Background The objective of this study was to determine the pattern of congenital cardiac disease among children attending UNTH, Enugu, Nigeria. The nature of these abnormalities and the outcome were also considered. The exact etiology is unknown but genetic and environmental factors tend to be implicated. The difference in the pattern obtained worldwide and few studies in Nigeria could be due to genetic, environmental, socioeconomic, or ethnic origin. Methods A retrospective analysis of discharged cases in which a review of the cases of all children attending children outpatient clinics including cardiology clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu over a five year period (January 2007-June 2012) was undertaken. All the children presenting with cardiac anomalies were included in the study and the cases were investigated using ECG, X-ray and echocardiography studies. Results A total of 31,795 children attended the children outpatient clinics of the hospital over the study period. Of these, seventy one (71) had cardiac diseases. The overall prevalence of cardiac disease is 0.22%. The commonest symptoms were breathlessness, failure to thrive and cyanosis. Almost all types of congenital detects were represented, the commonest being isolated ventricular septal detect (VSD), followed by tetralogy of Fallot. One of these cardiac anomalies presented with Downs’s syndrome and another with VACTERAL association. Conclusions The results of this study show that 0.22% per cent of children who attended UNTH in Enugu State had congenital cardiac abnormalities and the commonest forms seen were those with VSD.
Background: Female genital tract malignancy is common in our low resource setting. Options now exist for prevention, detection, treatment, and palliative care for the wide spectrum of female genital tract malignancies. Women will continue to die from these cancers unless health professionals and civil society adopt means to control female genital tract cancers in our low resource setting. Aim: The objective was to determine the frequency and patterns of female genital tract malignancy at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Materials and Methods: A 6-year retrospective study of female genital tract malignancies was conducted at the UNTH, Enugu. The case notes of patients admitted for female genital tract malignancy between January 1, 2003 and December 31, 2008 were retrieved from the medical records and cancer registry of the University of Nigeria Teaching Hospital, Enugu and relevant data were extracted. The data were analyzed using SPSS version 12 (SPSS Inc., Chicago, IL, USA) and the results expressed in descriptive statistics by simple percentages. Results: One hundred and sixty six (166) cases of genital malignancies were recorded during the 6-year review. Majority of the patients were in the fifth and sixth decades of life. Cancer of the cervix accounted for 66.3% (110/166) followed by ovarian cancer 21.1% (35/166). The other tumors seen during the period were tumors involving corpus uteri 9% (15/166) and vulva 3.6% (6/166). Tumors of fallopian tube and vagina were not seen during the study period. Conclusion: Despite the preventable nature of cancer of cervix, it remained the most common female genital tract malignancy in Enugu, South-East Nigeria. In our low resource setting in the developing countries, education and public enlightenment on the importance of routine screening and treatment of premalignant lesions of the cervix are necessary tools to reduce the incidence and mortality of cervical cancer.
Okeke, TC; Onah, N; Ikeako, LC; Ezenyeaku, CCT
Background: Rapid urbanization and changing lifestyle have modified the profile and pattern of various medical disorders in many Nigerian communities. Surveys of medical admissions into various Nigerian health institutions show an increasing burden of non-communicable diseases in our communities. Aim: To determine the profile and pattern of medical cases admitted and their outcome in a new tertiary medical institution in South East Nigeria. Materials and Methods: A review of medical admissions into the Enugu State University of Science and Technology Teaching Hospital (ESUTTH), Enugu, Nigeria over 5 years between January 1, 2006 and December 30, 2010 was undertaken. Morbidity and mortality data were obtained from ward registers and subsequently medical record registers. Classifications of medical disorders were grouped using ICD 10 coding system. Results: A total of 3,865 case records were analyzed. Males were 2,312/3,865 (59.6%) and females 1,660/3,865 (40.2%). The age range was 14-105 years with a mean age of 54.3 (18.1) years. The 4 commonest causes of medical ward admissions were neurological disorders-850/3,865 (22%), endocrine disorders-735/3,865 (19.1%), cardiovascular disorders-718/3,865 (18.5%) and infectious diseases-604/3,865 (15.6%). The diseases encountered most were diabetes mellitus-735/3,865 (19.1%), hypertension/congestive cardiac failure-703/3,865 (18.2%), strokes-614/3,865 (15.9%) and human immunodeficiency virus (HIV)/AIDS-503 (13.1%). The overall mortality was 766/3,865 (19.8%) men-467/2,312 (20.2%); women-299/2,312 (19.3%). Strokes accounted for most of the deaths-171/766 (22.3%) followed by HIV/AIDS 127/766 (16.6%). Hypertension/cardiac failure and diabetes each accounted for 116/766 (15.1%) of all deaths. Case fatality rates for strokes and HIV/AIDS were the highest (171/614 (27.9%) and 127/503 (25.2%) respectively). Mortality rate was highest in the above 70 years age group. Conclusion: Non-communicable disorders are the commonest causes of medical ward admission in this tertiary institution. Efforts aimed at primary prevention will help to reduce the burden of these disorders in the community.
Ezeala-Adikaibe, BA; Aneke, E; Orjioke, C; Ezeala-Adikaibe, NP; Mbadiwe, N; Chime, P; Okafor, U
Background Respiratory diseases are one of the causes of childhood morbidity and mortality as well as hospitalization globally. The patterns of different respiratory illnesses in several parts of the world have been reported but there are few on the combined burden of the diseases. Determination of the burden of respiratory diseases as a group will help ascertain their collective impact on the health systems in order to develop intervention measures. Methods Data from case notes of children with respiratory diseases admitted to the University of Nigeria Teaching Hospital Enugu, Nigeria over a six year period were extracted. Age, gender, admission rates, types of respiratory illness, duration of admission, season of presentation and outcome were analysed. Descriptive and inferential (Chi square) statistics were used to describe the various disease types and ascertain association of the disease outcome, seasonal pattern with the types of diseases. Results Of the total of 8974 children admissions, 2214 (24.7%) were due to respiratory diseases. The mean age of all the children with respiratory diseases was 3.3?years (SD 3.9). Communicable diseases were the common cause of admission cases throughout the seasons, p < 0.001. The highest admission rates were for pneumonia, (34.0%), acute bronchial asthma, (27.7%) and rhinosinusitis (14.6%) p < 0.001. The frequency of respiratory disease decreases with age and children less than five years of age and of low socio-economic status were commonly affected, p?=?0.01. The median duration of hospital stay was two days [range 1 to 8?days], children less than five years old and those of low socio-economic status, spent more than four days (p?=?0.01 and p < 0.001 respectively). The all-cause mortality was 0.5% (11/2214) of which 81.8% (9/11) was due to pneumonia. Conclusions Respiratory diseases constitute a significant burden of childhood illnesses in our centre. Efforts are required to reduce the impact as part of the steps towards the achievement of the Millennium Development Goals.
This is a review of 72 patients who were treated for Spinal Cord Injuries in the University of Nigeria Teaching Hospital, Enugu, Nigeria, during the period January 1980 to January 1985. There were 20 patients who had tetraplegia as a result of their injuries and 52 with paraplegia. All the patients were treated conservatively.The catchment area of the hospital is
C A Okonkwo
Introduction: The epidemiology and pathology of meningioma in Nigeria are still evolving and little has been published about this tumor in Nigeria, especially in the southeast region. The aim of this paper is to compare the characteristics of intracranial meningioma managed in our center with the pattern reported in the literature worldwide. Materials and Methods: Retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2002 and December 2010 at a Private neurosurgery Hospital in Enugu, Nigeria. We excluded patients whose histology results were inconclusive. Results: Meningiomas constituted 23.8% of all intracranial tumors seen in the period. The male to female ratio was 1:1.1. The peak age range for males and females were in the fifth and sixth decades, respectively. The most common location is the Olfactory groove in 26.5% of patients followed by convexity in 23.5%. Presentation varied with anatomical location of tumor. Patients with olfactory groove meningioma (OGM) mostly presented late with personality changes and evidence of raised ICP. Tuberculum sellar and sphenoid region tumors presented earlier with visual impairment with or without hormonal abnormalities. Seizures occurred in 30.9% of all patients and in 45% of those with convexity meningiomas. Only 57.4% of the patients were managed surgically and there was no gender difference in this group. WHO grade1 tumors were the most common histological types occurring in 84.6%. One patient had atypical meningioma and two had anaplastic tumors. Conclusion: The pattern of meningioma in our area may have geographical differences in location and histology. Childhood meningioma was rare.
