problem. This method is examined on modified 33-bus distributed network as a MG for its performance.

Twenty-Third Report of the Administrative Committee on Co-ordination to the Economic and Social Council of the United Nations

Energy Technology Data Exchange (ETDEWEB)

NONE

1959-07-09

In accordance with Article XI of the Relationship Agreement between the Agency and the United Nations, the Agency is participating in the work of the Administrative Committee on Co-ordination (ACC) and of certain of its subsidiary bodies.

The relationship between transformational leadership and social capital in hospitals--a survey of medical directors of all German hospitals.

Science.gov (United States)

Hammer, Antje; Ommen, Oliver; Röttger, Julia; Pfaff, Holger

2012-01-01

The German hospital market has been undergoing major changes in recent years. Success in this new market is determined by a multitude of factors. One is the quality of the social relationships between staff and the presence of shared values and rules. This factor can be considered an organization's "social capital." This study investigates the relationship between social capital and leadership style in German hospitals using a written survey of medical directors. In 2008, a cross-sectional representative study was conducted with 1224 medical directors from every hospital in Germany with at least 1 internal medicine unit and 1 surgery unit. Among the scales included in the standardized questionnaire were scales used to assess the medical directors' evaluation of social capital and transformational leadership in the hospital. We used a multiple linear regression model to examine the relationship between social capital and internal coordination. We controlled for hospital ownership, teaching status, and number of beds. In total, we received questionnaires from 551 medical directors, resulting in a response rate of 45.2%. The participating hospitals had an average of 345 beds. The sample included public (41.3%), not-for-profit (46.9%), and for-profit (11.7%) hospitals. The data, which exclusively represent the perceptions of the medical directors, indicate a significant correlation between a transformational leadership style of the executive management and the social capital as perceived by medical directors. A transformational leadership style of the executive management accounted for 36% of variance of the perceived social capital. The perceived social capital in German hospitals is closely related to the leadership style of the executive management. A transformational leadership style of the executive management appears to successfully strengthen the hospital's social capital.

Care of "new" long-stay patients in a district general hospital psychiatric unit. The first two years of a hospital-hostel.

Science.gov (United States)

Gibbons, J S

1986-05-01

The paper describes the need for long-term inpatient care in an English health district whose psychiatric services were based on a unit in a District General Hospital. Patients who became long-stay were placed in a new hospital-hostel in a city centre. Three quarters of those eligible could be managed in the hostel, with those rejected posing more control problems. Patients in the hostel became less withdrawn and increased their activity and use of community facilities.

[Installation of Clinical Nutrition and Dietetics units in Spanish hospitals and the presence of dietitians in the same].

Science.gov (United States)

Martínez Alvarez, J R; Villarino Marín, A L; Cid Sanz, M C

2002-01-01

The appropriate nutritional status of hospitalized patients bears a close relationship with the existence of specialized Clinical Nutrition and Dietetics units or departments at health centres. The presence at these units of professionals with specific training to carry out tasks in the sphere of nutrition and dietetics, as is the case of dietitians, implies and evident strengthening of their capacity and operation. The main goal of the present paper to identify the number of Nutrition and Dietetics Units in the leading Spanish hospitals and also the presence of graduates in dietetics or nutrition specialists. Spanish hospital installations selected from the national hospital index. RESULTS OF THE TRIAL: It can be inferred that the implementation of the said services is not as complete as might be desired, and the presence of specifically qualified professionals (dietitians or nutritionists) is even lower. In this context, one is struck by the growing number of outsourced catering services at Spanish hospitals and the hiring of dietitians by these private companies, often at the request of the hospital itself. All of the data obtained show an ever greater importance of dietitians in hospital nutrition, with an uneven geographical distribution and implementation in Spain because of the peculiar policy adopted by the health authorities with regard to the recognition of these professionals. In Spain, these departments continue to be scorned and the role of the dietitian ignored.

What characterizes the work culture at a hospital unit that successfully implements change - a correlation study.

Science.gov (United States)

André, Beate; Sjøvold, Endre

2017-07-14

To successfully achieve change in healthcare, a balance between technology and "people ware", the human recourses, is necessary. However, the human aspect of the change implementation process has received less attention than the technological issues. The aim was to explore the factors that characterize the work culture in a hospital unit that successfully implemented change compared with the factors that characterize the work culture of a hospital unit with unsuccessful implementation. The Systematizing Person-Group Relations method was used for gathering and analyzing data to explore what dominate the behavior in a particular work environment identifying challenges, limitations and opportunities. This method applied six different dimensions, each representing different behavior in a work culture: Synergy, Withdrawal, Opposition, Dependence, Control and Nurture. We compared two different units at the same hospital, one that successfully implemented change and one that was unsuccessful. There were significant statistical differences between healthcare personnel working at a unit that successfully implemented change contrasted with the unit with unsuccessful implementation. These significant differences were found in both the synergy and control dimensions, which are important positive qualities in a work culture. The results of this study show that healthcare personnel at a unit with a successful implementation of change have a working environment with many positive qualities. This indicates that a work environment with a high focus on goal achievement and task orientation can handle the challenges of implementing changes.

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

Science.gov (United States)

... to American Indian women, and 0.54% to Asian or Pacific Islander women. In 2012, out-of-hospital births comprised 3%– ... the United States choose home birth. J Midwifery Womens Health 54(2):119–26. 2009. Health Management Associates. Midwifery licensure and discipline program in Washington ...

Dying in Palliative Care Units and in Hospital: A Comparison of the Quality of Life of Terminal Cancer Patients.

Science.gov (United States)

Viney, Linda L.; And Others

1994-01-01

Compared quality of life of terminal cancer patients (n=182) in two palliative care units with that of those in general hospital. Patients in specialized palliative care units were found to differ from those dying in hospital, showing less indirectly expressed anger but more positive feelings. They also reported more anxiety about death but less…

Toddler Developmental Delays After Extensive Hospitalization: Primary Care Practitioner Guidelines.

Science.gov (United States)

Lehner, Dana C; Sadler, Lois S

2015-01-01

This review investigated developmental delays toddlers may encounter after a lengthy pediatric hospitalization (30 days or greater). Physical, motor, cognitive, and psychosocial development of children aged 1 to 3 years was reviewed to raise awareness of factors associated with developmental delay after extensive hospitalization. Findings from the literature suggest that neonatal and pediatric intensive care unit (NICU/PICU) graduates are most at risk for developmental delays, but even non-critical hospital stays interrupt development to some extent. Primary care practitioners (PCPs) may be able to minimize risk for delays through the use of formal developmental screening tests and parent report surveys. References and resources are described for developmental assessment to help clinicians recognize delays and to educate families about optimal toddler development interventions. Pediatric PCPs play a leading role in coordinating health and developmental services for the young child following an extensive hospital stay.

The World Health Organization Performance Assessment Tool for Quality Improvement in Hospitals (PATH): an analysis of the pilot implementation in 37 hospitals

NARCIS (Netherlands)

Groene, Oliver; Klazinga, Niek; Kazandjian, Vahé; Lombrail, Pierre; Bartels, Paul

2008-01-01

OBJECTIVE: To evaluate the pilot implementation of the World Health Organization Performance Assessment Tool for Quality Improvement in hospitals (PATH). DESIGN: Semi-structured interviews with regional/country coordinators and Internet-based survey distributed to hospital coordinators. SETTING: A

Rural hospital ownership: medical service provision, market mix, and spillover effects.

Science.gov (United States)

Horwitz, Jill R; Nichols, Austin

2011-10-01

To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. © Health Research and Educational Trust.

A patient with autism and severe depression: medical and ethical challenges for an adolescent medicine unit.

Science.gov (United States)

Skinner, S Rachel; Ng, Cindy; McDonald, Ann; Walters, Tamara

2005-10-17

An adolescent with autism and intellectual disability presented with severe depression related to menstruation. Because of the complex medical, psychiatric and ethical issues involved, her care was coordinated by a hospital-based adolescent medicine unit. After trials of other therapies over an extended period and interdisciplinary and intersectoral case conferencing, it was decided that hysterectomy was the most appropriate management. This case highlights the complexity of adolescent health care in a tertiary hospital, the importance of intersectoral cooperation between hospital and community, and the integral role of interdisciplinary care of adolescent patients with chronic conditions.

Can National Healthcare-Associated Infections (HAIs) Data Differentiate Hospitals in the United States?

Science.gov (United States)

Masnick, Max; Morgan, Daniel J; Sorkin, John D; Macek, Mark D; Brown, Jessica P; Rheingans, Penny; Harris, Anthony D

2017-10-01

OBJECTIVE To determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website (http://medicare.gov/hospitalcompare) can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals. DESIGN Secondary analysis of publicly available HAI data for calendar year 2013. METHODS We assessed the availability of HAI data for geographically proximate hospitals (ie, hospitals within the same referral region) and then analyzed these data to determine whether they are useful to differentiate hospitals. We assessed data for the 6 HAIs reported by hospitals to the Centers for Disease Control and Prevention (CDC). RESULTS Data were analyzed for 4,561 hospitals representing 88% of registered community and federal government hospitals in the United States. Healthcare-associated infection data are only useful for comparing hospitals if they are available for multiple hospitals within a geographic region. We found that data availability differed by HAI. Clostridium difficile infections (CDI) data were most available, with 82% of geographic regions (ie, hospital referral regions) having >50% of hospitals reporting them. In contrast, 4% of geographic regions had >50% of member hospitals reporting surgical site infections (SSI) for hysterectomies, which had the lowest availability. The ability of HAI data to differentiate hospitals differed by HAI: 72% of hospital referral regions had at least 1 pair of hospitals with statistically different risk-adjusted CDI rates (SIRs), compared to 9% for SSI (hysterectomy). CONCLUSIONS HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI. CDI and catheter-associated urinary tract infection (CAUTI) are more likely to differentiate hospitals than the other publicly reported HAIs. Infect Control Hosp Epidemiol 2017;38:1167-1171.

Effectiveness of acute geriatric units in the real world: the case of short-term mortality among seniors hospitalized for pneumonia.

Science.gov (United States)

Ding, Yew Yoong; Abisheganaden, John; Chong, Wai Fung; Heng, Bee Hoon; Lim, Tow Keang

2013-01-01

We sought to compare the effectiveness of acute geriatric units with usual medical care in reducing short-term mortality among seniors hospitalized for pneumonia in the real world. In a retrospective cohort study, we merged chart and administrative data of seniors aged 65 years and older admitted to acute geriatric units and other medical units for pneumonia at three hospitals over 1 year. The outcome was 30-day mortality. Hierarchical logistic regression modeling was carried out to estimate the treatment effect of acute geriatric units for all seniors, those aged 80 years and older, and those with premorbid ambulation impairment, after adjusting for demographic and clinical characteristics, and accounting for clustering around hospitals. Among 2721 seniors, 30-day mortality was 25.5%. For those admitted to acute geriatric and other medical units, this was 24.2% and 25.8%, respectively. Using hierarchical logistic regression modeling, treatment in acute geriatric units was not associated with significant mortality reduction among all seniors (OR 0.72, 95% CI 0.52-1.00). However, significant mortality reduction was observed in the subgroups of those aged 80 years and older (OR 0.73, 95% CI 0.54-0.99), and with premorbid ambulation impairment (OR 0.65, 95% CI 0.46-0.93). Acute geriatric units reduced short-term mortality among seniors hospitalized for pneumonia who were aged 80 years and older or had premorbid ambulation impairment. Further research is required to determine if this beneficial effect extends to seniors hospitalized for other acute medical disorders. © 2012 Japan Geriatrics Society.

Assessment Of Nurses Performance During Cardiopulmonary Resuscitation In Intensive Care Unit And Cardiac Care Unit At The Alexandria Main University Hospital.

Directory of Open Access Journals (Sweden)

Dr. Nagla Hamdi Kamal Khalil El- Meanawi

2015-08-01

Full Text Available Abstract Background Cardiopulmonary resuscitation one of the most emergency management the nurse has a pivotal role and should be highly qualified in performing these procedures. The aim of the study is to assess performance of nurses during Cardio pulmonary resuscitation for patient with cardiac arrest In Intensive Care Unit and Cardiac Care Unit at the Alexandria main university hospital. To answer the question what are the most common area of satisfactory and area of neglection in nurses performance during Cardio Pulmonary Resuscitation. The sample consists of 53 staff nurses working in Intensive care unit amp cardiac care unit at Alexandria main university hospital. The tools of data collection were structured of questionnaire sheet and observational cheek list. The results showed that unsatisfactory performance between nurses in both units. The study concluded that all nurses need to improve their performance during cardiopulmonary resuscitation for patient with cardiac arrest it is crucial for nursing staff to participate in CPR courses in order to refresh and update their theoretical knowledge and performance skills and consequently to improve the safety and effectiveness of care. The study recommended that continuous evaluation of nurses knowledge and performance is essential the optimal frequency with which CPR training should be implemented at least every 6 months in order to avoid deterioration in nurses CPR knowledge and skills.

Nursing Leaders' Satisfaction with Information Systems in the Day-to-Day Operations Management in Hospital Units.

Science.gov (United States)

Peltonen, Laura-Maria; Junttila, Kristiina; Salanterä, Sanna

2018-01-01

Information usage in the day-to-day operations management of hospital units is complex due to numerous information systems in use. The aim of this study was to describe and compare nurse leaders' satisfaction with information systems used in the day-to-day operations management in hospital units. The design was a cross-sectional survey with five questions rated from one (disagree) to five (fully agree). The response rate was 65 % (n = 453). Respondents reported fair satisfaction with how information systems support decision-making (median 4, IQR 3-4) and improve ease of access to information (median 4, IQR 3-4). However, respondents were less satisfied with how systems improve speed of access to information (median 3, IQR 3-4). Nor did respondents think that systems were developed for them (median 3, IQR 2-4). Respondents further reported needing numerous systems daily to support decision-making (median 4, IQR 3-5). A clear need for one system, which would gather important information for display was stated (median 5, IQR 4-5). Work experience, gender and time when overseeing the unit were associated with some aspects related to satisfaction. In conclusion, information system improvements are needed to better support the day-to-day operations management in hospital units.

Use of antibacterial agents in an intensive care unit in a hospital in Brazil.

Science.gov (United States)

dos Santos, E F; Lauria-Pires, L; Pereira, M G; Silva, A E; Rodrigues, I P; Maia, M O

2007-06-01

It is essential to monitor the utilisation of antibacterial drugs in order to establish appropriate measures for their control. The pattern of usage of antibacterial drugs, and its association with indicators of hospital infection, has been investigated in a non-specialized adult intensive care unit (ICU) located in Santa Luzia Hospital (Brasília, DF, Brazil). The study was conducted between January 2001 and June 2004. Data concerning the utilisation of systemic antibacterial drugs, classified according to the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) system, and indicators of hospital infection, defined according to the National Nosocomial Infections Surveillance (NNIS) system, were obtained from appropriate hospital archives. During the study period, the average utilisation of antibacterial drugs was 1918.5 DDD units per 1000 patient-day (DDD(1000)). The three most used drugs were penicillins/beta-lactamase inhibitors (535.3 DDD(1000)), third generation cephalosporins (239.1 DDD(1000)) and quinolones (212.5 DDD(1000)). The total utilisation of antibacterial drugs was correlated significantly with the incidence of hospital infection (R = 0.62; p < 0.01) and the index of invasive procedures (R = 0.41; p < 0.01). Furthermore, the latter two indicators were significantly and positively correlated with the use of recently commercialized, broad spectrum antibacterial drugs (except for carbapenems). It is concluded that improved infection control procedures, together with more rigorous criteria regarding the use of invasive procedures, should be implemented by the ICU studied in order to diminish the utilisation of antibacterial drugs.

Culture-dependent strategies in coordination games.

Science.gov (United States)

Jackson, Matthew O; Xing, Yiqing

2014-07-22

We examine different populations' play in coordination games in online experiments with over 1,000 study participants. Study participants played a two-player coordination game that had multiple equilibria: two equilibria with highly asymmetric payoffs and another equilibrium with symmetric payoffs but a slightly lower total payoff. Study participants were predominantly from India and the United States. Study participants residing in India played the strategies leading to asymmetric payoffs significantly more frequently than study participants residing in the United States who showed a greater play of the strategy leading to the symmetric payoffs. In addition, when prompted to play asymmetrically, the population from India responded even more significantly than those from the United States. Overall, study participants' predictions of how others would play were more accurate when the other player was from their own populations, and they coordinated significantly more frequently and earned significantly higher payoffs when matched with other study participants from their own population than when matched across populations.

Hospital Preparedness to Respond to Biological and Chemical Terrorist Attack

International Nuclear Information System (INIS)

Florin, P.

2007-01-01

There is a growing concern about the terrorist use of chemical or biological agents against civilian population. A large proportion of hospitals are probably poorly prepared to handle victims of chemical or biological terrorism. At national level, starting with 2008 hospitals will be under the administration and control of local authorities. That is good opportunities for local authorities and public health office to tailor the activity of the hospitals to the real needs in the area of responsibility, and to allocate the suitable budget for them. Commonly hospitals are not fully prepared to respond to massive casualty disaster of any kind, either i their capacity to care for large numbers of victims or in their ability to provide care in coordination with a regional or national incident command structure. Preparedness activities to respond properly to chemical or biological attack including the adequate logistic, the principle of training and drill for the hospital emergency units and medical personal, communication and integration of the hospital team in local and regional civil response team are developed by the author.(author)

How to reduce hospital-acquired pressure ulcers on a neuroscience unit with a skin and wound assessment team.

Science.gov (United States)

McGuinness, Janice; Persaud-Roberts, Sherry; Marra, Susan; Ramos, Jeannine; Toscano, Diane; Policastro, Linda; Epstein, Nancy E

2012-01-01

In 2008, the incidence of hospital acquired pressure ulcers (HAPUs) continued to increase on a neuroscience unit that included both neurosurgical and neurological patients in a 14-bed intensive care unit, and in a 18-bed floor unit. To reduce HAPUs, several changes were instituted in 2008; (1) turning patients every 1-2 h/repositioning, (2) specialty beds, and (3) a "skin and wound assessment team (SWAT)" that included one (or two) "expert" nurses/nursing assistants who made rounds on all the patients in the unit at least once a week. They would examine patients from "head to toe", document/measure all pressure ulcers, and educate primary nurses/nurse assistants on the plan/products needed for the patients wound care based on their assessments. In 2010, further measures included: (1) adding eight Stryker beds, (2) adding pressure relieving heel protector boots, and (3) requiring that all new hospital orientees work one shift (7.5 h) shadowing the SWAT team. The SWAT team initially decreased HAPUs by 48% in 2009; this reduction was further increased in 2010 (57%), and 2011 (61%). Additionally, in 2010, the SWAT team was required to educate nurses in all other units. By 2011, all nurses had to complete the hospital acquired pressure ulcer prevention tutorial. Since instituting a specialized SWAT team for our neuroscience unit, the incidence of HAPUs (cost estimated for grade IV, US $129,248) was decreased by 48% in 2009, by 57% in 2010, and by 61% in 2011. The SWAT program is now hospital-wide.

Measuring patient safety culture: an assessment of the clustering of responses at unit level and hospital level

NARCIS (Netherlands)

Smits, M.; Wagner, C.; Spreeuwenberg, P.; Wal, van der G.

2009-01-01

OBJECTIVES: To test the claim that the Hospital Survey on Patient Safety Culture (HSOPS) measures patient safety culture instead of mere individual attitudes and to determine the most appropriate level (individual, unit or hospital level) for interventions aimed at improving the culture of patient

Measuring patient safety culture : an assessment of the clustering of responses at unit level and hospital level

NARCIS (Netherlands)

Smits, M.; Wagner, C.; Spreeuwenberg, P.; Wal, G. van der; Groenewegen, P.P.

2009-01-01

Objectives: To test the claim that the Hospital Survey on Patient Safety Culture (HSOPS) measures patient safety culture instead of mere individual attitudes and to determine the most appropriate level (individual, unit or hospital level) for interventions aimed at improving the culture of patient

Diabetes mellitus and infection: an evaluation of hospital utilization and management costs in the United States.

Science.gov (United States)

Korbel, Lindsey; Spencer, John David

2015-03-01

The objective of this study is to evaluate the number of diabetics that seek medical treatment in emergency departments or require hospitalization for infection management in the United States. This study also assesses the socioeconomic impact of inpatient infection management among diabetics. We accessed the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample database and the Nationwide Inpatient Sample database to perform a retrospective analysis on diabetics presenting to the emergency department or hospitalized for infection management from 2006 to 2011. Emergency Department: Since 2006, nearly 10 million diabetics were annually evaluated in the emergency department. Infection was the primary reason for presentation in 10% of these visits. Among those visits, urinary tract infection was the most common infection, accounting for over 30% of emergency department encounters for infections. Other common infections included sepsis, skin and soft tissue infections, and pneumonia. Diabetics were more than twice as likely to be hospitalized for infection management than patients without diabetes. Hospitalization: Since 2006, nearly 6 million diabetics were annually hospitalized. 8-12% of these patients were hospitalized for infection management. In 2011, the inpatient care provided to patients with DM, and infection was responsible for over $48 billion dollars in aggregate hospital charges. Diabetics commonly present to the emergency department and require hospitalization for infection management. The care provided to diabetics for infection management has a large economic impact on the United States healthcare system. More efforts are needed to develop cost-effective strategies for the prevention of infection in patients with diabetes. Copyright © 2015 Elsevier Inc. All rights reserved.

Improving care coordination using organisational routines.

Science.gov (United States)

Prætorius, Thim

2016-01-01

The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can be replicated, the way they are influenced by the organisation and the way they influence health care professionals. Theory of routines is systematically applied to care pathways in order to develop theoretically derived propositions. Care pathways mirror routines by being recurrent, collective and embedded and specific to an organisation. In particular, care pathways resemble standard operating procedures that can give rise to recurrent collective action patterns. In all, 11 propositions related to five categories are proposed by building on these insights: care pathways and coordination, change, replication, the organisation and health care professionals. Research limitations/implications - The paper is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point for empirical research. The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals. Originality/value - Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination.

Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality.

Science.gov (United States)

Yoshihara, Hiroyuki; Yoneoka, Daisuke

2014-02-01

Unstable pelvic fracture is predominantly caused by high-energy blunt trauma and is associated with a high risk of mortality. The epidemiology in the United States is largely unknown. The purpose of this study was to examine the epidemiology of unstable pelvic fracture based on patient and hospital demographics in the United States during the last decade. The Nationwide Inpatient Sample was used to identify patients who were hospitalized with unstable pelvic fracture from 2000 to 2009, using the International Classification of Diseases--9th Rev.--Clinical Modification (ICD-9-CM) codes. The primary outcome parameter consisted of analyzing the temporal trends of in-hospital admissions for unstable pelvic fracture and the associated in-hospital mortality. The data were stratified by demographic variables, including age, sex, race, and hospital region in the United States. From 2000 to 2009, there were 24,059 patients in total; among these, 1,823 (7.6%) had open fractures, and 22,236 (92.4%) had closed fractures. The population growth-adjusted incidence was stable over time (p = 0.431). The incidence was the lowest in the northeastern region. The in-hospital mortality rate in patients with unstable pelvic fracture was 8.3% (21.3% for open fracture, 7.2% for closed fracture) and remained stable over time (p = 0.089). The in-hospital mortality rate was higher in several subgroups of patients, such as older patients, male patients, African-American patients, and patients in the northeastern region. During the last decade, the incidence of unstable pelvic fracture has remained stable over time in the United States. The in-hospital mortality rate in patients with unstable pelvic fracture was 8.3% and remained stable over time. The rate in patients with an open fracture was approximately three times higher than that in patients with a closed fracture. The incidence was the lowest, but the in-hospital mortality rate was the highest in the northeastern region compared with the

A Business Case Analysis of the Special Care Unit at Moncrief Army Community Hospital

National Research Council Canada - National Science Library

Unruh, Charles

2002-01-01

The goal of this project is to develop and evaluate four courses of action (COA) in order to determine the most efficient and effective method to care for Moncrief Army Community Hospitals Special Care Unit (SCU) inpatients...

Work-unit social capital and long-term sickness absence: a prospective cohort study of 32 053 hospital employees.

Science.gov (United States)

Török, Eszter; Clark, Alice Jessie; Jensen, Johan Høy; Lange, Theis; Bonde, Jens Peter; Bjorner, Jakob Bue; Rugulies, Reiner; Hvidtfeldt, Ulla Arthur; Hansen, Åse Marie; Ersbøll, Annette Kjær; Rod, Naja Hulvej

2018-06-06

There is a lack of studies investigating social capital at the workplace level in small and relatively homogeneous work-units. The aim of the study was to investigate whether work-unit social capital predicts a lower risk of individual long-term sickness absence among Danish hospital employees followed prospectively for 1 year. This study is based on the Well-being in HospitAL Employees cohort. The study sample consisted of 32 053 individuals nested within 2182 work-units in the Capital Region of Denmark. Work-unit social capital was measured with an eight-item scale covering elements of trust, justice and collaboration between employees and leaders. Social capital at the work-unit level was computed as the aggregated mean of individual-level social capital within each work-unit. Data on long-term sickness absence were retrieved from the employers' payroll system and were operationalised as ≥29 consecutive days of sickness absence. We used a 12-point difference in social capital as the metric in our analyses and conducted two-level hierarchical logistic regression analysis. Adjustments were made for sex, age, seniority, occupational group and part-time work at the individual level, and work-unit size, the proportion of female employees and the proportion of part-time work at the work-unit level. The OR for long-term sickness absence associated with a 12-point higher work-unit social capital was 0.73 (95% CI 0.68 to 0.78). Further, we found an association between higher work-unit social capital and lower long-term sickness absence across quartiles of social capital: compared with the lowest quartile, the OR for long-term sickness absence in the highest quartile was 0.51 (95% CI 0.44 to 0.60). Our study provides support for work-unit social capital being a protective factor for individual long-term sickness absence among hospital employees in the Capital Region of Denmark. © Article author(s) (or their employer(s) unless otherwise stated in the text of the

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

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

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

Early Exercise in the Burn Intensive Care Unit Decreases Hospital Stay, Improves Mental Health, and Physical Performance

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2017-10-01

Decreases Hospital Stay, Improves Mental Health , and Physical Performance 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Oscar E. Suman, PhD...Multicenter Study of the Effect of In-Patient Exercise Training on Length of Hospitalization, Mental Health , and Physical Performance in Burned...Intensive Care Unit Decreases Hospital Stay, Improves Mental Health , and Physical Performance,” Proposal Log Number 13214039, Award Number W81XWH-14

Referral Regions for Time-Sensitive Acute Care Conditions in the United States.

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Wallace, David J; Mohan, Deepika; Angus, Derek C; Driessen, Julia R; Seymour, Christopher M; Yealy, Donald M; Roberts, Mark M; Kurland, Kristen S; Kahn, Jeremy M

2018-03-24

Regional, coordinated care for time-sensitive and high-risk medical conditions is a priority in the United States. A necessary precursor to coordinated regional care is regions that are actionable from clinical and policy standpoints. The Dartmouth Atlas of Health Care, the major health care referral construct in the United States, uses regions that cross state and county boundaries, limiting fiscal or political ownership by key governmental stakeholders in positions to create incentive and regulate regional care coordination. Our objective is to develop and evaluate referral regions that define care patterns for patients with acute myocardial infraction, acute stroke, or trauma, yet also preserve essential political boundaries. We developed a novel set of acute care referral regions using Medicare data in the United States from 2011. For acute myocardial infraction, acute stroke, or trauma, we iteratively aggregated counties according to patient home location and treating hospital address, using a spatial algorithm. We evaluated referral political boundary preservation and spatial accuracy for each set of referral regions. The new set of referral regions, the Pittsburgh Atlas, had 326 distinct regions. These referral regions did not cross any county or state borders, whereas 43.1% and 98.1% of all Dartmouth Atlas hospital referral regions crossed county and state borders. The Pittsburgh Atlas was comparable to the Dartmouth Atlas in measures of spatial accuracy and identified larger at-risk populations for all 3 conditions. A novel and straightforward spatial algorithm generated referral regions that were politically actionable and accountable for time-sensitive medical emergencies. Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Safety culture in the maternity unit of hospitals in Ilam province, Iran: a census survey using HSOPSC tool.

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Akbari, Nahid; Malek, Marzieh; Ebrahimi, Parvin; Haghani, Hamid; Aazami, Sanaz

2017-01-01

Improving quality of maternal care as well as patients' safety are two important issues in health-care service. Therefore, this study aimed to assess the culture of patient safety at maternity units. This cross-sectional study was conducted among staffs working at maternity units in seven hospitals of Ilam city, Iran. The staffs included in this study were gynecologists and midwifes working in different positions including matron, supervisors, head of departments and staffs. Data were collected using the Hospital Survey on Patient Safety Culture (HSOPSC). This study indicated that 59.1% of participants reported fair level of overall perceptions of safety and 67.1% declared that no event was reported during the past 12 months. The most positively perceived dimension of safety culture was teamwork within departments in view of managers (79.41) and personnel (81.10). However, the least positively perceived dimensions of safety culture was staffing levels. The current study revealed areas of strength (teamwork within departments) and weakness (staffing, punitive responses to error) among managers and personnel. In addition, we found that staffs in Ilam's hospitals accept the patient safety culture in maternity units, but, still are far away from excellent culture of patient safety. Therefore, it is necessary to promote culture of patient's safety among professions working in the maternity units of Ilam's hospitals.

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

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

2001-01-01

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

Comparing Outcomes of Coronary Artery Bypass Grafting Among Large Teaching and Urban Hospitals in China and the United States.

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Zheng, Zhe; Zhang, Heng; Yuan, Xin; Rao, Chenfei; Zhao, Yan; Wang, Yun; Normand, Sharon-Lise; Krumholz, Harlan M; Hu, Shengshou

2017-06-01

Coronary artery disease is prevalent in China, with concomitant increases in the volume of coronary artery bypass grafting (CABG). The present study aims to compare CABG-related outcomes between China and the United States among large teaching and urban hospitals. Observational analysis of patients aged ≥18 years, discharged from acute-care, large teaching and urban hospitals in China and the United States after hospitalization for an isolated CABG surgery. Data were obtained from the Chinese Cardiac Surgery Registry in China and the National Inpatient Sample in the United States. Analysis was stratified by 2 periods: 2007, 2008, and 2010; and 2011 to 2013 periods. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay. The sample included 51 408 patients: 32 040 from 77 hospitals in the China-CABG group and 19 368 from 303 hospitals in the US-CABG group. In the 2007 to 2008, 2010 period and for all-age and aged ≥65 years, the China-CABG group had higher mortality than the US-CABG group (1.91% versus 1.58%, P =0.059; and 3.12% versus 2.20%, P =0.004) and significantly higher age-, sex-, and comorbidity-adjusted odds of death (odds ratio, 1.58; 95% confidential interval, 1.22-2.04; and odds ratio, 1.73; 95% confidential interval, 1.24-2.40). There were no significant mortality differences in the 2011 to 2013 period. For preoperative, postoperative, and total hospital stay, respectively, the median (interquartile range) length of stay across the entire study period between China-CABG and US-CABG groups were 9 (8) versus 1 (3), 9 (6) versus 6 (3), and 20 (12) versus 7 (5) days (all P China and the United States. The longer length of stay in China may represent an opportunity for improvement. © 2017 The Authors.

Microbiological burden in air culture at various units of a tertiary care government hospital in Nepal

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Binaya Sapkota

2016-01-01

Full Text Available Background The environmental matrices (water, air, and surfaces play a vital role as reservoirs of Legionella spp. and Pseudomonas aeruginosa (Pseudomonas spp.. Hence, hospital environment control procedures are effective measures for reducing nosocomial infections. Aims This study was carried out to explore the profiles of microorganisms in air culture at various wards/units of a tertiary care hospital in Nepal. Methods A descriptive cross-sectional study was carried out at various wards/units of a tertiary care hospital in Nepal between January and September 2015 to explore the microbiological burden in inanimate objects. Each week one ward or unit was selected for the study. Bed, tap, the entire room, trolley, computer, phone, rack handles, table, chair, door, stethoscope, oxygen mask, gown, cupboard handles, and wash basins were selected for air culture testing. Ten different wards/units and 77 locations/pieces of equipment were selected for air culture by employing a simple random sampling technique. Information about the organisms was entered into the Statistical Package for the Social Sciences (SPSS Version 22 (IBM: Armonk, NY and descriptive analyses were carried out. Results Staphylococcus aureus (S. aureus, Micrococcus, coagulase negative staphylococcus (CONS, Bacillus, Pseudomonas aeruginosa, yeast, and Acinetobacter were the most commonly detected organisms. In the postoperative ward, S. aureus was the most frequently detected microorganism. Micrococcus was detected in four out of 10 locations. In the x-ray unit, S. aureus was detected in three out of four locations. Conclusion S. aureus, Micrococcus, CONS, Bacillus, Pseudomonas, yeast, and Acinetobacter were the most common organisms detected.

Incidence and Treatment Patterns in Hospitalizations for Malignant Spinal Cord Compression in the United States, 1998-2006

International Nuclear Information System (INIS)

Mak, Kimberley S.; Lee, Leslie K.; Mak, Raymond H.; Wang, Shuang; Pile-Spellman, John; Abrahm, Janet L.; Prigerson, Holly G.; Balboni, Tracy A.

2011-01-01

Purpose: To characterize patterns in incidence, management, and costs of malignant spinal cord compression (MSCC) hospitalizations in the United States, using population-based data. Methods and Materials: Using the Nationwide Inpatient Sample, an all-payer healthcare database representative of all U.S. hospitalizations, MSCC-related hospitalizations were identified for the period 1998-2006. Cases were combined with age-adjusted Surveillance, Epidemiology and End Results cancer death data to estimate annual incidence. Linear regression characterized trends in patient, treatment, and hospital characteristics, costs, and outcomes. Logistic regression was used to examine inpatient treatment (radiotherapy [RT], surgery, or neither) by hospital characteristics and year, adjusting for confounding. Results: We identified 15,367 MSCC-related cases, representing 75,876 hospitalizations. Lung cancer (24.9%), prostate cancer (16.2%), and multiple myeloma (11.1%) were the most prevalent underlying cancer diagnoses. The annual incidence of MSCC hospitalization among patients dying of cancer was 3.4%; multiple myeloma (15.0%), Hodgkin and non-Hodgkin lymphomas (13.9%), and prostate cancer (5.5%) exhibited the highest cancer-specific incidence. Over the study period, inpatient RT for MSCC decreased (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.61-0.81), whereas surgery increased (OR 1.48, 95% CI 1.17-1.84). Hospitalization costs for MSCC increased (5.3% per year, p < 0.001). Odds of inpatient RT were greater at teaching hospitals (OR 1.41, 95% CI 1.19-1.67), whereas odds of surgery were greater at urban institutions (OR 1.82, 95% CI 1.29-2.58). Conclusions: In the United States, patients dying of cancer have an estimated 3.4% annual incidence of MSCC requiring hospitalization. Inpatient management of MSCC varied over time and by hospital characteristics, with hospitalization costs increasing. Future studies are required to determine the impact of treatment patterns on MSCC

Payment of hospital cardiac services.

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Unger, W J

1991-01-01

This report describes how acute-care community hospitals in the United States get paid for services when their patients either are entitled to Medicare or Medicaid benefits or subscribe to a Blue Cross or Blue Shield plan, a commercial insurance plan, a health maintenance organization, a preferred provider organization, or some other third-party payment mechanism. The focus of this report is on cardiac services, which are the most common type of inpatient services provided by acute-care community hospitals. Over the past three decades, extraordinary advances in medical and surgical technologies as well as healthier life-styles have cut the annual death rate for coronary heart disease in half. Despite this progress, cardiovascular disease remains the number one cause of hospitalization. On average nationwide, diseases and disorders of the circulatory system are the primary reason for 17 percent of all patient admissions, and among the nation's 35 million Medicare beneficiaries they are the primary reason for 25 percent of all admissions. In the United States heart disease is the leading cause of death and a major cause of morbidity. Its diagnosis and treatment are often complex and costly, often requiring multiple hospitalizations and years of medical management. To focus management attention and resources on the immense cardiology marketplace, many hospitals have hired individuals with strong clinical backgrounds to manage their cardiology programs. These "front-line" managers play a key role in coordinating a hospital's services for patients with cardiovascular disease. Increasingly, these managers are being asked to become active participants in the reimbursement process. This report was designed to meet their needs. Because this report describes common reimbursement principles and practices applicable to all areas of hospital management and because it provides a "tool kit" of analytical, planning, and forecasting techniques, it could also be useful to hospital

An Evaluation and Ranking of Children's Hospital Websites in the United States.

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Huerta, Timothy R; Walker, Daniel M; Ford, Eric W

2016-08-22

Children's hospitals are faced with the rising need for technological innovation. Their prospective health care consumers, who increasingly depend on the Web and social media for communication and consumer engagement, drive this need. As patients and family members navigate the Web presence of hospitals, it is important for these specialized organizations to present themselves and their services efficiently. The purpose of this study was to evaluate the website content of children's hospitals in order to identify opportunities to improve website design and create benchmarks to judge improvement. All websites associated with a children's hospital were identified using a census list of all children's hospitals in the United States. In March of 2014, each website and its social media were evaluated using a Web crawler that provided a 5-dimensional assessment that included website accessibility, marketing, content, technology, and usability. The 5-dimensional assessment was scored on a scale ranging from 0 to 10 with positive findings rated higher on the scale. Websites were ranked by individual dimensions as well as according to their average ranking across all dimensions. Mean scores of 153 websites ranged from 5.05 to 8.23 across all 5 dimensions. Results revealed that no website scored a perfect 10 on any dimension and that room exists for meaningful improvement. Study findings allow for the establishment of baseline benchmarks for tracking future website and social media improvements and display the need for enhanced Web-based consumer engagement for children's hospitals.

Quality of communication about medicines in United States hospitals: A national retrospective study.

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Mullings, Lauren; Sankaranarayanan, Jayashri

Despite the benefits of improving transitions across care, literature is very limited on inpatient "Communication about Medicines" (ComMed) by staff across United States (U.S.) hospitals. To evaluate ComMed quality variations by hospital characteristics. In a cross-sectional, retrospective study of publicly available U.S. Medicare's Hospital Consumer Assessment of Health Care Plans Survey (HCAHPS) data (January 2013-September 2014), ComMed quality (high = above average/excellent vs. low = average/below average/poor star ratings) of 3125 hospitals were compared across region, rural-urban location, and health information technology (HIT) infrastructure giving providers access to patients' electronic medical records. Multivariate logistic regression analysis was conducted with adjusting for confounders (hospital - bed size, ownership, type, ED services, the number of completed HCAHPS surveys). After adjusting for other characteristics, Midwest versus Western region hospitals (OR = 1.55, 95% CI: 1.21-1.98, p=quality. Hospitals' small bed-size, physician/non-profit ownership, critical-access type, absent ED services, and 100-299 HCAHPS completed surveys were more likely to be associated with high ComMed quality. One of the first national studies found significant variations in ComMed quality across U.S. hospitals by location (high in Midwest and low in Northeast regions and urban areas) and by access to HIT infrastructure (high) after controlling for other hospital characteristics. With this baseline data, hospital providers and policymakers can design, implement, and evaluate service programs with pharmacists and HIT to enhance ComMed quality in the future delivery of patient-centered care. Copyright © 2016 Elsevier Inc. All rights reserved.

Healthy hospital food initiatives in the United States: time to ban sugar sweetened beverages to reduce childhood obesity.

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Wojcicki, Janet M

2013-06-01

While childhood obesity is a global problem, the extent and severity of the problem in United States, has resulted in a number of new initiatives, including recent hospital initiatives to limit the sale of sweetened beverages and other high calorie drinks in hospital vending machines and cafeterias. These proposed policy changes are not unique to United States, but are more comprehensive in the number of proposed hospitals that they will impact. Meanwhile, however, it is advised, that these initiatives should focus on banning sugar sweetened beverages, including sodas, 100% fruit juice and sports drinks, from hospital cafeterias and vending machines instead of limiting their presence, so as to ensure the success of these programs in reducing the prevalence of childhood obesity. If US hospitals comprehensively remove sugar sweetened beverages from their cafeterias and vending machines, these programs could subsequently become a model for efforts to address childhood obesity in other areas of the world. Hospitals should be a model for health care reform in their communities and removing sugar sweetened beverages is a necessary first step. ©2013 Foundation Acta Paediatrica. Published by Blackwell Publishing Ltd.

Feelings of women accompanying children hospitalized in a Paediatric Intensive Care Unit

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Cassiana Mendes Bertoncello Fontes

2017-03-01

Full Text Available Objective: Analise feelings of women accompanying children in a paediatric intensive care unit Materials and Methods: Data were collected from August to October 2015 by the authors from individual interviews recorded with 15 women. The instrument was structured with the identification of qualitative variables, described in absolute and relative frequencies, and a guiding question. The "corpus" of each interview was electronically transcribed, floating readings were held and statements were categorized and analysed according Analise Content.  Results: 14 (93% are biological mothers; average age 30 years; 11 (73% have completed primary education; six (46% have an occupation or a profession. The four themes were inferred: ambivalence of feelings and coping were related to how individuals express and deal with the hospitalized patient’s situation; empathy with the health team and the structural condition of the critical environment can also generate feelings. Nursing diagnoses were formulated from the reported feelings. Conclusion: It was observed that the feelings identified could be originated by the health-illness hospitalization process as well as the structural components of the critical environment. Keywords: Paediatric Intensive Care Units; Women; Feelings.

Post-destructive eye surgery, associated depression at Sekuru Kaguvi Hospital Eye Unit, Zimbabwe: Pilot Study

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M. M. Kawome

2013-12-01

Full Text Available Destructive eye surgery is associated with more complications than just loss of visual functions of the eye and aesthetics. Currently there is very little published literature on post-destructive eye surgery associated depression. Zimbabwe has been experiencing a surge in the rate of destructive eye surgery done at the National Tertiary Eye Unit. This situation could be churning out lots of unrecognized depressed clients into the community who require assistance in one form or another. Objectives: To determine the prevalence of post-destructive eye surgery associated depression among patients attending Sekuru Kaguvi Hospital Eye Unit and assess if the current management protocol of patients undergoing destructive eye surgery at the Eye Unit addresses the problem adequately. Methods: A cross-sectional study of 28 randomly selected patients who had destructive eye surgeries at Sekuru Kaguvi Hospital was conducted over five months from 1st March 2012 to end of July 2012. A structured questionnaire containing 15 questions on the following items: gender, age, diagnosis, surgical procedure done, expectations before and after surgery, adequacy of counseling given and involvement of family was used to collect data. Nine questions to assess depression were adapted from the Patient Health Questionnaire (PHQ-9. Setting:  The study was conducted at SekuruKaguvi Hospital Eye Unit, Parirenyatwa Group of Hospitals in Harare. Results:  Twenty-eight patients who underwent destructive eye surgery during the study period were selected using systematic random sampling. The gender ratio was 1:1 and the mean age was 38.7 years with a range from 24 to 65 years. Fifty percent of the patients in the study had orbital exenteration while the rest had enucleation (14% and evisceration (36%. Twenty-eight percent of the study population had depression. Conclusion: Destructive eye surgery is frequently associated with depression and our current management protocol of

Trends of Heller myotomy hospitalizations for achalasia in the United States, 1993-2005: effect of surgery volume on perioperative outcomes.

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Wang, Y Richard; Dempsey, Daniel T; Friedenberg, Frank K; Richter, Joel E

2008-10-01

Achalasia is a rare chronic disorder of esophageal motor function. Single-center reports suggest that there has been greater use of laparoscopic Heller myotomy for achalasia in the United States since its introduction in 1992. We aimed to study the trends of Heller myotomy and the relationship between surgery volume and perioperative outcomes. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) is a 20% stratified sample of all hospitalizations in the United States. It was used to study the macro-trends of Heller myotomy hospitalizations during 1993-2005. We also used the NIS 2003-2005 micro-data to study the perioperative outcomes of Heller myotomy hospitalizations, using other achalasia and laparoscopic cholecystectomy hospitalizations as control groups. The generalized linear model with repeated observations from the same unit was used to adjust for multiple hospitalizations from the same hospital. The national estimate of Heller myotomy hospitalizations increased from 728 to 2,255 during 1993-2005, while its mean length of stay decreased from 9.9 to 4.3 days. Of the 1,117 Heller myotomy hospitalizations in the NIS 2003-2005, 10 (0.9%) had the diagnosis of esophageal perforation at discharge. Length of stay was negatively correlated with a hospital's number of Heller myotomy per year (correlation coefficient -0.171, P Heller myotomy per year was negatively associated with length of stay (coefficient -0.215 to -0.119, both P Heller myotomy for achalasia was associated with greater use of surgery and shorter length of stay. A larger volume of Heller myotomy in a hospital was associated with better perioperative outcomes in terms of shorter length of stay and lower total charges.

Patient perception of pain care in hospitals in the United States

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Anita Gupta

2009-11-01

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

Does Coordinated Postpartum Care Influence Costs?

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Elisabeth Zemp

2017-03-01

Full Text Available Questions under study: To investigate changes to health insurance costs for post-discharge postpartum care after the introduction of a midwife-led coordinated care model. Methods: The study included mothers and their newborns insured by the Helsana health insurance group in Switzerland and who delivered between January 2012 and May 2013 in the canton of Basel Stadt (BS (intervention canton. We compared monthly post-discharge costs before the launch of a coordinated postpartum care model (control phase, n = 144 to those after its introduction (intervention phase, n = 92. Costs in the intervention canton were also compared to those in five control cantons without a coordinated postpartum care model (cross-sectional control group: n = 7, 767. Results: The average monthly post-discharge costs for mothers remained unchanged in the seven months following the introduction of a coordinated postpartum care model, despite a higher use of midwife services (increasing from 72% to 80%. Likewise, monthly costs did not differ between the intervention canton and five control cantons. In multivariate analyses, the ambulatory costs for mothers were not associated with the post-intervention phase. Cross-sectionally, however, they were positively associated with midwifery use. For children, costs in the post-intervention phase were lower in the first month after hospital discharge compared to the pre-intervention phase (difference of –114 CHF [95%CI –202 CHF to –27 CHF], yet no differences were seen in the cross-sectional comparison. Conclusions: The introduction of a coordinated postpartum care model was associated with decreased costs for neonates in the first month after hospital discharge. Despite increased midwifery use, costs for mothers remained unchanged.

A measurement tool to assess culture change regarding patient safety in hospital obstetrical units.

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Kenneth Milne, J; Bendaly, Nicole; Bendaly, Leslie; Worsley, Jill; FitzGerald, John; Nisker, Jeff

2010-06-01

Clinical error in acute care hospitals can only be addressed by developing a culture of safety. We sought to develop a cultural assessment survey (CAS) to assess patient safety culture change in obstetrical units. Interview prompts and a preliminary questionnaire were developed through a literature review of patient safety and "high reliability organizations," followed by interviews with members of the Managing Obstetrical Risk Efficiently (MOREOB) Program of the Society of Obstetricians and Gynaecologists of Canada. Three hundred preliminary questionnaires were mailed, and 21 interviews and 9 focus groups were conducted with the staff of 11 hospital sites participating in the program. To pilot test the CAS, 350 surveys were mailed to staff in participating hospitals, and interviews were conducted with seven nurses and five physicians who had completed the survey. Reliability analysis was conducted on four units that completed the CAS prior to and following the implementation of the first MOREOB module. Nineteen values and 105 behaviours, practices, and perceptions relating to patient safety were identified and included in the preliminary questionnaire, of which 143 of 300 (47.4%) were returned. Among the 220 cultural assessment surveys returned (62.9%), six cultural scales emerged: (1) patient safety as everyone's priority; (2) teamwork; (3) valuing individuals; (4) open communication; (5) learning; and (6) empowering individuals. The reliability analysis found all six scales to have internal reliability (Cronbach alpha), ranging from 0.72 (open communication) to 0.84 (valuing individuals). The CAS developed for this study may enable obstetrical units to assess change in patient safety culture.

COORDINATING HOSPITAL AND COMMUNITY WORK ADJUSTMENT SERVICES. FINAL REPORT.

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GOERTZEL, VICTOR; AND OTHERS

THE GOALS OF THIS STUDY WERE TO USE WORK TO HELP PATIENTS LEAVE THE CAMARILLO STATE HOSPITAL SOONER, BECOME A PART OF THE COMMUNITY, AND BECOME SELF-SUPPORTING. THE PROJECT SELECTED 146 SCHIZOPHRENIC MALES WHO HAD A HISTORY OF POOR WORK ADJUSTMENT. AS PART OF THE TREATMENT, THE MEN WERE PLACED IN THE HOSPITAL BAKERY. AFTER ADJUSTMENT TO THE WORK…

Elaboration of leadership and culture in high-performing nursing units of hospitals as perceived by staff nurses.

Science.gov (United States)

Casida, Jesus M; Crane, Patrick C; Walker, Tara L; Wargo, Lisa M

2012-01-01

The leadership-culture phenomenon, a known explanatory construct for organizational performance, is understudied in nursing. Building on our previous work, we further addressed this knowledge gap through explorations of demographics and hospital variables which may have a significant influence on staff nurses' (SNs) perceptions of their nurse managers' (NMs) leadership and nursing unit culture. Furthermore, we explored the extent to which the NMs' leadership predicted specific cultures which typify nursing unit effectiveness. Using dissertation data provided by278 SNs, we found that SNs educated at the baccalaureate level or higher had favorable perceptions of their nursing unit performance and viewed their NMs' leadership differently than the SNs with diploma or associate degrees. The frequent portrayals of transformational (TFL) leadership behaviors (e.g., visionary) by the NMs were paramount in shaping culture traits which exemplify high performance outcomes. TFL leaders were more likely to shape unit cultures which are flexible and adaptive to the environmental challenges within and outside the nursing unit. Thus, the type of NMs' leadership and unit culture may provide an added value in explaining the performance level in patient care units which consequently affects the overall hospital/organizational outcomes. Implications for research and leadership practices are presented.

Antimicrobial Suspectibility of Bacterial Isolated from Burn Unit in Dr. Hasan Sadikin General Hospital Bandung, Indonesia from June to September 2013

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Yodya Evila

2015-09-01

Full Text Available Background: Development of infection in burned patients is a crucial matter because it may increase morbidity and mortality. Factors contributing to high risk for infections are disrupted skin barrier, dysfunction of the immune system and prolonged hospitalization. Crowded hospital condition and transfer of patients from one unit to another can affect development of infection caused by environmental factors. The aim of the study was to identify the antimicrobial suspectibility of bacterial isolated from Burn Unit in Dr. Hasan Sadikin General Hospital, Bandung. Methods: A descriptive study was carried out in Burn Unit Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from June to September 2013. A total of 30 environment samples were collected and cultured to identify the bacterias. Futhermore, the colonies found, underwent antimicrobial susceptibility test. Results: Most common bacteria found from the environmental samples in Burn Unit was Staphylococcus saprophyticus (24%. Other bacterias found were Klebsiella pneumonia (17%, Acinetobacter baumanii (15%, Staphylococcus epidermidis (12%, Bacillus sp.(12%, Pseudomonas sp.(7%, Staphylococcus aureus (5%, Enterobacter aerogenes (5% and Serratia sp. (2%. Some bacteria still had good sensitivity to antibiotics while the Enterobacteriaceae were almost completely resistant to antimicrobial used in the study. Conclusions: The most common bacteria found from the environment samples in Burn Unit is Staphylococcuss aprophyticus. Additionally, Klebsiella pneumoniae as one of the Enterobacteriaceae groups, appears as an emerging hospital associated infection pathogen with their resistant to many antimicrobials.

The Influence of Setting on Care Coordination for Childhood Asthma

Science.gov (United States)

Kelly, R. Patrick; Stoll, Shelley C.; Bryant-Stephens, Tyra; Janevic, Mary R.; Lara, Marielena; Ohadike, Yvonne U.; Persky, Victoria; Ramos-Valencia, Gilberto; Uyeda, Kimberly; Malveaux, Floyd J.

2015-01-01

Asthma affects 7.1 million children in the United States, disproportionately burdening African American and Latino children. Barriers to asthma control include insufficient patient education and fragmented care. Care coordination represents a compelling approach to improve quality of care and address disparities in asthma. The sites of The Merck Childhood Asthma Network Care Coordination Programs implemented different models of care coordination to suit specific settings—school district, clinic or health care system, and community—and organizational structures. A variety of qualitative data sources were analyzed to determine the role setting played in the manifestation of care coordination at each site. There were inherent strengths and challenges of implementing care coordination in each of the settings, and each site used unique strategies to deliver their programs. The relationship between the lead implementing unit and entities that provided (1) access to the priority population and (2) clinical services to program participants played a critical role in the structure of the programs. The level of support and infrastructure provided by these entities to the lead implementing unit influenced how participants were identified and how asthma care coordinators were integrated into the clinical care team. PMID:26232778

Adherence to guidelines in bleeding oesophageal varices and effects on outcome: comparison between a specialized unit and a community hospital

DEFF Research Database (Denmark)

Hobolth, Lise; Krag, Aleksander; Malchow-Møller, Axel

2010-01-01

is difficult. Our aims were to compare adherence to evidence-based guidelines in BOV between a specialized unit and a community hospital, and to investigate whether differences in adherence affected the outcome. METHODS: Two cohorts hospitalized during 2000-2007 with a first episode of BOV were retrospectively...... rebleeding were not statistically different. CONCLUSION: Our study shows that patients with BOV are more likely to receive therapy according to guidelines when hospitalized in a specialized unit compared with a community hospital. This however did not affect mortality.......OBJECTIVES: Randomized controlled trials have shown beneficial effects of vasoactive drugs, endoscopic treatment and prophylactic antibiotics on the outcome of bleeding oesophageal varices (BOV). However, translating guidelines based on randomized controlled trials into clinical practice...

Improving care coordination using organisational routines

DEFF Research Database (Denmark)

Prætorius, Thim

2016-01-01

Purpose – The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change......: care pathways and coordination, change, replication, the organisation and health care professionals. Research limitations/implications – The paper is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point for empirical research....... Practical implications – The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals. Originality...

47 CFR 1.928 - Frequency coordination, Canada.

Science.gov (United States)

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Frequency coordination, Canada. 1.928 Section 1... coordination, Canada. (a) As a result of mutual agreements, the Commission has, since May 1950 had an... information and engineering comments on proposed assignments along the Canada-United States borders in certain...

Primary immunodeficiency investigation in patients during and after hospitalization in a pediatric Intensive Care Unit

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Erica Suavinho

2014-03-01

Full Text Available Objective: To analyze whether the patients with severe infections, admitted in the Pediatric Intensive Care Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia, underwent the active screening for primary immunodeficiencies (PID. Methods: Retrospective study that assessed the data records of patients with any severe infections admitted in the Pediatric Intensive Care Unit, covering a period from January 2011 to January 2012, in order to confirm if they performed an initial investigation for PID with blood count and immunoglobulin dosage. Results: In the studied period, 53 children were hospitalized with severe infections in the Pediatric Intensive Care Unit, and only in seven (13.2% the initial investigation of PID was performed. Among these patients, 3/7 (42.8% showed quantitative alterations in immunoglobulin G (IgG levels, 1/7 (14.3% had the diagnosis of cyclic neutropenia, and 1/7 (14.3% presented thrombocytopenia and a final diagnosis of Wiskott-Aldrich syndrome. Therefore, the PID diagnosis was confirmed in 5/7 (71.4% of the patients. Conclusions: The investigation of PID in patients with severe infections has not been routinely performed in the Pediatric Intensive Care Unit. Our findings suggest the necessity of performing PID investigation in this group of patients.

[Results of pulmonary embolism treatment in a tertiary hospital short stay unit. Is this the right place?].

Science.gov (United States)

Rosa Salazar, V; Bernal Martínez, L; García Pino, M J; Hernández Contreras, M E; García Méndez, M M; García Pérez, B; Marras Fernández-Cid, C

2016-01-01

To determine the mean stay (MS) of patients with pulmonary embolism (PE) in a thrombosis unit (TU) with a short stay unit (SSU) in a tertiary hospital. To compare the data collected with those of other hospitals in the same region, of other regions (Autonomous Communities [AACC]), and within the same hospital in the year before the SSU opened. A descriptive retrospective observational study that included patients with a diagnosis of PE in the University Hospital Virgen de la Arrixaca (HCUVA) in 2012. These data were classified by hospital department, and used for calculating the mean stay. This was then compared with that of other hospitals in our region, with the rest of the regions, and with the data in 2007 (the last year without a TU). A total of 113patients with PE were included, 60 (53%) in the TU with an MS of 4.39, in Oncology, 7.45, and Internal Medicine (IM), 15.38days. There were no deaths in the TU and only 3 (5%) readmissions. Published data showed that the MS in all hospitals in our region was 8.25, 5.18 in our hospital, and higher in the rest of hospitals. The best AACC was the Basque Country with an MS of 6.85days. In 2007, there were 70patients with PE in the HCUVA, 34 (49%) in IM, with an MS of 8.50, Oncology 11 (31%) with an MS 9.64, and Chest Diseases 3 (4.3%) with an MS 19days, and with an overall mortality of 11% and a rate of readmissions in IM of 6%. The mean stay for a PE in the SSU of a TU was lower than in the rest of the hospital departments, lower than the rest hospitals of our region, lower than the rest of the regions, and lower than any department of our hospital before the SSU existed, without increasing the readmission or mortality rate. Copyright © 2015 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

50 CFR 82.7 - Coordination with States.

Science.gov (United States)

2010-10-01

...-IN-AID (MARINE MAMMAL PROTECTION ACT OF 1972) Application for Grants § 82.7 Coordination with States... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Coordination with States. 82.7 Section 82.7 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR...

Implications of design on infection prevention and control practice in a novel hospital unit: the Medical Ward of the 21st Century.

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VanSteelandt, Amanda; Conly, John; Ghali, William; Mather, Charles

2015-01-01

The physical design of hospital wards is associated with transmission of pathogenic organisms and hospital-acquired infections. A novel hospital unit, the Medical Ward of the 21st Century (W21C), optimizes features for infection prevention and control practices. Ethnographic research on the W21C versus conventional hospital wards examined the experiential and behavioural elements of the different designs. Three recurring themes emerged regarding the design features on the W21C and included visual cues, 'having a place for things', and less sharing of spaces and materials. Observational data of healthcare worker practices demonstrated significantly higher compliance with hand hygiene opportunities on the W21C compared with older hospital units. These findings suggest how the physical design of a hospital ward may enhance infection prevention and control practices.

The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients.

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Hartgerink, J M; Cramm, J M; Bakker, T J E M; van Eijsden, A M; Mackenbach, J P; Nieboer, A P

2014-04-01

To identify predictors of relational coordination among professionals delivering care to older patients. Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. This study was performed in spring 2010 among team members delivering care to older hospitalized patients (192 respondents; 44% response rate) in one hospital. Relational coordination was measured by the Relational Coordination survey; team climate by the Team Climate Inventory and questions were asked about participation in multidisciplinary team meetings and disciplines represented in these meetings. To account for the hierarchical structure, a multilevel analysis was performed. Correlation analysis revealed a positive relationship among being female, being a nurse and relational coordination; medical specialists showed a negative relationship. The number of disciplines represented during multidisciplinary team meetings and team climate were positively related with relational coordination. The multilevel analysis showed a positive relationship between the number of disciplines represented during multidisciplinary team meetings and team climate with relational coordination. The enhancement of team climate and attendance of diverse professionals during multidisciplinary team meetings are expected to improve relational coordination. Furthermore, this study underscores the importance of enhancing relational coordination between medical specialists and other professionals. © 2013 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.

Reducing length of stay for acute diabetic foot episodes: employing an extended scope of practice podiatric high-risk foot coordinator in an acute foundation trust hospital.

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Cichero, Matthew J; Bower, Virginia M; Walsh, Tom P; Yates, Ben J

2013-12-11

To enhance the acute management of people with diabetic foot disease requiring admission, an extended scope of practice, podiatric high-risk foot coordinator position, was established at the Great Western Hospital, Swindon in 2010. The focus of this new role was to facilitate more efficient and timely management of people with complex diabetic foot disease. The aim of this project was to investigate the impact of the podiatric high-risk foot coordinator role on length of stay, rate of re-admission and bed cost. This study evaluated the difference in length of stay and rate of re-admission between an 11- month pre-pilot period (November 2008 to October 2009) and a 10-month pilot period (August 2010 to June 2011). The estimated difference in bed cost between the pre-pilot and pilot audits was also calculated. Inclusion criteria were restricted to inpatients admitted with a diabetic foot ulcer, gangrene, cellulitis or infection as the primary cause for admission. Eligible records were retrieved using ICD-10 (V9) coding via the hospital clinical audit department for the pre-pilot period and a unique database was used to source records for the pilot phase. Following the introduction of the podiatric high-risk foot coordinator, the average length of stay reduced from 33.7 days to 23.3 days (mean difference 10.4 days, 95% CI 0.0 to 20.8, p = 0.050). There was no statistically significant difference in re-admission rate between the two study periods, 17.2% (95% CI 12.2% to 23.9%) in the pre-pilot phase and 15.4% (95% CI 12.0% to 19.5%) in the pilot phase (p = 0.820). The extrapolated annual cost saving following the implementation of the new coordinator role was calculated to be £234,000 for the 2010/2011 year. This audit found that the extended scope of practice coordinator role may have a positive impact on reducing length of stay for diabetic foot admissions. This paper advocates the role of a podiatric high-risk foot coordinator utilising an extended scope of

A randomized controlled trial of a Return-to-Work Coordinator model of care in a general hospital to facilitate return to work of injured workers.

Science.gov (United States)

Tan, Heidi Siew Khoon; Yeo, Doreen Sai Ching; Giam, Joanna Yu Ting; Cheong, Florence Wai Fong; Chan, Kay Fei

2016-04-07

Return-to-work (RTW) programmes for injured workers have been prevalent in Western countries with established work injury management policies for decades. In recent years, more Asian countries have started to develop RTW programmes in the absence of work injury management policies. However, few studies have evaluated the effectiveness of RTW programmes in Asia. Return-to-work coordination has been found to be an important facilitator in RTW programmes. This study seeks to determine the effectiveness of a Return-to-work coordinator (RTWC) model of care in facilitating early RTW for injured workers in Singapore. A randomized controlled trial was used. 160 injured workers in a general hospital were randomly allocated to either control (receive usual hospital standard care) or intervention (assigned a RTWC) group. The RTWC closely supported RTW arrangements and proactively liaised with employers and healthcare professionals on RTW solutions for the injured workers. At three months post injury, workers in the intervention group RTW 10 days earlier than the control group, with a higher proportion of workers in the intervention group returning to modified jobs. There were no significant differences in the quality of life measures between the two groups. The addition of a RTWC into the hospital model of care is effective in facilitating early RTW for injured workers. This could be a potential model of care for injured workers in Asian countries where work injury management policies are not yet established.

[Interpersonal relationships: perception of the communication, treatment and adverse experiences encountered by users of medical units that belong to the Coordinating Commission of the National Institutes of Health and High Specialty Hospitals (CCINSHAE)].

Science.gov (United States)

Arroyo-Valerio, América Guadalupe Guadalupe; Cortés-Poza, David; Aguirre Hernández, Rebeca; Fuentes García, Ruth; Ramírez de la Roche, Omar Fernando; Hamui Sutton, Alicia

2013-01-01

User's perception with regard to the attention they received in healthcare units is increasingly being taken into account by the health service providers in order to improve the quality of their service. Describe how the users perceive the health services provided by the CCINSHAE with regard to the communication with the physicians, the attention of the staff and the adverse personal and institutional experiences and to explore their relation with user's demographic characteristics, health condition, physical limitations to carry out daily activities and service area. A questionnaire was designed to collect information about the user and his/her opinion with regard to the healthcare units, the communication with the physicians, the attention of the staff and the adverse personal and institutional experiences. The data were analyzed with STATA using sample weights. A total of 2,176 individuals were interviewed after they had received attention and represent a population of 1,457,964 users, over 6 months, of the CCINSAHE. We then calculated four binary variables that reflect the perception of the users. These four variables were significantly associated with the type of health unit where the user received attention, schooling, limitations to carry out daily activities, facilities provided to the relatives, family income, the use of alternative medicine, and the area of attention. A fundamental aspect of the service provided by the healthcare institutions is the communication between the physicians and the users. We found that the perception of the users with regard to the communication with the physician, the attention of the staff, and the adverse personal and institutional experiences was associated with the type of healthcare unit. The federal reference hospitals produced the most unfavorable perception while the regional hospitals produced the most favorable impression. This study enables the decision-making personnel to determine what needs to be modified in

Coordination of Conditional Poisson Samples

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Grafström Anton

2015-12-01

Full Text Available Sample coordination seeks to maximize or to minimize the overlap of two or more samples. The former is known as positive coordination, and the latter as negative coordination. Positive coordination is mainly used for estimation purposes and to reduce data collection costs. Negative coordination is mainly performed to diminish the response burden of the sampled units. Poisson sampling design with permanent random numbers provides an optimum coordination degree of two or more samples. The size of a Poisson sample is, however, random. Conditional Poisson (CP sampling is a modification of the classical Poisson sampling that produces a fixed-size πps sample. We introduce two methods to coordinate Conditional Poisson samples over time or simultaneously. The first one uses permanent random numbers and the list-sequential implementation of CP sampling. The second method uses a CP sample in the first selection and provides an approximate one in the second selection because the prescribed inclusion probabilities are not respected exactly. The methods are evaluated using the size of the expected sample overlap, and are compared with their competitors using Monte Carlo simulation. The new methods provide a good coordination degree of two samples, close to the performance of Poisson sampling with permanent random numbers.

Evaluation of Patients Visiting the Dermatology Emergency Unit of a University Dermatology Hospital in Tehran, Iran.

Science.gov (United States)

Abedini, Robabeh; Matinfar, Amin; Sasani, Pardis; Salehi, Anahita; Daneshpazhooh, Maryam

2017-11-01

Published studies on dermatological emergencies are limited in the literature. To our knowledge, no study has previously explored this subject in Iran. Our aim was to ascertain the characteristics of patients visiting the dermatologic emergency (DE) unit of a university skin hospital in Tehran, Iran. We studied the files of all the patients seen in the DE unit over a 3-month period, collecting data on age, sex, referral mode, duration of consultation, status (true emergency or non-emergency), and diagnosis. A total of 2539 patients were evaluated; 53% of them were female. Infection and infestation (41.9%), urticaria (16.7%), and dermatitis (13.2%) were the most prevalent entities. Almost 1% of the patients were referred by another physician and psoriasis was their most frequent diagnosis. Almost 2.6% of the patients were hospitalized; psoriasis was once again the most frequent cause. The hospitalization rate was significantly higher in referred patients (Pdermatologic disorders. This data could also help in tailoring the educational curriculum for medical students more appropriately in order to increase their knowledge of the most prevalent skin disorders.

[Clinical audit on drug prescriptions for elderly patients hospitalized in a unit of psychiatry].