Mezue, Wilfred C; Ohaegbulam, Samuel C; Ndubuisi, Chika C; Chikani, Mark C; Achebe, David S
Objective: To identify the possible barriers to the implementation of Pharmaceutical care among Community and Hospital pharmacists in Enugu State using Nsukka and Enugu metropolis as a case study. Method: A semi structured questionnaire was designed to carry out a cross sectional descriptive study. The questionnaires were distributed to community and hospital pharmacists from designated areas during one of their quarterly meeting and their practice sites in 2009. Results: Eighty completed questionnaires were collected with 22.8% from community pharmacists, and 77.2% from hospital pharmacists. The important barriers identified were lack of space, enough personnel in pharmacy to handle routine technical tasks, time, need for too much effort, and need for payment for services. Conclusion: The opinions on barriers to Pharmaceutical care of Pharmacists from community and hospital practice areas in these two metropolises of Enugu State are majorly ‘lack of time, space and routine technical task personnel.
Okonta, Jegbefume Mathew; Okonta, Eleje Oboma; Ofoegbu, Tochi Chimuaya
Objective: To evaluate the current practices of segregation approaches, storage arrangements, collection and disposal systems in the teaching hospitals of Karachi. Methods: A cross-sectional survey was conducted in eight teaching hospitals of Karachi, using convenient sam- pling technique. The instrument of research was a self administered questionnaire, with four sections, relating to the general information of the institution, administrative information,
Shahida Rasheed; Saira Iqbal; Lubna A. Baig; Kehkashan Mufti
Despite the prestige and reputation of teaching hospitals, as a group they are in financial distress. If this trend continues, one would expect to see a higher incidence of mergers and acquisitions or divestitures of assets and services, and other strategies designed to combat failing businesses. Nearly one out of every six teaching hospitals sampled was predicted to be near immediate bankruptcy, and the overwhelming majority was not far behind. It will take a significant effort for these hospitals to continue to treat their operations as a clinical and research "business," but they must do just that if they are to survive the continually turbulent market. PMID:19175242
Addressing the need for updated teaching hospital facilities is one of the most significant issues that an academic medical center faces. The authors describe the process they underwent in deciding to build a new facility at the Medical University of South Carolina (MUSC). Initial issues included whether or not the teaching hospital would continue to play a role in clinical education and whether to replace or renovate the existing facility. Once the decision to build was reached, MUSC had to choose between an on-campus or distant site for the new hospital and determine what the function of the old hospital would be. The authors examine these questions and discuss the factors involved in different stages of decision making, in order to provide the academic medicine community guidance in negotiating similar situations. Open communication within MUSC and with the greater community was a key component of the success of the enterprise to date. The authors argue that decisions concerning site, size, and focus of the hospital must be made by developing university-wide and community consensus among many different constituencies. The most important elements in the success at MUSC were having unified leadership, incorporating constituent input, engaging an external consultant, remaining unfazed by unanticipated challenges, and adhering to a realistic, aggressive timetable. The authors share their strategies for identifying and successfully managing these complex and potentially divisive aspects of building a new teaching hospital. PMID:16249296
Reves, J G; Smith, Stuart; Greenberg, Ray; Johnson, Donald
Gives reasons why Medicare cannot provide financial support for needs of teaching hospitals over and above payments for those health services specified in the legislation. Speech delivered at the 79th Annual Meeting of the Association of American Medical Colleges, Houston, Texas, November 1, 1968. (WM)
Tierney, Thomas M.
Merger has served as a major strategy for the leaders of academic medical centers (i.e., teaching hospitals) who are pursuing health system development for their institutions. Applying hindsight to their personal experience, the authors explore common themes in several mergers that have survived the test of time. Although many elements influence merger outcomes, experience suggests several of unique importance. These include effective leadership in the areas of creating trust, managing uncertainty, ensuring medical staff stability, and bridging cultural divides across the organizations. While a quantitative business case should support any merger, the authors' experiences underscore the importance of successfully assessing and managing organizational and individual dynamics when bringing together major teaching hospitals. PMID:24362373
Thier, Samuel O; Kelley, William N; Pardes, Herbert; Knight, Amy Wimpey; Wietecha, Mark
For a nurse educator, the sudden assignment to teaching in the community after years of hospital teaching and practice can cause distress. While persons with such experience do not possess the skills to teach the care of aggregate populations, they can be successful in teaching students to care for patients in their homes and in other community settings. Participating in on-site orientation, developing perspectives that recognize patient autonomy and the significance of family context, and using more discovery learning strategies enable faculty to achieve course goals and to contribute to curricular goals. PMID:9653206
Reed, F C; Wuyscik, M A
An analytical model for examining the impact of hospital teaching programs on the costs of certain products and services used in treating patients is developed and applied to data on radiology departments from Veterans' Administration (VA) hospitals. The ...
J. R. Hosek A. P. Massell
Teaching hospitals are the principal site of many specialized surgical procedures. The recipients of these procedures tend to be younger, male, and nonwhite and tend to reside in either the poorest or the most affluent neighborhoods. Although the numbers of these procedures performed at major teaching hospitals increased dramatically between 1989 and 1995, they accounted for only a modest proportion of hospital discharges and patient days. Concentration of specialized surgical procedures in major teaching hospitals will likely continue. This trend has implications not only for these hospitals but for health care purchasers, policymakers, medical educators, and clinical researchers as well. PMID:10645091
Levin, R; Moy, E; Griner, P F
...Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for...entitled ``Notification of Closure of Teaching Hospitals and Opportunity to Apply for...of the city in which one of the closed teaching hospitals was located....
... Conditions of payment: Assistants at surgery in teaching hospitals. 415.190 ...Conditions of payment: Assistants at surgery in teaching hospitals. (a) Basis...basis for the services of an assistant at surgery in a teaching hospital. This...
... Conditions of payment: Assistants at surgery in teaching hospitals. 415.190 ...Conditions of payment: Assistants at surgery in teaching hospitals. (a) Basis...basis for the services of an assistant at surgery in a teaching hospital. This...
Background More than half of the pregnant women in the world have hemoglobin levels indicative of anemia. Knowledge of the current situation of the condition in our environment is necessary. This knowledge will motivate antenatal caregivers toward early detection and prompt management of anemia in pregnancy. Aims Our aim was to determine the prevalence of anemia among pregnant women at registration for antenatal care at a major tertiary healthcare center in Enugu, southeastern Nigeria. Methods This was a retrospective study of 530 normal pregnant women registered with the antenatal unit of the University of Nigeria Teaching Hospital (UNTH), Enugu, between January 1, 2005 and October 30, 2005. Data on the age, parity, gestational age at booking, interval between last confinement and last menstrual period in the index pregnancy, hemoglobin concentration at booking, and HIV status were obtained and analyzed. Results The mean gestational age at booking was 21.7 ± 7.1 weeks (range, 6–37). Two hundred fourteen (40.4%) of the women were anemic (hemoglobin [Hb] < 11.0 g/dL). The majority (90.7%) of these anemic patients were mildly anemic, whereas 9.3% were moderately anemic. There was no case of severe anemia (Hb < 7.0 g/dL). The prevalence of anemia at booking was significantly higher in those who registered for antenatal care in the third trimester than in those who registered in the second trimester, and in HIV-positive pregnant women than in HIV-negative ones (P = .00). The patients' age, parity, and the interval between the last confinement and the index pregnancy had no significant relationship with the hemoglobin concentration of pregnant women at booking (P > .05). Conclusion The prevalence of anemia in pregnancy at booking is still high in Enugu. Preconception care, including iron and folic acid supplementation, is advocated to reduce this problem. Early antenatal booking and improved antenatal care are also necessary for early diagnosis and treatment of the condition. All would ensure safe motherhood.
Dim, Cyril C.; Onah, Hyacinth E.
Background Paracetamol (also known as acetaminophen) is the commonest available analgesic and anti-pyretic. It is readily accessed from pharmacy, patent medicine and provision shops as over the counter drug making it a potential drug of abuse, especially in children. We sought to find its use and/or misuse in children seen at the paediatric outpatient clinic of the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu. Objective To determine the dosage, formulation, and frequency of paracetamol administration to children by caregivers and factors associated with its use and/or misuse. Method An observational prospective study involving 231 children and their caregivers seen at the paediatric outpatient clinic of the University of Nigeria Teaching Hospital, Ituku - Ozalla, Enugu between June and November 2011 was undertaken. Data on paracetamol use before presentation to the clinic, in addition to demographic and other data were obtained from the caregivers using a structured questionnaire. Ethical consent for the study was obtained from the Hospital Ethics and Research Committee and informed consent was further obtained from the caregivers of the children. Results A total of 231 children aged six weeks to 16?years and their caregivers participated in this study. The mean ages of the children and their caregivers were 3.8 and 33.9?years, respectively. One hundred and thirty three of the children studied were males while 98 were females. Most of the children (75.6%) received paracetamol at home before presenting. Paracetamol tablet alone or in combination with the syrup was mostly used (60%) and this observation was made across all age groups. The commonest reason for using paracetamol tablet instead of the syrup was that it was more effective. Most caregivers relied on past experience (71.2%) rather than on enclosed information leaflet to decide the appropriate dosage. Half of the children also received other medications, mainly anti-malarials and antibiotics. Conclusions Paracetamol was commonly given to children on “self prescription” basis and the tablet formulation was most frequently used, with the possibility of misuse and overdose. Caregivers need to be educated on age-appropriate formulations which are less likely to lead to overdose.