Science.gov (United States)

Humaraut, C; Caron, J; Bayonne, L; Moalic, Y

2016-02-01

The elderly are particularly vulnerable to the iatrogenic effects of drugs that are a major public health problem. In a geriatric care unit of a psychiatric hospital, the pharmacist, in close cooperation with the various health professionals, takes part in the optimization of drug therapy of these patients during cross-professional consultation meetings. From 2009 to 2011, an evaluation of professional practices was run through a targeted clinical audit on the theme of "prescription drugs at the age of 75 and over". The main objective of this study is to measure the differences between the practices and the guidelines for prescription drugs concerning the elderly, and then to analyze and amend these differences. The secondary objective is to gather data on the prescription drugs for the elderly in the particular context of a psychiatric unit. The evaluation was performed using two standards: the evaluation chart of prescriptions of the Professional College of French Geriatrics (CPGF) and the French National Authority for Health and the list of Laroche et al. In the first round, after analyzing the prescriptions of 105 patients, the gap between practice and accepted standards led to the definition of three areas of improvement on the associations of neuroleptics, on the use of anticholinergic drugs and on the prescription of benzodiazepines, the latter being subject of another communication. After reassessment, the prescriptions of 101 patients were thereafter analyzed in relation to the identified areas of improvement. Patient samples of both phases were statistically homogeneous. Between the two evaluations, the percentage of prescriptions with at least two neuroleptics remained stable, the decline was not significant (18.1% to 13.9%, P≥0.05). However, it was observed that the second suggested a "conditional" decline with dosages less than or equal to those recommended for the elderly dosages. The proportion of patients who did not take anticholinergic drugs

Nurses’ Burnout in Oncology Hospital Critical Care Unit

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Yeliz İrem Tunçel

2014-08-01

Full Text Available Objective: Burnout is common in intensive care units (ICU because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory and depression (Beck Depression Scale. Results: From a total of 37 ICU nurses, 35 participated in the study (%94,5 response rate. High levels of emotional exhaustion in 82% and depersonalization in 51,4% of nurses was determined. Personal accomplishment was higher at 80%. Mild to moderate emotional state and mild anxiety was revealed. Years in profession,finding salary insufficient, finding the profession in its proper, choosing the profession of his own accord, work environment satisfaction and finding the social activity adequate were associated with burnout (p≤0.05. Conclusion: In our study, intensive care unit nurses’ burnout scores were found to be higher. Burnout was rare in nurses that choose the profession of his own accord, find the nursing profession in its proper, and social activity adequate and are satisfied with the work environment. Therefore, we believe that attention should be given to individual needs and preferences in the selection of ICU staff.

Sexual Behavior in Patients with Psychosis Admitted to a Hospital Unit.

Science.gov (United States)

Del Mar Baños-Martín, María; Márquez-Hernández, Verónica V; Gutiérrez-Puertas, Lorena; Aguilera-Manrique, Gabriel; Gutiérrez-Puertas, Vanesa; Granados-Gámez, Genoveva

2017-06-01

The sexual dimension is part of a person's functionality. Patients with mental disorders have the same sexual needs as any other person, although they may not always be recognized. This is a retrospective observational study to describe the information on sexuality of patients with mental disorders, admitted to an acute short-stay inpatient unit between 2011 and 2015. We analyzed 293 clinical histories of patients, comprising diagnoses in the ICD-10 (International Classification of Diseases) between F20 and F29, inclusively. The information collected corresponded to the beginning of hospitalization, its duration and discharge. The results showed that 24% of the patients had sexual delusions. These delusions were more frequent in women, who in turn had more emotional symptoms, persecutory deception being the most common. There were few reports found on sexual dysfunction. In conclusion, the lack of data in the reports shows little recognition of sexuality in hospitalized patients with mental disorder, highlighting the need to promote the training of health personnel.

Hospital Prices Increase in California, Especially Among Hospitals in the Largest Multi-hospital Systems

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Glenn A. Melnick PhD

2016-06-01

Full Text Available A surge in hospital consolidation is fueling formation of ever larger multi-hospital systems throughout the United States. This article examines hospital prices in California over time with a focus on hospitals in the largest multi-hospital systems. Our data show that hospital prices in California grew substantially (+76% per hospital admission across all hospitals and all services between 2004 and 2013 and that prices at hospitals that are members of the largest, multi-hospital systems grew substantially more (113% than prices paid to all other California hospitals (70%. Prices were similar in both groups at the start of the period (approximately $9200 per admission. By the end of the period, prices at hospitals in the largest systems exceeded prices at other California hospitals by almost $4000 per patient admission. Our study findings are potentially useful to policy makers across the country for several reasons. Our data measure actual prices for a large sample of hospitals over a long period of time in California. California experienced its wave of consolidation much earlier than the rest of the country and as such our findings may provide some insights into what may happen across the United States from hospital consolidation including growth of large, multi-hospital systems now forming in the rest of the rest of the country.

Adaptive coordination in surgical teams: an interview study.

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Bogdanovic, Jasmina; Perry, Juliana; Guggenheim, Merlin; Manser, Tanja

2015-04-01

Effective teamwork has been recognised as a major contributor to safe patient care in surgery. Previous research has highlighted the importance of adaptive coordination for effective performance in acute care settings. Expanding this line of research this study explores the coordination behaviours and adaptive coordination strategies employed by surgical teams and identifies relevant situational characteristics influencing those coordination processes. We conducted a qualitative content analysis of semi-structured interviews with 33 surgical team members (nurses and physicians) from different specialties and hospitals. We identified coordination behaviours (i.e. task management, information management, teaching and leadership) and adaptive coordination strategies triggered by varying requirements due to non-routine events, intraoperative complications and differing level of experience among operating room staff. Interviewees highlighted the importance of effectively managing challenging moments and the supporting effect of positive climate on teamwork. This study complements previous research on the non-technical skills underpinning safe performance in surgical teams. It highlights the central role of coordination and points out the ways in which situational variability requires the team to behave adaptively.

Implementation of a quality management system according to 9001 standard in a hospital in the home unit: changes and achievements.

Science.gov (United States)

Rodríguez-Cerrillo, Matilde; Fernández-Diaz, Eddita; Iñurrieta-Romero, Amaia; Poza-Montoro, Ana

2012-01-01

The purpose of this paper is to describe changes and results obtained after implementation of a quality management system (QMS) according to ISO standards in a Hospital in the Home (HIH) Unit. The paper describes changes made and outcomes achieved. This took part in the HiH Unit, Clinico Hospital, Madrid, Spain, and looked at admissions, mean stay, patient satisfaction, adverse events, returns to hospital, no admitted referrals, complaints, compliance to protocols, equipment failures and resolution of urgent consultations. In June 2008, HiH Unit, Clinico Hospital obtained ISO certification. The main results achieved are as follows. There was an increase in patients' satisfaction--in June 2008, assessment of the quality of care provided by staff was scored at 4.7 (on a scale of 1 to 5); in 2010 it has been scored at 4.96. Patient satisfaction rate has increased from 92 percent to 98.8 percent. No complaints from patients were received. Unscheduled returns to hospital have decreased from 7 percent to 3 percent. There were no medical equipment failures. External suppliers' performance has improved. Material and medication needed by staff was available when necessary. The number of admissions has increased. Compliance to protocols has reached 97 percent. Inappropriate referrals have decreased by 8 percent. Six medications-related incidents were detected; in two cases the incident was not due to an error. In the other four cases error could have been detected before reaching the patient. Implementations of an ISO quality management system allow improved quality of care and patient satisfaction in a HIH Unit.

The Study of Life Change Unit as Stressor Agents among Tehran University of Medical Sciences Hospitals' Employees

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Hossein Dargahi

2010-08-01

Full Text Available Life crises as stressor agents can disrupt the best stress management regime. Different life crises have different impacts. A standard scale to rate change and its related stress impact has been developed commonly referred to as LCU (Life Change Unit Rating. This allocates a number of Life Crisis Units or Life Change Units (LCUs to different event and then evaluates them and takes action accordingly. This idea behind this approach of is to rundown the LCU table, totaling the LCUs for life crisis that have occurred in the previous one year. A Cross - sectional, descriptive and analytical study was conducted among 900 Tehran University of Medical Sciences (TUMS Employees by a Holms and Rahe LCU questionnaire at 15 hospitals. The respondents were asked to determine their demographic information, list of stress symptoms which suffered from these diseases in the previous one year and finally, responded to 45 Life Change Unit as stressful life events and the value of each in "stress units" which occurred in the previous one year. The results showed that there is significant correlation between the employees LCU rating by sex, educational degree and size of hospital. Also we found that there are significant correlations between the employees stress symptoms with their LCU rating. Totally, 40% of the employees have less than 150 LCU rating (normal range and 60% of them have 150-300 or more than 300 LCU rating (abnormal range. In conclusion most of TUMS hospitals' employees who had stress symptoms have more LCU rating. One third of these employees are not in danger of suffering the illness effect, while two third of them are in danger.

The impact of reducing intensive care unit length of stay on hospital costs: evidence from a tertiary care hospital in Canada.

Science.gov (United States)

Evans, Jessica; Kobewka, Daniel; Thavorn, Kednapa; D'Egidio, Gianni; Rosenberg, Erin; Kyeremanteng, Kwadwo

2018-02-23

To use theoretical modelling exercises to determine the effect of reduced intensive care unit (ICU) length of stay (LOS) on total hospital costs at a Canadian centre. We conducted a retrospective cost analysis from the perspective of one tertiary teaching hospital in Canada. Cost, demographic, clinical, and LOS data were retrieved through case-costing, patient registry, and hospital abstract systems of The Ottawa Hospital Data Warehouse for all new in-patient ward (30,483) and ICU (2,239) encounters between April 2012 and March 2013. Aggregate mean daily variable direct (VD) costs for ICU vs ward encounters were summarized by admission day number, LOS, and cost centre. The mean daily VD cost per ICU patient was $2,472 (CAD), accounting for 67.0% of total daily ICU costs per patient and $717 for patients admitted to the ward. Variable direct cost is greatest on the first day of ICU admission ($3,708), and then decreases by 39.8% to plateau by the fifth day of admission. Reducing LOS among patients with ICU stays ≥ four days could potentially result in an annual hospital cost saving of $852,146 which represents 0.3% of total in-patient hospital costs and 1.2% of ICU costs. Reducing ICU LOS has limited cost-saving potential given that ICU costs are greatest early in the course of admission, and this study does not support the notion of reducing ICU LOS as a sole cost-saving strategy.

Coordination theory and collaboration technology

CERN Document Server

Olson, Gary M; Smith, John B

2001-01-01

The National Science Foundation funded the first Coordination Theory and Collaboration Technology initiative to look at systems that support collaborations in business and elsewhere. This book explores the global revolution in human interconnectedness. It will discuss the various collaborative workgroups and their use in technology. The initiative focuses on processes of coordination and cooperation among autonomous units in human systems, in computer and communication systems, and in hybrid organizations of both systems. This initiative is motivated by three scientific issues which have been

Associations between nursing home performance and hospital 30-day readmissions for acute myocardial infarction, heart failure and pneumonia at the healthcare community level in the United States.

Science.gov (United States)

Pandolfi, Michelle M; Wang, Yun; Spenard, Ann; Johnson, Florence; Bonner, Alice; Ho, Shih-Yieh; Elwell, Timothy; Bakullari, Anila; Galusha, Deron; Leifheit-Limson, Erica; Lichtman, Judith H; Krumholz, Harlan M

2017-12-01

To evaluate community-specific nursing home performance with community-specific hospital 30-day readmissions for Medicare patients discharged with acute myocardial infarction, heart failure or pneumonia. Cross-sectional study using 2009-2012 hospital risk-standardised 30-day readmission data for Medicare fee-for-service patients hospitalised for all three conditions and nursing home performance data from the Centers for Medicare & Medicaid Services Five-Star Quality Rating System. Medicare-certified nursing homes and acute care hospitals. 12,542 nursing homes and 3,039 hospitals treating 30 or more Medicare fee-for-service patients for all three conditions across 2,032 hospital service areas in the United States. Community-specific hospital 30-day risk-standardised readmission rates. Community-specific nursing home performance measures: health inspection, staffing, Registered Nurses and quality performance; and an aggregated performance score. Mixed-effects models evaluated associations between nursing home performance and hospital 30-day risk-standardised readmission rates for all three conditions. The relationship between community-specific hospital risk-standardised readmission rates and community-specific overall nursing home performance was statistically significant for all three conditions. Increasing nursing home performance by one star resulted in decreases of 0.29% point (95% CI: 0.12-0.47), 0.78% point (95% CI: 0.60-0.95) and 0.46% point (95% CI: 0.33-0.59) of risk-standardised readmission rates for AMI, HF and pneumonia, respectively. Among the specific measures, higher performance in nursing home overall staffing and Registered Nurse staffing measures was statistically significantly associated with lower hospital readmission rates for all three conditions. Notable geographic variation in the community-specific nursing home performance was observed. Community-specific nursing home performance is associated with community-specific hospital 30-day

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

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Flávia Antunes

2013-07-01

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

Microbiological contamination of mobile phones of clinicians in intensive care units and neonatal care units in public hospitals in Kuwait.

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Heyba, Mohammed; Ismaiel, Mohammad; Alotaibi, Abdulrahman; Mahmoud, Mohamed; Baqer, Hussain; Safar, Ali; Al-Sweih, Noura; Al-Taiar, Abdullah

2015-10-15

The objective of this study was to explore the prevalence of microbiological contamination of mobile phones that belong to clinicians in intensive care units (ICUs), pediatric intensive care units (PICUs), and neonatal care units (NCUs) in all public secondary care hospitals in Kuwait. The study also aimed to describe mobile phones disinfection practices as well as factors associated with mobile phone contamination. This is a cross-sectional study that included all clinicians with mobile phones in ICUs, PICUs, and NCUs in all secondary care hospitals in Kuwait. Samples for culture were collected from mobile phones and transported for microbiological identification using standard laboratory methods. Self-administered questionnaire was used to gather data on mobile phones disinfection practices. Out of 213 mobile phones, 157 (73.7 %, 95 % CI [67.2-79.5 %]) were colonized. Coagulase-negative staphylococci followed by Micrococcus were predominantly isolated from the mobile phones; 62.9 % and 28.6 % of all mobile phones, respectively. Methicillin-resistant Staphylococcus aureus (MRSA) and Gram-negative bacteria were identified in 1.4 % and 7.0 % of the mobile phones, respectively. Sixty-eight clinicians (33.5 %) reported that they disinfected their mobile phones, with the majority disinfecting their mobile phones only when they get dirty. The only factor that was significantly associated with mobile phone contamination was whether a clinician has ever disinfected his/her mobile phone; adjusted odds ratio 2.42 (95 % CI [1.08-5.41], p-value = 0.031). The prevalence of mobile phone contamination is high in ICUs, PICUs, and NCUs in public secondary care hospitals in Kuwait. Although some of the isolated organisms can be considered non-pathogenic, various reports described their potential harm particularly among patients in ICU and NCU settings. Isolation of MRSA and Gram-negative bacteria from mobile phones of clinicians treating patients in high-risk healthcare

Impact of Relational Coordination on Nurse Job Satisfaction, Work Engagement and Burnout: Achieving the Quadruple Aim.

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Havens, Donna Sullivan; Gittell, Jody Hoffer; Vasey, Joseph

2018-03-01

To explore how relational coordination, known to enhance quality and efficiency outcomes for patients and hospitals, impacts direct care nurse outcomes such as burnout, work engagement, and job satisfaction, addressing the "Quadruple Aim," to improve the experience of providing care. Hospitals are complex organizations in which multiple providers work interdependently, under conditions of uncertainty and time constraints, to deliver safe quality care despite differences in specialization, training, and status. Relational coordination-communicating and relating for the purpose of task integration-is known to improve quality, safety, and efficiency under these conditions, but less is known about its impact on the well-being of direct care providers themselves. Surveys measuring relational coordination among nurses and other types of providers as well as job-related outcomes in 5 acute care community hospitals were completed by direct care RNs. Relational coordination was significantly related to increased job satisfaction, increased work engagement, and reduced burnout. Relational coordination contributes to the well-being of direct care nurses, addressing the Quadruple Aim by improving the experience of providing care.

Hospital Related Stress Among Patients Admitted to a Psychiatric In-patient Unit in India

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Latha KS

2011-04-01

Full Text Available The psychiatric patient’s attitudes towards hospitalization have found an association between patient perceptions of the ward atmosphere and dissatisfaction. The aim of the study was to determine the aspects of stress related to hospitalization in inpatients admitted to a psychiatric facility. Fifty in-patients of both sexes admitted consecutively to a psychiatric unit in a General Hospital were asked to rate the importance of, and their satisfaction with, 38 different aspects of in-patient care and treatment. Results showed that the major sources of stress were related to having a violent patient near to his/her bed; being away from family; having to stay in closed wards; having to eat cold and tasteless food; losing income or job due to illness, being hospitalized away from home; not able to understand the jargons used by the clinical staff and not getting medication for sleep. A well-differentiated assessment of stress and satisfaction has implications for the evaluation of the quality of psychiatric care and for the improvement of in-patient psychiatric care.

The epidemic profiles of intensive care units in Hospital oncologico SOLCA, Quito

International Nuclear Information System (INIS)

Caballero, Henry; Marin, Karina; Gonzalez, Alba; Vega, Mireya; Castelo, Marcelo; Trujillo Cruz, Freddy

2006-01-01

The epidemic profiles of intensive care units are very few and they have not been published recently, punctual epidemic studies of morbidity, mortality and quality controls of intensive care exist, but we could not find the profiles of the oncological units. Since the establishment of the intensive care unit of Oncological Hospital Solca in Quito city. It was not possible to find any epidemiological profile of this unit because it is important to know their morbidity rates, mortality, the main complications and to relate these with the study of the index prognostic, to plan the annual operative programs and the innovations according to the specific necessities, justified by realities studied, to observe the organic shortcoming that in critical patients are present, for a planning adapted in the outlines with the rational use of medication, since the critical users have specific characteristics especially in the infectious processes, due to their immunosuppression condition and for the chemotherapy administration and the radiotherapy, oncological patient for their condition they are poly medicates and it requires the use of interventionist processes, that triggers major risks of complications and infection with opportunist germs. (The author)

Adherence to guidelines in bleeding oesophageal varices and effects on outcome: comparison between a specialized unit and a community hospital

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Hobolth, Lise; Krag, Aleksander; Malchow-Møller, Axel

2010-01-01

OBJECTIVES: Randomized controlled trials have shown beneficial effects of vasoactive drugs, endoscopic treatment and prophylactic antibiotics on the outcome of bleeding oesophageal varices (BOV). However, translating guidelines based on randomized controlled trials into clinical practice is diffi......OBJECTIVES: Randomized controlled trials have shown beneficial effects of vasoactive drugs, endoscopic treatment and prophylactic antibiotics on the outcome of bleeding oesophageal varices (BOV). However, translating guidelines based on randomized controlled trials into clinical practice...... is difficult. Our aims were to compare adherence to evidence-based guidelines in BOV between a specialized unit and a community hospital, and to investigate whether differences in adherence affected the outcome. METHODS: Two cohorts hospitalized during 2000-2007 with a first episode of BOV were retrospectively...... enrolled, one in a community hospital comprising 66 patients and one in a specialized unit comprising 111 patients. Data on treatment, rebleeding and mortality were collected from medical records according to the Baveno III/IV Criteria. RESULTS: Treatments in the specialized unit versus the community...

Sporotrichosis-Associated Hospitalizations, United States, 2000-2013.

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Gold, Jeremy A W; Derado, Gordana; Mody, Rajal K; Benedict, Kaitlin

2016-10-01

To determine frequency and risk for sporotrichosis-associated hospitalizations, we analyzed the US 2000-2013 National (Nationwide) Inpatient Sample. An estimated 1,471 hospitalizations occurred (average annual rate 0.35/1 million persons). Hospitalizations were associated with HIV/AIDS, immune-mediated inflammatory diseases, and chronic obstructive pulmonary disease. Although rare, severe sporotrichosis should be considered for at-risk patients.

Sporotrichosis-Associated Hospitalizations, United States, 2000?2013

OpenAIRE

Gold, Jeremy A.W.; Derado, Gordana; Mody, Rajal K.; Benedict, Kaitlin

2016-01-01

To determine frequency and risk for sporotrichosis-associated hospitalizations, we analyzed the US 2000?2013 National (Nationwide) Inpatient Sample. An estimated 1,471 hospitalizations occurred (average annual rate 0.35/1 million persons). Hospitalizations were associated with HIV/AIDS, immune-mediated inflammatory diseases, and chronic obstructive pulmonary disease. Although rare, severe sporotrichosis should be considered for at-risk patients.

The visual arts in Northern Ireland hospitals.

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Cromie, H

1995-10-01

Since 1989 there has been a burgeoning of the visual arts in Northern Ireland hospitals. This paper compares the three organisational models for hospital arts currently operating within the Province and in an overview discusses ways to coordinate working practice for future development of the visual arts in local hospitals.

Trends in hospitalizations of pregnant HIV-infected women in the United States: 2004 through 2011.

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Ewing, Alexander C; Datwani, Hema M; Flowers, Lisa M; Ellington, Sascha R; Jamieson, Denise J; Kourtis, Athena P

2016-10-01

With the development and widespread use of combination antiretroviral therapy, HIV-infected women live longer, healthier lives. Previous research has shown that, since the adoption of combination antiretroviral therapy in the United States, rates of morbidity and adverse obstetric outcomes remained higher for HIV-infected pregnant women compared with HIV-uninfected pregnant women. Monitoring trends in the outcomes these women experience is essential, as recommendations for this special population continue to evolve with the progress of HIV treatment and prevention options. We conducted an analysis comparing rates of hospitalizations and associated outcomes among HIV-infected and HIV-uninfected pregnant women in the United States from 2004 through 2011. We used cross-sectional hospital discharge data for girls and women age 15-49 from the 2004, 2007, and 2011 Nationwide Inpatient Sample, a nationally representative sample of US hospital discharges. Demographic characteristics, morbidity outcomes, and time trends were compared using χ(2) tests and multivariate logistic regression. Analyses were weighted to produce national estimates. In 2011, there were 4751 estimated pregnancy hospitalizations and 3855 delivery hospitalizations for HIV-infected pregnant women; neither increased since 2004. Compared with those of HIV-uninfected women, pregnancy hospitalizations of HIV-infected women were more likely to be longer, be in the South and Northeast, be covered by public insurance, and incur higher charges (all P pregnant women with HIV infection had higher rates for many adverse outcomes. Compared to 2004, hospitalizations of HIV-infected pregnant women in 2011 had higher odds of gestational diabetes (adjusted odds ratio, 1.81; 95% confidence interval, 1.16-2.84), preeclampsia/hypertensive disorders of pregnancy (adjusted odds ratio, 1.58; 95% confidence interval, 1.12-2.24), viral/mycotic/parasitic infections (adjusted odds ratio, 1.90; 95% confidence interval, 1

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

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

2015-01-01

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

Dysphagia referrals to a district general hospital gastroenterology unit: hard to swallow.

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Melleney, Elizabeth Mary-Ann; Subhani, Javaid Mohammed; Willoughby, Charles Peter

2004-01-01

The aim of our study was to audit dysphagia referrals received by a specialist gastroenterology unit during an entire year. We used a prospective audit carried out over a 12-month period at the District General Hospital gastroenterology unit. The audit included 396 consecutive patients who were referred with swallowing difficulties. We found that 60 referrals (15.2%) were inaccurate and the patients had no swallowing problem. Of the 336 patients with genuine dysphagia, only 29 (8.6%) were new cancer cases. The large majority of subjects had benign disease mostly related to acid reflux. Weight loss was significantly associated with malignancy but also occurred in one third of patients with reflux alone. The temporal pattern of dysphagia was not significantly predictive of cancer. All the cancer patients were above the age of 50 years. Although patients were in general assessed rapidly after hospital referral, the productivity, in terms of early tumor diagnosis, was extremely low. We conclude that there is a substantial rate of inaccurate referrals of dysphagia patients. Most true cases of swallowing difficulty relate to benign disease. Even the devotion of considerable resources to the early diagnosis of esophago gastric malignancy in an attempt to conform with best practice guidelines results in a very low success rate in terms of the detection of potentially curable tumors.

Variation in critical care unit admission rates and outcomes for patients with acute coronary syndromes or heart failure among high- and low-volume cardiac hospitals.

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van Diepen, Sean; Bakal, Jeffrey A; Lin, Meng; Kaul, Padma; McAlister, Finlay A; Ezekowitz, Justin A

2015-02-27

Little is known about cross-hospital differences in critical care units admission rates and related resource utilization and outcomes among patients hospitalized with acute coronary syndromes (ACS) or heart failure (HF). Using a population-based sample of 16,078 patients admitted to a critical care unit with a primary diagnosis of ACS (n=14,610) or HF (n=1467) between April 1, 2003 and March 31, 2013 in Alberta, Canada, we stratified hospitals into high (>250), medium (200 to 250), or low (<200) volume based on their annual volume of all ACS and HF hospitalization. The percentage of hospitalized patients admitted to critical care units varied across low, medium, and high-volume hospitals for both ACS and HF as follows: 77.9%, 81.3%, and 76.3% (P<0.001), and 18.0%, 16.3%, and 13.0% (P<0.001), respectively. Compared to low-volume units, critical care patients with ACS and HF admitted to high-volume hospitals had shorter mean critical care stays (56.6 versus 95.6 hours, P<0.001), more critical care procedures (1.9 versus 1.2 per patient, <0.001), and higher resource-intensive weighting (2.8 versus 1.5, P<0.001). No differences in in-hospital mortality (5.5% versus 6.2%, adjusted odds ratio 0.93; 95% CI, 0.61 to 1.41) were observed between high- and low-volume hospitals; however, 30-day cardiovascular readmissions (4.6% versus 6.8%, odds ratio 0.77; 95% CI, 0.60 to 0.99) and cardiovascular emergency-room visits (6.6% versus 9.5%, odds ratio 0.80; 95% CI, 0.69 to 0.94) were lower in high-volume compared to low-volume hospitals. Outcomes stratified by ACS or HF admission diagnosis were similar. Cardiac patients hospitalized in low-volume hospitals were more frequently admitted to critical care units and had longer hospitals stays despite lower resource-intensive weighting. These findings may provide opportunities to standardize critical care utilization for ACS and HF patients across high- and low-volume hospitals. © 2015 The Authors. Published on behalf of the American

Profile of nursing diagnoses of hospitalized patients in an infectious disease unit

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Vinicius Lino de Souza Neto

Full Text Available Objective: To define the profile of nursing diagnoses of hospitalized patients at an infectious diseases unit.Methods: This is a descriptive study based on the quantitative approach conducted at an infectious diseases unit in Paraiba, Brazil, from January to February 2014. The data collection instrument was based on the Theory of Basic Human Needs by Wanda de Aguiar Horta, followed by the classification system CIPE(r version 2.0 to construct the diagnoses.Results: Data analysis resulted in 36 nursing diagnoses statements, with a higher prevalence of impaired food intake, cachexia, impaired spontaneous bladder elimination, impaired oral cavity hygiene, exposure to contamination, rapid heart rate, insomnia, drug abuse, alcohol and tobacco abuse, social isolation, acceptance and fear.Conclusions: The identification of a diagnostics profile is critical to guide nursing interventions.

Beyond the clinic: redefining hospital ambulatory care.

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Rogut, L

1997-07-01

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

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

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

2016-04-01

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

Achievements and barriers in the organ donation process: a critical analysis of donation coordinators' discourse.

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Mercado-Martínez, Francisco J; Díaz-Medina, Blanca A; Hernández-Ibarra, Eduardo

2013-09-01

Donation coordinators play an important role in the success or failure of organ donation and transplant programs. Nevertheless, these professionals' perspectives and practices have hardly been explored, particularly in low- and middle-income countries. To examine donation coordinators' discourse on the organ donation process and the barriers they perceive. A critical qualitative study was carried out in Guadalajara, Mexico. Twelve donation coordinators from public and private hospitals participated. DATA GATHERING AND ANALYSIS: Data were gathered by using semistructured interviews and critical discourse analysis. Participants indicated that partial results have been achieved in deceased organ donation. Concomitantly, multiple obstacles have adversely affected the process and outcomes: at the structural level, the fragmentation of the health system and the scarcity of financial and material resources; at the relational level, nonegalitarian relationships between coordinators and hospital personnel; at the ideational level, the transplant domain and its specialists overshadow the donation domain and its coordinators. Negative images are associated with donation coordinators. Organ donation faces structural, relational, and ideational barriers; hence, complex interventions should be undertaken. Donation coordinators also should be recognized by the health system.

Incidence of congenital heart disease among neonates in a neonatal unit of a tertiary care hospital

International Nuclear Information System (INIS)

Hussain, S.; Sabir, M.U.

2014-01-01

Objectives: To determine the incidence and pattern of various congenital heart disease in a neonatal unit of a tertiary care hospital. Methods: The prospective study was carried out in the neonatal unit of Combined Military Hospital, Rawalpindi, from September 2008 to August 2011. All 5800 neonates admitted with gestational age of >28 weeks irrespective of birthweight were included in the study. Neonatologist/Paediatrician carried out the neonatal examination during the first 12 hours of life. Neonates suspected of having congenital heart disease were further evaluated by pulse oxymetry, X-ray chest and echocardiography to ascertain final diagnosis and type of lesion. Data was collected on a predesigned proforma containing information regarding gender, mode of delivery, gestational age, weight at birth, family history, and associated malformations. SPSS 16 was used for statistical analysis. Results: Of the 5800 neonates, 87 (1.5%) were found to have congenital heart disease with an incidence of 15/1000. There was a male preponderance. Most common lesion was ventricular septal defect 27(31.3%), followed by atrial septal defect 20 (22.9%), patent ductus arteriosus 13 (14.94%), tetralogy of fallot 06 (6.89%), transposition of great arteries 04 (4.59%), Pulmonary stenosis 05 (5.79%) and 03(3.44%) had atrioventricular canal defects. Conclusion: Congenital heart disease is a common congenital anomaly. Its incidence varies from centre to centre due to different factors like nature of the sample, method of detection and early examination by a neonatologist/paediatrician. In this study a higher incidence is reported because it was carried out in a tertiary care unit, which is a referral hospital and all the neonates admitted in the unit were included in the study. (author)

Polysulfide coordination clusters of the lanthanides

Energy Technology Data Exchange (ETDEWEB)

Ma, Ying-Zhao; Bestgen, Sebastian; Gamer, Michael T.; Roesky, Peter W. [Institute of Inorganic Chemistry, Karlsruhe Institute of Technology, Karlsruhe (Germany); Konchenko, Sergey N. [Institute of Inorganic Chemistry, Karlsruhe Institute of Technology, Karlsruhe (Germany); Nikolaev Institute of Inorganic Chemistry, SB RAS, Novosibirsk (Russian Federation); Novosibirsk State University (Russian Federation)

2017-10-16

The reaction of [(DippForm){sub 2}Ln(thf){sub 2}] with an excess of elemental sulfur in toluene resulted in the formation of the trinuclear polysulfide coordination clusters [(DippForm){sub 3}Ln{sub 3}S{sub 12}] (Ln=Sm, Yb; DippForm=N,N'-bis(2,6-diisopropylphenyl)formamidinate). These are the first f element coordination clusters (Ln{sub n}S{sub x}) with a larger polysulfide unit (n and x>2). The formation of the coordination clusters can be rationalized by the reductive cleavage of S{sub 8} with divalent lanthanides. (copyright 2017 Wiley-VCH Verlag GmbH and Co. KGaA, Weinheim)

Hospital all-risk emergency preparedness in Ghana | Norman ...

African Journals Online (AJOL)

(2) The hospitals' respective abilities to handle large scale RTA's were ... The biggest challenge facing the hospitals in their emergency intervention is the lack of preemergency and emergency preparedness plans as well as the coordination of the hospitals response mechanisms. Conclusion: The paper ended with ...

Strategic management process in hospitals.

Science.gov (United States)

Zovko, V

2001-01-01

Strategic management is concerned with strategic choices and strategic implementation; it provides the means by which organizations meet their objectives. In the case of hospitals it helps executives and all employees to understand the real purpose and long term goals of the hospital. Also, it helps the hospital find its place in the health care service provision chain, and enables the hospital to coordinate its activities with other organizations in the health care system. Strategic management is a tool, rather than a solution, that helps executives to identify root causes of major problems in the hospital.

Early hospital mortality prediction of intensive care unit patients using an ensemble learning approach.

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Awad, Aya; Bader-El-Den, Mohamed; McNicholas, James; Briggs, Jim

2017-12-01

Mortality prediction of hospitalized patients is an important problem. Over the past few decades, several severity scoring systems and machine learning mortality prediction models have been developed for predicting hospital mortality. By contrast, early mortality prediction for intensive care unit patients remains an open challenge. Most research has focused on severity of illness scoring systems or data mining (DM) models designed for risk estimation at least 24 or 48h after ICU admission. This study highlights the main data challenges in early mortality prediction in ICU patients and introduces a new machine learning based framework for Early Mortality Prediction for Intensive Care Unit patients (EMPICU). The proposed method is evaluated on the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database. Mortality prediction models are developed for patients at the age of 16 or above in Medical ICU (MICU), Surgical ICU (SICU) or Cardiac Surgery Recovery Unit (CSRU). We employ the ensemble learning Random Forest (RF), the predictive Decision Trees (DT), the probabilistic Naive Bayes (NB) and the rule-based Projective Adaptive Resonance Theory (PART) models. The primary outcome was hospital mortality. The explanatory variables included demographic, physiological, vital signs and laboratory test variables. Performance measures were calculated using cross-validated area under the receiver operating characteristic curve (AUROC) to minimize bias. 11,722 patients with single ICU stays are considered. Only patients at the age of 16 years old and above in Medical ICU (MICU), Surgical ICU (SICU) or Cardiac Surgery Recovery Unit (CSRU) are considered in this study. The proposed EMPICU framework outperformed standard scoring systems (SOFA, SAPS-I, APACHE-II, NEWS and qSOFA) in terms of AUROC and time (i.e. at 6h compared to 48h or more after admission). The results show that although there are many values missing in the first few hour of ICU admission

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

Science.gov (United States)

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

2012-03-01

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

Anatomical localization of electrophysiological recording sites by co-ordinate transformation.