A study is presented of 217 adults referred for psychiatric assessment from the wards of a postgraduate teaching hospital. The pattern of referral and the disproportionate importance of disturbed behaviour amongst referrals from non-medical wards are discussed. The main diagnostic groups, namely, affective disorders, organic states, psychogenic somatic symptoms and attempted suicide, are tabulated and discussed. Complex problems of diagnosis and management were common and are considered under five headings: multiple pathology; the effects of intensive treatment procedures; language and cultural differences, and difficulties in follow-up. It is concluded that the problems met in this specialized setting are likely to become general as intensive treatment and diagnostic procedures become more widespread. The importance of organic reactions is stressed and their relative neglect by both psychiatrists and physicians commented on. The frequency of social precipitants of affective disorders and attempted suicide, however, is considered to emphasize the range of activities required of the psychiatrist in even the most technologically advanced centres.
Poisoning is an increasingly common social problem in Nepal. Studies on poisoning in semi urban areas of Nepal are minimal. Here we, present a prospective study of poisoning in semi urban area of capital, Kathmandu lasting for six years duration. Altogether there were 354 cases of various poisoning, admitted in Nepal Medical College Teaching Hospital from Baisakh 2062 (April 16, 2005) to Chaitra 2067 (April 15, 2011). Male: Female ratio was 135:219 (1:1.6) and Age +/- SD was age 29.3 +/- 13.8 years. Age group (20-29 years) comprised of 138 patients (38.9% followed by < 20 years age group (92, 25.9%). Brahman/ chhetri (150, 42.4%) and Mongolian (146, 41.2%) ethnic groups were the main sufferers of poisoning, followed by newars (41, 11.6%) patients. Deliberate self harm was the cause for poisoning in maximum number of patients (156, 44.1%), followed by depression (64, 18.1%) and accidental poisoning (42, 11.9%). Organophosphorus (152, 42.9%), medicines (71, 20.1%), and rodenticide poisoning (38, 10.7%) were common poisons. Metacid (Methyl parathion) (46, 15.5%) was the most popular brand of poisoning agent used in Nepal for suicidal purpose. The over all mortality rate of poisoning in general was 7.1% with organophosphorus poisoning topping the list (19, 12.5%). We also present mad honey poisonings in a small group of 9 (3.2%) patients with M:F 8:1, age 26.5 +/- 8.8 years. Due precaution should be undertaken during their management as some of them may go into cardiopulmonary arrest and should not be considered benign when more than 5 tablespoonful wild honey is consumed. PMID:22808816
Shrestha, B; Singh, P M; Bharati, U; Dhungel, S
The treatment and disposal of hospital effluent is a major challenge in most developing nations, including Nigeria. This study was aimed at investigating the physio chemical properties of hospital waste water from a University Teaching Hospital based in Southern Nigeria. Six sampling points were identified within and outside the premises of the university teaching hospital.The results showed that the values
I. N Ibeh; M. I Omoruyi
Background and Objectives Nosocomial infections are usually acquired during hospitalization. Fungal infection of the urinary tract is increasing due to predisposing factors such as; antibacterial agents, indwelling urinary catheters, diabetes mellitus, long hospitalization, immunosuppressive agents, use of IV catheters, radiation therapy, malignancy. The aim of our study was to determine the prevalence of candiduria and urinary tract infection in patients admitted in Golestan and Emam Khomeini hospitals of Ahvaz, Iran. Materials and Methods During 14 months, a total of 744 urine samples were collected and transferred to medical mycology laboratory immediately. Ten µl of uncentrifuged sample was cultured on CHROM agar Candida plates and incubated at 37°C for 24-48h aerobically. Candida species were identified based on colony morphology on CHROM agar Candida, germ tube production and micro-morphology on corn meal agar including 1% Tween 80. Results In the present study, 744 hospitalized patients were sampled (49.5%, female; 50.5%, male). The prevalence of candiduria in subjects was 16.5% that included 65.1% female and 34.9% male. The most common isolates were C. albicans (53.3%), followed by C. glabrata (24.4%), C. tropicalis (3.7%), C. krusei (2.2%), and Geotrichum spp. (0.7%) Urine cultures yielded more than 10,000 yeast colonies in 34.1% of cases, and the major predisposing factor associated with candiduria was antibiotic therapy (69.1%). Conclusion Candiduria is relatively common in hospitalized patients in educational hospitals of Ahvaz. In addition, there is a strong correlation between the incidence of candiduria in hospitalized patients and broad-spectrum antibiotics therapy.
Zarei-Mahmoudabadi, A; Zarrin, M; Ghanatir, F; Vazirianzadeh, B
The relationship between medical schools and their teaching hospitals involves a complex and variable mixture of monopoly and monopsony power, which has not been previously been ethically analyzed. As a consequence, there is currently no ethical framework to guide leaders of both institutions in the responsible management of this complex power relationship. The authors define these two forms of power and, using economic concepts, analyze the nature of such power in the medical school-teaching hospital relationship, emphasizing the potential for exploitation. Using concepts from both business ethics and medical ethics, the authors analyze the nature of transparency and co-fiduciary responsibility in this relationship. On the basis of both rational self-interest, drawn from business ethics, and co-fiduciary responsibility, drawn from medical ethics, they argue for the centrality of transparency in the medical school-teaching hospital relationship. Understanding the ethics of monopoly and monopsony power is essential for the responsible management of the complex relationship between medical schools and their teaching hospitals and can assist the leadership of academic health centers in carrying out one of their major responsibilities: to prevent the exploitation of monopoly power and monopsony power in this relationship. PMID:15980088
Chervenak, Frank A; McCullough, Laurence B
The University of California at Davis Veterinary Medical Teaching Hospital created a healthier environment with inexpensive business procedures. Reported are: removal of billing responsibilities from faculty, separation of discharge functions from receptionist's functions, billing system/medical records system, and use of credit cards and…
Walker, Terry S.
A novel idea for information security education created by the New York State Center for Information Forensics and Assurance (CIFA) is presented. This new approach incorporates a teaching hospital model originally developed for medical training. In this model, information security problems from industry and government are solved and abstracted…
Goel, Sanjay; Pon, Damira; Bloniarz, Peter; Bangert-Drowns, Robert; Berg, George; Delio, Vince; Iwan, Laura; Hurbanek, Thomas; Schuman, Sandoor P.; Gangolly, Jagdish; Baykal, Adnan; Hobbs, Jon
Introduction: The sources of racial disparity in duration of patients’ visits to emergency departments (EDs) have not been documented well enough for policymakers to distinguish patient-related factors from hospital- or area-related factors. This study explores the racial disparity in duration of routine visits to EDs at teaching and non-teaching hospitals. Methods: We performed retrospective data analyses and multivariate regression analyses to investigate the racial disparity in duration of routine ED visits at teaching and non-teaching hospitals. The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) were used in the analyses. The data include 4.3 million routine ED visits encountered in Arizona, Massachusetts, and Utah during 2008. We computed duration for each visit by taking the difference between admission and discharge times. Results: The mean duration for a routine ED visit was 238 minutes at teaching hospitals and 175 minutes at non-teaching hospitals. There were significant variations in duration of routine ED visits across race groups at teaching and non-teaching hospitals. The risk-adjusted results show that the mean duration of routine ED visits for Black/African American and Asian patients when compared to visits for white patients was shorter by 10.0 and 3.4%, respectively, at teaching hospitals; and longer by 3.6 and 13.8%, respectively, at non-teaching hospitals. Hispanic patients, on average, experienced 8.7% longer ED stays when compared to white patients at non-teaching hospitals. Conclusion: There is significant racial disparity in the duration of routine ED visits, especially in non-teaching hospitals where non-White patients experience longer ED stays compared to white patients. The variation in duration of routine ED visits at teaching hospitals when compared to non-teaching hospitals was smaller across race groups.
Karaca, Zeynal; Wong, Herbert S.