Science.gov (United States)

Sinex, D G

1997-07-18

A method for estimating the anatomical locations of the units recorded in electrophysiological mapping experiments is described. A total of three locations must be marked by dye injections or electrolytic lesions and identified in tissue sections. From those locations, equations are derived to translate, scale, and rotate the three-dimensional co-ordinates of the recording sites, so that they are correct for a second, three-dimensional co-ordinate system based on the anatomy of the mapped structure. There is no limit to the number of recording sites that can be localized. This differs from methods that require a dye injection or lesion to be made at the exact location at which a particular unit was recorded. The accuracy of the transformed co-ordinates is limited by the accuracy with which the co-ordinates can be measured: in test measurements and in the experiments for which this algorithm was developed, the computed co-ordinates were typically accurate to within 100 microns or less.

Attributes of advanced practice registered nurse care coordination for children with medical complexity.

Science.gov (United States)

Cady, Rhonda G; Kelly, Anne M; Finkelstein, Stanley M; Looman, Wendy S; Garwick, Ann W

2014-01-01

Care coordination is an essential component of the pediatric health care home. This study investigated the attributes of relationship-based advanced practice registered nurse care coordination for children with medical complexity enrolled in a tertiary hospital-based health care home. Retrospective review of 2,628 care coordination episodes conducted by telehealth over a consecutive 3-year time period for 27 children indicated that parents initiated the majority of episodes and the most frequent reason was acute and chronic condition management. During this period, care coordination episodes tripled, with a significant increase (p < .001) between years 1 and 2. The increased episodes could explain previously reported reductions in hospitalizations for this group of children. Descriptive analysis of a program-specific survey showed that parents valued having a single place to call and assistance in managing their child's complex needs. The advanced practice registered nurse care coordination model has potential for changing the health management processes for children with medical complexity. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Drug utilization study in a burn care unit of a tertiary care hospital

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Santoshkumar R Jeevangi

2011-03-01

Full Text Available Objective: To evaluate drug utilization and associated costs for the treatment of patients admitted in burn care unit of a tertiary care hospital. Methods: A prospective cross sectional study was conducted for a period of 15 months at Basaweshwara Teaching and General Hospital (BTGH, Gulbarga and the data collected was analyzed for various drug use indicators. Results: A total of 100 prescriptions were collected with 44% belonging to males and 56% to females. The average number of drugs per prescription ranged from 4.5 to 9.5. 9.5% of generics and 92% of essential drugs were prescribed. The opioid analgesics and sedatives were prescribed to all the patients who were admitted in burn care unit. The (Defined daily dose DDD/1 000/day for amikacin (359 was the highest followed by diclofenac sodium (156, pantoprazole (144, diazepam (130, ceftazidime (124, tramadol (115, ceftriaxone (84 and for paracetamol (4 which was the lowest. Conclusions: Significant amount of the money was spent on procurement of drugs. Most of the money was spent on prescribed antibiotics. The prescription of generic drugs should be promoted, for cost effective treatment. Hence the results of the present study indicate that there is a considerable scope for improvement in the prescription pattern.

Use of transcutaneous electrical nerve stimulation in the Unit of Pain Management of the Alcorcón Foundation University Hospital

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Andrea Isabel Martínez Tapia

2014-08-01

Full Text Available Transcutaneous electrical nerve stimulation (TENS is a non-pharmacological therapy (TNF used to alleviate pain and is among the current available treatments offered by the Units of Pain Management (Unidades del Dolor in Spanish Hospitals. The goal of this study was to identify the characteristics of portable electro-stimulator use, and its costs in the Unit of Pain Management of the Alcorcón Foundation University Hospital (Hospital Universitario Fundación Alcorcón. A retrospective descriptive study was carried out between January, 1999, and October, 2010, in the Unit of Pain Management of the Alcorcón Foundation University Hospital. The information on TENS delivery forms and its supplies was collected, and the characteristics of use and the associated costs were calculated. It was observed that the longest period of time used was less than a year. The cost of delivery for the portable equipment was 148 050 euros and the average annual cost for the use of TENS by a patient was 854 euros. From the information gathered, it can be concluded that the use of electro-analgesia is a valid option in terms of expenses for long periods of use, thereby allowing a reduction in costs and decreasing the use of other healthcare treatments.

Understanding the occupational and organizational boundaries to safe hospital discharge.

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Waring, Justin; Marshall, Fiona; Bishop, Simon

2015-01-01

Safe hospital discharge relies upon communication and coordination across multiple occupational and organizational boundaries. Our aim was to understand how these boundaries can exacerbate health system complexity and represent latent sociocultural threats to safe discharge. An ethnographic study was conducted in two local health and social care systems (health economies) in England, focusing on two clinical areas: stroke and hip fracture patients. Data collection involved 345 hours of observations and 220 semi-structured interviews with health and social care professionals, patients and their lay carers. Hospital discharge involves a dynamic network of interactions between heterogeneous health and social care actors, each characterized by divergent ways of organizing discharge activities; cultures of collaboration and interaction and understanding of what discharge involves and how it contributes to patient recovery. These interrelated dimensions elaborate the occupational and organisational boundaries that can influence communication and coordination in hospital discharge. Hospital discharge relies upon the coordination of multiple actors working across occupational and organizational boundaries. Attention to the sociocultural boundaries that influence communication and coordination can help inform interventions that might support enhanced discharge safety. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

The Study of Life Change Unit as Stressor Agents among Tehran University of Medical Sciences Hospitals' Employees

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Hossein Dargahi

2010-07-01

Full Text Available "nLife crises as stressor agents can disrupt the best stress management regime. Different life crises have different impacts. A standard scale to rate change and its related stress impact has been developed commonly referred to as LCU (Life Change Unit Rating. This allocates a number of Life Crisis Units or Life Change Units (LCUs to different event and then evaluates them and takes action accordingly. This idea behind this approach of is to rundown the LCU table, totaling the LCUs for life crisis that have occurred in the previous one year. A Cross - sectional, descriptive and analytical study was conducted among 900 Tehran University of Medical Sciences (TUMS Employees by a Holms and Rahe LCU questionnaire at 15 hospitals. The respondents were asked to determine their demographic information, list of stress symptoms which suffered from these diseases in the previous one year and finally, responded to 45 Life Change Unit as stressful life events and the value of each in "stress units" which occurred in the previous one year. The results showed that there is significant correlation between the employees LCU rating by sex, educational degree and size of hospital. Also we found that there are significant correlations between the employees stress symptoms with their LCU rating. Totally, 40% of the employees have less than 150 LCU rating (normal range and 60% of them have 150-300 or more than 300 LCU rating (abnormal range. In conclusion most of TUMS hospitals' employees who had stress symptoms have more LCU rating. One third of these employees are not in danger of suffering the illness effect, while two third of them are in danger.

Hospitals, finance, and health system reform in Britain and the United States, c. 1910-1950: historical revisionism and cross-national comparison.

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Gorsky, Martin

2012-06-01

Comparative histories of health system development have been variously influenced by the theoretical approaches of historical institutionalism, political pluralism, and labor mobilization. Britain and the United States have figured significantly in this literature because of their very different trajectories. This article explores the implications of recent research on hospital history in the two countries for existing historiographies, particularly the coming of the National Health Service in Britain. It argues that the two hospital systems initially developed in broadly similar ways, despite the very different outcomes in the 1940s. Thus, applying the conceptual tools used to explain the U.S. trajectory can deepen appreciation of events in Britain. Attention focuses particularly on working-class hospital contributory schemes and their implications for finance, governance, and participation; these are then compared with Blue Cross and U.S. hospital prepayment. While acknowledging the importance of path dependence in shaping attitudes of British bureaucrats toward these schemes, analysis emphasizes their failure in pressure group politics, in contrast to the United States. In both countries labor was also crucial, in the United States sustaining employment-based prepayment and in Britain broadly supporting system reform.

The visual arts in Northern Ireland hospitals.

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Cromie, H.

1995-01-01

Since 1989 there has been a burgeoning of the visual arts in Northern Ireland hospitals. This paper compares the three organisational models for hospital arts currently operating within the Province and in an overview discusses ways to coordinate working practice for future development of the visual arts in local hospitals. Images Fig 1 Fig 2 Fig 3 PMID:8533183

Assessment of teamwork during structured interdisciplinary rounds on medical units.

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O'Leary, Kevin J; Boudreau, Yvonne N; Creden, Amanda J; Slade, Maureen E; Williams, Mark V

2012-01-01

Interdisciplinary rounds (IDR) provide a means to assemble hospital team members and improve collaboration. Little is known about teamwork during IDR. To evaluate and characterize teamwork during IDR. Cross-sectional observational study. Six medical units which had implemented structured interdisciplinary rounds (SIDR). We adapted the Observational Teamwork Assessment for Surgery (OTAS) tool, a behaviorally anchored rating scale shown to be reliable and valid in surgical settings. OTAS provides scores ranging from 0 to 6 (0 = problematic behavior; 6 = exemplary behavior) across 5 domains (communication, coordination, cooperation/backup behavior, leadership, and monitoring/situational awareness) and for prespecified subteams. Two researchers conducted direct observations using the adapted OTAS tool. We conducted 7-8 independent observations for each unit (total = 44) and 20 joint observations. Inter-rater reliability was excellent at the unit level (Spearman's rho = 0.75), and good across domains (rho = 0.53-0.68) and subteams (rho = 0.53-0.76) with the exception of the physician subteam, for which it was poor (rho = 0.35). Though teamwork scores were generally high, we found differences across units, with a median (interquartile range [IQR]) 4.5 (3.9-4.9) for the lowest and 5.4 (5.3-5.5) for the highest performing unit (P teamwork during SIDR across units, domains, and most subteams. Variation in performance suggests a need to improve consistency of teamwork and emphasizes the importance of leadership. Copyright © 2012 Society of Hospital Medicine.

N-donor co-ligands driven two new Co(II)- coordination polymers with bi- and trinuclear units: Crystal structures, and magnetic properties

Energy Technology Data Exchange (ETDEWEB)

Zhou, Zhi-Hang [College of Materials and Chemical Engineering, Hubei Provincial Collaborative Innovation Center for New Energy Microgrid, Key Laboratory of Inorganic Non-metallic Crystalline and Energy Conversion Materials, China Three Gorges University, Yichang 443002 (China); Han, Min-Le [College of Chemistry and Chemical Engineering, Henan Key Laboratory of Function-Oriented Porous Materials, Luoyang Normal University, Luoyang 471022 (China); Wu, Ya-Pan; Dong, Wen-Wen [College of Materials and Chemical Engineering, Hubei Provincial Collaborative Innovation Center for New Energy Microgrid, Key Laboratory of Inorganic Non-metallic Crystalline and Energy Conversion Materials, China Three Gorges University, Yichang 443002 (China); Li, Dong-Sheng, E-mail: lidongsheng1@126.com [College of Materials and Chemical Engineering, Hubei Provincial Collaborative Innovation Center for New Energy Microgrid, Key Laboratory of Inorganic Non-metallic Crystalline and Energy Conversion Materials, China Three Gorges University, Yichang 443002 (China); Lu, Jack Y., E-mail: lu@uhcl.edu [Department of Chemistry, University of Houstons-Clear Lake, Houston, TX 77058 (United States)

2016-10-15

Two new Co(II) coordination polymers(CPs), namely [Co{sub 2}(bpe){sub 2}(Hbppc)]{sub n} (1) and [Co{sub 3}(μ{sub 3}-OH)(bppc)(bpm)(H{sub 2}O)]·3H{sub 2}O (2) (H{sub 5}bppc=biphenyl-2,4,6,3′,5′-pentacarboxylic acid, bpe=1,2-bis(4-pyridyl)ethene, bpm=bis(4-pyridyl)amine), have been obtained and characterized by elemental analysis, single-crystal X-ray diffraction, powder X-ray diffraction (PXRD), IR spectra and thermogravimetric analysis (TGA). 1 shows a binodal (4,6)-connected fsc net with a (4{sup 4}·6{sup 10}·8)(4{sup 4}·6{sup 2}) topology, while 2 shows a binodal (5,7)-connected 3D network based on trinuclear [Co{sub 3}(μ{sub 3}-OH)]{sup 5+} units with unusual (3.4{sup 6}.5{sup 2}.6)(3{sup 2}.4{sup 6}.5{sup 7}.6{sup 5}.7) topology. Variable-temperature magnetic susceptibility measurements reveals that complex 1 shows ferromagnetic interactions between the adjacent Co(II) ions, whereas 2 is a antiferromagnetic system. - Graphical abstract: Two new Co(II) coordination polymers with bi- and trinuclear units have been obtained. 1 shows a binodal (4,6)-connected fsc net with a (4{sup 4}·6{sup 10}·8)(4{sup 4}·6{sup 2}) topology and antiferromagnetic interactions between the adjacent Co(II) ions, while 2 is a binodal (5,7)-connected 3D network with unusual (3.4{sup 6}.5{sup 2}.6)(3{sup 2}.4{sup 6}.5{sup 7}.6{sup 5}.7) topology and a ferromagnetic system. - Highlights: • Two Co(II) coordination polymers with different multimetallic clusters as building units. • A (4,6)-connected fsc net and a (5,7)-connected 3D network. • A antiferromagnetic coupling for 1 and A ferromagnetic coupling for 2.

Association of bystander interventions and hospital length of stay and admission to intensive care unit in out-of-hospital cardiac arrest survivors.

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Riddersholm, Signe; Kragholm, Kristian; Mortensen, Rikke Nørmark; Pape, Marianne; Hansen, Carolina Malta; Lippert, Freddy K; Torp-Pedersen, Christian; Christiansen, Christian F; Rasmussen, Bodil Steen

2017-10-01

The impact of bystander interventions on post-arrest hospital course is sparsely studied. We examined the association between bystander interventions and length of hospital stay and admission to intensive care unit (ICU) in one-day survivors after OHCA. This cohort study linked data of 4641 one-day OHCA survivors from 2001 to 2014 to data on hospital length of stay and ICU admission. We examined associations between bystander efforts and outcomes using regression, adjusted for age, sex, comorbidities, calendar year and witnessed status. We divided bystander efforts into three categories: 1. No bystander interventions; 2.Bystander CPR only; 3. Bystander defibrillation with or without bystander CPR. For patients surviving to hospital discharge, hospital length of stay was 20days for patients without bystander interventions, compared to 16 for bystander CPR, and 13 for bystander defibrillation. 82% of patients without bystander interventions were admitted to ICU compared to 77.2% for bystander CPR, and 61.2% for bystander defibrillation. In-hospital mortality was 60% in the first category compared to 40.5% and 21.7% in the two latter categories. In regression models, bystander CPR and bystander defibrillation were associated with a reduction of length of hospital stay of 21% (Estimate: 0.79 [95% CI: 0.72-0.86]) and 32% (Estimate: 0.68 [95% CI: 0.59-0.78]), respectively. Both bystander CPR (OR: 0.94 [95% CI: 0.91-0.97]) and bystander defibrillation (OR: 0.81 [0.76-0.85]), were associated with lower risk of ICU admission. Bystander interventions were associated with reduced hospital length of stay and ICU admission, suggesting that these efforts improve recovery in OHCA survivors. Copyright © 2017 Elsevier B.V. All rights reserved.

Trends and Characteristics of United States Out-of-Hospital Births 2004-2014: New Information on Risk Status and Access to Care.

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MacDorman, Marian F; Declercq, Eugene

2016-06-01

Out-of-hospital births are increasing in the United States. Our purpose was to examine trends in out-of-hospital births from 2004 to 2014, and to analyze newly available data on risk status and access to care. Newly available data from the revised birth certificate for 47 states and Washington, DC, were used to examine out-of-hospital births by characteristics and to compare them with hospital births. Trends from 2004 to 2014 were also examined. Out-of-hospital births increased by 72 percent, from 0.87 percent of United States births in 2004 to 1.50 percent in 2014. Compared with mothers who had hospital births, those with out-of-hospital births had lower prepregnancy obesity (12.5% vs 25.0%) and smoking (2.8% vs 8.5%) rates, and higher college graduation (39.3% vs 30.0%) and breastfeeding initiation (94.3% vs 80.8%) rates. Among planned home births, 67.1 percent were self-paid, compared with 31.9 percent of birth center and 3.4 percent of hospital births. Vaginal births after cesarean (VBACs) comprised 4.6 percent of planned home births and 1.6 percent of hospital and birth center births. Sociodemographic and medical risk status of out-of-hospital births improved substantially from 2004 to 2014. Improvements in risk status of out-of-hospital births from 2004 to 2014 suggest that appropriate selection of low-risk women is improving. High rates of self-pay for the costs of out-of-hospital birth suggest serious gaps in insurance coverage, whereas higher-than-average rates of VBAC could reflect lack of access to hospital VBACs. Mandating private insurance and Medicaid coverage could substantially improve access to out-of-hospital births. Improving access to hospital VBACs might reduce the number of out-of-hospital VBACs. © 2016 Wiley Periodicals, Inc.

Hospital markup and operation outcomes in the United States.

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Gani, Faiz; Ejaz, Aslam; Makary, Martin A; Pawlik, Timothy M

2016-07-01

Although the price hospitals charge for operations has broad financial implications, hospital pricing is not subject to regulation. We sought to characterize national variation in hospital price markup for major cardiothoracic and gastrointestinal operations and to evaluate perioperative outcomes of hospitals relative to hospital price markup. All hospitals in which a patient underwent a cardiothoracic or gastrointestinal procedure were identified using the Nationwide Inpatient Sample for 2012. Markup ratios (ratio of charges to costs) for the total cost of hospitalization were compared across hospitals. Risk-adjusted morbidity, failure-to-rescue, and mortality were calculated using multivariable, hierarchical logistic regression. Among the 3,498 hospitals identified, markup ratios ranged from 0.5-12.2, with a median markup ratio of 2.8 (interquartile range 2.7-3.9). For the 888 hospitals with extreme markup (greatest markup ratio quartile: markup ratio >3.9), the median markup ratio was 4.9 (interquartile range 4.3-6.0), with 10% of these hospitals billing more than 7 times the Medicare-allowable costs (markup ratio ≥7.25). Extreme markup hospitals were more often large (46.3% vs 33.8%, P markup ratio compared with 19.3% (n = 452) and 6.8% (n = 35) of nonprofit and government hospitals, respectively. Perioperative morbidity (32.7% vs 26.4%, P markup hospitals. There is wide variation in hospital markup for cardiothoracic and gastrointestinal procedures, with approximately a quarter of hospital charges being 4 times greater than the actual cost of hospitalization. Hospitals with an extreme markup had greater perioperative morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

Moving Upstream in U.S. Hospital Care Toward Investments in Population Health.

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Begun, James W; Potthoff, Sandra

The root causes for most health outcomes are often collectively referred to as the social determinants of health. Hospitals and health systems now must decide how much to "move upstream," or invest in programs that directly affect the social determinants of health. Moving upstream in healthcare delivery requires an acceptance of responsibility for the health of populations. We examine responses of 950 nonfederal, general hospitals in the United States to the 2015 American Hospital Association Population Health Survey to identify characteristics that distinguish those hospitals that are most aligned with population health and most engaged in addressing social determinants of health. Those "upstream" hospitals are significantly more likely to be large, not-for-profit, metropolitan, teaching-affiliated, and members of systems. Internally, the more upstream hospitals are more likely to organize their population health activities with strong executive-level involvement, full-time-equivalent support, and coordination at the system level.The characteristics differentiating hospitals strongly involved in population health and upstream activity are not unlike those characteristics associated with diffusion of many innovations in hospitals. These hospitals may be the early adopters in a diffusion process that will eventually include most hospitals or, at least, most not-for-profit hospitals. Alternatively, the population health and social determinants movements could be transient or could be limited to a small portion of hospitals such as those identified here, with distinctive patient populations, missions, and resources.

Pediatric traumatic amputations and hospital resource utilization in the United States, 2003.

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Conner, Kristen A; McKenzie, Lara B; Xiang, Huiyun; Smith, Gary A

2010-01-01

Despite the severity of consequences associated with traumatic amputation, little is known about the epidemiology or healthcare resource burden of amputation injuries, and even less is known about these injuries in the pediatric population. An analysis of patients aged lawn mower, motorized vehicle or explosives/fireworks, and children's hospital type were associated with longer LOS. Pediatric traumatic amputations contribute substantially to the health resource burden in the United States, resulting in 21 million dollars in inpatient charges annually. More effective interventions to prevent these costly injuries among children must be implemented.

Special Needs Dentistry: Interdisciplinary Management of Medically-Complex Patients at Hospital-Based Dental Units in Tasmania, Australia

Directory of Open Access Journals (Sweden)

Lim

2017-06-01

Full Text Available Background: Increasing awareness of the interactions between oral and general health has led to the establishment of Special Needs Dentistry as a dental specialty in many countries. This specialty assists with the interdisciplinary management of patients between the medical and dental professions particularly those with complex medical problems, intellectual and physical impairments, and psychiatric conditions that may affect their oral health or the manner in which they receive treatment. However, little is known about the utilisation of specialised services provided to facilitate individuals with these needs. Aim: The aim of this study was to understand current utilisation of hospital-based dental services established to provide medically-necessary dental care. Methods: A retrospective review of the demographics and medical status of patients treated at referral hospital-based dental clinics in the state of Tasmania was completed for the month of August 2015. Results: Patients treated at these units had a variety of medical backgrounds. Most (46.4% were referred from medical professionals within the hospital. On average, patients treated at these units had 2.56 medical conditions and were taking 3.59 medications each. Many of these were chronic medical conditions known to have an interaction with oral health. Conclusions: Our results demonstrate the growing recognition of dynamic interactions between oral and general health and the importance of these hospitalbased units and interprofessional relationships in providing timely and holistic health care to these patients.

Impact of a prevention bundle on Clostridium difficile infection rates in a hospital in the Southeastern United States.

Science.gov (United States)

Davis, Bionca M; Yin, Jingjing; Blomberg, Doug; Fung, Isaac Chun-Hai

2016-12-01

We sought to assess the impact of a multicomponent prevention program on hospital-acquired Clostridium difficile infections in a hospital in the Southeastern United States. We collected retrospective data of 140 patients from years 2009-2014 and applied the Poisson regression model for analysis. We did not find any significant associations of increased risk of Clostridium difficile infections for the preintervention group. Further studies are needed to test multifaceted bundles in hospitals with high infection rates. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Osteoporosis among hospitalized patients with proximal femoral fractures in Assiut University Trauma Unit, Egypt.

Science.gov (United States)

Farouk, Osama; Mahran, Dalia G; Said, Hatem G; Alaa, Mohamed M; Eisa, Amr; Imam, Hisham; Said, G Z

2017-12-01

The study was done to investigate osteoporosis prevalence in 275 hip fracture admissions at the Trauma Unit of Assiut University Hospitals and associated factors, which are understudied in our locality. Prevalence was 74.9%. Female sex, older age, low body mass index, and fall on the ground were associated with osteoporosis. This study aims to identify osteoporosis prevalence in hip fracture admissions at the Trauma Unit of Assiut University Hospitals and to study the independent correlates of osteoporosis-related fracture. A prospective cross-sectional study was carried out in 275 hip fracture patients admitted to the Trauma Unit of Assiut University Hospitals from January through December 2014 of both sexes aged 50 years and older. Exclusion criteria were polytrauma, major accidents, and history of chronic conditions and long-term medication associated with osteoporosis risk increase and bilateral hip fractures. For every patient, weight, height, and bone mineral density by dual-energy x-ray absorptiometry (DEXA) were recorded. Tests of significance for non-parametric data were used. The questionnaire included sociodemographic characteristics, dietary habits, lifestyle factors such as smoking and physical activity, and female obstetric and gynecological factors. Mean age was 70.82 ± 11.02 SD; 51.6% were males and 8.4% were obese. Fall on ground was in 81.1% of fractures. Osteoporosis (femoral neck T score ≤ -2.5 SD) prevalence was 74.9%. By univariable analysis, significant correlates were female gender, older age, normal BMI, and fall on the ground. Milk and cheese daily intake was significantly associated with lower prevalence of osteoporosis. In a multivariable logistic regression model, female sex, older age, low BMI, and fall on the ground were associated with osteoporosis. Osteoporosis prevalence is high among hip fracture patients and associated with female sex, increase in age, low BMI, and fall on ground. Strategies to prevent osteoporosis are

The emergency to home project: impact of an emergency department care coordinator on hospital admission and emergency department utilization among seniors.

Science.gov (United States)

Bond, Christopher Matthew; Freiheit, Elizabeth A; Podruzny, Lesley; Kingsly, Alianu Akawakun; Wang, Dongmei; Davenport, Jamie; Gutscher, Abram; Askin, Cathy; Taylor, Allison; Lee, Vivian; Choo, Queenie; Lang, Eddy Samuel

2014-01-01

Seniors comprise 14% to 21% of all emergency department (ED) visits, yet are disproportionately larger users of ED and inpatient resources. ED care coordinators (EDCCs) target seniors at risk for functional decline and connect them to home care and other community services in hopes of avoiding hospitalization. The goal of this study was to measure the association between the presence of EDCCs and admission rates for seniors aged ≥ 65. Secondary outcomes included length of stay, recidivism at 30 days, and revisit resulting in admission at 30 days. This was a matched pairs study using administrative data from eight EDs in six Alberta cities. Four of these hospitals were intervention sites, in which patients were seen by an EDCC, while the other four sites had no EDCC presence. All seniors aged ≥ 65 with a discharge diagnosis of fall or musculoskeletal pathology were included. Cases were matched by CTAS category, age, gender, mode of arrival, and home living environment. McNemar's test for matched pairs was used to compare admission and recidivism rates at EDCC and non-EDCC hospitals. A paired t-test was used to compare length of stay between groups. There were no statistically significant differences for baseline admission rate, revisit rate at 30 days, and readmission rate at 30 days between EDCC and non-EDCC patients. This study showed no reduction in senior patients' admission rates, recidivism at 30 days, or hospital length of stay when comparing seniors seen by an EDCC with those not seen by an EDCC.

Use of the hospital anxiety and depression scale (HADS) in a cardiac emergency room: chest pain unit

OpenAIRE

Soares-Filho, Gastão L. F.; Freire, Rafael C.; Biancha, Karla; Pacheco, Ticiana; Volschan, André; Valença, Alexandre M.; Nardi, Antonio E.

2009-01-01

OBJECTIVE: To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. INTRODUCTION: Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. METHODOLOGY: Patients were assessed by the "Hospital Anxiety and Depression Scale" as a screening instrument wile following a systematized protocol to rule out the...

Pediatric Neglected Tropical Diseases in a Major Metropolitan Children's Hospital in the United States, 2004-2013.

Science.gov (United States)

Sweet, Leigh R; Palazzi, Debra L

2016-12-01

We conducted a retrospective study of neglected tropical diseases (NTDs) diagnosed at Texas Children's Hospital between 2004 and 2013. Forty-three patients with an NTD were identified; 47% had never traveled outside of the United States. The results of this study highlight the importance of physician awareness of NTDs in children in the United States. © The Author 2015. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

[Training and experience in stroke units].

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Arenillas, J F

2008-01-01

The social and sanitary benefits provided by stroke units can not be achieved without an adequate training and learning process. This dynamic process consists of the progressive acquisition of: a) a greater degree of expertise in stroke management by the stroke team; b) better coordination between the stroke team, extrahospitalary emergency medical systems, and other in-hospital professionals involved in stroke assistance, and c) more human and technological resources dedicated to improve attention to stroke patients. The higher degree of experience in a stroke unit will have an effect: a) improving (time and quality) the diagnostic process in acute stroke patients; b) increasing the proportion of patients treated with thrombolysis; c) reducing extra and intrahospitalary latencies to stroke treatment, and d) improving stroke outcome in terms of reducing mortality and increasing functional independence. Finally, comprehensive stroke centers will achieve a higher degree of organizational complexity that will permit a global assessment of the most advanced aspects in stroke management, including education and research.

Resistance patterns of bacterial isolates to antimicrobials from 3 hospitals in the United Arab Emirates

International Nuclear Information System (INIS)

AlDhaheri, Ahmed S; AlNiyadi, Mohammed S; AlDhaheri Ahmed D; Bastaki, Salim M

2009-01-01

To compare the resistance pattern of common bacterial pathogens to commonly used drugs. Information and statistics of antimicrobial resistance for 1994 and 2005 were collected from the 3 hospital microbiology laboratories in the United Arab Emirates. The resistance patterns of Staphylococcus aureus, Escherichia coli, Klebsiella spp, and Pseudomonas aeruginosa to several front-line drugs were estimated. All laboratories used automatic machines (Vitek 2), which identifies and determines minimum inhibitory concentrations simultaneously. Increased resistance was observed for Staphylococcus aureus, (n=315, 2005) to erythromycin (approximately 6 fold, Al-Ain Hospital only), cloxacillin (Al-Ain Hospital), and gentamicin (more than 3-10 folds in all hospitals). Increased penicillin resistance was not observed. For the common Gram-negative organisms, there was a high resistance to ampicillin, gentamicin, ceftriaxone, ciprofloxacin, and imipenem, which seemed to increase for Escherichia coli, (by 4.2-200%, n=305, 2005); however, there was very little resistance to imipenem (0.4%) in Tawam Hospital. Variable resistance patterns were obtained for Pseudomonas aeruginosa (n=316, 2005) and Klebsiella spp,(n=316, 2005) against aminoglycosides, cephalosporins, ciprofloxacin, and norfloxacin. Overall, there was an obvious increase in resistance of bacteria and the prevalence rate to a number of drugs from 1-120 folds during the 11-year period. (author)

Why does it take so long? ‘Lean processing’ in the aseptic compounding unit at the Midland Regional Hospital Tullamore

LENUS (Irish Health Repository)

Greene, C

2011-06-01

Increasing numbers of oncology\\/haematology patients attending Midland Regional Hospital Tullamore (MRHT) has increased the workload of the Regional Oncology Haematology Pharmacy (ROHP) compounding unit. Staff restrictions require optimisation of current workflow practices. This audit (November 2010 and June 2011) focused on workflow in the aseptic compounding unit.\\r\

[Reminiscence on the municipal out-of-hospital maternity unit and the motherhood home in Novi Sad].

Science.gov (United States)

Dobanovacki, Dusanka; Breberina, Milan; Vujosević, Bozica; Pećanac, Marija; Zakula, Nenad; Trajković, Velicko

2013-01-01

In the mid-twentieth century, the health care of women and children was inadequate in the post-war Yugoslavia, including the city of Novi Sad, due to the severe post-war reality: poverty in the devastated country, shortage of all commodities and services and especially of medical supplies, equipment and educated staff. OUT-OF-HOSPITAL MATERNITY UNIT: One of the serious problems was parturition at home and morbidity and mortality of the newborns and women. Soon after the World War II the action programme of improving the women's health was realized on the state level by establishing out-of-hospital maternity units but under the expert supervision. The Maternity unit at 30 Ljudevita Gaja Street in Novi Sad played a great role in providing skilled birth attendance at mainly normal deliveries. With a minimal number of medical staff and modest medical equipment, about 2000 healthy babies were born in this house. After 5 years of functioning in that way, this unit was transformed into the Motherhood Home and became a social and medical institution for pregnant women and new mothers. Regardless of the redefined organization concept the curative and preventive health care as well as women and children social protection programmes were provided successfully for the next 12 years. Although the Motherhood Home was moved into the Women Health Centre of Novi Sad and later into the former Maternity Hospital in Sremski Karlovci, its great importance for women and children's health care remained unchanged. In 1979 the overall social situation and mostly economic issues led to its closing. The house in Gajeva Street is now used as the municipality office. However, this house with its story recommends itself to become a house for a special social function, such as a museum of medical history of Novi Sad. A small investment could make it possible to collect, preserve and display the valuable records of our past, which is something we do owe to the generations to come.

48 CFR 1652.204-71 - Coordination of Benefits.

Science.gov (United States)

2010-10-01

... payment of benefits under this contract with the payment of benefits under Medicare, other group health benefits coverages, and the payment of medical and hospital costs under no-fault or other automobile... precedence established by the NAIC Model Guidelines for Coordination of Benefits (COB) as specified by OPM...

Robotic surgery claims on United States hospital websites.

Science.gov (United States)

Jin, Linda X; Ibrahim, Andrew M; Newman, Naeem A; Makarov, Danil V; Pronovost, Peter J; Makary, Martin A

2011-11-01

To examine the prevalence and content of robotic surgery information presented on websites of U.S. hospitals. We completed a systematic analysis of 400 randomly selected U.S. hospital websites in June of 2010. Data were collected on the presence and location of robotic surgery information on a hospital's website; use of images or text provided by the manufacturer; use of direct link to manufacturer website; statements of clinical superiority; statements of improved cancer outcome; mention of a comparison group for a statement; citation of supporting data and mention of specific risks. Forty-one percent of hospital websites described robotic surgery. Among these, 37% percent presented robotic surgery on their homepage, 73% used manufacturer-provided stock images or text, and 33% linked to a manufacturer website. Statements of clinical superiority were made on 86% of websites, with 32% describing improved cancer control, and 2% described a reference group. No hospital website mentioned risks. Materials provided by hospitals regarding the surgical robot overestimate benefits, largely ignore risks and are strongly influenced by the manufacturer. © 2011 National Association for Healthcare Quality.

Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

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Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

2012-01-01

The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

Sporotrichosis-Associated Hospitalizations, United States, 2000–2013

Science.gov (United States)

Gold, Jeremy A.W.; Derado, Gordana; Mody, Rajal K.

2016-01-01

To determine frequency and risk for sporotrichosis-associated hospitalizations, we analyzed the US 2000–2013 National (Nationwide) Inpatient Sample. An estimated 1,471 hospitalizations occurred (average annual rate 0.35/1 million persons). Hospitalizations were associated with HIV/AIDS, immune-mediated inflammatory diseases, and chronic obstructive pulmonary disease. Although rare, severe sporotrichosis should be considered for at-risk patients. PMID:27648881

Ambient Noise Levels in Acute Neonatal Intensive Care Unit of a Tertiary Referral Hospital

OpenAIRE

Sonia R. B D'Souza; Leslie Edward Lewis; Vijay Kumar; Ramesh Bhat Y; Jayashree Purkayastha; Hari Prakash

2017-01-01

Background: Advances in neonatal care have resulted in improved survival of neonates admitted to the intensive care of the Neonatal Intensive Care Unit (NICU). However, the NCU may be an inappropriate milieu, with presence of overwhelming stimuli, most potent being the continuous presence of noise in the ambience of the NICU. Aim and Objectives: To determine and describe the ambient noise levels in the acute NICU of a tertiary referral hospital. Material and Methods...

The effect on organizational change on relational coordination – a multi case study

DEFF Research Database (Denmark)

Edwards, Kasper; Lundstrøm, Sanne Lykke

2014-01-01

This study presents results from an original empirical study of 11 organizational change projects in different wards at two Danish hospitals. The purpose of the study was to study was to study changes in relation coordination as a consequence of organizational change. We measured relational...... coordination before and after the organizational change using the 7 question relational coordination questionnaire. A group of employees were interviewed after the change project to uncover the nature and extent of the changes. We find that organizations’ relational coordination score change very little – even...... for organizational change that introduces new work relations and new processes....

Participation of a coordinating center pharmacy in a multicenter international study.

Science.gov (United States)

Jeon, Jihyun Esther; Mighty, Janet; Lane, Karen; McBee, Nichol; Majkowski, Ryan; Mayo, Steven; Hanley, Daniel

2016-11-15

The activities of a coordinating center pharmacy (CCP) supporting a multicenter, international clinical trial are described. Serving in a research support role comparable to that of a commercial clinical trial supply company, a CCP within the Johns Hopkins Hospital Investigational Drug Service (JHH IDS) uses its management expertise and infrastructure to support multicenter trials, such as the recently completed Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage, Phase III (CLEAR III) trial. The role of the CCP staff in supporting the CLEAR III trial was overall investigational product (IP) management through coordination of IP-related operations to ensure high-quality care for study participants at study sites in the United States and abroad. For the CLEAR III trial, the CCP coordinated IP supply activities; provided education to site pharmacists; developed study-specific documents, including pharmacy manuals; communicated with trial stakeholders, including third-party IP distributors; monitored treatment assignments; and performed quality assurance monitoring to ensure compliance with institutional, state, federal, and international regulations regarding IP procurement and storage. Acting as a CCP for a multicenter international study poses a number of operational challenges while providing opportunities for the CCP to contribute to research of global importance and enrich the skill sets of its personnel. The development and implementation of the CCP at JHH IDS for the CLEAR III trial included several responsibilities, such as IP supply management, communication, and database, regulatory, and finance management. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Danish general practitioners only play a minor role in the coordination of cancer treatment

DEFF Research Database (Denmark)

Dalsted, R.J.; Guassora, A.D.; Thorsen, T.

2011-01-01

INTRODUCTION: Despite initiatives to integrate treatment and care across organisations, patient trajectories in Danish health-care are not well coordinated. Coordination among many health-care professionals is essential, and it is frequently suggested that a single person should perform the task....... In the majority of cases, GPs had no access to information or were not informed about hospital decisions affecting the patients' trajectories, and they were therefore unable to perform a coordinating role. CONCLUSION: GPs only played a minor or no role at all as coordinators of individual cancer patient...

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

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Ali Hossein Zeinalzadeh

2017-09-01

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

Epidemiological Study of Hospital-Acquired Bacterial Conjunctivitis in a Level III Neonatal Unit

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Catarina Dias

2013-01-01

Full Text Available Background. Conjunctivitis is one of the most frequently occurring hospital-acquired infections among neonates, although it is less studied than potentially life-threatening infections, such as sepsis and pneumonia. Objectives. The aims of our work were to identify epidemiologic characteristics, pathogens, and susceptibility patterns of bacterial hospital-acquired conjunctivitis (HAC in a level III neonatal unit. Materials and Methods. Data were collected retrospectively from patient charts and laboratory databases. Hospital-acquired conjunctivitis was defined in accordance with the Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN diagnostic criteria. Results. One or more episodes of HAC were diagnosed in 4,0% ( of 1492 neonates admitted during the study period. Most of the episodes involved premature (75,4% and low birth weight (75,4% neonates. Infection rates were higher among patients undergoing noninvasive mechanical ventilation (46,7%, parenteral nutrition (13,6%, and phototherapy (6,8%. Predominant pathogens included Serratia marcescens (27,9%, Escherichia coli (23%, and Pseudomonas aeruginosa (18%. Susceptibility patterns revealed bacterial resistances to several antibiotic classes. Gentamicin remains the adequate choice for empirical treatment of HAC in our NICU. Conclusion. It is important to know the local patterns of the disease in order to adjust prevention strategies. Our work contributes to the epidemiological characterization of a sometimes overlooked disease.

Hospital based patient coordination for ethnic minority patients - a health technology assessment

DEFF Research Database (Denmark)

Sodemann, Morten

A cross diciplinary, cross specialty, cross sectoral hospital based approach to cultural management of ethnic minority patients is effective in creating more approprite patient flows, better quality of care and increases functional level of patients. Surprisingly the aggregated effect saves...... especially on public medicine expenses and social services. Ethnic minority patients can achieve increased empowerment & Equity in type and quality of hospital care through cross dicplinary cross specialty cultural case management & support between hospital departments and primary sectors...

The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients

OpenAIRE

Hartgerink, Jacqueline; Cramm, Jane; Bakker, Ton; Eijsden, A.; Mackenbach, Johan; Nieboer, Anna

2013-01-01

textabstractAim: To identify predictors of relational coordination among professionals delivering care to older patients. Background: Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design: This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. Methods: This study was performed in sp...

The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients

OpenAIRE

J.M. Hartgerink; J.M. Cramm; T.J.E.M. Bakker; A.M. van Eijsden; J.P. Mackenbach; A.P. Nieboer

2013-01-01

Aim To identify predictors of relational coordination among professionals delivering care to older patients. Background Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. Methods This study was performed in spring 2010 among ...

Chapter 2. Surge capacity and infrastructure considerations for mass critical care. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

Science.gov (United States)

Hick, John L; Christian, Michael D; Sprung, Charles L

2010-04-01

To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for a mass disaster or influenza epidemic with a specific focus on surge capacity and infrastructure considerations. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including surge capacity and infrastructure considerations. Key recommendations include: (1) hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas; (2) hospitals should have appropriate beds and monitors for these expansion areas; hospitals should develop contingency plans at the facility and government (local, state, provincial, national) levels to provide additional ventilators; (3) hospitals should develop a phased staffing plan (nursing and physician) for ICUs that provides sufficient patient care supervision during contingency and crisis situations; (4) hospitals should provide expert input to the emergency management personnel at the hospital both during planning for surge capacity as well as during response; (5) hospitals should assure that adequate infrastructure support is present to support critical care activities; (6) hospitals should prioritize locations for expansion by expanding existing ICUs, using postanesthesia care units and emergency departments to capacity, then step-down units, large procedure suites, telemetry units and finally hospital wards. Judicious planning and adoption of protocols for surge capacity and infrastructure considerations are necessary to optimize outcomes during a pandemic.

Determining Family Needs on an Oncology Hospital Unit Using Interview, Art, and Survey.

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Catlin, Anita; Ford, Marilee; Maloney, Carrie

2016-04-01

A movement worldwide, and specifically new to our hospital, is the implementation of Patient- and Family-Centered Care. We were unsure, however, what the needs were of our patients' families. This triangulated study, on a 28-bed oncology unit, studied family members at the bedside. We asked family members what their needs were in a three-step process (open-ended interview, use of the Draw a Bridge art therapy technique, and the Family Inventory of Needs survey). Nineteen interviews revealed needs for physical comfort, emotional support, cultural sensitivity, recognition of help provided by family members and improved pain management. Art therapy revealed the stress of caregiving and helped to uncover unmet needs for interviewers to explore. The FIN identified that care at home after discharge was a major worry. Knowledge of family members' needs while a loved one is in the hospital allows for planning and provision of modalities to assist them in their caregiving. © The Author(s) 2015.

Concordance among remission and admission diagnoses at intensive care unit, Hospital Universitario San José, Popayán, 2011

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Victor Daniel Montenegro

2012-03-01

Full Text Available There are few published studies about diagnostic concordance in hospital services. The objective of this study was to calculate the concordance among remission and admission diagnoses from Hospital Universitario San José adult intensive care unit (I.C.U. of Popayán, 2011. Methods: Descriptive and retrospective study about concordance between the main remission and admission diagnoses from patients admitted in the Hospital adult intensive care unit; 914 patients were studied from the intensive care unit database, months January to December 2011. Statistical analysis about sociodemographic variables was performed, and Kappa index according to Landis and Koch scale among remission and admission diagnoses defined as priority was calculated. Results: It was found al almost perfect level of concordance in the diagnoses pancreatitis and intoxication, a substantial level of concordance in the diagnoses acute coronary syndrome, convulsive status, gastric cancer and eclampsia, a moderate level of concordance in the diagnoses stroke, head trauma, politraumatism and cardiac failure, and a fair level of concordance in the diagnoses sepsis, pneumonia, chronic obstructive pulmonary disease (COPD, gastrointestinal bleeding, acute respiratory infection and acute respiratory distress syndrome. Conclusion: Six of the seventeen studied diagnoses presented an outstanding concordance level; this can be related to factors such as: physicians’, diagnostic ability, provenance of the patients remitted to the I.C.U. and diagnostic coding made by health staff.

Medication prescribing errors in the medical intensive care unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

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Sada, Oumer; Melkie, Addisu; Shibeshi, Workineh

2015-09-16

Medication errors (MEs) are important problems in all hospitalized populations, especially in intensive care unit (ICU). Little is known about the prevalence of medication prescribing errors in the ICU of hospitals in Ethiopia. The aim of this study was to assess medication prescribing errors in the ICU of Tikur Anbessa Specialized Hospital using retrospective cross-sectional analysis of patient cards and medication charts. About 220 patient charts were reviewed with a total of 1311 patient-days, and 882 prescription episodes. 359 MEs were detected; with prevalence of 40 per 100 orders. Common prescribing errors were omission errors 154 (42.89%), 101 (28.13%) wrong combination, 48 (13.37%) wrong abbreviation, 30 (8.36%) wrong dose, wrong frequency 18 (5.01%) and wrong indications 8 (2.23%). The present study shows that medication errors are common in medical ICU of Tikur Anbessa Specialized Hospital. These results suggest future targets of prevention strategies to reduce the rate of medication error.

Cesarean Delivery Rates Vary 10-Fold Among US Hospitals; Reducing Variation May Address Quality, Cost Issues

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Kozhimannil, Katy Backes; Law, Michael R.; Virnig, Beth A.

2013-01-01

Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordination of maternity care, more data collection and measurement, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting. PMID:23459732

Metaheuristics for Engineering and Architectural Design of Hospitals

DEFF Research Database (Denmark)

Holst, Malene Kirstine Østergaard; Kirkegaard, Poul Henning

2014-01-01

This paper presents an approach for optimized hospital layout design based on metaheuristics. Through the use of metaheuristics the hospital functionalities are decomposed into geometric units. The units define the baseline for the design of the hospital, as the units are based on correlations of...

Medication errors in the adult emergency unit of a tertiary care teaching hospital in Addis Ababa

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Gediwon Negash

2013-01-01

Conclusion: Incidence and types of medication errors committed in Tikur Anbesa Specialized Hospital Adult Emergency Unit were substantiated; moreover, necessary information on factors within the healthcare delivery system that predispose healthcare professionals to commit errors have been pointed, which should be addressed by healthcare professionals through multidisciplinary efforts and involvement of decision makers at national level.

Transfer from planned home birth to hospital: improving interprofessional collaboration.

Science.gov (United States)

Vedam, Saraswathi; Leeman, Lawrence; Cheyney, Melissa; Fisher, Timothy J; Myers, Susan; Low, Lisa Kane; Ruhl, Catherine

2014-01-01

Women's heightened interest in choice of birthplace and increased rates of planned home birth in the United States have been well documented, yet there remains significant public and professional debate about the ethics of planned home birth in jurisdictions where care is not clearly integrated across birth settings. Simultaneously, the quality of interprofessional interactions is recognized as a predictor of health outcomes during obstetric events. When care is transferred across birth settings, confusion and conflict among providers with respect to roles and responsibilities can adversely affect both outcomes and the experience of care for women and newborns. This article reviews findings of recent North American studies that examine provider attitudes toward planned home birth, differing concepts of safety of birthplace as reported by women and providers, and sources of conflict among maternity care providers during transfer from home to hospital. Emerging evidence and clinical exemplars can inform the development of systems for seamless transfer of women and newborns from planned home births to hospital and improve experience and perceptions of safety among families and providers. Three successful models in the United States that have enhanced multidisciplinary cooperation and coordination of care across birth settings are described. Finally, best practice guidelines for roles, communication, and mutual accommodation among all participating providers when transfer occurs are introduced. Research, health professional education, and policy recommendations for incorporation of key components into existing health care systems in the United States are included. © 2014 by the American College of Nurse-Midwives.

Perceptions of the hospital ethical environment among hospital social workers in the United States.

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Pugh, Greg L

2015-01-01

Hospital social workers are in a unique context of practice, and one where the ethical environment has a profound influence on the ethical behavior. This study determined the ratings of ethical environment by hospital social workers in large nationwide sample. Correlates suggest by and compared to studies of ethical environment with nurses are explored. Positive ratings of the ethical environment are primarily associated with job satisfaction, as well as working in a centralized social work department and for a non-profit hospital. Religiosity and MSW education were not predictive. Implications and suggestions for managing the hospital ethical environment are provided.

HOSPITAL SOUNDSCAPE: ACOUSTICS EVALUATION IN NEONATAL INTENSIVE CARE UNIT (NICU ROOM OF A NATIONAL HOSPITAL IN JAKARTA, INDONESIA

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SARWONO R. Sugeng Joko

2016-12-01

Full Text Available Acoustics comfort in a room is one of the most important building physics aspect that should be observed. in public spaces like hospital, especially in an intensive care unit such as NICU. Researches on the acoustic conditions of NICU in Indonesia are still limited. The acoustical study conducted in this research is using objective, subjective, and simulation methods based on soundscape concept with the concern on the nurse’s perception. This research was conducted at a national hospital in Jakarta. According to National Standardization Agency of Indonesia (SNI and World Health Organization (WHO, the suitable sound pressure level (SPL for noise in patient’s room is 35 dBA. From the study, it was found that the equivalent SPL value exceeded the standard. Soundscape in NICU can be improve with the addition of curtain on the incubator’s side, installation of glass partition, and ceiling absorber in the nurse station area. The result of simulation showed that the SPL in the room decreased with average value 8.9 dBA for sound source alarm ventilator and 8.2 dBA for sound source medical officer conversations. And the speech transmission index (STI increased from “bad” to “good” range became “fair” to “excellent” range.

Coordinators for health science libraries in the Midwest Health Science Library Network.

Science.gov (United States)

Holtum, E A; McKloskey, J; Mahan, R

1977-04-01

In the summer of 1973 one resource library in each of the six states of the Midwest Health Science Library Network received funding from the National Library of Medicine to hire a coordinator for health science libraries. The development of the role of coordinator is examined and evaluated. The coordinators have proved valuable in the areas of consortium formation, basic unit development, communication facilitation, and program initiation. The function of the coordinators in the extensive planning effort now being undertaken by the network and the future need for the coordinator positions are discussed.

Attitudes of Registered and Licensed Practical Nurses About the Importance of Families in Surgical Hospital Units: Findings From the Landspitali University Hospital Family Nursing Implementation Project.

Science.gov (United States)

Blöndal, Katrin; Zoëga, Sigridur; Hafsteinsdottir, Jorunn E; Olafsdottir, Olof Asdis; Thorvardardottir, Audur B; Hafsteinsdottir, Sigrun A; Sveinsdóttir, Herdis

2014-08-01

The purpose of this study was to examine attitudes of registered nurses and licensed practical nurses about the importance of the family in surgical hospital units before (T1) and after (T2) implementation of a Family Systems Nursing educational intervention based on the Calgary Family Assessment and Intervention Models. This study was part of the Landspitali University Hospital Family Nursing Implementation Project and used a nonrandomized, quasi-experimental design with nonequivalent group before and after and without a control group. There were 181 participants at T1 and 130 at T2. No difference was found in nurses' attitudes as measured by the Families Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire, before and after the educational intervention. Attitudes toward families were favorable at both times. Analysis of demographic variables showed that age, work experience, and workplace (inpatient vs. outpatient units) had an effect on the nurses' attitudes toward families. The influence of work experience on attitudes toward family care warrants further exploration. © The Author(s) 2014.

Coordination and standardization of federal sedimentation activities

Science.gov (United States)

Glysson, G. Douglas; Gray, John R.

1997-01-01

In August 1964, the Bureau of the Budget issued Circular A-67 to set forth guidelines for the coordination of water-data acquisition activities throughout the Federal government. The U.S. Department of the Interior was assigned the task of implementing Circular A-67, which in turn redelegated this responsibility to the U.S. Geological Survey (USGS). Delegation of the lead responsibility for water-data coordination to the USGS occurred because of its historical role as the primary agency for water-data acquisition in the United States. To provide overall leadership for implementing the provisions of Circular A-67, the USGS established the Office of Water Data Coordination in the Water Resources Division (WRD). In addition, regional and district offices of the WRD were delegated responsibility for coordinating water data within their geographic areas of responsibility. On December 10, 1991, the Office of Management and Budget issued OMB Number Memorandum M-92-01, which expands the USGS's coordination role to encompass all water information. This includes data critical to water resources in the following categories: - surface- and ground-water quality and quantity,

Puesta en marcha de una Unidad de Valoración Sociosanitaria (UVASS ubicada en un hospital de agudos (Fundación Hospital Son Llatzer: FHSLL Implementation of a socio-medical assessment unit (UVASS located in a hospital for acute patients (Foundation Hospital Son Llatzer: FHSLL

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Mª. Inés Cuesta Antelo

2008-03-01

Dependencia.Introduction: The social health assessment unit of the Hospital Complex of Majorca (CHM is located at the Hospital for acute patients of Son Llátzer (FHSLL, in Palma de Majorca. For its start-up, the model will be the functional interdisciplinary units (UFISS of Catalonia, which work since the creation in 1986 of the "Vida als anys" program, although other autonomous regions also have these support equipments. Its activity began in June, 2002, when the General Hospital (HG and the Joan March Hospital (HJM reconverted into social health hospitals. We are an interdisciplinary unit in charge of defining and prioritizing every user needs by means of a comprehensive professional evaluation. Objectives: To show the most common typology of patients evaluated by this unit and the main problems found when deriving them to more appropriate centres for their case; and describing the difficulties found from the beginning, just as the consultations made to our team. Material and method: Retrospective study of the patients evaluated between June, 2002, and December, 2005. The parameters used are: Barthel scale, Pheiffer scale, control of symptoms scale, as well as the age and sex of the patients. For the nursing assessment it's been utilized the Virginia Henderson's model with the 14 basic needs. Results: They reflect the different services which the patients have been referred to, just as the lack of resources that we have detected during the study period. We believe that the right selection of patients is the basis for a good performance of the UVASS. We are a young unit, in phase of expansion, with still a long way to go and lots of possibilities, taking into account the projects of new social health resources, both at autonomic and national level (Dependence Law.

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

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Badia BISBIS

2016-06-01

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

Frequency and pattern of skin diseases among uniformed personnel at united nations level iii hospital-darfur, sudan

International Nuclear Information System (INIS)

Raza, N.; Suhail, M.

2014-01-01

Objective: The objective of the study was to determine the frequency and pattern of skin diseases among uniformed personnel at a United Nations peace-keeping mission Level III hospital at Darfur, Sudan. Design: A descriptive study Place and Duration of Study: This study was conducted at dermatology outpatient department of United Nations peace keeping mission (UNAMID) level III Hospital from Jan 2010-2011. Patients and Methods: All soldiers/ policemen of either gender reporting to dermatology department of the hospital for the first time during the study period were registered after informed consent. A specially designed proforma was filled for each patient separately. In addition to date of reporting, demographic profile and disease information were noted. The data was managed and analyzed using SPSS-14. Results: There were a total of 438 uniformed personnel of the age ranging from 20-52 years (mean of 34.30+6.43). Eczema in various forms was the most common disease (21.9%), followed by fungal infections (10%) and melasma (08.9%). One hundred and seventy five (40.0%) patients had the disease 02 months to >30 years before their deployment, whereas 263 (60%) developed the disease 03 days to 01 year after deployment. Conclusion: Eczema, fungal infections and melasma were the commonest skin problems among uniformed personnel. Forty percent of these had dermatological problems before deployment. (author)

Radiation dose in the neonatal intensive care unit of Antoine Beclere Hospital

International Nuclear Information System (INIS)

Lebreton, C.; Rehel, J. L.; Aubert, B.; Musset, D.

2006-01-01

As part of a program aiming a better knowledge of the medical exposure of the french population and in the frame of the principle of optimisation, a study of radiation doses to neonates was carried out in neonatal intensive care unit of Antoine Beclere hospital. From March to August 2005, entrance surface dose (ESD) received by 63 neonates classified according the their weight (184 X-ray examinations) was measured with thermoluminescent dosimeters (TLD) during examination. The mean ESD ESD per exposure was found between 20 and 37 μGy according to the weight of neonates. The newborn of less than 1000 g at birth have a mean of 20 X-ray examinations. Above 1000 g the number of X-ray examinations was between 5 and 8.5. During their stay in neonatal intensive care unit, the total ESD of neonates was from 500 μGy for the smallest Neonates (<1000 g) and the other respectively. Results indicate that neonate exposition, is very small compared with french and international data. ESD was significantly lower than the french reference level of 80 μGy. (Author)

[The meanings of working in intensive care units of two Brazilian hospitals].

Science.gov (United States)

Baasch, Davi; Laner, Aline Dos Santos

2011-01-01

Health workers working in Intensive Care Units experience complex situations where there is suffering due to patients suffering, among other factors. This article aimed to verify the meanings and the satisfaction arising from the work of 80 ICU employees at a public hospital from Santa Catarina and a private one from Rio de Janeiro. For data collection, questionnaires and interviews were used and the analysis was made by descriptive statistics. It is noteworthy that the meanings of working at the ICUs researched varied around the notion of social contribution and responsibility and/or exchange. Social relations at work were shown as a central dimension for most of the individuals. Most of them consider working not as something negative, but as one of the most important item of their lives, surpassing even the idea of the payment that it originates. It was observed that the understanding of the meanings assigned to work is an essential factor to achieve the emotional balance of workers at hospitals and to understand the conditioning causes of possible disruptions of this balance, which is a crucial factor for the promotion of mental health and life quality at work.

On Hospital Design – Identifying Building Attributes of Hospital Design

DEFF Research Database (Denmark)

Holst, Malene Kirstine; Kirkegaard, Poul Henning; Christoffersen, Lars D.

The present paper surveys the input parameters in hospital design and describes them formally as building attributes in preparation for facilitating planning and designing of hospitals with the aim of a more optimal design process. The overview of the hospital functionalities, bonds, logistics...... and needs is based on an approach of understanding the complexity of the hospital functionalities based on capacities, qualities and times beforehand specific department or units are described. This approach attempts to create an overview of the hospital functionalities respecting capacities, qualities...

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

International Nuclear Information System (INIS)

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

2015-01-01

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

Hierarchical Delay-Dependent Distributed Coordinated Control for DC Ring-Bus Microgrids

DEFF Research Database (Denmark)

Dou, Chunxia; Yue, Dong; Zhang, Zhanqiang

2017-01-01

In this paper, a hierarchical distributed coordinated control method is proposed based on the multi-agent system for dc ring-bus microgrids to improve the bus voltage performance. First, a two-level multi-agent system is built, where each first-level unit control agent is associated with a distri......In this paper, a hierarchical distributed coordinated control method is proposed based on the multi-agent system for dc ring-bus microgrids to improve the bus voltage performance. First, a two-level multi-agent system is built, where each first-level unit control agent is associated...

Implementation of pharmacists’ interventions and assessment of medication errors in an intensive care unit of a Chinese tertiary hospital

Directory of Open Access Journals (Sweden)

Jiang SP

2014-10-01

Full Text Available Sai-Ping Jiang,1,* Jian Chen,2,* Xing-Guo Zhang,1 Xiao-Yang Lu,1 Qing-Wei Zhao1 1Department of Pharmacy, 2Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China *These authors contributed equally to this work Background: Pharmacist interventions and medication errors potentially differ between the People’s Republic of China and other countries. This study aimed to report interventions administered by clinical pharmacists and analyze medication errors in an intensive care unit (ICU in a tertiary hospital in People’s Republic of China.Method: A prospective, noncomparative, 6-month observational study was conducted in a general ICU of a tertiary hospital in the People’s Republic of China. Clinical pharmacists performed interventions to prevent or resolve medication errors during daily rounds and documented all of these interventions and medication errors. Such interventions and medication errors were categorized and then analyzed.Results: During the 6-month observation period, a total of 489 pharmacist interventions were reported. Approximately 407 (83.2% pharmacist interventions were accepted by ICU physicians. The incidence rate of medication errors was 124.7 per 1,000 patient-days. Improper drug frequency or dosing (n=152, 37.3%, drug omission (n=83, 20.4%, and potential or actual occurrence of adverse drug reaction (n=54, 13.3% were the three most commonly committed medication errors. Approximately 339 (83.4% medication errors did not pose any risks to the patients. Antimicrobials (n=171, 35.0% were the most frequent type of medication associated with errors.Conclusion: Medication errors during prescription frequently occurred in an ICU of a tertiary hospital in the People’s Republic of China. Pharmacist interventions were also efficient in preventing medication errors. Keywords: pharmacist, medication error, preva­lence rate, type, severity, intensive care

Endemic carbapenem-nonsusceptible Acinetobacter baumannii-calcoaceticus complex in intensive care units of the national referral hospital in Jakarta, Indonesia

NARCIS (Netherlands)

Saharman, Y.R. (Yulia Rosa); Karuniawati, A. (Anis); Sedono, R. (Rudyanto); Aditianingsih, D. (Dita); Sudarmono, P. (Pratiwi); W.H.F. Goessens (Wil); Klaassen, C.H.W. (Corné H.W.); H.A. Verbrugh (Henri); J.A. Severin (Juliëtte)

2018-01-01

textabstractBackground: Carbapenem-nonsusceptible A. baumannii-calcoaceticus complex have emerged worldwide, but the epidemiology in Indonesian hospitals has not been studied. Methods: A prospective observational study was performed on the intensive care units (ICUs) of the national referral

Cranial computed tomography findings in patients admitted to the emergency unit of Hospital Universitario Cajuru; Achados tomograficos de pacientes submetidos a tomografia de cranio no pronto-socorro do Hospital Universitario Cajuru

Energy Technology Data Exchange (ETDEWEB)

Lara Filho, Lauro Aparecido; Omar, Samir Sari; Biguelini, Rodrigo Foletto; Santos, Rony Augusto de Oliveira, E-mail: samir176@gmail.com [Pontificia Universidade Catolica do Parana (PUCPR), Curitiba, PR (Brazil). Cuso de Medicina

2013-05-15

Objective: to identify and analyze the prevalence of cranial computed tomography findings in patients admitted to the emergency unit of Hospital Universitario Cajuru. Materials and methods: cross-sectional study analyzing 200 consecutive non contrast-enhanced cranial computed tomography reports of patients admitted to the emergency unit of Hospital Universitario Cajuru. Results: alterations were observed in 76.5% of the patients. Among them, the following findings were most frequently observed: extracranial soft tissue swelling (22%), bone fracture (16.5%), subarachnoid hemorrhage (15%), nonspecific hypodensity (14.5%), paranasal sinuses opacification (11.5%), diffuse cerebral edema (10.5%), subdural hematoma (9.5%), cerebral contusion (8.5%), hydrocephalus (8%), retractable hypodensity /gliosis/ encephalomalacia (8%). Conclusion: the authors recognize that the most common findings in emergency departments reported in the literature are similar to the ones described in the present study. This information is important for professionals to recognize the main changes to be identified at cranial computed tomography, and for future planning and hospital screening aiming at achieving efficiency and improvement in services. (author)

Patient flow based allocation of hospital resources.

Science.gov (United States)

Vissers, J M

1995-01-01

The current practice of allocating resources within a hospital introduces peaks and troughs in the workloads of departments and leads therefore to loss of capacity. This happens when requirements for capacity coordination are not adequately taken into account in the decision making process of allocating resources to specialties. The first part of this research involved an analysis of the hospital's production system on dependencies between resources, resulting in a number of capacity coordination requirements that need to be fulfilled for optimized resource utilization. The second, modelling, part of the study involved the development of a framework for resource management decision making, of a set of computer models to support hospital managerial decision making on resource allocation issues in various parts of the hospital, and of an implementation strategy for the application of the models to concrete hospital settings. The third part of the study was devoted to a number of case-studies, illustrating the use of the models when applied in various resource management projects, such as a reorganization of an operating theatre timetable, or the development of a master plan for activities of a group of general surgeons serving two locations of a merged hospital system. The paper summarizes the main findings of the study and concludes with a discussion of results obtained with the new allocation procedure and with recommendations for future research.

Medical Professionals Designing Hospital Management Models

OpenAIRE

Byg, Vibeke

2016-01-01

Health care administration in many OECD countries has undergone substantial changes in recent years as a consequence of NPM reforms, rising costs, the pace of technological innovation, heightened competition for patients and resources, quality of managed care and demographic shifts. Hospitals especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research lit...

Performance evaluation of nonhomogeneous hospitals: the case of Hong Kong hospitals.

Science.gov (United States)

Li, Yongjun; Lei, Xiyang; Morton, Alec

2018-02-14

Throughout the world, hospitals are under increasing pressure to become more efficient. Efficiency analysis tools can play a role in giving policymakers insight into which units are less efficient and why. Many researchers have studied efficiencies of hospitals using data envelopment analysis (DEA) as an efficiency analysis tool. However, in the existing literature on DEA-based performance evaluation, a standard assumption of the constant returns to scale (CRS) or the variable returns to scale (VRS) DEA models is that decision-making units (DMUs) use a similar mix of inputs to produce a similar set of outputs. In fact, hospitals with different primary goals supply different services and provide different outputs. That is, hospitals are nonhomogeneous and the standard assumption of the DEA model is not applicable to the performance evaluation of nonhomogeneous hospitals. This paper considers the nonhomogeneity among hospitals in the performance evaluation and takes hospitals in Hong Kong as a case study. An extension of Cook et al. (2013) [1] based on the VRS assumption is developed to evaluated nonhomogeneous hospitals' efficiencies since inputs of hospitals vary greatly. Following the philosophy of Cook et al. (2013) [1], hospitals are divided into homogeneous groups and the product process of each hospital is divided into subunits. The performance of hospitals is measured on the basis of subunits. The proposed approach can be applied to measure the performance of other nonhomogeneous entities that exhibit variable return to scale.

Internal medicine network: a new way of thinking hospital-territory integration and public-private partnership

Directory of Open Access Journals (Sweden)

Filomena Pietrantonio

2016-10-01

Full Text Available This working proposal aims to establish an Internal Medicine Network (IMN model for the appropriate management of the poly-pathological complex patient in the different phases of his illness natural hystory. The IMN is based on an organization recalling the Hub and Spoke system already used for existing specialized networks. The Internal Medicine Unit (IMU is the natural destination of acutely ill patients suffering from systemic or multi-organ diseases. Three are the IMU specific tasks: i to stabilize acute, severe, poly-pathologic and complex patients; ii to develop difficult etiological diagnosis in these patients and in those who should necessarily be admitted to the hospital, not being possible, for different reasons, alternative routes; iii to select the acute poly-pathological complex patient’s priorities. The expected results of a new model of integration system inside the IMN are: i reduction and rationalization of expenditure in the medical area, increasing effectiveness, quality and safety guaranteeing patient centrality; ii patients stratification based on characteristics of gravity, acute illness, estimated duration of hospitalization; iii reduction of inappropriate hospital admissions ensuring connections between hospital and primary care units; iv definition of different care pathways for patients hospitalized due to non-communicable diseases; v implementation of new common medical records. The public-private partnership inside the IMN could be able to increase appropriateness reducing health costs. Patient-centered problems assessment, together with integration, cooperation, coordination and effective communication are some simple rules useful to achieve tangible results in a complex system and the IMN model represents its practical application.

The impact of HMO and hospital competition on hospital costs.