Background: Meningiomas may range on presentation from incidentally identified small lesions to large symptomatic tumors in eloquent areas of the brain. Management options correspondingly vary and include careful observation, surgical excision, and palliative application of very limited therapeutic maneuvers in select cases. This paper discusses the options and difficulties in the management of meningiomas in a developing country. Methods: This study is a retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2006 and September 2011 at Memfys Hospital for Neurosurgery, Enugu. Radiographic diagnosis of meningioma was based on computed tomography (CT) and or magnetic resonance imaging (MRI) criteria in all cases, but only patients who had surgery and a histological diagnosis were analyzed. Results: Seventy-four patients were radiographically diagnosed with intracranial meningioma over the period under review. Fifty-five patients were operated upon and 52 (70.3%) with histological diagnosis of meningioma were further analyzed. Histological diagnosis was complete in 42 (56.8%) patients and in 10 (13.5%) patients the subtype of meningioma was not determined. The male to female ratio was 1:1.08. The peak age range for females was in the 6th decade and for males in the 5th decade. The locations were olfactory groove (26.9%), convexity (21.2%), parasagittal/falx (19.2%), sphenoid ridge (15.4%), tuberculum sellae (7.7%), tentorial (3.8%), and posterior fossa (5.8%). The most common clinical presentation was headaches in 67.3% followed by seizures (40.4%) and visual impairment (38.5%). Histology was benign (World Health Organization [WHO] grade 1) in 39 patients. One patient harbored an atypical and two had anaplastic tumors. Gross total resection of the tumor was achieved in 41 patients. Surgical mortality was 3.9%. Conclusion: Effective management of meningioma depends largely on adequate and complete surgical resection and results in good outcomes. Adequate preoperative assessment, including visual assessment, and hormonal assessment in olfactory groove and sphenoid region meningiomas, is necessary.
Mezue, Wilfred C; Ohaegbulam, Samuel C; Ndubuisi, Chikandu A; Chikani, Mark C.; Achebe, David S
In this study stochastic frontier cost function was used to estimate the teaching and research costs of Finnish hospitals. Predicted efficiency adjusted costs were calculated and compared to evaluate the current level of teaching and research reimbursement. The efficiency adjustment had significant impact on the marginal and average cost estimates of the teaching and research output. The results suggest that the average rate of teaching and research reimbursement should be approximately 14.6% of the total operating costs in university teaching hospitals. The main finding was that the university teaching hospitals were underfunded with respect to both research and teaching output. PMID:16612572
Linna, Miika; Häkkinen, Unto
This is a quantitative exploratory, descriptive study performed with the objective to identify and analyze the performance of the average time of nursing care delivered to patients of the Inpatient Units of the University Hospital at University of São Paulo (UH-USP), from 2001 to 2005. The average nursing care time delivered to patients of the referred units was identified by applying of a mathematical equation proposed in the literature, after surveying data from the Medical and Statistical Service and based on the monthly working shifts of the nursing professionals. Data analysis was performed using descriptive statistics. The average nursing care time observed in most units, despite some variations, remained stable during the analyzed period. Based on this observed stability, it is concluded that the nursing staff in the referred HU-USP units has been continuously evaluated with the purposes of maintaining the average time of assistance and, thus, the quality of the care being delivered. PMID:21445512
Rogenski, Karin Emília; Fugulin, Fernanda Maria Togeiro; Gaidzinski, Raquel Rapone; Rogenski, Noemi Marisa Brunet
Forty-eight units were enrolled in a descriptive, cross-sectional study to identify strengths and weaknesses of pain management in a German university teaching hospital. Patients had to be ?18 years old and able to speak German; intensive care, psychiatric, obstetric and pediatric units were excluded. Structured interviews were conducted by an independent researcher not involved in patient care. Patients were asked
Barbara Strohbuecker; Herbert Mayer; George C. M. Evers; Rainer Sabatowski
We describe the implementation of an electronic medication management system (eMMS) in an Australian teaching hospital, to inform future similar exercises. The success of eMMS implementation depends on: a positive workplace culture (leadership, teamwork and clinician ownership); acceptance of the major impact on work practices by all staff; timely system response to user feedback; training and support for clinicians; a usable system; adequate decision support. PMID:22060071
Day, Richard O; Roffe, David J; Richardson, Katrina L; Baysari, Melissa T; Brennan, Nicholas J; Beveridge, Sandy; Melocco, Teresa; Ainge, John; Westbrook, Johanna I
Background: Despite an expected high prevalence of pregnancy-mask in the Negroid tropical environments, only a few women present to the physicians with this condition in Enugu. It is unclear whether this is due to low prevalence or poor awareness of the condition. Objectives: To determine the prevalence, awareness and treatment of pregnancy-mask among Igbo women in Enugu, Nigeria. Method: The study was a cross-sectional survey of pregnant women in Enugu; South-East Nigeria. The study sample consisted of the first 500 consecutive eligible pregnant women seen at the antenatal clinic of a tertiary health care facility. Socio-demographic data was obtained and the women were examined for site, size and treatments for pregnancy mask. Results: The prevalence of pregnancy-mask was 8.6%. Increasing gestational age was significantly associated with increased prevalence rate (P=0.037). Only 11.6% of those who had pregnancy-mask knew that it was related to pregnancy. Among those who had the lesion in the index pregnancy, 46.5% had applied some treatments to the lesion. The commonly used treatments were anti-fungal ointments (45%), bleaching creams (35%), herbal preparations (15%) and sunscreen (5%). Conclusions: It is concluded that pregnancy-mask has low prevalence and poor awareness among the Igbo women in Enugu and is commonly misdiagnosed. Antifungal and bleaching creams are the common treatment while sunscreen is poorly used. Teaching of this condition in pre-service schools is recommended in order to improve its knowledge among health workers thereby improving its awareness and management in the community.
The Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program has focused attention on ways to reduce thirty-day readmissions and on factors affecting readmission risk. Using inpatient data from an urban teaching hospital, we examined how elements of individual characteristics and neighborhood socioeconomic status influenced the likelihood of readmission under a single fixed organizational and staffing structure. Patients living in high-poverty neighborhoods were 24 percent more likely than others to be readmitted, after demographic characteristics and clinical conditions were adjusted for. Married patients were at significantly reduced risk of readmission, which suggests that they had more social support than unmarried patients. These and previous findings that document socioeconomic disparities in readmission raise the question of whether CMS's readmission measures and associated financial penalties should be adjusted for the effects of factors beyond hospital influence at the individual or neighborhood level, such as poverty and lack of social support. PMID:24799574
Hu, Jianhui; Gonsahn, Meredith D; Nerenz, David R
Background: Hematological abnormalities such as anemia, neutropenia, and thrombocytopenia occur in children infected by the human immunodeficiency virus (HIV). These abnormalities are due to myelosuppression caused by the HIV and contribute to the morbidity and mortality of HIV-infected children. Malnutrition is prominent in HIV-infected children due to associated conditions such as oropharyngeal candidiasis, diarrhea, and cytokine production which result in poor intake, nutrient loss, and increased metabolic rate, respectively. Objectives: To determine the prevalence of hematological abnormalities (using the World Health Organization (WHO) case definitions) and malnutrition in HIV-infected children receiving care at the University of Nigeria Teaching Hospital, Enugu. Materials and Methods: The hematological and anthropometric indices of HIV-infected children between 18 and 59 months were assessed. Their hemoglobin level, neutrophil, and platelet counts were the hematological profiles evaluated using the WHO case definitions in HIV clinical staging. The weight-for-height z-score index was used to assess the nutritional status of subjects using the WHO reference ranges. The t-test, Chi-square, and Pearson correlation coefficient were used for statistical analysis. Results: There were 67 HIV positive children: 34 males and 33 females, aged 18-59 months. The mean hematological levels of subjects were hemoglobin (Hb) 10.4 ± 1.2 g/dl, neutrophil count 3,031 ± 1,039 cells/mm 3 , platelets count 294 ± 78 × 109/L. Two children (3.0%) had anemia (hemoglobin < 8 gm/dl) and were severely immunosuppressed, on highly active antiretroviral therapy treatment and had advanced HIV disease (clinical stage 3). Children who were malnourished were 15 (22.4%). Conclusion: Hematological abnormalities and malnutrition occur in HIV positive children. PMID:24714007
Ezeonwu, B U; Ikefuna, A N; Oguonu, T; Okafor, H U
Objective To compare risk- and volume-adjusted outcomes of colon resections performed at teaching hospitals (THs) vs non-THs to assess whether benign disease may influence the volume-outcome effect. Design Retrospective data analysis examining colon resections determined by International Classification of Diseases, Ninth Revision, Clinical Modification classification performed in the United States from 2001 through 2005 using the Nationwide Inpatient Sample (NIS) and the Area Resource File (2004). Patient covariates used in adjustment included age, sex, race, Charlson Index comorbidity score, and insurance status. Hospital covariates included TH status, presence of a colorectal surgery fellowship approved by the Accreditation Council for Graduate Medical Education, geographical region, institutional volume, and urban vs rural location. County-specific surgeon characteristics used in adjustment included average age of surgeons and proportion of colorectal board-certified surgeons within each county. Environmental or county covariates included median income and percentage of county residents living below the federal poverty level. Setting A total of 1045 hospitals located in 38 states in the United States that were included in the NIS. Patients All patients older than 18 years who had colon resection and were discharged from a hospital included in the NIS. Main Outcome Measures Operative mortality, length of stay (LOS), and total charges. Results A total of 115 250 patients were identified, of whom 4371 died (3.8%). The mean LOS was 10 days. Fewer patients underwent surgical resection in THs than in non-THs (46 656 vs 68 589). Teaching hospitals were associated with increased odds of death (odds ratio, 1.14) (P=.03), increased LOS (P=.003), and a nonsignificant trend toward an increase in total charges (P=.36). Conclusions With the inclusion of benign disease, colon surgery displays a volume-outcome relationship in favor of non-THs. Inclusion of benign disease may represent a tipping point.
Hayanga, Awori J.; Mukherjee, Debraj; Chang, David; Kaiser, Heather; Lee, Timothy; Gearhart, Susan; Ahuja, Nita; Freischlag, Julie
Quality Of Care For Two Common Illnesses In Teaching And Nonteaching Hospitals Teaching status appears to make a difference, when physicians and nurses assess hospitals' quality of care in four states
Teaching hospitals are recognized for treating rare diseases, but their value in caring for common illnesses is less clear. To assess quality of care for congestive heart failure and pneumonia, we reviewed the medical records of Medicare beneficiaries in major teaching, other teaching, and nonteaching hospitals in four states. Overall quality was rated better in major and other teaching hospitals
John Z. Ayanian; Joel S. Weissman; Scott Chasan-Taber; Arnold M. Epstein
To respond to the increasing demand for information from medical educators and clinicians and to persuade administrators to purchase the newly available microcomputer library systems, medical librarians in community teaching hospitals may find it useful to engage in intermediate term (for example, five-year) program planning. To increase the probability that the plan which emerges will be implemented, the planning process should fit the organizational nexus. Planning involves needs assessment, prioritized program elements, a written plan, and facilities planning (if applicable), which lead to program implementation. Components of a model program plan are presented.
McCorkel, J; Cook, V
To respond to the increasing demand for information from medical educators and clinicians and to persuade administrators to purchase the newly available microcomputer library systems, medical librarians in community teaching hospitals may find it useful to engage in intermediate term (for example, five-year) program planning. To increase the probability that the plan which emerges will be implemented, the planning process should fit the organizational nexus. Planning involves needs assessment, prioritized program elements, a written plan, and facilities planning (if applicable), which lead to program implementation. Components of a model program plan are presented. PMID:4027443
McCorkel, J; Cook, V
A 10-year review of ruptured gravid uterus at the University Teaching Hospital, Aleppo, Syria showed an incidence of one ruptured uterus in 565 deliveries. This is an average figure compared with published studies but is still high compared with developed countries. Sixty-four per cent of the cases of ruptured uterus had no antenatal care. It is no surprise therefore that maternal and fetal mortality was highest amongst the unbooked labouring women. In survivors the morbidity was also higher. Ruptured uterus is therefore a major cause of maternal and perinatal mortality and morbidity in Syria. The overall hospital maternal and perinatal mortalities for the period under review were 4.3% and 2.6% respectively. The main risk factor identified is scarring from previous caesarean sections. Other risk factors are discussed. PMID:15512134
Bakour, S; Nassif, B; Nwosu, E C
Abnormal fluoride levels in drinking water have been associated with adverse health effects. To determine the fluoride content of well waters in Enugu, southeastern Nigeria, water samples from 50 artisan wells chosen by multistage sampling procedure from the 5 zones of Enugu municipality were analyzed in duplicates for their fluoride content. The zonal mean values were 0.60, 0.70, 0.62, 0.62, and 0.63 mg/L for Abakpa Nike, Achara Layout, Obiagu/ Ogui, Trans Ekulu and Uwani, respectively (p<0.05). The mean value for the whole city was 0.63 mg/L. Although, the mean level of fluoride recorded in this study is currently within safe limits (1.5 mg/L, WHO 2011), it is important to monitor continuously the fluoride content of well waters in the municipality in view of the increasing industrial activities going on in the city and heavy reliance on well water for domestic purposes and the widespread use of consumer products containing fluoride. PMID:23022857
Ogbu, I Si; Okoro, O Io; Ugwuja, E I
Purpose – Hospitals are all required to be prepared against crisis, while according to studies, most hospitals are not prepared enough to encounter disaster problems. Therefore, each hospital should have an established programme to face earthquake and other catastrophes. This paper aims to investigate this issue. Design\\/methodology\\/approach – This descriptive study was carried out in teaching hospitals of Iran University
Parisa Shojaei; Mohammad Reza Maleki; Rafat Bagherzadeh
Patients’ rights observance is one of the effective measures of patients’ satisfaction of health care services. We performed this study at the aim of evaluation of nurses’ awareness of patients’ rights in a teaching hospital in Tehran. This cross-sectional study was conducted in 2010. In this study 156 nurses were randomly selected. Two-part questionnaire was used for data collection. The validity and reliability of questionnaire was determined and then it was distributed between subjects. The data were analyzed by SPSS version 15 using descriptive and inferential statistics. Our results showed that %58.33, %39.10 and % 2.56 of nurses have good, medium, and poor levels of awareness respectively. We observed a significant relationship between nurses awareness and work experience (P=0.008) and concurrent work in public and private hospitals (P=0.01). The most of the nurses (%95.51) were aware of “right to privacy protection and ensure confidentiality of information” and the least of them (%33.97) were aware of “right to receiving necessary information about the health care providers, the rate of tariff and insurance coverage”. According to our survey it is concluded that implementation of Patients’ Right Charter in this hospital is accompanied by some limitations which necessitates promotion of the nurses’ awareness about patients’ rights. Taken together in order to enhance nurses’ awareness special measures and strategies should be considered.
Mohammad Nejad, Esmaeil; Begjani, Jamaloddin; Abotalebi, Ghasem; Salari, Amir; Ehsani, Seyyedeh Roghayeh
Illustrates how the implementation of the internal customer concept has assisted United Leeds Teaching Hospitals NHS Trust to establish a culture for quality. Explains the conceptual framework on which the notion of the internal customer is derived. Describes how, from 1992 to date, the Trust’s quality management approach was designed to apply these management principles in a large teaching hospital
Colin Lewisohn; Javier Reynoso
The purpose of this study was to find out the etiological pattern of blepharoptosis among patients presenting in BPKLCOS, T.U. Teaching Hospital. This was a hospital based descriptive and cross-sectional study conducted from February 2003 to July 2004. A total of 125 patients with ptosis were evaluated. 78 cases (62.4%) were congenital and 47 cases (37.6 %) were acquired. Congenital simple ptosis and congenital complicated ptosis comprised of 58% and 42% respectively. Among the acquired cause, ptosis due to trauma was the commonest 32%, followed by third cranial nerve palsy 25.5%, myasthenia gravis 17%, aponeurotic 10.7%, chronic progressive external ophthalmoplegia 8.5% etc. Aetiology-wise, myogenic ptosis was the commonest (65.6%) which was followed by neurogenic (16.8%), traumatic (12%) and aponeurotic ptosis (5.6%). Congenital ptosis is more common than acquired ptosis. Myogenic ptosis is the most predominant type of ptosis. Among the congenital ptosis, congenital simple ptosis is more common than congenital complicated ptosis. Among the acquired cases trauma, third cranial nerve palsy and myasthenia gravis are the major attendees. PMID:17189964
Thapa, R; Karmacharya, P C; Nepal, B P
Trauma is a major problem in both developing and developed countries. World wide road-traffic injuries (RTIs) represent 25% of all trauma deaths. Injuries cause 12% of the global disease burden and are the third commonest cause of death globally. In our own environment, trauma is also important, with RTIs being a leading cause of morbidity and mortality. There is limited data on RTIs in West African countries, and this necessitated our study. We aimed to find common causative factors and proffer solutions. This was a one year prospective study examining all cases of trauma from RTIs seen at the Accident and Emergency Department of the Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki, Nigeria. Three hundred and sixty-three patients were studied. There was a male/female ratio of 3.4:1, with the modal age being 25 years. Most injuries involved motorcycles (54%). Passengers from cars and buses were also commonly affected (34.2%). Most of accidents occurred from head-on collisions (38.8%). Soft-tissue injuries and fractures accounted for 83.5% of injuries. The head and neck region was the commonest injury site (41.1%), and the most commonly fractured bones were the tibia and fibula (5.8%). Death occurred in 17 patients (4.7%), and 46 (12.7%) patients discharged themselves against medical advice. Improvements in road safety awareness, proper driver education-especially motorcycle drivers-and proper hospital care are needed in our subregion. PMID:20623283
Madubueze, Christian C; Chukwu, Christian O Onyebuchi; Omoke, Njoku I; Oyakhilome, Odion P; Ozo, Chidi
Analyzed databases from four U.S. National Clinical Pharmacy Services Studies and the American Hospital Association for trends in hospital involvement in pharmacy education. Detailed findings indicated that clinical pharmacy services within the nation's teaching hospitals are not standardized and that financial pressures impede a full, consistent…
Raehl, Cynthia; Bond, C. A.