Science.gov (United States)

Younis, Mustafa Z; Rivers, Patrick A; Fottler, Myron D

2005-01-01

This study examines the impact of HMO penetration and competition on health system performance, as measured by hospital cost per adjusted admissions. The study population consisted of acute-care hospitals in the United States. The findings of this study suggest that there is no relationship between HMO competition and hospital cost per adjusted admission. Governmental efforts to stimulate competition in the hospital market, if focused on promoting HMOs, are not likely to produce cost-containing results quickly.

The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients

NARCIS (Netherlands)

J.M. Hartgerink (Jacqueline); J.M. Cramm (Jane); T.J.E.M. Bakker (Ton); A.M. van Eijsden (A.); J.P. Mackenbach (Johan); A.P. Nieboer (Anna)

2013-01-01

textabstractAim: To identify predictors of relational coordination among professionals delivering care to older patients. Background: Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design: This cross-sectional

THE RELATIONSHIP BETWEEN MARKETING MIX AND PATIENT LOYALTY IN INTENSIVE CARE UNIT, ANUTAPURA PUBLIC HOSPITAL PALU

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Muh. Ryman Napirah

2016-09-01

Full Text Available Background: The problem generally faced by hospital is unable to provide something really needed by the customers. One of the main factors is the poor marketing mix of hospital that impacts to low quality and influences the patients loyality. Objective: The research aims to investigate the relationship between marketing mix and patient loyalty in intensive care unit at Anutapura Public Hospital Palu. Methods: This was a cross sectional study involving 97 persons who were randomly selected without considering the level of population. The data were analyzed thought univariat and bivariat on the significance level 95% (p<0,05. The marketing mix concept of 7P (product, price, place, promotion, people, process, dan physical evidence. Was used to guide this study. Results: The result of chi-square test indicated that there was a relationship of marketing mix product (p= 0,01, price (p= 0,00, promotion (p= 0,04, people (p= 0,00; and no relationship of marketing mix place (p= 0,21, process (p= 1,00, dan physical evidence (p= 1,00 with patient loyalty. Conclusion: It is expected tht the hospital of Anutapura Palu could increase the strategy of marketing mix for the sake of keeping the patients loyalty as the profit value of the hospital, especially for marketing place, process, and physical evidence.

The Sociology of the Deceased Harvard Medical Unit at Boston City Hospital.

Science.gov (United States)

Tishler, Peter V

2015-12-01

Many graduates of the Harvard Medical Unit (HMU) at Boston City Hospital, in either the clinical training/residency program or the research program at the Thorndike Memorial Laboratory, contributed in major ways to the HMU and constantly relived their HMU experiences. The HMU staff physicians, descending from founder and mentor physicians Francis W. Peabody, Soma Weiss, and George R. Minot, were dedicated to the teaching, development, and leadership of its clinical and research trainees, whose confidence and dedication to patient care as a result of their mentorship led many to lifelong achievements as clinicians, teachers, and mentors. Their experience also led to a lifelong love of the HMU (despite its loss), camaraderie, happiness, and intense friendships with their associates.

The Impact of Market Orientation on Patient Safety Climate Among Hospital Nurses.

Science.gov (United States)

Weng, Rhay-Hung; Chen, Jung-Chien; Pong, Li-Jung; Chen, Li-Mei; Lin, Tzu-Chi

2016-03-01

Improving market orientation and patient safety have become the key concerns of nursing management. For nurses, establishing a patient safety climate is the key to enhancing nursing quality. This study explores how market orientation affects the climate of patient safety among hospital nurses. We proposed adopting a cross-sectional research design and using questionnaires to collect responses from nurses working in two Taiwanese hospitals. Three-hundred and forty-three valid samples were obtained. Multiple regression and path analyses were conducted to test the study. Market orientation was defined as the combination of customer orientation, competitor orientation, and interfunctional coordination. Customer orientation directly affects the climate of patient safety. Although the findings only supported Hypothesis 1, competitor orientation and interfunctional coordination positively affected the patient safety climate through the mediating effects of hospital support for staff. Health care managers could encourage nurses to adopt customer-oriented perspectives to enhance their nursing care. In addition, to enhance competitor orientation, interfunctional coordination, and the patient safety climate, hospital managers could strengthen their support for staff members. © The Author(s) 2014.

Medical Professionals Designing Hospital Management Models

DEFF Research Database (Denmark)

Byg, Vibeke

Health care administration in many OECD countries has undergone substantial changes in recent years as a consequence of NPM reforms, rising costs, the pace of technological innovation, heightened competition for patients and resources, quality of managed care and demographic shifts. Hospitals...... especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research literature on the topic of reforming hospital management models. Lacking from the literature, however......, is insight into how we can understand and explain how medical professionals adapt hospital management over time in relation to changing hospital management models that are global in their influence in hospital organizations. The aim of this dissertation is to understand and explain how medical professionals...

Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals.

Science.gov (United States)

Dubois, Carl-Ardy; D'amour, Danielle; Tchouaket, Eric; Clarke, Sean; Rivard, Michèle; Blais, Régis

2013-04-01

To examine the associations of four distinct nursing care organizational models with patient safety outcomes. Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events 'without major' consequences for patients and events 'with' consequences. After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.

Prevalence and pattern of congenital malformations among neonates in the neonatal unit of a teaching hospital

International Nuclear Information System (INIS)

Hussain, S.; Sabir, M.; Tarar, S. H.; Mushtaq, R.; Asghar, I.; Chattha, M. N.

2014-01-01

Objective: To determine the prevalence and pattern of congenital malformations among neonates in a teaching hospital. Methods: The prospective hospital-based study was conducted over a period of 18 months in the neonatal unit of Combined Military Hospital, Kharian, from September 2011 to February 2013. All neonates from newborn to 28 days of age admitted to the unit irrespective of their condition comprised the study population. Neonatal examination was done by the Registrar at the time of admission followed by neonatologist/paediatrician. Information regarding gender, weight, gestational age, mode of delivery, consanguinity, maternal age, antenatal visit record and family history were recorded on a predesigned proforma. After clinical examination, if required, relevant investigations like ultrasonography, radiology, echocardiography, laboratory and genetic studies were done to confirm diagnosis. Data was statistically analysed by using SPSS 20. Results: Out of 3,210 total admissions, 226 (7%) neonates were congenitally malformed. Of them, 130 (57.52 %) were male and 96 (42.47 %) females. Among different body systems affected, anomalies related to the central nervous system were 46(20.35%) musculoskeletal 42(18.58%), genitourinary 34 (15.04%), cardiovascular system 30 (13.27%), ear, eye, face, neck 27(11.94%), digestive system 19 (8.40%), syndromes and skin 14 (6.19%) each. Conclusion: Congenital Malformations are not rare in our community and central nervous system is the most commonly affected system. Healthcare managers must stress upon primary prevention in the form of vaccination, nutrition and drugs to decrease preventable share of congenital malformations. (author)

Twenty years of electroconvulsive therapy in a psychiatric unit at a university general hospital

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Amilton dos Santos Jr.

2013-01-01

Full Text Available Objective: To describe the sociodemographic and clinical profile of patients who underwent electroconvulsive therapy (ECT at a university general hospital. Method: In this retrospective study, records from all patients undergoing ECT between January 1988 and January 2008 at the psychiatric unit of the general hospital of Universidade Estadual de Campinas (UNICAMP were reviewed. Telephone contact was made with patients/relatives to collect follow-up data. Results: A total of 200 charts were reviewed. The majority of patients were women, with a mean age of 39 years, and history of psychiatric hospitalization. The main indications for ECT were depression and catatonia. Complications were observed in less than half of the cases, and most were temporary and not severe. There was a good psychiatric outcome for 89.7% of the patients, especially for catatonic patients (100%, p = 0.02. Thirty-four percent of the cases were later contacted by telephone calls, at a mean of 8.5 years between the procedure and the contact. Among these, three (1.5% reported persistent memory disorders and 73% considered ECT a good treatment. Conclusion: ECT has been performed according to international guidelines. In the vast majority of cases, undesirable effects were temporary and not severe. Response to ECT was positive in most cases, particularly in catatonic patients.

[Evolution and follow-up of hunger strikers: experience from an interregional hospital secured unit].

Science.gov (United States)

Dubois, F; Sudre, E; Porte, A; Bédry, R; Gromb, S

2011-11-01

A hunger strike is a voluntary fast, performed to protest publicly against an issue deemed unfair. In the case of French prisoners, hospitalization in an interregional hospital secured units (UHSI) may be necessary. A retrospective epidemiological study based on one UHSI medical records was performed on the period of May, 2006 to December, 2008, and focused on symptoms, outcomes and ethical problems encountered. Seven men and one woman with a mean age of 32.6 years were hospitalized in an UHSI, with nine episodes of hunger strike of a median duration of 57 days. Clinical symptoms began after two weeks of voluntary deprivation in the form of dizziness, weakness, muscle pain and headache. Laboratory tests showed hypoglycemia (hunger strikes. All hunger strikes were respected by medical staff, and treatment was based upon surveillance of symptoms, vitamin B and sweetened drinks administration and explanations of the clinical hazards on a daily basis. The special problem encountered in the medical management of these strikers was to convince them to accept treatments in order to avoid a coercive life-saving treatment as requested by French law. Copyright © 2011 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Smoking habits and attitudes toward tobacco bans among United Kingdom hospital staff and students.

Science.gov (United States)

Lewis, K E; Shin, D; Davies, G

2011-08-01

A group of United Kingdom (UK) hospitals. To estimate the current smoking habits of health care professionals (HCPs) in a country with active tobacco control measures, and to record their attitudes to national and hospital tobacco bans. A cross-sectional survey of 500 HCPs. HCPs reported a lower rate of current smoking (7%) than the general population (24%). Doctors (2.6%) and medical students (3.8%) were less likely to be current smokers than both nurses (8.7%) and allied health professionals (10.9%, P smoking in health care premises. A higher proportion of UK doctors (69%) than nurses (52%) favoured a complete ban (odds ratio 2.01, 95% confidence interval 1.14-3.56). Self-reported smoking patterns in UK health professionals are lower than previously and compared to other industrialised and developing countries. Support for bans is very high, but differences remain in behaviour and especially attitudes to local bans according to professional status, although this gap is also narrowing.

Pediatric vancomycin use in 421 hospitals in the United States, 2008.

Directory of Open Access Journals (Sweden)

Tamar Lasky

Full Text Available Recommendations to prevent the spread of vancomycin resistance have been in place since 1995 and include guidelines for inpatient pediatric use of vancomycin. The emergence of large databases allows us to describe variation in pediatric vancomycin across hospitals. We analyzed a database with hospitalizations for children under 18 at 421 hospitals in 2008.The Premier hospital 2008 database, consisting of records for 877,201 pediatric hospitalizations in 421 hospitals, was analyzed. Stratified analyses and logistic mixed effects models were used to calculate the probability of vancomycin use while considering random effects of hospital variation, hospital fixed effects and patient effects, and the hierarchical structure of the data. Most hospitals (221 had fewer than 10 hospitalizations with vancomycin use in the study period, and 47 hospitals reported no vancomycin use in 17,271 pediatric hospitalizations. At the other end of the continuum, 21 hospitals (5.6% of hospitals each had over 200 hospitalizations with vancomycin use, and together, accounted for more than 50% of the pediatric hospitalizations with vancomycin use. The mixed effects modeling showed hospital variation in the probability of vancomycin use that was statistically significant after controlling for teaching status, urban or rural location, size, region of the country, patient ethnic group, payor status, and APR-mortality and severity codes.The number and percentage of pediatric hospitalizations with vancomycin use varied greatly across hospitals and was not explained by hospital or patient characteristics in our logistic models. Public health efforts to reduce vancomycin use should be intensified at hospitals with highest use.

Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing.

Science.gov (United States)

McHugh, Matthew D; Berez, Julie; Small, Dylan S

2013-10-01

The Affordable Care Act's Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals' financial incentives with payers' and patients' quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses' efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients.

Costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home units in Spain.

Science.gov (United States)

González-Ramallo, V J; Mirón-Rubio, M; Mujal, A; Estrada, O; Forné, C; Aragón, B; Rivera, A J

2017-07-01

The aim of this study was to assess the direct healthcare costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home (HaH) units in Spain. An observational, multicentre, economic evaluation of retrospective cohorts was conducted. Patients were treated at home by the HaH units of three Spanish hospitals between January 2012 and December 2013. From the cost accounting of HaH OPAT (staff, pharmacy, transportation, diagnostic tests and structural), the cost of each outpatient course was obtained following a top-down strategy based on the use of resources. Costs associated with inpatient stay, if any, were estimated based on length of stay and ICD-9-CM diagnosis. There were 1324 HaH episodes in 1190 patients (median age 70 years). The median (interquartile range) stay at home was 10 days (7-15 days). Of the OPAT episodes, 91.5% resulted in cure or improvement on completion of intravenous therapy. The mean total cost of each infectious episode was €6707 [95% confidence interval (CI) €6189-7406]. The mean cost per OPAT episode was €1356 (95% CI €1247-1560), mainly distributed between healthcare staff costs (46%) and pharmacy costs (39%). The mean cost of inpatient hospitalisation of an infectious episode was €4357 (95% CI €3947-4977). The cost per day of inpatient hospitalisation was €519, whilst the cost per day of OPAT was €98, meaning a saving of 81%. This study shows that OPAT administered by HaH units resulted in lower costs compared with inpatient care in Spain. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

[Coordination between pharmaceutical services for integrated pharmacotherapy: the case of Catalonia].

Science.gov (United States)

Costa, Karen Sarmento; Goldbaum, Moisés; Guayta-Escolies, Rafel; Modamio, Pilar; Mariño, Eduardo Luis; Tolsá, José Luis Segú

2017-08-01

Pharmaceutical policies have been considered strategies to contribute to the guarantee of care coordination and clinical integration. This study sought to describe the pharmaceutical services developed at different levels of care in the health network in Catalonia, as well as to identify and analyze the mechanisms and instruments that act as facilitators and/or barriers to the coordination of pharmacotherapy. This is a descriptive study of 12 cases of hospital pharmacy services, primary care and community pharmacies. Advances related to the perception, formalization and clinical and assistance coordination of the pharmaceutical services were identified. However, weaknesses and potential improvements in coordination were observed. The conclusion drawn was that the different tools and instruments implemented appear to facilitate a greater possibility of integration between pharmaceutical services and the latter with the health services network to contribute to integrated pharmacotherapy.

Additional funding mechanisms for Public Hospitals in Greece: the case of Chania Mental Health Hospital.

Science.gov (United States)

Rentoumis, Anastasios; Mantzoufas, Nikolaos; Kouris, Gavriil; Golna, Christina; Souliotis, Kyriakos

2010-11-10

To investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental) health hospitals. We performed a financial analysis of the official 2008 data of a case - study hospital (Mental Health Hospital of Chania). We used a capital budgeting approach to investigate whether value is created for the public hospital by engaging its assets in a project for the development of a private renal dialysis Unit. The development of the private unit in hospital owned land is a good investment decision, as it generates high project Net Present Value and Internal Rate of Return. When the project commences generating operating cash flows, nearly €400.000 will be paid annually to the Mental Health Hospital of Chania as rent, thereby gradually decreasing the annual deficit of the hospital. Revenue generated from the long term lease of public hospital land is crucial to gradually eliminate hospital deficit. The Ministry of Health should encourage similar forms of Public Private Partnerships in order to ensure the sustainability of public (mental) hospitals.

Positive predictive value and impact of misdiagnosis of a heart failure diagnosis in administrative registers among patients admitted to a University Hospital cardiac care unit

DEFF Research Database (Denmark)

Mard, Shan; Nielsen, Finn Erland

2010-01-01

To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF.......To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF....

20 CFR 631.37 - Coordination activities.

Science.gov (United States)

2010-04-01

... TITLE III OF THE JOB TRAINING PARTNERSHIP ACT State Administration § 631.37 Coordination activities. (a..., including the formation of labor-management committees under this part, the dislocated worker unit shall... Training Act (29 U.S.C. 1721 note), title IV-C of the Job Training Partnership Act (29 U.S.C. 1721, et seq...

Changes in the conjunctival bacterial flora of patients hospitalized in an intensive care unit

Directory of Open Access Journals (Sweden)

Afsun Sahin

Full Text Available ABSTRACT Purpose: To identify the changes in aerobic conjunctival bacterial flora and to correlate culture results with physical health and the duration of patients' hospitalization in an intensive care unit (ICU. Methods: Patients hospitalized in the ICU were included in this study. Conjunctival cultures from all patients were obtained using a standard technique on days 1, 3, 7, and 14. Swabs were plated on nonselective (blood agar and enriched (chocolate agar media within one hour. Visible colonies were isolated, and standard microbiological techniques were used to identify the bacteria. The frequency, identity, and correlation of culture results with patients' physical findings and the duration of hospitalization were determined. Results: We obtained 478 cultures (day 1, 270; day 3, 156; day 7, 36; and day 14, 16 from 135 patients; 288 (60.2% cultures were positive, and 331 microorganisms were isolated. The most frequently isolated microorganism from the cultures was coagulase-negative Staphylococcus species (n=210/331, 63.5%, and the others were Corynebacterium diphtheriae (n=52/331, 15.7%, S. aureus (n=26/331, 7.9%, gram-negative bacilli other than Pseudomonas (n=14/331, 4.2%, Neisseria species (n=8/331, 2.4%, Pseudomonas aeruginosa (n=6/331, 1.8%, Haemophilus influenzae (n=7/331, 2.1%, Acinetobacter species (n=6/331, 1.8%, and Streptococcus species (n=2/331, 0.6%. The frequency of positive cultures significantly increased (p<0.03 with time. Conclusions: Prolonged hospitalization significantly predisposes to bacterial colonization. The colonization rate of S. aureus and Neisseria spp. increased significantly after one week.

[Cost of intensive care in a German hospital: cost-unit accounting based on the InEK matrix].

Science.gov (United States)

Martin, J; Neurohr, C; Bauer, M; Weiss, M; Schleppers, A

2008-05-01

The aim of this study was to determine the actual cost per intensive care unit (ICU) day in Germany based on routine data from an electronic patient data management system as well as analysis of cost-driving factors. A differentiation between days with and without mechanical ventilation was performed. On the ICU of a German focused-care hospital (896 beds, 12 anesthesiology ICU beds), cost per treatment day was calculated with or without mechanical ventilation from the perspective of the hospital. Costs were derived retrospectively with respect to the period between January and October 2006 by cost-unit accounting based on routine data collected from the ICU patients. Patients with a length of stay of at least 2 days on the ICU were included. Demographic, clinical and economical data were analyzed for patient characterization. Data of 407 patients (217 male and 190 female) were included in the analysis, of which 159 patients (100 male, 59 female) were completely or partially mechanically ventilated. The mean simplified acute physiology (SAPS) II score at the onset of ICU stay was 28.2. Average cost per ICU day was 1,265 EUR and costs for ICU days with and without mechanical ventilation amounted to 1,426 EUR and 1,145 EUR, respectively. Personnel costs (50%) showed the largest cost share followed by drugs plus medicinal products (18%) and infrastructure (16%). For the first time, a cost analysis of intensive care in Germany was performed with routine data based on the matrix of the institute for reimbursement in hospitals (InEK). The results revealed a higher resource use on the ICU than previously expected. The large share of personnel costs on the ICU was evident but is comparable to other medical departments in the hospital. The need for mechanical ventilation increases the daily costs of resources by approximately 25%.

Trends and characteristics of home and other out-of-hospital births in the United States, 1990-2006.

Science.gov (United States)

MacDorman, Marian F; Menacker, Fay; Declercq, Eugene

2010-03-03

This report examines trends and characteristics of out-of-hospital and home births in the United States. Descriptive tabulations of data are presented and interpreted. In 2006, there were 38,568 out-of-hospital births in the United States, including 24,970 home births and 10,781 births occurring in a freestanding birthing center. After a gradual decline from 1990 to 2004, the percentage of out-of-hospital births increased by 3% from 0.87% in 2004 to 0.90% in 2005 and 2006. A similar pattern was found for home births. After a gradual decline from 1990 to 2004, the percentage of home births increased by 5% to 0.59% in 2005 and remained steady in 2006. Compared with the U.S. average, home birth rates were higher for non-Hispanic white women, married women, women aged 25 and over, and women with several previous children. Home births were less likely than hospital births to be preterm, low birthweight, or multiple deliveries. The percentage of home births was 74% higher in rural counties of less than 100,000 population than in counties with a population size of 100,000 or more. The percentage of home births also varied widely by state; in Vermont and Montana more than 2% of births in 2005-2006 were home births, compared with less than 0.2% in Louisiana and Nebraska. About 61% of home births were delivered by midwives. Among midwife-delivered home births, one-fourth (27%) were delivered by certified nurse midwives, and nearly three-fourths (73%) were delivered by other midwives. Women may choose home birth for a variety of reasons, including a desire for a low-intervention birth in a familiar environment surrounded by family and friends and cultural or religious concerns. Lack of transportation in rural areas and cost factors may also play a role.

Hospital Variation in Early Tracheostomy in the United States: A Population-Based Study.

Science.gov (United States)

Mehta, Anuj B; Cooke, Colin R; Wiener, Renda Soylemez; Walkey, Allan J

2016-08-01

Controversy exists regarding perceived benefits of early tracheostomy to facilitate weaning among mechanically ventilated patients, potentially leading to significant practice-pattern variation with implications for outcomes and resource utilization. We sought to determine practice-pattern variation and outcomes associated with tracheostomy timing in the United States. In a retrospective cohort study, we identified mechanically ventilated patients with the most common causes of respiratory failure leading to tracheostomy: pneumonia/sepsis and trauma. "Early tracheostomy" was performed within the first week of mechanical ventilation. We determined between-hospital variation in early tracheostomy utilization and the association of early tracheostomy with patient outcomes using hierarchical regression. 2012 National Inpatient Sample. A total of 6,075 pneumonia/sepsis patients and 12,030 trauma patients with tracheostomy. None. Trauma patients were twice as likely as pneumonia/sepsis patients to receive early tracheostomy (44.5% vs 21.7%; p tracheostomy-to-total-tracheostomy ratios was associated with increased risk for tracheostomy among mechanically ventilated trauma patients (adjusted odds ratio = 1.04; 95% CI, 1.01-1.07) but not pneumonia/sepsis (adjusted odds ratio =1.00; 95% CI, 0.98-1.02). We observed greater between-hospital variation in early tracheostomy rates among trauma patients (21.9-81.9%) compared with pneumonia/sepsis (14.9-38.3%; p tracheostomy had fewer feeding tube procedures and higher odds of discharge home. Early tracheostomy is potentially overused among mechanically ventilated trauma patients, with nearly half of tracheostomies performed within the first week of mechanical ventilation and large unexplained hospital variation, without clear benefits. Future studies are needed to characterize potentially differential benefits for early tracheostomy between disease subgroups and to investigate factors driving hospital variation in tracheostomy

Pattern of Blood Stream Infections within Neonatal Intensive Care Unit, Suez Canal University Hospital, Ismailia, Egypt.

Science.gov (United States)

Kishk, Rania Mohammed; Mandour, Mohamed Fouad; Farghaly, Rasha Mohamed; Ibrahim, Ahmed; Nemr, Nader Attia

2014-01-01

Introduction. Blood stream infection (BSI) is a common problem of newborn in neonatal intensive care units (NICUs). Monitoring neonatal infections is increasingly regarded as an important contributor to safe and high-quality healthcare. It results in high mortality rate and serious complications. So, our aim was to determine the incidence and the pattern of BSIs in the NICU of Suez Canal University Hospital, Egypt, and to determine its impact on hospitalization, mortality, and morbidity. Methods. This study was a prospective one in which all neonates admitted to the NICUs in Suez Canal University hospital between January, 2013 and June 2013 were enrolled. Blood stream infections were monitored prospectively. The health care associated infection rate, mortality rate, causative organism, and risk factors were studied. Results. A total of 317 neonates were admitted to the NICU with a mortality rate of 36.0%. During this study period, 115/317 (36.3%) developed clinical signs of sepsis and were confirmed as BSIs by blood culture in only 90 neonates with 97 isolates. The total mean length of stay was significantly longer among infected than noninfected neonates (34.5 ± 18.3 and 10.8 ± 9.9 days, resp., P value Suez Canal University Hospital was relatively high with high mortality rate (36.0%).

Co-ordination Action on Ocean Energy (CA-OE)

DEFF Research Database (Denmark)

Tedd, James; Frigaard, Peter

In October 2004, the Co-ordination Action on Ocean Energy (CA-OE) was launched, co-financed by the European Commission, under the Renewable Energy Technologies priority within the 6th Framework programme, contract number 502701, chaired by Kim Nielsen, Rambøll, Denmark. The project involves 41...... partners. In general the public is not aware of the development of ocean energy and its exploitation. There is a need to make a united effort from the developers and research community to present the various principles and results in a coordinated manner with public appeal. The main objectives of the Co......-ordination Action on Ocean Energy are: To develop a common knowledge base necessary for coherent research and development policiesTo bring a co-ordinated approach within key areas of ocean energy research and development.To provide a forum for the longer term marketing of promising research developments...

Medicine and management: looking inside the box of changing hospital governance.

Science.gov (United States)

Kuhlmann, Ellen; Rangnitt, Ylva; von Knorring, Mia

2016-05-24

Health policy has strengthened the demand for coordination between clinicians and managers and introduced new medical manager roles in hospitals to better connect medicine and management. These developments have created a scholarly debate of concepts and an increasing 'hybridization' of tasks and roles, yet the organizational effects are not well researched. This research introduces a multi-level governance approach and aims to explore the organizational needs of doctors using Sweden as a case study. We apply an assessment framework focusing on macro-meso levels and managerial-professional modes of hospital governance (using document analysis, secondary sources, and expert information) and expand the analysis towards the micro-level. Qualitative explorative empirical material gathered in two different studies in Swedish hospitals serves to pilot research into actor-centred perceptions of clinical management from the viewpoint of the 'managed' and the 'managing' doctors in an organization. Sweden has developed a model of integrated hospital governance with complex structural coordination between medicine and management on the level of the organization. In terms of formal requirements, the professional background is less relevant for many management positions but in everyday work, medical managers are perceived primarily as colleagues and not as experts advising on managerial problems. The managers themselves seem to rely more on personal strength and medical knowledge than on management tools. Bringing doctors into management may hybridize formal roles and concepts, but it does not necessarily change the perceptions of doctors and improve managerial-professional coordination at the micro-level of the organization. This study brings gaps in hospital governance into view that may create organizational weaknesses and unmet management needs, thereby constraining more coordinated and integrated medical management.

75 FR 69573 - Export Enforcement Coordination Center

Science.gov (United States)

2010-11-15

... Export Enforcement Coordination Center By the authority vested in me as President by the Constitution and... enforcement of United States export control laws and enhanced intelligence exchange in support of such enforcement efforts, it is hereby ordered as follows: Section 1. Policy. Export controls are critical to...

Recent age- and gender-specific trends in mortality during stroke hospitalization in the United States.

Science.gov (United States)

Ovbiagele, Bruce; Markovic, Daniela; Towfighi, Amytis

2011-10-01

Advancements in diagnosis and treatment have resulted in better clinical outcomes after stroke; however, the influence of age and gender on recent trends in death during stroke hospitalization has not been specifically investigated. We assessed the impact of age and gender on nationwide patterns of in-hospital mortality after stroke. Data were obtained from all US states that contributed to the Nationwide Inpatient Sample. All patients admitted to hospitals between 1997 and 1998 (n=1 351 293) and 2005 and 2006 (n=1 202 449), with a discharge diagnosis of stroke (identified by the International Classification of Diseases, Ninth Revision procedure codes), were included. Time trends for in-hospital mortality after stroke were evaluated by gender and age group based on 10-year age increments (84) using multivariable logistic regression. Between 1997 and 2006, in-hospital mortality rates decreased across time in all sub-groups (all P84 years. In unadjusted analysis, men aged >84 years in 1997-1998 had poorer mortality outcomes than similarly aged women (odds ratio 0·93, 95% confidence interval=0·88-0·98). This disparity worsened by 2005-2006 (odds ratio 0·88, 95% confidence interval=0·84-0·93). After adjusting for confounders, compared with similarly aged women, the mortality outcomes among men aged >84 years were poorer in 1997-1998 (odds ratio 0·97, 95% confidence interval=0·92-1·02) and were poorer in 2005-2006 (odds ratio 0·92, 95% confidence interval=0·87-0·96), P=0·04, for gender × time trend. Over the last decade, in-hospital mortality rates after stroke in the United States have declined for every age/gender group, except men aged >84 years. Given the rapidly ageing US population, avenues for boosting in-hospital survival among very elderly men with stroke need to be explored. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

[Analysis on workload for hospital DOTS service].

Science.gov (United States)

Nagata, Yoko; Urakawa, Minako; Kobayashi, Noriko; Kato, Seiya

2014-04-01

A directly observed treatment short course (DOTS) trial was launched in Japan in the late 1990s and targeted patients with social depression at urban areas. Based on these findings, the Ministry of Health, Labour and Welfare established the Japanese DOTS Strategy in 2003, which is a comprehensive support service ensuring the adherence of tuberculosis patients to drug administration. DOTS services are initially provided at the hospital to patients with infectious tuberculosis who are hospitalized according to the Infectious Diseases Control Law. After being discharged from the hospital, the patients are referred to a public health center. However, a survey conducted in 2008 indicated that all the patients do not receive appropriate DOTS services at some hospitals. In the present study, we aimed to evaluate the protocols and workload of DOTS at hospitals that are actively involved in tuberculosis medical practice, including DOTS, to assess whether the hospital DOTS services were adequate. We reviewed a series of articles on hospital DOTS from a Japanese journal on nursing for tuberculosis patients and identified 25 activities regarding the hospital DOTS service. These 25 items were then classified into 3 categories: health education to patients, support for adherence, and coordination with the health center. In total, 20 hospitals that had > 20 authorized tuberculosis beds were selected--while considering the geographical balance, schedule of this survey, etc.--from 33 hospitals where an ex-trainee of the tuberculosis control expert training program in the Research Institute of Tuberculosis (RIT) was working and 20 hospitals that had collaborated with our previous survey on tuberculosis medical facilities. All the staff associated with the DOTS service were asked to record the total working time as well as the time spent for each activity. The data were collected and analyzed at the RIT. The working times for each activity of the DOTS service for nurses, pharmacists

Childhood motor coordination and adult schizophrenia spectrum disorders

DEFF Research Database (Denmark)

Schiffman, Jason; Sorensen, Holger J; Maeda, Justin

2009-01-01

in May 2007. RESULTS: Children who later developed a schizophrenia spectrum disorder (N=32) displayed significantly higher scores on a scale of coordination deficits compared with those who did not develop a mental illness in this category (N=133). CONCLUSIONS: Results from this study provide further......-13 years old. Adult diagnostic information was available for 244 members of the sample. Participants fell into three groups: children whose mothers or fathers had a psychiatric hospital diagnosis of schizophrenia (N=94); children who had at least one parent with a psychiatric record of hospitalization...... for a nonpsychotic disorder (N=84); and children with no parental records of psychiatric hospitalization (N=66). Psychiatric outcomes of the offspring were assessed through psychiatric interviews in 1992 when participants were 31-33 years of age, as well as through a scan of national psychiatric registers completed...

[How management teams use information and control systems to manage hospitals].

Science.gov (United States)

Naranjo-Gil, David

2016-01-01

To analyze the relationship between the characteristics of top management teams and the different use of management information and control systems (MICS) to implement policies that encourage cooperation and activity coordination in public hospitals. Data were collected through a questionnaire sent to each member of the top management teams of 231 Spanish public hospitals (chief executive director, medical director, nursing director and director for financial and social issues). A total of 457 valid questionnaires were returned, composing 86 full top management teams (37.23%). Top management team diversity was positively related to the interactive use of MICS. Management teams composed of younger members and members with longer service used MICS interactively. Top management teams with a predominantly clinical education and experience used MICS interactively, while top teams with a predominantly administrative education and experience used MICS diagnostically. The results also showed that cooperation and coordination in hospitals were positively related to the interactive use of MICS and were negatively related to the diagnostic use of MICS. The interactive use of MICS is an important mediator in the relationship between top team diversity and policies focused on hospital decentralization. Top management teams with diverse characteristics (e.g. age, length of service, education and experience) use management information interactively to enhance activity coordination and resource allocation in hospitals. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes.

Science.gov (United States)

Brown, Kyla N; Leigh, Jeanna Parsons; Kamran, Hasham; Bagshaw, Sean M; Fowler, Rob A; Dodek, Peter M; Turgeon, Alexis F; Forster, Alan J; Lamontagne, Francois; Soo, Andrea; Stelfox, Henry T

2018-01-28

Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks. This was a prospective cohort study in ten Canadian hospitals. We analyzed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward. The number, length, legibility and content of notes was counted and compared across care settings using mixed-effects linear regression models accounting for clustering within hospitals. Qualitative content analyses were conducted on a stratified random sample of 32 patients. A total of 447 patient medical records that included 7052 progress notes (mean 2.1 notes/patient/day 95% CI 1.9-2.3) were analyzed. Notes written by the ICU team were significantly longer than notes written by the ward team (mean lines of text 21 vs. 15, p notes; mean agreement of patient issues was 42% [95% CI 31-53%]. Qualitative analyses identified eight themes related to focus (central point - e.g., problem list), structure (organization, - e.g., note-taking style), and purpose (intention - e.g., documentation of patient course) of the notes that varied across clinical specialties and physician seniority. Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.

The Sociology of the Deceased Harvard Medical Unit at Boston City Hospital

Science.gov (United States)

Tishler, Peter V.