BACKGROUND The United States instituted restrictions on resident work-hours in July 2003. The clinical impact of this reform on critically ill patients is unknown. OBJECTIVE We sought to examine the association of the resident work-hours reform with mortality for patients in medical and surgical intensive care units (ICUs). DESIGN We conducted a retrospective cohort study, comparing mortality trends before and after July 1, 2003, in teaching and non-teaching hospitals. SETTING AND PATIENTS The study included 230,151 adult patients admitted to 104 different ICUs at 40 hospitals participating in the APACHE IV clinical information system from July 1, 2001, to June 30, 2005. MEASUREMENTS AND MAIN RESULTS The primary exposure was the date of admission, relative to the implementation of the work-hours regulations. The primary outcome was in-hospital mortality; a secondary outcome was ICU mortality. The analysis included 79,377 patients in 12 academic hospitals; 73,580 patients in 12 community hospitals with residents; and 77,194 patients in 16 non-teaching hospitals. Risk-adjusted mortality improved in hospitals of all teaching levels during the study period. There were no significant differences in the mortality trends between hospitals of different teaching intensities, as demonstrated by non-significant interaction between time and teaching status (global test of interaction p=0.56). CONCLUSIONS There was a decrease in in-hospital mortality in ICU patients during the years of observation. This decrease was not associated with hospital teaching status, suggesting no net positive or negative association of the resident work-hours regulations with a major patient-centered outcome.
Prasad, Meeta; Iwashyna, Theodore J.; Christie, Jason D.; Kramer, Andrew A.; Silber, Jeffrey H.; Volpp, Kevin G.; Kahn, Jeremy M.
Diabetes mellitus presenting in adolescents age 10 to 20 years accounts for less than 5% of all diabetes in tropical African countries. Consequently, inadequate attention is paid to the medical and psychosocial problems attendant on adolescent diabetes in those countries. This article highlights our clinical experience in the management of 30 adolescent diabetic subjects who presented consecutively in the diabetic clinic of a major Nigerian teaching hospital. In these patients, adolescent diabetes appeared heterogeneous, comprising classical insulin-dependent diabetes mellitus (IDDM) in approximately 80%; the remaining fraction (20%) was contributed variably by malnutrition-related diabetes (MRDM) and an "atypical" form of IDDM. The most common medical complications were recurrent hypoglycemia, ketoacidosis, and infections. About 80% of the patients were poor, and up to two thirds had to withdraw from school or trade because of recurrent illness. One third of the girls had a history of unwanted pregnancies. Almost all (93%) had a history of general rebelliousness and clinic truancy. Therefore, the high prevalence of acute metabolic decompensation may be related to the increased frequency of psychosocial problems, especially poverty, in these patients. It is suggested that agencies in tropical Africa increase welfare facilities for adolescent chronic disease, and also establish and encourage clinics dedicated to adolescent diabetes care.
Akanji, A. O.
Summary A total of 36 patients were seen and managed at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria, over a period of five years (2000 to 2004). There were 28 males and 8 females (male to female ratio, 3.5:1). The ages ranged from 1 to 46 yr (mean, 14.5 yr). The burn surface area percentage ranged between 2.5 and 70% (mean, 22.9%). Flame constituted the commonest source of injury (66.7%). Other agents were scalding (9 patients = 25%) and electrical burns (3 patients = 8.3%). The sources of flame burns were kerosene lantern/stove explosion (7 patients = 29.2%); petrol explosion (7 patients = 29.2%); road accidents followed by an explosion (3 patients = 12.5%); one case each (4.2%%) involving ethanol explosion, gun powder explosion, firewood, a lighted candle that ignited furniture and then a whole house; and other unexplained sources (3 patients = 12.5%). Mortality in this study was 7 cases (19.4%). Death was due to acute respiratory distress syndrome in one patient, sepsis in five, and tetanus infection in one. We conclude that most of the injuries were preventable. Education regarding refuelling a lighted lantern/stove, discouraging the storing of petrol in the house, and driving with care will reduce the number of accidents and subsequent possible burn injuries. Children should be monitored carefully to prevent scalding from hot water and food.
Olaitan, P.B.; Fadiora, S.O.; Agodirin, O.S.
Background\\/PurposeLaparoscopic pyloromyotomy (LP) is used widely for treatment of hypertrophic pyloric stenosis. We examined the results of pyloromyotomy at a high-volume pediatric teaching hospital to compare outcomes of laparoscopic and open pyloromyotomy (OP).
Obinna O. Adibe; Peter F. Nichol; Alan W. Flake; Peter Mattei
This prospective hospital-based study was done at Tikur Anbessa Teaching Hospital (TATH) between July 1991 and July 1992 in order to obtain base-line data on the rates of caesarean section, pregnancy out-come, major indications for caesarean and caesarean section complications. Out of a total of 3237 deliveries conducted during the study period, 318(10%) were caesarean section. The leading or the major indication for abdominal deliveries were: repeat caesarean section, 103(32.4%), cephalo-pelvic disproportion, 93(29.2%), placenta previa and abruptio-placentae 40(12.6%). Age ranged from 15-40 years, 58(18.2%) were women under the age of 20, and 182(57%) were between 20 and 30 years of age which is the safest period to bear children. Eighty one (25%) of the mothers were primiparae, 158(50%) were between para one and para four, 79(25%) were grand multiparae. Seventy six (24%) of the cases were not registered for antenatal care in any health institutions. Two hundred and fifteen (67.6%) of the mothers had primary caesarean section. The chance of repeat caesarean section was statistically significant (P < 0.001). Fifty seven (18%) had elective caesarean section and 261 (82%) were emergency caesarean section. On eight (2.5%) of the patient, obstetric hysterectomy was performed. There were five maternal deaths among the caesarean section cases. The main cause of maternal death was failure to control bleeding during the caesarean section. These were preventable deaths in experienced hands. There were nine (2.8%) stillbirths and 15(4.7%) early neonatal deaths. A foetal wastage of 24(7.5%) was noted in the study. The mean birthweight among booked caesarean section were 3108 grams and unbooked caesarean section were 2991 grams. The major obstetric complications in the cases were antepartum haemorrhage, and 34(11%), pregnancy induced-hypertensive disorder, 32(10%). Sixty one (19%) had blood transfusion. The blood loss was significantly more in operations done by residents compared to consultants even using the most crude measurement as estimated by the operator at the time. PMID:8991247
Tadesse, E; Adane, M; Abiyou, M
The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients' pain symptoms during the 24?h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28%) answered the questionnaire and for the other 72% (unable to communicate), the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49%) had observed their child's pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.
Linhares, M.B.M.; Doca, F.N.P.; Martinez, F.E.; Carlotti, A.P.P.; Cassiano, R.G.M.; Pfeifer, L.I.; Funayama, C.A.; Rossi, L.R.G.; Finley, G.A.
Based upon the Self-Efficacy Theory, this study examined the relationship between self-efficacy, self-efficacy-related variables, and postpartum depression teaching behaviors of hospital-based perinatal nurses. Findings revealed that teaching new mothers about postpartum depression is related to a perinatal nurse's self-efficacy in postpartum-depression teaching, self-esteem, and the following self-efficacy-related variables: social persuasion (supervisor's expectations for teaching); mastery (postpartum depression continuing education and teaching experience); and vicarious experience (observing other nurses teach new mothers about postpartum depression). Teaching new mothers about postpartum depression can assist mothers in overcoming barriers to depression treatment. Nurse educators and managers play an important role in encouraging postpartum depression education for perinatal nurses. PMID:21886417
Logsdon, M Cynthia; Foltz, Melissa Pinto; Scheetz, James; Myers, John A
The Martland Hospital Library converted many of its periodical backfiles to 16 mm microfilm cartridges. Some details of program implementation, user reactions, costs, and problems are discussed. In a teaching hospital library microfilm in cartridge format has been well accepted by patrons, in part because the need to read from a projection screen has been minimized by granting liberal printing privileges.
Meiboom, E R
The Martland Hospital Library converted many of its periodical backfiles to 16 mm microfilm cartridges. Some details of program implementation, user reactions, costs, and problems are discussed. In a teaching hospital library microfilm in cartridge format has been well accepted by patrons, in part because the need to read from a projection screen has been minimized by granting liberal printing privileges. PMID:1247708
Meiboom, E R
Objective: To study the perceptions on bioethics among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan Study design: Questionnaire based cross sectional survey Settings: The study was carried out at the family practice center, the Aga Khan University Hospital, Karachi Main outcome measures: Perceptions on the broad principles of bioethics Results: Majority of the respondents were
Waris Qidwai; Hafeez Qureshi; Syed Sohail Ali; Mahboob Alam; Syed Iqbal Azam
The present study examined the effects of certain hospital workplace factors on job involvement among healthcare employees\\u000a at the paramedical levels and quality of patient care in public hospitals in North India. The sample consisted of paramedical\\u000a healthcare employees (N?=?200), from a medical college affiliated teaching hospital and public hospitals (non-teaching) run by the railway services.\\u000a Data were analyzed statistically
Manisha Agarwal; Abhishek Sharma
There is recognition that the provision of excellence in education and training results in a skilled and competent workforce. However, the educational experiences of dental core trainees (DCT's) working in the hospital oral and maxillofacial surgery (OMFS) setting have not been previously investigated. In this paper, we examine DCT's learning experiences both 'formal' and 'non-formal' within the hospital setting of ward and clinic-based teaching. Are hospital dental core trainees receiving a meaningful educational experience? To conclude this paper, the authors recommend methods, based upon sound educational principles, to maximise the value of clinical sessions for teaching. PMID:25012332
Mannion, C J; Brotherton, P
The medical school-hospital relationship is examined in terms of graduate medical education, primary care initiatives, classification of patients, financing house staff, hospital referrals, and planning constraints. (LBH)
Derzon, Robert A.
This paper explores the cost structure of Swiss hospitals, focusing on differences due to teaching activities and those related to ownership and subsidization types. A stochastic total cost frontier with a Cobb-Douglas functional form has been estimated for a panel of 148 general hospitals over the six-year period from 1998 to 2003. Inpatient cases adjusted by DRG cost weights and ambulatory revenues are considered as two separate outputs. The adopted econometric specification allows for unobserved heterogeneity across hospitals. The results suggest that teaching activities are an important cost-driving factor and hospitals that have a broader range of specialization are relatively more costly. The excess costs of university hospitals can be explained by more extensive teaching activities as well as the relative complexity of the offered medical treatments from a teaching point of view. However, even after controlling for such differences university hospitals have shown a relatively low cost-efficiency especially in the first two or three years of the sample period. The analysis does not provide any evidence of significant efficiency differences across ownership/subsidy categories. PMID:17619236
Farsi, Mehdi; Filippini, Massimo
Hospital waste materials pose a wide variety of health and safety hazards for patients and healthcare workers. Many of hospitals in Iran have neither a satisfactory waste disposal system nor a waste management and disposal policy. The main objective of this research was to investigate the solid waste management in the eight teaching hospitals of Iran University of Medical Sciences. In this cross-sectional study, the main stages of hospital waste management including generation, separation, collection, storage, and disposal of waste materials were assessed in these hospitals, located in Tehran city. The measurement was conducted through a questionnaire and direct observation by researchers. The data obtained was converted to a quantitative measure to evaluate the different management components. The results showed that the waste generation rate was 2.5 to 3.01 kg bed(-1) day(-1), which included 85 to 90% of domestic waste and 10 to 15% of infectious waste. The lack of separation between hazardous and non-hazardous waste, an absence of the necessary rules and regulations applying to the collection of waste from hospital wards and on-site transport to a temporary storage location, a lack of proper waste treatment, and disposal of hospital waste along with municipal garbage, were the main findings. In order to improve the existing conditions, some extensive research to assess the present situation in the hospitals of Iran, the compilation of rules and establishment of standards and effective training for the personnel are actions that are recommended. PMID:19487312
Farzadkia, Mahdi; Moradi, Arash; Mohammadi, Mojtaba Shah; Jorfi, Sahand
Objective: To explore Family Medicine Trainees views regarding the hospital component of their Family Medicine (FM) training program. Methodology: This is a qualitative focus group discussion based study. Thirteen trainees, eight from final year of FM training program and five from third year of the same program participated in the study. The structure for discussion included a previously distributed and completed questionnaire that included three sections. The first section was evaluation of the satisfaction of trainees with the different hospital specialties rotations. The second section related to reasons for rating the different rotations as excellent and very good. The third section related to deficiencies in training for those rotations which received a score of 3-5. The items in the questionnaire were utilized in the focus group discussion. Two facilitators who were investigators facilitated the discussion. The data was qualitatively analyzed to identify emergent themes and subthemes that described the trainees’ views. Results: The trainees highlighted the following views: Teaching in the hospital component is not relevant to the needs of Family Medicine trainees. Duration of the hospital posts should be reviewed. Emphasis should be on out-patient clinics rather than in-patient. More emphasis must be given to procedural skills, minor surgery and teaching in clinical contexts. Conclusion: Hospital training component of the Family Medicine training program should be reviewed, as the structure and its implementation doesn’t reflect the views of trainees regarding its relevance to their day to day practice.
Alquaiz, Aljohara M; Abdulghani, Hamza M; Karim, Syed Irfan; Qureshi, Riaz
Objective: To explore Family Medicine Trainees views regarding the hospital component of their Family Medicine (FM) training program. Methodology: This is a qualitative focus group discussion based study. Thirteen trainees, eight from final year of FM training program and five from third year of the same program participated in the study. The structure for discussion included a previously distributed and completed questionnaire that included three sections. The first section was evaluation of the satisfaction of trainees with the different hospital specialties rotations. The second section related to reasons for rating the different rotations as excellent and very good. The third section related to deficiencies in training for those rotations which received a score of 3-5. The items in the questionnaire were utilized in the focus group discussion. Two facilitators who were investigators facilitated the discussion. The data was qualitatively analyzed to identify emergent themes and subthemes that described the trainees' views. Results: The trainees highlighted the following views: Teaching in the hospital component is not relevant to the needs of Family Medicine trainees. Duration of the hospital posts should be reviewed. Emphasis should be on out-patient clinics rather than in-patient. More emphasis must be given to procedural skills, minor surgery and teaching in clinical contexts. Conclusion: Hospital training component of the Family Medicine training program should be reviewed, as the structure and its implementation doesn't reflect the views of trainees regarding its relevance to their day to day practice. PMID:24353498
Alquaiz, Aljohara M; Abdulghani, Hamza M; Karim, Syed Irfan; Qureshi, Riaz
The objective of our study was to evaluate the appropriateness of admission and hospital stay in pediatric wards of a Teaching Hospital in Rome using the Italian version of pediatric Appropriateness Evaluation Protocol (AEP). We reviewed 263 medical records of patients admitted in hospital during 2004. For each hospitalisation a judge on appropriateness/inappropriateness of admission and hospital stay was elaborated. We retrieved also data on type of ward, date, time and type of admission, date of discharge and data related to each patient. We carried out an univariate and a multivariate logistic regression analysis. Our results showed that the risk of an inappropriate admission is associated to residence out of Rome (OR = 2.45; CI 95%: 1.35-4.47) while the urgent admission is protective against inappropriateness (OR = 0.14; CI 95%: 0.07-0.25). The inappropriate hospital stay is associated to inappropriate admission (OR = 5.82; CI 95%: 3.17-10.70) and hospitalisation in a medical ward (OR = 3.26; CI 95%: 1.81-5.90). Stay in hospital in spring or summer periods is protective against hospitalisation inappropriateness (OR = 0.52; CI 95%: 0.30-0.91). The percentage of inappropriate admission and hospital stay is, respectively, 42.1%, and 50.2%, thus pointing out that there is the need of organisational interventions to reduce inappropriate hospitalisations. PMID:18478673
Chiaradia, G; de Waure, C; La Torre, G; Paparatti, M; Ricciardi, W