2015-01-01

Many graduates of the Harvard Medical Unit (HMU) at Boston City Hospital, in either the clinical training/residency program or the research program at the Thorndike Memorial Laboratory, contributed in major ways to the HMU and constantly relived their HMU experiences. The HMU staff physicians, descending from founder and mentor physicians Francis W. Peabody, Soma Weiss, and George R. Minot, were dedicated to the teaching, development, and leadership of its clinical and research trainees, whose confidence and dedication to patient care as a result of their mentorship led many to lifelong achievements as clinicians, teachers, and mentors. Their experience also led to a lifelong love of the HMU (despite its loss), camaraderie, happiness, and intense friendships with their associates. PMID:26604868

[Introduction of hospital information system and anesthesia information management system into the perianesthetic practice at Osaka City University Hospital].

Science.gov (United States)

Shimizu, Motoko; Tanaka, Katsuaki; Hagiwara, Chie; Ikenaga, Kazutake; Yoshioka, Miwako; Asada, Akira

2011-06-01

Recently, the hospital information systems (HIS) and anesthesia information management systems (AIMS) have been rapidly improved and have been introduced into the clinical practice in Japan drastically; however, few reports have detailed their influences on clinical practice. We here report our experience. We introduced HIS (EGMAIN-EX, Fujitsu Co., Ltd.) in our preoperative evaluation clinic and in the postoperative care unit. AIMS (ORSYS, Philips Electronics Japan) was introduced almost only to the intraoperative management. It became easy for us to acquire patient's information and to share it with the medical staffs in the other departments. However, we had to invest large human resources for the introduction and maintenance of the HIS and the AIMS. Though AIMS is more useful in anesthetic management than HIS, it seems to be more suitable for coordination with the medical staffs in the other departments to use HIS for perioperative management than to use AIMS.

Contraceptive choices among women attending the fertility research unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto

Directory of Open Access Journals (Sweden)

Constance E Shehu

2013-01-01

Full Text Available Background: One of the most sensitive and intimate decisions made by any individual or couple is that of fertility control . The knowledge of the factors which influence contraceptive choices may increase its acceptance and uptake. This study determines the choice and reason for contraception among new clients attending the Fertility Research Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Materials and Methods: In this prospective study a structured questionnaire was administered to 251 consecutive clients, who attended the Fertility Research Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto between 1 July 2008 and 31 December 2008. Results: Most (58.2% of the clients were between 21 and 30 years of age. Many (42.6% were grand multipara. Majority (76.9% of the clients were married. The main source of knowledge of contraception and referral (45.8% was the physicians. Child spacing (87.7% was the most common reason given for contraceptive use. Majority (55.8% of the clients chose Implanon and the least preferred method of contraception was the condom (2.0%. Conclusion: Our data shows that the most commonly chosen contraceptive method in the study population was the Implanon. Child spacing was the main reason for seeking family planning while the source of contraceptive knowledge was the physicians.

BACTERIAL AIR MICROFLORA ISOLATES IN TWO OBSTETRICS AND GYNAECOLOGY UNITS OF A HOSPITAL IN NIGERIA ARE POTENTIAL THREATS OF NOSOCOMIAL INFECTIONS.

OpenAIRE

2016-01-01

Ever since the history of infirmaries, nosocomial infections have been of grave threats to hospital set-ups, the deadliest being nosocomial respiratory tract infection (RTI). Nosocomial RTI was consequently investigated in two units of Obstetrics and Gynaecology department of a hospital in Nigeria using the and ldquo;Settling Plate and rdquo; technique and various culture media for bacteria isolation. Identification of the isolates was done on the basis of each isolate\\'s cultural, morpholog...

Group of family companions of hospitalized patients: an occupational therapy intervention strategy in a general hospital

Directory of Open Access Journals (Sweden)

Daniel Ferreira Dahdah

2013-08-01

Full Text Available There is a consensus in the literature that the company of a family member during the hospitalization period increases patient recovery. However, this can have some negative effects on the caregiver’s health. With the purpose of reducing these negatives effects, it is useful to let family members express themselves. The State Hospital of Ribeirão Preto created a Group of Family Companions coordinated by the Occupational Therapy and Social Service. This study focuses on the assistance offered in a general hospital to families that undergo the whole illness and hospitalization process of their family member, suffering the impacts of this process in their daily lives, and on the intervention of Occupational Therapy in these cases.

Does adoption of electronic health records improve organizational performances of hospital surgical units? Results from the French e-SI (PREPS-SIPS) study.

Science.gov (United States)

Plantier, Morgane; Havet, Nathalie; Durand, Thierry; Caquot, Nicolas; Amaz, Camille; Philip, Irène; Biron, Pierre; Perrier, Lionel

2017-02-01

Electronic health records (EHR) are increasingly being adopted by healthcare systems worldwide. In France, the "Hôpital numérique 2012-2017" program was implemented as part of a strategic plan to modernize health information technology (HIT), including promotion of widespread EHR use. With significant upfront investment costs as well as ongoing operational expenses, it is important to assess this system in terms of its ability to result in improvements in hospital performances. The aim of this study was to evaluate the impact of EHR use on the organizational performances of acute care hospital surgical units throughout France. This retrospective study was based on data derived from three national databases for year the 2012: IPAQSS (Indicators of improvement in the quality and the management of healthcare, "IPAQSS"), Hospi-Diag (French hospital performance indicators), and the national accreditation database. National data and methodological support were provided by the French Ministry of Health (DGOS) and the French National Authority for Health (HAS). Multivariate linear models were used to assess four organizational performance indicators: the occupancy rate of surgical inpatient beds, operating room utilization, the activity per surgeon, and the activity per both nurse anesthetist and anesthesiologist which were dependent variables. Several independent variables were taken into account, including the degree of EHR use. The models revealed a significant positive impact of EHR use on operating room utilization and bed occupancy rates for surgical inpatient units. No significant association was found between the activity per surgeon or the activity per nurse anesthetist and anesthesiologist with EHR use. All four organizational performance indicators were impacted by the type of hospital, the geographical region, and the severity of the pathologies. We were able to verify the purported potential benefits of EHR use on the organizational performances of surgical

Associations between perceived crisis mode work climate and poor information exchange within hospitals.

Science.gov (United States)

Patterson, Mark E; Bogart, Miller S; Starr, Kathleen R

2015-03-01

Because hospital units operating in crisis mode could create unsafe transitions of care due to miscommunication, our objective was to estimate associations between perceived crisis mode work climate and patient information exchange problems within hospitals. Self-reported data from 247,140 hospital staff members across 884 hospitals were obtained from the 2010 Hospital Survey on Patient Safety Culture. Presence of a crisis mode work climate was defined as respondents agreeing that the hospital unit in which they work tries to do too much too quickly. Presence of patient information exchange problems was defined as respondents agreeing that problems often occur in exchanging patient information across hospital units. Multivariable ordinal regressions estimated the likelihood of perceived problems in exchanging patient information across hospital units, controlling for perceived levels of crisis mode work climate, skill levels, work climate, and hospital infrastructure. Compared to those disagreeing, hospital staff members agreeing that the hospital unit in which they work tries to do too much too quickly were 1.6 times more likely to perceive problems in exchanging patient information across hospital units (odds ratio: 1.6, 95% confidence interval: 1.58-1.65). Hospital staff members perceiving crisis mode work climates within their hospital unit are more likely to perceive problems in exchanging patient information across units, underscoring the need to improve communication during transitions of care. © 2014 Society of Hospital Medicine.

Additional funding mechanisms for Public Hospitals in Greece: the case of Chania Mental Health Hospital

Directory of Open Access Journals (Sweden)

Golna Christina

2010-11-01

Full Text Available Abstract Objectives To investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental health hospitals. Methods We performed a financial analysis of the official 2008 data of a case - study hospital (Mental Health Hospital of Chania. We used a capital budgeting approach to investigate whether value is created for the public hospital by engaging its assets in a project for the development of a private renal dialysis Unit. Results The development of the private unit in hospital owned land is a good investment decision, as it generates high project Net Present Value and Internal Rate of Return. When the project commences generating operating cash flows, nearly €400.000 will be paid annually to the Mental Health Hospital of Chania as rent, thereby gradually decreasing the annual deficit of the hospital. Conclusions Revenue generated from the long term lease of public hospital land is crucial to gradually eliminate hospital deficit. The Ministry of Health should encourage similar forms of Public Private Partnerships in order to ensure the sustainability of public (mental hospitals.

Turnover of professional nurses at Mokopane Hospital in the Limpopo Province, South Africa: Experiences of nursing unit managers

Directory of Open Access Journals (Sweden)

Mogale L. Mmamma

2015-12-01

Full Text Available Background: Staff turnover of professional nurses remains a concern for public and private hospitals management because it has an impact on the morale of nurses and it may also lead to poor patient care. Objectives: The objectives of this study were to explore and describe the experiences of nursing unit managers with regard to the turnover of professional nurses who were under their supervision. Method: A qualitative, explorative, descriptive research design was used to determine the experiences of nursing unit managers related to the turnover of professional nurses. Data collection was done by using semi-structured one-to-one interviews with professional nurses .Two groups of participants were interviewed: Those working day duty (n = 9 and those working night duty (n = 3 who were at work on the anticipated days for data collection. Results: The findings revealed that every unit was experiencing a shortage of professional nurses, which caused other nurses to work overtime with an inevitable increase in workload. That led to tiredness, conflict amongst professional nurses, job dissatisfaction, and absenteeism which compromised nursing care. This resulted in patient dissatisfaction and sometimes led to deaths that could have been prevented. Conclusion: It is recommended that staff turnover should be addressed by the hospital top management implementing several strategies. For example, top management could ensure that staff members work in a healthy environment with resources that they need during the provision of care, address the effects of the staff turnover, support the staff members and refrain from putting pressure on nursing unit managers whilst they are attending to problems.

Turnover of professional nurses at Mokopane Hospital in the Limpopo Province, South Africa: Experiences of nursing unit managers.

Science.gov (United States)

Mmamma, Mogale L; Mothiba, Tebogo M; Nancy, Malema R

2015-12-17

Staff turnover of professional nurses remains a concern for public and private hospitals management because it has an impact on the morale of nurses and it may also lead to poor patient care. The objectives of this study were to explore and describe the experiences of nursing unit managers with regard to the turnover of professional nurses who were under their supervision. A qualitative, explorative, descriptive research design was used to determine the experiences of nursing unit managers related to the turnover of professional nurses. Data collection was done by using semi-structured one-to-one interviews with professional nurses .Two groups of participants were interviewed: Those working day duty (n = 9) and those working night duty (n = 3) who were at work on the anticipated days for data collection. The findings revealed that every unit was experiencing a shortage of professional nurses, which caused other nurses to work overtime with an inevitable increase in workload. That led to tiredness, conflict amongst professional nurses, job dissatisfaction, and absenteeism which compromised nursing care. This resulted in patient dissatisfaction and sometimes led to deaths that could have been prevented. It is recommended that staff turnover should be addressed by the hospital top management implementing several strategies. For example, top management could ensure that staff members work in a healthy environment with resources that they need during the provision of care, address the effects of the staff turnover, support the staff members and refrain from putting pressure on nursing unit managers whilst they are attending to problems.

Supporting Hospital Inter-departmental Coordination of work with Electronic Whiteboards

DEFF Research Database (Denmark)

Lassen, Jens Vejrup; Simonsen, Jesper

We present an ethnographic study of the organizational aspects of the use of an electronic whiteboard (EW) system implemented in a Danish hospital located in Nykøbing Falster (NFH) . The EW system had originally been developed for the emergency department (ED), but had later been extended to the ...

Performance of risk-adjusted control charts to monitor in-hospital mortality of intensive care unit patients: A simulation study

NARCIS (Netherlands)

Koetsier, Antonie; de Keizer, Nicolette F.; de Jonge, Evert; Cook, David A.; Peek, Niels

2012-01-01

Objectives: Increases in case-mix adjusted mortality may be indications of decreasing quality of care. Risk-adjusted control charts can be used for in-hospital mortality monitoring in intensive care units by issuing a warning signal when there are more deaths than expected. The aim of this study was

Quality of stroke care at an Irish Regional General Hospital and Stroke Rehabilitation Unit.

LENUS (Irish Health Repository)

Walsh, T

2012-01-31

BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.

Prehospital and hospital delays after stroke onset--United States, 2005-2006.

Science.gov (United States)

2007-05-18

Each year approximately 700,000 persons in the United States have a new or recurrent stroke; of these persons, 15%-30% become permanently disabled, and 20% require institutionalization during the first 3 months after the stroke. The severity of stroke-related disability can be reduced if timely and appropriate treatment is received. Patients with ischemic stroke may be eligible for treatment with intravenous thrombolytic (i.e., tissue plasminogen activator [t-PA]) therapy within 3 hours of symptom onset. Receipt of this treatment usually requires patients to recognize stroke symptoms and receive prompt transport to a hospital emergency department (ED), where timely evaluation and brain imaging (i.e., computed tomography or magnetic resonance imaging) can take place. For patients eligible for t-PA, evidence suggests that the earlier patients are treated after the onset of symptoms the greater the likelihood of a more favorable outcome. In 2001, Congress established the Paul Coverdell National Acute Stroke Registry to measure and track the quality of care provided to acute stroke patients. To assess prehospital delays from onset of stroke symptoms to ED arrival and hospital delays from ED arrival to receipt of brain imaging, CDC analyzed data from the four states participating in the national stroke registry. The results of that analysis indicated that fewer than half (48.0%) of stroke patients for whom onset data were available arrived at the ED within 2 hours of symptom onset, and prehospital delays were shorter for persons transported to the ED by ambulance (i.e., emergency medical services) than for persons who did not receive ambulance transport. The interval between ED arrival and brain imaging also was significantly reduced for those arriving by ambulance. More extensive public education is needed regarding early recognition of stroke and the urgency of telephoning 9-1-1 to receive ambulance transport. Shortening prehospital and hospital delays will increase

The impact of pediatric obesity on hospitalized children with lower respiratory tract infections in the United States.

Science.gov (United States)

Okubo, Yusuke; Nochioka, Kotaro; Testa, Marcia A

2018-04-01

Obesity is the most common public health problem and is a clinically complicating risk factor among hospitalized children. The impact of pediatric obesity on the severity and morbidity of lower respiratory tract infections remains unclear. We conducted a retrospective cohort study of bronchitis and pneumonia among children aged 2-20 years using hospital discharge records. The data were obtained from the Kid's Inpatient Database in 2003, 2006, 2009, and 2012, and were weighted to estimate the number of hospitalizations in the United States. We used the International Classification of Diseases, Ninth Revision, Clinical Modification code (278.0×) to classify whether the patient was obese or not. We investigated the associations between pediatric obesity and use of mechanical ventilation using multivariable logistic regression model. In addition, we ascertained the relationships between pediatric obesity, comorbid blood stream infections, mean healthcare cost, and length of hospital stay. We estimated a total of 133 602 hospitalizations with pneumonia and bronchitis among children aged between 2 and 20 years. Obesity was significantly associated with use of mechanical ventilation (adjusted OR 2.90, 95% CI 2.15-3.90), comorbid bacteremia or septicemia (adjusted OR 1.58, 95% CI 1.03-2.44), elevated healthcare costs (adjusted difference $383, 95%CI $276-$476), and prolonged length of hospital stay (difference 0.32 days, 95%CI 0.23-0.40 days), after adjusting for patient and hospital characteristics using multivariable logistic regression models. Pediatric obesity is an independent risk factor for severity and morbidity among pediatric patients with lower respiratory tract infections. These findings suggest the importance of obesity prevention for pediatric populations. © 2017 John Wiley & Sons Ltd.

An outbreak of Serratia marcescens infection in a special-care baby unit of a community hospital in United Arab Emirates: the importance of the air conditioner duct as a nosocomial reservoir.

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Uduman, S A; Farrukh, A S; Nath, K N R; Zuhair, M Y H; Ifrah, A; Khawla, A D; Sunita, P

2002-11-01

We report an outbreak of Serratia marcescens infection in a special-care baby unit (SCBU) of a university-affiliated community hospital in the United Arab Emirates. The outbreak involved 36 infants and lasted for 20 weeks. Seven of the colonized infants developed invasive illnesses in the form of bacteraemia (four cases), bacteraemic meningitis (two) and clinical sepsis (one). Three other term infants had purulent conjunctivitis. There were five deaths with an overall mortality of 14%. S. marcescens was cultured from airflow samples from the air conditioning (AC) which was the reservoir of infection in this outbreak. Elimination of the nosocomial source and outbreak containment were eventually achieved by specialized robotic cleaning of the entire AC duct system of the SCBU. Strict adherence to the infection control policies was reinforced to prevent transmission of cross-infection. Copyright 2002 The Hospital Infection Society

Comparing The Profile Of Chemical Dependents Hospitalized At A Chemical Dependency Unit In Porto Alegre/RS In 2002 And 2006

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Leonel Tesch Formiga

2009-09-01

Full Text Available Background: Studies on the use of psychoactive substances have been focused on identifying risk and protective factors related to this behavior based on the definition of the epidemiologic profile of such populations. The objective of the present study is to compare the profiles of samples of chemical dependent patients hospitalized at a Detoxification Unit (DU in Porto Alegre, state of Rio Grande do Sul, Brazil, in 2002 with the patients hospitalized in 2006. Method: This is a cross-sectional, descriptive and retrospective study. The research was carried out using medical records. We used a convenience sample divided into two groups: 1 all patients hospitalized at the DU from September to December 2006 (n=118; 2 all patients hospitalized at the same Unit from April to May 2002 (n=202. Results: There was a significant increase in the use of marijuana, inhaled cocaine and crack and a decrease in the use of solvents; there was no change concerning the use of alcohol and injected cocaine. It is important to mention the increase in the prevalence of crack users, which increased from 21.8% to 61.9%. There was a decrease of almost 30% in the number of alcoholics who did not use other psychoactive substances except for tobacco in the 2006 sample. Psychiatric comorbidities were quite prevalent, and we can highlight a significant increase in the number of patients with personality disorders. Conclusion: We conclude that the profile of chemical dependents hospitalized for detoxification is changing; therefore, it is important that new therapeutic strategies are planned in order to better assist this population.

Prevalence, characteristics and risk factors of pressure ulcers in public and private hospitals care units and nursing homes in France.

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Barrois, Brigitte; Colin, Denis; Allaert, François-André

2018-02-01

The aim of this study conducted in 2014 was to describe the prevalence of pressure ulcers in different types of French hospital unit at the national level to compare them with data from the 1994 and 2004 study. This cross-sectional study was conducted over a single day. All care units were invited to participate by drawing lots stratified by region in successive waves until 1,200 agreements were obtained. Lots were drawn for towns with more than 10,000 inhabitants. All public- and private-sector hospital facilities in each town drawn by lot were invited to participate in the survey. 776 hospital services throughout France took part and accommodated 21,538 patients: 12,752 women (59.2%) and 8,786 men (40.8%). Of these patients, 1,753 (8.1%; IC95% = 7.7; 8.5) had pressure ulcers. The pressure-ulcer rate was 7.8% (IC95% = [7.3; 8.3] (n = 997)) for hospitalized women and 8.6% (IC95% = [8.0; 9.2] (n = 756)) for men (p = 0.0381). The 8.1% level reported in 2014 therefore points to a reduction in pressure-ulcer prevalence; 8.6% in 1994 and 8.9% in 2004. The actions performed daily by healthcare professionals to prevent pressure ulcers, supported by research and training programs, including those by PERSE, are having a real impact over time.

Promoting coordination in Norwegian health care

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Tor I. Romøren

2011-10-01

Full Text Available   Introduction: The Norwegian health care system is well organized within its two main sectors - primary health and long term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures.Policy practice: Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term "Coordination Reform". These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented.Discussion: The article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden.

Nurses Caring and Patient’s Satisfaction at Internal Medicine Unit of Dr. Soetomo Hospital, Surabaya

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Nur Hasanah

2017-06-01

Full Text Available Patient’s satisfaction is crucial for a hospital, and nursing as an integral part of health care in hospitals also determine the level of patient’s satisfaction. At the order of the clinic nurses deal directly with the public as their client. A direct relationship between the nurse and the client need a behaviour that can be accepted by the whole society. Caring as one of the basic values of nursing, is a phenomenon that affects the way to think, feel and relate to others. This study aimed to analyze the relationship between the nurses caring with patient’s satisfaction by using cross sectional design. Population of this study was patients who were treated in Internal Medicine Unit of Dr. Soetomo Hospital in November 2015. The sample size was 75 people, who were selected  by simple random sampling technique. Data collection was done by filling out the questionnaire, then anayzed by using Chi-square test. Results showed 57.33% of the patients gave judgment of satisfactory to nurse caring behaviour and 42.67% gave a good assessment. 62.67% of the patients said they were satisfied with the caring services. There was a significant relationship between nurses caring with patient satisfaction.

Frequency and causes of discharges against medical advice from hospital cardiac care units of East Azerbaijan, Iran

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Saber Azami-Aghdash

2016-05-01

Full Text Available Introduction: Discharges against medical advice (DAMA is a common problem of hospitals that could lead increasing the complications and readmission. For this, the aim of this study is to investigate the frequency and effective factors of DAMA in patients with cardiovascular disease in hospital cardiac care units (CCU of East Azerbaijan, Iran. Methods: This cross-sectional study was performed, in 2013, in Tabriz University of Medical Sciences, Iran. Required information was extracted using valid and reliable forms of medical records of 2000 patients admitted to 20 CCU in 17 hospitals of East Azerbaijan, by two trained interviewers. Data analysis was performed using descriptive statistics (frequency, mean, percentage, etc., chi-square test, and linear regression model using the SPSS software. The tests were considered a statistically significant level of 0.05%. Results: The results showed that 272 patients (13.6% were DAMA from the hospital. The frequency of DAMA was in men more than women. The most frequency of discharge has occurred in the range of 40-80 years old. Results of linear regression showed that there was a significant correlation between DAMA and type of insurance, history of myocardial infarction (MI, comorbid disease, cause of hospitalization, location of hospital, and staying < 48 hours (P < 0.050. Conclusion: In this study, the rate of DAMA was relatively high compared with similar studies and it is considered as a concern problem that should study the reasons and its effective factors and plan effective interventions to reduce them.

Clinic, hospital try to fulfill vision of coordinated care with joint venture company.

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2000-09-01

Coordinated Care Services Inc., a joint venture of Carle Foundation and Carle Clinic Association in Urbana, IL, shares its initial successes and ongoing challenges after one year of operation. The biggest barrier to further improvements remains insufficient information management capability.

The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units.

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Vogus, Timothy J; Sutcliffe, Kathleen M

2011-01-01

Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on the joint benefits of safety organizing and other contextual factors that help foster safety. Although we know that organizational practices often have more powerful effects when combined with other mutually reinforcing practices, little research exists on the joint benefits of safety organizing and other contextual factors believed to foster safety. Specifically, we examined the benefits of bundling safety organizing with leadership (trust in manager) and design (use of care pathways) factors on reported medication errors. A total of 1033 RNs and 78 nurse managers in 78 emergency, internal medicine, intensive care, and surgery nursing units in 10 acute-care hospitals in Indiana, Iowa, Maryland, Michigan, and Ohio who completed questionnaires between December 2003 and June 2004. Cross-sectional analysis of medication errors reported to the hospital incident reporting system for the 6 months after the administration of the survey linked to survey data on safety organizing, trust in manager, use of care pathways, and RN characteristics and staffing. Multilevel Poisson regression analyses indicated that the benefits of safety organizing on reported medication errors were amplified when paired with high levels of trust in manager or the use of care pathways. Safety organizing plays a key role in improving patient safety on hospital nursing units especially when bundled with other organizational components of a safety supportive system.

Description of hot debriefings after in-hospital cardiac arrests in an international pediatric quality improvement collaborative.

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Sweberg, Todd; Sen, Anita I; Mullan, Paul C; Cheng, Adam; Knight, Lynda; Del Castillo, Jimena; Ikeyama, Takanari; Seshadri, Roopa; Hazinski, Mary Fran; Raymond, Tia; Niles, Dana E; Nadkarni, Vinay; Wolfe, Heather

2018-05-22

The American Heart Association recommends debriefing after attempted resuscitation from in-hospital cardiac arrest (IHCA) to improve resuscitation quality and outcomes. This is the first published study detailing the utilization, process and content of hot debriefings after pediatric IHCA. Using prospective data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q), we analyzed data from 227 arrests occurring between February 1, 2016, and August 31, 2017. Hot debriefings, defined as occurring within minutes to hours of IHCA, were evaluated using a modified Team Emergency Assessment Measure framework for qualitative content analysis of debriefing comments. Hot debriefings were performed following 108 of 227 IHCAs (47%). The median interval to debriefing was 130 min (Interquartile range [IQR] 45, 270). Median debriefing duration was 15 min (IQR 10, 20). Physicians facilitated 95% of debriefings, with a median of 9 participants (IQR 7, 11). After multivariate analysis, accounting for hospital site, debriefing frequency was not associated with patient age, gender, race, illness category or unit type. The most frequent positive (plus) comments involved cooperation/coordination (60%), communication (47%) and clinical standards (41%). The most frequent negative (delta) comments involved equipment (46%), cooperation/coordination (45%), and clinical standards (36%). Approximately half of pediatric IHCAs were followed by hot debriefings. Hot debriefings were multi-disciplinary, timely, and often addressed issues of team cooperation/coordination, communication, clinical standards, and equipment. Additional studies are warranted to identify barriers to hot debriefings and to evaluate the impact of these debriefings on patient outcomes. Copyright © 2018 Elsevier B.V. All rights reserved.

Disparities in Chronic Conditions Among Women Hospitalized for Delivery in the United States, 2005-2014.

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Admon, Lindsay K; Winkelman, Tyler N A; Moniz, Michelle H; Davis, Matthew M; Heisler, Michele; Dalton, Vanessa K

2017-12-01

To estimate trends in the prevalence and socioeconomic distribution of chronic conditions among women hospitalized for obstetric delivery in the United States. A retrospective, serial cross-sectional analysis was conducted using 2005-2014 data from the National Inpatient Sample. We estimated the prevalence of eight common, chronic conditions, each associated with obstetric morbidity and mortality, among all childbearing women and then across socioeconomic predictors of obstetric outcomes. Differences over time were measured and compared across rural and urban residence, income, and payer subgroups for each condition. We identified 8,193,707 delivery hospitalizations, representing 39,273,417 delivery hospitalizations occurring nationally between 2005 and 2014. Identification of at least one chronic condition increased significantly between 2005-2006 and 2013-2014 (66.9 per 1,000 delivery hospitalizations in 2005-2006 compared with 91.8 per 1,000 delivery hospitalizations in 2013-2014). The prevalence of multiple chronic conditions also increased during the study period, from 4.7 (95% CI 4.2-5.2) to 8.1 (95% CI 7.8-8.4) per 1,000 delivery hospitalizations between 2005-2006 and 2013-2014. Chronic respiratory disease, chronic hypertension, substance use disorders, and pre-existing diabetes were the disorders with the greatest increases in prevalence over time. Increasing disparities over time were identified across all socioeconomic subgroups analyzed including rural compared with urban residence, income, and payer. Key areas of concern include the rate at which substance use disorders rose among rural women and the disproportionate burden of each condition among women from the lowest income communities and among women with Medicaid as their primary payer. Between 2005-2006 and 2013-2014, the prevalence of chronic conditions increased across all segments of the childbearing population. Widening disparities were identified over time with key areas of concern including

Improving operating room coordination: communication pattern assessment.

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Moss, Jacqueline; Xiao, Yan

2004-02-01

To capture communication patterns in operating room (OR) management to characterize the information needs of OR coordination. Technological applications can be used to change system processes to improve communication and information access, thereby decreasing errors and adverse events. The successful design of such applications relies on an understanding of communication patterns among healthcare professionals. Charge nurse communication was observed and documented at four OR suites at three tertiary hospitals. The data collection tool allowed rapid coding of communication patterns in terms of duration, mode, target person, and the purpose of each communication episode. Most (69.24%) of the 2074 communication episodes observed occurred face to face. Coordinating equipment was the most frequently occurring purpose of communication (38.7%) in all suites. The frequency of other purposes in decreasing order were coordinating patient preparedness (25.7%), staffing (18.8%), room assignment (10.7%), and scheduling and rescheduling surgery (6.2%). The results of this study suggest that automating aspects of preparing patients for surgery and surgical equipment management has the potential to reduce information exchange, decreasing interruptions to clinicians and diminishing the possibility of adverse events in the clinical setting.

Uranium chemistry research unit

International Nuclear Information System (INIS)

Anon.

1978-01-01

The initial field of research of this Unit, established in 1973, was the basic co-ordination chemistry of uranium, thorium, copper, cobalt and nickel. Subsequently the interest of the Unit extended to extractive metallurgy relating to these metals. Under the term 'co-ordination chemistry' is understood the interaction of the central transition metal ion with surrounding atoms in its immediate vicinity (within bonding distance) and the influence they have on each other - for example, structural studies for determining the number and arrangement of co-ordinated atoms and spectrophotometric studies to establish how the f electron energy levels of uranium are influenced by the environment. New types of uranium compounds have been synthesized and studied, and the behaviour of uranium ions in non-aqueous systems has also received attention. This work can be applied to the development and study of extractants and new extractive processes for uranium

UnitedHealth Group

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UnitedHealth Group provides accessible and affordable services, improved quality of care, coordinated health care efforts, and a supportive environment for shared decision making between patients and their physicians.

[Cardiorenal syndrome type 1 in the intensive coronary care unit of the Hospital Nacional Arzobispo Loayza].

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Preza, Paul M; Hurtado, Abdías; Armas, Victoria; Cárcamo, César P

2015-01-01

This study sought to evaluate the incidence of cardiorenal syndrome (CRS) type 1 in a coronary care unit and its association with hospital mortality within 30 days of admission, as well as other epidemiological characteristics. The medical records of all the patients who were hospitalized with the diagnosis of acute heart failure in a 4-year period were reviewed. CRS type 1 was characterized by the presence of acute heart failure and an elevation of serum creatinine ≥0.3mg/dL in comparison to the baseline creatinine calculated by the MDRD75 equation and/or the elevation of ≥50% of the admission serum creatinine within a 48 h period. The incidence of CRS type 1 was 27.87%, 95% CI: 20.13-36.71 (34 of 122). There was a higher frequency of CRS type 1 in those patients who were admitted with the diagnosis of cardiogenic shock (adjusted RR 2.02, 95% CI: 1.20-3.93, p=0.0378) and in those with higher hemoglobin levels (p=0.0412). The CRS type 1 was associated with an increase of 30-day mortality (HR: 4.11, 95% CI: 1.20-14.09, p=0.0244). The incidence of CRS type 1 in the coronary care unit found in our study is similar to those found in foreign studies. The history of stroke and the higher values of hemoglobin were associated with a higher incidence of cardiorenal syndrome type 1. Patients with CRS type 1 had a higher hospital mortality within 30 days of admission. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

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

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

2012-08-01

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

Interventions to Improve Safe Sleep Among Hospitalized Infants at Eight Children's Hospitals.

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Kuhlmann, Stephanie; Ahlers-Schmidt, Carolyn R; Lukasiewicz, Gloria; Truong, Therese Macasiray

2016-02-01

Within hospital pediatric units, there is a lack of consistent application or modeling of the American Academy of Pediatrics recommendations for safe infant sleep. The purpose of this study was to improve safe sleep practices for infants in nonneonatal pediatric units with implementation of specific interventions. This multi-institutional study was conducted by using baseline observations collected for sleep location, position, and environment (collectively, "safe sleep") of infants admitted to pediatric units. Interventions consisted of: (1) staff education, including a commitment to promote safe sleep; (2) implementing site-generated safe sleep policies; (3) designating supply storage in patient rooms; and/or (4) caregiver education. Postintervention observations of safe sleep were collected. Eight hospitals participated from the Inpatient FOCUS Group of the Children's Hospital Association. Each site received institutional review board approval/exemption. Safe sleep was observed for 4.9% of 264 infants at baseline and 31.2% of 234 infants postintervention (Ppresent in 77% of cribs at baseline and 44% postintervention. However, the mean number of unsafe items observed in each sleeping environment was reduced by >50% (P=.001). Implementation of site-specific interventions seems to improve overall safe sleep in inpatient pediatric units, although continued improvement is needed. Specifically, extra items are persistently left in the sleeping environment. Moving forward, hospitals should evaluate their compliance with American Academy of Pediatrics recommendations and embrace initiatives to improve modeling of safe sleep. Copyright © 2016 by the American Academy of Pediatrics.

[Quality Manager 2.0 in hospitals: A practical guidance for executive managers, medical directors, senior consultants, nurse managers and practicing quality managers].

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Pilz, Stefan; Hülsmann, Sylvia; Michallik, Stefan; Rimbach-Schurig, Monika; Schollmeier, Margarita; Sommerhoff, Benedikt; Weßling, Adelheid

2013-01-01

Aiming at the development of perspectives and recommendations for modern quality management in health services the GQMG conducted a study on the role and self-conception of quality managers in hospitals. It seems obvious that the effectiveness of quality management clearly depends on the executive board's skilful installation of quality management, their support of quality managers and, particularly in larger-sized institutions on the coordination of staff units and cross-sectional functions.(As supplied by author). Copyright © 2013. Published by Elsevier GmbH.

[Medullary carcinoma experience in breast oncology unit of Hospital Juarez Mexico].

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Jiménez-Villanueva, Xicoténcatl; Hernández-Rubio, Angela; García-Rodríguez, Francisco Mario; García, Rebeca Gil; Moreno-Eutimio, Mario; Herrera-Torre, Analy

2014-01-01

Medullary breast cancer is a rare type, considered of good prognosis. To know the epidemiological and clinical characteristics of the population attended in the Hospital Juarez de Mexico, to know if they are alike to described worldwide and if the treatments proposed internationally are applicable for this hospitable center. We performed a retrospective analysis. Reviewing the records with histopathologic diagnosis of medullary breast cancer from February 1993 to February 2011. Finding 41 patients in the oncology unit of the institution. We report an incidence of 3.04%, originating in 11 Mexican States, with a low to middle socioeconomic level in 39.02%. The average age at the time of diagnosis was 50 years. No family history was reported but some patients had medical history for type 2 diabetes, hypertension and previous breast cancer. 63.41% were menopausal. The average clinical size of the tumor was 58 mm. The 63% of the cases were located in the left breast. The 53.1% were clinical stages I and II, 46.3% were clinical stages III and in 9.6% of the cases primary tumor could not be assessed. Only 47% of the patients had positive axillary lynph nodes at diagnosis. The inmunohistochemestry was only reported in 14 of the 41 patients, according to the molecular classification of breast cancer: 8 were triple negative, 2 luminal A, 1 luminal B and 3 Her2neu. The Mexican population presents epidemiological and clinical characteristics similar to those patients described in other studies worldwide.

Hospital safety climate surveys: measurement issues.

Science.gov (United States)

Jackson, Jeanette; Sarac, Cakil; Flin, Rhona

2010-12-01

Organizational safety culture relates to behavioural norms in the workplace and is usually assessed by safety climate surveys. These can be a diagnostic indicator on the state of safety in a hospital. This review examines recent studies using staff surveys of hospital safety climate, focussing on measurement issues. Four questionnaires (hospital survey on patient safety culture, safety attitudes questionnaire, patient safety climate in healthcare organizations, hospital safety climate scale), with acceptable psychometric properties, are now applied across countries and clinical settings. Comparisons for benchmarking must be made with caution in case of questionnaire modifications. Increasing attention is being paid to the unit and hospital level wherein distinct cultures may be located, as well as to associated measurement and study design issues. Predictive validity of safety climate is tested against safety behaviours/outcomes, with some relationships reported, although effects may be specific to professional groups/units. Few studies test the role of intervening variables that could influence the effect of climate on outcomes. Hospital climate studies are becoming a key component of healthcare safety management systems. Large datasets have established more reliable instruments that allow a more focussed investigation of the role of culture in the improvement and maintenance of staff's safety perceptions within units, as well as within hospitals.

Reasons that lead mothers looking for a pre-hospital unit as a first option for attendance - Sorocaba/SP

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Thais Helena Campos

2015-06-01

Full Text Available Objective: to verify the reasons lead mothers to seek the Pre- hospital Unit of Sorocaba Western Zone (UPH-ZO as first option of attendance and quantify the inappropriate motives for this search. Method: it is an exploratory study with quantitative analyze performed at UPH-ZO through the emergence bulletin (BE and the mothers or guardians interview. Results: nine hundred mothers and guardians were interviewed. Four reasons prevailed as motivation for search the UPH-ZO by first option: better and quick resolution with technological resources provided; restrict period for attendance at the Basic Health Unit (UBS; delay for appointment in the UBS; lack of Pediatrician in this Unit. The prevalent diagnostic hypothesis in the sample was acute gastroenterocolitis and superior aerial way infections. Conclusions: for the 68.8% of the sample the looking for UPH-ZO was adequate; 31.2% referred reasons that could be solved at the UBS. This Unit must just be the entrance for the users of the Health Unique System (SUS.

Differences in Hospital Managers’, Unit Managers’, and Health Care Workers’ Perceptions of the Safety Climate for Respiratory Protection

Science.gov (United States)

Peterson, Kristina; Rogers, Bonnie M. E.; Brosseau, Lisa M.; Payne, Julianne; Cooney, Jennifer; Joe, Lauren; Novak, Debra

2017-01-01

This article compares hospital managers’ (HM), unit managers’ (UM), and health care workers’ (HCW) perceptions of respiratory protection safety climate in acute care hospitals. The article is based on survey responses from 215 HMs, 245 UMs, and 1,105 HCWs employed by 98 acute care hospitals in six states. Ten survey questions assessed five of the key dimensions of safety climate commonly identified in the literature: managerial commitment to safety, management feedback on safety procedures, coworkers’ safety norms, worker involvement, and worker safety training. Clinically and statistically significant differences were found across the three respondent types. HCWs had less positive perceptions of management commitment, worker involvement, and safety training aspects of safety climate than HMs and UMs. UMs had more positive perceptions of management’s supervision of HCWs’ respiratory protection practices. Implications for practice improvements indicate the need for frontline HCWs’ inclusion in efforts to reduce safety climate barriers and better support effective respiratory protection programs and daily health protection practices. PMID:27056750

Differences in Hospital Managers', Unit Managers', and Health Care Workers' Perceptions of the Safety Climate for Respiratory Protection.

Science.gov (United States)

Peterson, Kristina; Rogers, Bonnie M E; Brosseau, Lisa M; Payne, Julianne; Cooney, Jennifer; Joe, Lauren; Novak, Debra

2016-07-01

This article compares hospital managers' (HM), unit managers' (UM), and health care workers' (HCW) perceptions of respiratory protection safety climate in acute care hospitals. The article is based on survey responses from 215 HMs, 245 UMs, and 1,105 HCWs employed by 98 acute care hospitals in six states. Ten survey questions assessed five of the key dimensions of safety climate commonly identified in the literature: managerial commitment to safety, management feedback on safety procedures, coworkers' safety norms, worker involvement, and worker safety training. Clinically and statistically significant differences were found across the three respondent types. HCWs had less positive perceptions of management commitment, worker involvement, and safety training aspects of safety climate than HMs and UMs. UMs had more positive perceptions of management's supervision of HCWs' respiratory protection practices. Implications for practice improvements indicate the need for frontline HCWs' inclusion in efforts to reduce safety climate barriers and better support effective respiratory protection programs and daily health protection practices. © 2016 The Author(s).

Formulating Public Policy in Croatia and the Problem of Policy Coordination

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Zdravko Petak

2008-01-01

Full Text Available The paper explores the role of politicians and civil servants in the process of horizontal and vertical policy coordination, with a special emphasis on the specific context of Croatia. Starting from Guy Peters’ typology, which distinguishes four distinct types of coordination, ranging from more simple to more complex ones – negative coordination, positive coordination, policy integration and development of strategies for government, the author stresses that the Croatian case is connected with failure in achieving all types of coordination. One of the reasons for such a situation lies in a low level of applying classical policy analysis in the Croatian public administration system. A direct consequence of this is the existence of the system of coordination based on ad hoc assessment of proposed policies, and not on standard policy analysis tools. Therefore, in the lack of central government policy unit the prominent role in such a system belongs to the finance Minister, who serves as some kind of “policy switchman”.

Graduate Education for Hospital Administration in the United States: Trends.

Science.gov (United States)

Chester, Theodore E.

In 1968, 75% of the 5,466 graduates of hospital administration were in management positions in hospitals and related institutions, and about 1,000 to 1,500 held key government jobs. The US needs approximately 40,000 trained hospital administrators, but the total graduate output is about one-eighth of that amount. Of the 23 existing programs, 8 are…

[Controlling and operation management in hospitals].

Science.gov (United States)

Vagts, Dierk A

2010-03-01

The economical pressure on the health system and especially on hospitals is growing rapidly. Hence, economical knowledge for people in medical executive positions becomes imperative. In advanced and forward-looking hospitals controlling is gaining more and more weight, because it takes over a coordinative responsibility. Ideally controlling is navigating the teamwork of managers (CEOs) and medical executives by weighing medical necessities and economical framework. Controlling is contributing to evaluate an optimal efficiency of a hospital in a highly competitive surrounding by providing medical and economical data on a regular basis. A close, open-minded and trusting cooperation between all people, who are involved, is imperative. Hence, controlling in the proper meaning of the word can not flourish in dominant and hierarchic hospital structures. Georg Thieme Verlag Stuttgart * New York.

System-level planning, coordination, and communication: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

Science.gov (United States)

Dichter, Jeffrey R; Kanter, Robert K; Dries, David; Luyckx, Valerie; Lim, Matthew L; Wilgis, John; Anderson, Michael R; Sarani, Babak; Hupert, Nathaniel; Mutter, Ryan; Devereaux, Asha V; Christian, Michael D; Kissoon, Niranjan

2014-10-01

System-level planning involves uniting hospitals and health systems, local/regional government agencies, emergency medical services, and other health-care entities involved in coordinating and enabling care in a major disaster. We reviewed the literature and sought expert opinions concerning system-level planning and engagement for mass critical care due to disasters or pandemics and offer suggestions for system-planning, coordination, communication, and response. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. The American College of Chest Physicians (CHEST) consensus statement development process was followed in developing suggestions. Task Force members met in person to develop nine key questions believed to be most relevant for system-planning, coordination, and communication. A systematic literature review was then performed for relevant articles and documents, reports, and other publications reported since 1993. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions were developed and grouped according to the following thematic elements: (1) national government support of health-care coalitions/regional health authorities (HC/RHAs), (2) teamwork within HC/RHAs, (3) system-level communication, (4) system-level surge capacity and capability, (5) pediatric patients and special populations, (6) HC/RHAs and networks, (7) models of advanced regional care systems, and (8) the use of simulation for preparedness and planning. System-level planning is essential to provide care for large numbers of critically ill patients because of disaster or pandemic. It also entails a departure from the routine, independent system and

Impact of Medicare Advantage penetration and hospital competition on technical efficiency of nursing care in US intensive care units.

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Min, Ari; Scott, Linda D; Park, Chang; Vincent, Catherine; Ryan, Catherine J; Lee, Taewha

2018-04-10

This study aimed to evaluate technical efficiency of US intensive care units and determine the effects of environmental factors on technical efficiency in providing quality of nursing care. Data were obtained from the 2014 National Database of Nursing Quality Indicators and the Centers for Medicare and Medicaid Services. Data envelopment analysis was used to estimate technical efficiency for each intensive care unit. Multilevel modeling was used to determine the effects of environmental factors on technical efficiency. Overall, Medicare Advantage penetration and hospital competition in a market did not create pressure for intensive care units to become more efficient by reducing their inputs. However, these 2 environmental factors showed positive influences on technical efficiency in intensive care units with certain levels of technical efficiency. The implications of the study results for management strategies and health policy may vary according to the levels of technical efficiency in intensive care units. Further studies are needed to examine why and how intensive care units with particular levels of technical efficiency are differently affected by certain environmental factors. Copyright © 2018 John Wiley & Sons, Ltd.

Integrated Specialized Early-Course Psychosis Treatment Services - University Psychiatric Hospital Vrapce Model.

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Ostojić, DraŽenka; Čulo, Ilaria; Silić, Ante; Kos, Suzana; Savić, Aleksandar

2018-06-01

First episode of psychosis presents a critical period in terms of numerous associated risks, but also possibilities for effective therapeutic interventions. There is a continued focus on early interventions in prodromal states and early course of frank psychosis, aimed at ensuring faster remission, reducing relapses, achieving better long-term functioning, and preventing adverse outcomes linked to untreated psychosis and chronic psychotic disorders. A number of different specialized treatment models and services exist trying to close knowledge gaps and provide clinical interventions to first-episode psychosis (FEP) patients, but there is still no generally accepted standard of care informing our every-day practice. FEP and early-course psychosis specialized treatment model developed in 2004 in University Psychiatric Hospital Vrapce rests on integration of care across different organization units and clinical presentation acuity levels and patient needs (intensive care, FEP inpatient unit, FEP outpatient services including day hospital). Such integration of FEP services allows for flexible entry point on multiple levels, earlier structuring of therapeutic alliance for those requiring inpatient care, reduction of risks associated with FEP, quicker formation of long-term treatment plans, reduction of delay in accessing specialized services, and a more coordinated diagnostic process and recruitment of FEP patient population. Detailed evaluations of outcomes and comparisons with different treatment models are necessary in order to assess strengths and weaknesses of each specific model and inform modifications to current practice models.

Safety climate in Swiss hospital units: Swiss version of the Safety Climate Survey

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Gehring, Katrin; Mascherek, Anna C.; Bezzola, Paula

2015-01-01

Abstract Rationale, aims and objectives Safety climate measurements are a broadly used element of improvement initiatives. In order to provide a sound and easy‐to‐administer instrument for the use in Swiss hospitals, we translated the Safety Climate Survey into German and French. Methods After translating the Safety Climate Survey into French and German, a cross‐sectional survey study was conducted with health care professionals (HCPs) in operating room (OR) teams and on OR‐related wards in 10 Swiss hospitals. Validity of the instrument was examined by means of Cronbach's alpha and missing rates of the single items. Item‐descriptive statistics group differences and percentage of ‘problematic responses’ (PPR) were calculated. Results 3153 HCPs completed the survey (response rate: 63.4%). 1308 individuals were excluded from the analyses because of a profession other than doctor or nurse or invalid answers (n = 1845; nurses = 1321, doctors = 523). Internal consistency of the translated Safety Climate Survey was good (Cronbach's alpha G erman = 0.86; Cronbach's alpha F rench = 0.84). Missing rates at item level were rather low (0.23–4.3%). We found significant group differences in safety climate values regarding profession, managerial function, work area and time spent in direct patient care. At item level, 14 out of 21 items showed a PPR higher than 10%. Conclusions Results indicate that the French and German translations of the Safety Climate Survey might be a useful measurement instrument for safety climate in Swiss hospital units. Analyses at item level allow for differentiating facets of safety climate into more positive and critical safety climate aspects. PMID:25656302

Post-acute referral patterns for hospitals and implications for bundled payment initiatives.

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Lau, Christopher; Alpert, Abby; Huckfeldt, Peter; Hussey, Peter; Auerbach, David; Liu, Hangsheng; Sood, Neeraj; Mehrotra, Ateev

2014-09-01

Under new bundled payment models, hospitals are financially responsible for post-acute care delivered by providers such as skilled nursing facilities (SNFs) and home health agencies (HHAs). The hope is that hospitals will use post-acute care more prudently and better coordinate care with post-acute providers. However, little is known about existing patterns in hospitals׳ referrals to post-acute providers. Post-acute provider referrals were identified using SNF and HHA claims within 14 days following hospital discharge. Hospital post-acute care network size and concentration were estimated across hospital types and regions. The 2008 Medicare Provider Analysis and Review claims for acute hospitals and SNFs, and the 100% HHA Standard Analytic Files were used. The mean post-acute care network size for U.S. hospitals included 57.9 providers with 37.5 SNFs and 23.4 HHAs. The majority of these providers (65.7% of SNFs, 60.9% of HHAs) accounted for 1 percent or less of a hospital׳s referrals and classified as "low-volume". Other post-acute providers we classified as routine. The mean network size for routine providers was greater for larger hospitals, teaching hospitals and in regions with higher per capita post-acute care spending. The average hospital works with over 50 different post-acute providers. Moreover, the size of post-acute care networks varies considerably geographically and by hospital characteristics. These results provide context on the complex task hospitals will face in coordinating care with post-acute providers and cutting costs under new bundled payment models. Copyright © 2014 Elsevier Inc. All rights reserved.

Predictors associated with unplanned hospital readmission of medical and surgical intensive care unit survivors within 30 days of discharge.

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Ohnuma, Tetsu; Shinjo, Daisuke; Brookhart, Alan M; Fushimi, Kiyohide

2018-01-01

Reducing the 30-day unplanned hospital readmission rate is a goal for physicians and policymakers in order to improve quality of care. However, data on the readmission rate of critically ill patients in Japan and knowledge of the predictors associated with readmission are lacking. We investigated predictors associated with 30-day rehospitalization for medical and surgical adult patients separately. Patient data from 502 acute care hospitals with intensive care unit (ICU) facilities in Japan were retrospectively extracted from the Japanese Diagnosis Procedure Combination (DPC) database between April 2012 and February 2014. Factors associated with unplanned hospital readmission within 30 days of hospital discharge among medical and surgical ICU survivors were identified using multivariable logistic regression analysis. Of 486,651 ICU survivors, we identified 5583 unplanned hospital readmissions within 30 days of discharge following 147,423 medical hospitalizations (3.8% readmitted) and 11,142 unplanned readmissions after 339,228 surgical hospitalizations (3.3% readmitted). The majority of unplanned hospital readmissions, 60.9% of medical and 63.1% of surgical case readmissions, occurred within 15 days of discharge. For both medical and surgical patients, the Charlson comorbidity index score; category of primary diagnosis during the index admission (respiratory, gastrointestinal, and metabolic and renal); hospital length of stay; discharge to skilled nursing facilities; and having received a packed red blood cell transfusion, low-dose steroids, or renal replacement therapy were significantly associated with higher unplanned hospital readmission rates. From patient data extracted from a large Japanese national database, the 30-day unplanned hospital readmission rate after ICU stay was 3.4%. Further studies are required to improve readmission prediction models and to develop targeted interventions for high-risk patients.

Tensor calculus in polar coordinates using Jacobi polynomials

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Vasil, Geoffrey M.; Burns, Keaton J.; Lecoanet, Daniel; Olver, Sheehan; Brown, Benjamin P.; Oishi, Jeffrey S.

2016-11-01

Spectral methods are an efficient way to solve partial differential equations on domains possessing certain symmetries. The utility of a method depends strongly on the choice of spectral basis. In this paper we describe a set of bases built out of Jacobi polynomials, and associated operators for solving scalar, vector, and tensor partial differential equations in polar coordinates on a unit disk. By construction, the bases satisfy regularity conditions at r = 0 for any tensorial field. The coordinate singularity in a disk is a prototypical case for many coordinate singularities. The work presented here extends to other geometries. The operators represent covariant derivatives, multiplication by azimuthally symmetric functions, and the tensorial relationship between fields. These arise naturally from relations between classical orthogonal polynomials, and form a Heisenberg algebra. Other past work uses more specific polynomial bases for solving equations in polar coordinates. The main innovation in this paper is to use a larger set of possible bases to achieve maximum bandedness of linear operations. We provide a series of applications of the methods, illustrating their ease-of-use and accuracy.

Tuberculosis during pregnancy in the United States: Racial/ethnic disparities in pregnancy complications and in-hospital death.

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Dennis, Erika M; Hao, Yun; Tamambang, Mabella; Roshan, Tasha N; Gatlin, Knubian J; Bghigh, Hanane; Ogunyemi, Oladimeji T; Diallo, Fatoumata; Spooner, Kiara K; Salemi, Jason L; Olaleye, Omonike A; Khan, Kashif Z; Aliyu, Muktar H; Salihu, Hamisu M

2018-01-01

Despite decades of efforts to eliminate tuberculosis (TB) in the United States (US), TB still contributes to adverse ill health, especially among racial/ethnic minorities. According to the Centers for Disease Control and Prevention, in 2016, about 87% of the TB cases reported in the US were among racial and ethnic minorities. The objective of this study is to explore the risks for pregnancy complications and in-hospital death among mothers diagnosed with TB across racial/ethnic groups in the US. This retrospective cohort study utilized National Inpatient Sample data for all inpatient hospital discharges in the US. We analyzed pregnancy-related hospitalizations and births in the US from January 1, 2002 through December 31, 2014 (n = 57,393,459). Multivariable logistic regression was applied to generate odds ratios for the association between TB status and the primary study outcomes (i.e., pregnancy complications and in-hospital death) across racial/ethnic categories. The prevalence of TB was 7.1 per 100,000 pregnancy-related hospitalizations. The overall prevalence of pregnancy complications was 80% greater among TB-infected mothers than their uninfected counterparts. Severe pre-eclampsia, eclampsia, placenta previa, post-partum hemorrhage, sepsis and anemia occurred with greater frequency among mothers with a TB diagnosis than those without TB, irrespective of race/ethnicity. The rate of in-hospital death among TB patients was 37 times greater among TB-infected than in non-TB infected mothers (468.8 per 100,000 versus 12.6 per 100,000). A 3-fold increased risk of in-hospital death was observed among black TB-negative mothers compared to their white counterparts. No racial/ethnic disparities in maternal morbidity or in-hospital death were found among mothers with TB disease. TB continues to be an important cause of morbidity and mortality among pregnant women in the US. Resources to address TB disease should also target pregnant women, especially racial

Transmission congestion and voltage profile management coordination in competitive electricity markets

International Nuclear Information System (INIS)

Yamin, H.Y.; Shahidehpour, S.M.

2003-01-01

This paper describes a generalized active/reactive iterative coordination process between GENCOs and the Independent System Operator (ISO) for active (transmission congestion) and reactive (voltage profile) management in the day-ahead market. GENCOs apply priced-based unit commitment without transmission and voltage security constraints, schedule their units and submit their initial bids to the ISO. The ISO executes congestion and voltage profile management for eliminating transmission and voltage profile violations. If violations are not eliminated, the ISO minimizes the transmission and voltage profile violations and sends a signal via the Internet to GENCOs. GENCOs reschedule their units taking into account the ISO signals and submit modified bids to the ISO. The voltage problem is addressed and a linear model is formulated and used in the proposed method. The voltage problem is formulated as a linear programming with a block-angular structure and Dantzig-Wolfe decomposition is applied to generate several smaller problems for a faster and easier solution of large-scale power systems. Two 36 unit GENCOs are used to demonstrate the performance of the proposed generalized active/reactive coordination algorithm. (author)

Problems facing Korean hospitals and possible countermeasures.

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Kim, Kwang-Tae

2004-07-01

Korea has a unique health care system, of which the private sector comprises most of the country's health resources: 88% of the beds and 91% of specialists in Korea, but are funded by public financing, such as national health insurance and the national aid program. However, the public financing pays only 50% of actual costs and the patient's co-payment is still high. Healthcare organizations in Korea are categorized into four types; tertiary care hospitals, general hospitals, hospitals and clinics by scale of operator: number of beds. General hospitals must have 100 beds and over, and compulsorily specialties in internal medicine, surgery, obstetrics-gynecology, pediatrics, dental service, other ancillary service units and an emergency care unit. General hospitals with 300 beds and more must operate an intensive care unit. There are many challenges facing the Korean healthcare system, such as reformation of primary healthcare system, enhancing hospitals' competitiveness, and permission of for-profit hospital, introduction of private health insurance, enhancement of geriatric care. These challenges can be resolved with long-term vision, willingness and strategies of the Korean government to ensure equitable financing and access to healthcare, combined with the active participation and utilization of the private sector.

The Implications of the National Minimum Wage for Training Practices and Skill Utilisation in the United Kingdom Hospitality Industry

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Norris, Gill; Williams, Steve; Adam-Smith, Derek

2003-01-01

Two key issues thrown up by the 1999 introduction of the National Minimum Wage (NMW) in the United Kingdom are its likely impact on employers' training practices in low paying sectors of the economy and the implications for skills. Based on a study of the hospitality industry, this article assesses the limited significance of the differential,…

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

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

2017-09-01

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

Motor coordination and balance in rodents.

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Carter, R J; Morton, J; Dunnett, S B

2001-08-01

Measurement of motor coordination and balance can be used not only to assess the effect of drugs or other experimental manipulations on mice and rats, but also to characterize the motor phenotype of transgenic or knock-out animals. Three well established and widely used protocols for measuring motor coordination and balance in mice and rats (rotarod, beam walking and footprint analysis) are described in this unit. The tests can be used equally well for rats and mice, and have been used both for the phenotypic characterization of transgenic mice and for evaluating the effects of lesions and aging in rats. The protocols are described in the primary context of testing mice, but modifications of the test apparatus or variations in the test parameters for assessment of rats are noted.

Reliability of Pressure Ulcer Rates: How Precisely Can We Differentiate Among Hospital Units, and Does the Standard Signal‐Noise Reliability Measure Reflect This Precision?

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Cramer, Emily

2016-01-01

Abstract Hospital performance reports often include rankings of unit pressure ulcer rates. Differentiating among units on the basis of quality requires reliable measurement. Our objectives were to describe and apply methods for assessing reliability of hospital‐acquired pressure ulcer rates and evaluate a standard signal‐noise reliability measure as an indicator of precision of differentiation among units. Quarterly pressure ulcer data from 8,199 critical care, step‐down, medical, surgical, and medical‐surgical nursing units from 1,299 US hospitals were analyzed. Using beta‐binomial models, we estimated between‐unit variability (signal) and within‐unit variability (noise) in annual unit pressure ulcer rates. Signal‐noise reliability was computed as the ratio of between‐unit variability to the total of between‐ and within‐unit variability. To assess precision of differentiation among units based on ranked pressure ulcer rates, we simulated data to estimate the probabilities of a unit's observed pressure ulcer rate rank in a given sample falling within five and ten percentiles of its true rank, and the probabilities of units with ulcer rates in the highest quartile and highest decile being identified as such. We assessed the signal‐noise measure as an indicator of differentiation precision by computing its correlations with these probabilities. Pressure ulcer rates based on a single year of quarterly or weekly prevalence surveys were too susceptible to noise to allow for precise differentiation among units, and signal‐noise reliability was a poor indicator of precision of differentiation. To ensure precise differentiation on the basis of true differences, alternative methods of assessing reliability should be applied to measures purported to differentiate among providers or units based on quality. © 2016 The Authors. Research in Nursing & Health published by Wiley Periodicals, Inc. PMID:27223598

"The Doctor Needs to Know": Acceptability of Smartphone Location Tracking for Care Coordination.

Science.gov (United States)

Liss, David T; Serrano, Eloisa; Wakeman, Julie; Nowicki, Christine; Buchanan, David R; Cesan, Ana; Brown, Tiffany

2018-05-04

Care coordination can be highly challenging to carry out. When care is fragmented across health systems and providers, there is an increased likelihood of hospital readmissions and wasteful health care spending. During and after care transitions, smartphones have the potential to bolster information transfer and care coordination. However, little research has examined patients' perceptions of using smartphones to coordinate care. This study's primary objective was to explore patient acceptability of a smartphone app that could facilitate care coordination in a safety net setting. Our secondary objective was to identify how clinicians and other members of primary care teams could use this app to coordinate care. This qualitative study was conducted at a federally qualified health center in metropolitan Chicago, IL. We conducted four focus groups (two in English, two in Spanish) with high-risk adults who owned a smartphone and received services from an organizational care management program. We also conducted structured interviews with clinicians and a group interview with care managers. Focus groups elicited patients' perceptions of a smartphone app designed to: (1) identify emergency department (ED) visits and inpatient stays using real-time location data; (2) send automated notifications (ie, alerts) to users' phones, asking whether they were a patient in the hospital; and (3) send automated messages to primary care teams to notify them about patients' confirmed ED visits and inpatient stays. Focus group transcripts were coded based on emergent themes. Clinicians and care managers were asked about messages they would like to receive from the app. Five main themes emerged in patient focus group discussions. First, participants expressed a high degree of willingness to use the proposed app during inpatient stays. Second, participants expressed varying degrees of willingness to use the app during ED visits, particularly for low acuity ED visits. Third, participants

The nursing professorial unit: translating acute and critical care nursing research

Directory of Open Access Journals (Sweden)

Martin Christensen

2017-11-01

Full Text Available Background and context: Implementation of current research in practice is challenging for ward-based nursing staff. However, university-based nursing academics are seen as the research experts and are perhaps well placed to support clinical nursing research. The problem lies with the divide between practice and academia; universities often use the clinical environment as the place to conduct research but this is often not translated effectively into practice. The development of a nursing professorial unit for acute and critical care was undertaken to meet this challenge. The unit’s key aim is to develop, mentor and support a nursing research culture that is wholly situated within and driven by the requirements of the clinical environment. Aim: The aim of this article is to offer some insights as to how staff set about engaging with and developing the nursing professorial unit to support nursing research in our local hospital. Conclusions: The article highlights how an effective and coordinated approach to supporting clinical nursing research is possible. The nursing professorial unit has been successful in bridging the divide between academia and practice by using a non-university approach to supporting nursing research. Instead we have adopted the philosophy that practice is the sole driver for research and as academics our role is to support that position. Implications for practice: The adoption of the nursing professorial unit model for supporting clinical nursing research is beneficial in closing the divide between clinical practice and the university The continual presence of the academics in the clinical environment has had a positive impact on research development and implementation in practice The nursing professorial unit has become an integral part of the nursing culture in the hospital environment

Unlicensed and off-label use of drugs in pediatric surgical units at tertiary care hospitals of Pakistan.

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Aamir, Muhammad; Khan, Jamshaid Ali; Shakeel, Faisal; Asim, Syed Muhammad

2017-08-01

Background Unlicensed and off-label prescribing practice is global dilemma around the world. This pioneering study was designed to determine unlicensed and off-label use of drug in surgical wards of tertiary care hospitals of Pakistan. Objective To assess unlicensed and off-label use of drugs in pediatric surgical unit at three tertiary care hospitals in Peshawar, Pakistan. Setting Two government and one private tertiary care hospitals in Pakistan. Method Drug profiles of 895 patients from three different clinical settings were evaluated for unlicensed and off-label use of drugs using Micromedex DRUGDEX. Main outcome measure Characteristics of the unlicensed and off-label drug prescriptions. Result Total of 3168 prescribed drugs were analyzed in this study. Indication (38.7%) and dose (34.8%) were the most frequent off-label categories. In comparison with the corresponding reference categories, infants and children, male patients and having less than five prescribed drugs were significant predictors of unlicensed prescriptions. In comparison with the corresponding reference categories, significant predictors of off-label drug prescribing were children younger than two year, children between 2-12 years, patient staying at hospital less than 5 days and patients having less than five prescribed drugs. Conclusion The prevalence of unlicensed and off-label drug prescriptions are high at pediatric surgical ward of tertiary care hospitals. More awareness of the efficacy and safety of drugs are required in pediatrics. In addition, new formulations with advanced dosing for children are also required to minimize the risk of adverse outcomes.

Simulation of operational processes in hospital emergency units as lean healthcare tool

Directory of Open Access Journals (Sweden)

Andreia Macedo Gomes

2017-07-01

Full Text Available Recently, the Lean philosophy is gaining importance due to a competitive environment, which increases the need to reduce costs. Lean practices and tools have been applied to manufacturing, services, supply chain, startups and, the next frontier is healthcare. Most lean techniques can be easily adapted to health organizations. Therefore, this paper intends to summarize Lean practices and tools that are already being applied in health organizations. Among the numerous techniques and lean tools used, this research highlights the Simulation. Therefore, in order to understand the use of Simulation as a Lean Healthcare tool, this research aims to analyze, through the simulation technique, the operational dynamics of the service process of a fictitious hospital emergency unit. Initially a systematic review of the literature on the practices and tools of Lean Healthcare was carried out, in order to identify the main techniques practiced. The research highlighted Simulation as the sixth most cited tool in the literature. Subsequently, a simulation of a service model of an emergency unit was performed through the Arena software. As a main result, it can be highlighted that the attendants of the built model presented a degree of idleness, thus, they are able to atend a greater demand. As a last conclusion, it was verified that the emergency room is the process with longer service time and greater overload.

Healthcare-associated vancomycin resistant Enterococcus faecium infections in the Mansoura University Hospitals intensive care units, Egypt

Directory of Open Access Journals (Sweden)

Dalia Moemen

2015-09-01

Full Text Available Vancomycin resistant Enterococcus faecium (VREF ia an emerging and challenging nosocomial pathogen. This study aimed to determine the prevalence, risk factors and clonal relationships between different VREF isolates in the intensive care units (ICUs of the university hospitals in our geographic location. This prospective study was conducted from July, 2012 until September, 2013 on 781 patients who were admitted to the ICUs of the Mansoura University Hospitals (MUHs, and fulfilled the healthcare-associated infection (HAI criteria. Susceptibility testing was determined using the disk diffusion method. The clonal relationships were evaluated with pulsed field gel electrophoresis (PFGE. Out of 52 E. faecium isolates, 12 (23.1% were vancomycin resistant. The significant risk factors for the VREF infections were: transfer to the ICU from a ward, renal failure, an extended ICU stay and use of third-generation cephalosporins, gentamicin, or ciprofloxacin. PFGE with the 12 isolates showed 9 different patterns; 3 belonged to the same pulsotype and another 2 carried a second pulsotypes. The similar pulsotypes isolates were isolated from ICUs of one hospital (EICUs; however, all of the isolates from the other ICUs had different patterns. Infection control policy, in conjunction with antibiotic stewardship, is important to combat VREF transmission in these high-risk patients.

Hospital information systems: experience at the fully digitized Seoul National University Bundang Hospital.

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Yoo, Sooyoung; Hwang, Hee; Jheon, Sanghoon

2016-08-01

The different levels of health information technology (IT) adoption and its integration into hospital workflow can affect the maximization of the benefits of using of health IT. We aimed at sharing our experiences and the journey to the successful adoption of health IT over 13 years at a tertiary university hospital in South Korea. The integrated system of comprehensive applications for direct care, support care, and smart care has been implemented with the latest IT and a rich user information platform, achieving the fully digitized hospital. The users experience design methodology, barcode and radio-frequency identification (RFID) technologies, smartphone and mobile technologies, and data analytics were integrated into hospital workflow. Applications for user-centered electronic medical record (EMR) and clinical decision support (CDS), closed loop medication administration (CLMA), mobile EMR and dashboard system for care coordination, clinical data warehouse (CDW) system, and patient engagement solutions were designed and developed to improve quality of care, work efficiency, and patient safety. We believe that comprehensive electronic health record systems and patient-centered smart hospital applications will go a long way in ensuring seamless patient care and experience.

Noise level in intensive care units of a public university hospital in Santa Marta (Colombia).

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Garrido Galindo, A P; Camargo Caicedo, Y; Vélez-Pereira, A M

2016-10-01