The medical records system of an upcoming teaching hospital in a developing nation was evaluated for its accessibility, completeness, physician satisfaction, presence of any lacunae, suggestion of necessary steps for improvisation and to emphasize the importance of Medical records system in education and research work. The salient aspects of the medical records department were evaluated based on a questionnaire which was evaluated by a team of 40 participants-30 doctors, 5 personnel from Medical Records Department and 5 from staff of Hospital administration. Most of the physicians (65%) were partly satisfied with the existing medical record system. 92.5% were of the opinion that upgradation of the present system is necessary. The need of the hour in the present teaching hospital is the implementation of a hospital-wide patient registration and medical records re-engineering process in the form of electronic medical records system and regular review by the audit commission. PMID:21409398
Kumar, B Deepak; Kumari, C M Vinaya; Sharada, M S; Mangala, M S
A descriptive, cross sectional, retrospective audit of admission records and hospital casualty cards were undertaken to determine the accuracy of identification of cases of deliberate self-poisoning (DSP) among youth admitted and presenting for self poisoning. To investigate the rate of admission for poisoning presentations. From 1,260 cases of poisoning, aged 10–25 years, admitted to three university teaching hospitals in Sydney
Meredith Nirui; Michael Dudley; Armita Adily; Mark Ferson
\\u000a In the Biomedical Engineering domain, Clinical Engineering has a crucial role requiring specialization and training in the\\u000a clinical setting of hospitals and clinics, to gain real-world experience with respect to safe and effective application of\\u000a biomedical equipment, technologies and systems to result in efficacious and high quality patient care. The academic training\\u000a coupled with internship in a teaching hospital gives
S. M. Krishnan; P. A. Cortès
Problem Statement: The contamination rates of Health Care Worker's (HCW) mobile phones and resistance to commonly used antimicrobials were evaluated in three teaching hospitals in Kerman, Iran. So, we examined 150 randomly selected HCWs in three teaching hospitals in Kerman, Iran, 2007. For each HCW a sterile swab moistened with sterile water was rotated over the surface of both sides
Gholamreza Sepehri; Nooshin Talebizadeh; Ali Mirzazadeh
Background To control the spread of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals, infection control measures such as hand hygiene practices were introduced into the teaching hospitals in Shanghai, China, in 2008. Currently, there is limited information characterizing the latest hospital-acquired S. aureus infections in this area. Therefore, we sought to determine the prevalence, molecular characteristics, and genotype-phenotype correlation of hospital-acquired S. aureus infections in Huashan Hospital, one of the largest teaching hospitals in Shanghai. Results Among 608 hospital-acquired S. aureus clinical isolates obtained from January to December of 2011 in Huashan Hospital, 68.1% were MRSA. The predominant MRSA clones were ST239-SCCmecIII and ST5-SCCmecII. ST239 was mainly recovered from respiratory specimens and sterile body fluids, ST5 was associated with respiratory specimens and blood, and ST1 was most prevalent in urine samples. In this study, 31 dispersed sequence types (STs) of methicillin-susceptible S. aureus (MSSA) were identified, most of which caused skin/soft tissue infection and bacteremia. The frequencies of pvl-, muPA-, and qacA/B-positive isolates were 1.6, 9.9, and 11.8% respectively. MuPA was more frequently identified in ST1 and ST5, and qacA/B was more prevalent in ST239 and ST5. Most of the pvl-positive isolates were MSSA, whereas the majority of muPA- and qacA/B-positive isolates were MRSA. ST239 and ST5 had higher resistance rates to multiple antibiotics. In Huashan Hospital, the infection rate in the intensive care unit (ICU) was 3.9 per 1000 hospitalized days, but only 1.2 per 1000 hospitalized days in the other wards. Each ward harbored its own dominant STs. Pulsed-field gel electrophoresis showed diversity within the same epidemic S. aureus clones originating from the same wards. Conclusion There is still a high prevalence of MRSA infections in the teaching hospital in Shanghai. There were also differences in the major infection types caused by MRSA and MSSA, and hospital-acquired S. aureus infections in the ICU of Huashan Hospital pose a greater threat to patient safety than in other wards. The high proportion of multiple antibiotic and chlorhexidine-based antiseptic-resistant clones in this hospital underscores the need for more effective infection control measures to help curtail dissemination of MRSA to hospitalized patients.
This research summarizes an analysis of the impact of environment pressures on hospital inefficiency during the period 1990-1999. The panel design included 616 hospitals. Of these, 211 were academic medical centers and 415 were hospitals with smaller teaching programs. The primary sources of data were the American Hospital Association's Annual Survey of Hospitals and Medicare Cost Reports. Hospital inefficiency was estimated by a regression technique called stochastic frontier analysis. This technique estimates a "best practice cost frontier" for each hospital that is based on the hospital's outputs and input prices. The cost efficiency of each hospital was defined as the ratio of the stochastic frontier total costs to observed total costs. Average inefficiency declined from 14.35% in 1990 to 11.42% in 1998. It increased to 11.78% in 1999. Decreases in inefficiency were associated with the HMO penetration rate and time. Increases in inefficiency were associated with for-profit ownership status and Medicare share of admissions. The implementation of the provisions of the Balanced Budget Act of 1997 was followed by a small decrease in average hospital inefficiency. Analysis found that the SFA results were moderately sensitive to the specification of the teaching output variable. Thus, although the SFA technique can be useful for detecting differences in inefficiency between groups of hospitals (i.e., those with high versus those with low Medicare shares or for-profit versus not-for-profit hospitals), its relatively low precision indicates it should not be used for exact estimates of the magnitude of differences associated with inefficiency-effects variables. PMID:14977089
Rosko, Michael D
A study of medical college faculty perceptions of the value of two groups of patients admitted to a teaching hospital 15 years apart suggests that changes in patient populations resulting from economic changes may have diminished the educational value of medical inpatients in academic settings. (MSE)
Davidson, Richard A.
This research was aimed at evaluating the pattern of obstetrics sonographic request and findings at the university of Maiduguri teaching hospital (UMTH). A total of 1535 records of antenatal patients referred for sonography within the period of 4years; from April, 1997 to march, 2001 were analyzed in this retrospective study. Dating was the highest request made by physicians, 74.07% (n=1137)
Nwobi IC; Ugwu AC; Abubakar A
Objective. This study sought to determine the relative frequency of odontogenic tumors in a Nigerian population and to compare these data with previous reports. Study design. Records of patients seen at the Lagos University Teaching Hospital between January 1980 and December 2003, with histologic diagnosis of odontogenic tumors (based on World Health Organisation classification, 1992), were analyzed. Results. Odontogenic tumors
Akinola Ladipo Ladeinde; Oluseyi Folake Ajayi; Mobolanle Olugbemiga Ogunlewe; Wasiu Lanre Adeyemo; Godwin Toyin Arotiba; Babatunde Olamide Bamgbose; Jelili Adisa Akinwande
The changing social milieu has removed the charity patient but not the need for a teaching population. The University Hospital's program is described, in which patients prepaid a fixed, single fee for all obstetrics-related care through the third post partum day. (LBH)
Young, Philip E.
Objective: The main goal of this study was to assess differences in the vaginal flora of pregnant women and provide a detailed evaluation of vaginal swabs for the presence of group B streptococcus (GBS) and other organisms in three teaching hospitals in Shiraz, southwest of Iran. Subjects and Methods: In a cross-sectional study from April 2006 to March 2007, 310
Parvin Hassanzadeh; Mohammad Motamedifar; Maral Namdari Gharaghani
BACKGROUND: Smooth working relationships between nurses and doctors are necessary for efficient health care delivery. However, previous studies have shown that this is often absent with negative impact on the quality of health care delivery. In 2002, we studied factors that affect nurse-doctor working relationships in University Teaching Hospitals (UTH) in Southern Nigeria in order to characterize it and identify
Roseline I Ogbimi; Clement A Adebamowo
The results are reported of a first round of costing by DRG in seven major teaching hospital sites in Sydney using the Yale cost model. These results, when compared between the hospitals and with values of relative costs by DRG from the United States, indicate that the cost modelling procedure has produced credible and potentially useful estimates of casemix costs. The rationale and underlying theory of cost modelling is explained, and the need for further work to improve the method of allocating costs to DRGs, and to improve the cost centre definitions currently used by the hospitals, is emphasised. PMID:10117339
Palmer, G; Aisbett, C; Fetter, R; Winchester, L; Reid, B; Rigby, E
Experience from a large teaching hospital regarding hospital waste management is presented. The quantum of hospital waste generated is 0.775 kg. per patient per day. Out of this biomedical waste constitute only 6.27 per cent. Though all resources have been provided, a large implementation gap for waste management is seen because of attitudinal problem. A particular difficulty is experienced for disposal of green coconut shells. Incineration has been advocated as a viable method of disposal. Cost of incineration is Rs. 2.71 per patient per day. PMID:10538171
Basu, R N
This paper documents, using a single test as a model, the significant increase in clinical laboratory workload which occurred in a university hospital when strong sections of nephrology, hematology-oncology, and immunology-rheumatology were added to the department of medicine. (Author)
Van Peenen, Hubert J.
During the past five years the incidence of imported malaria increased among patients seen in East Birmingham Hospital and in St Thomas's Hospital, London. Plasmodium vivax was the predominant species in Birmingham, and was almost always acquired by Asian immigrants visiting the Indian subcontinent. In St Thomas's P falciparum was most commonly imported, usually by African immigrants visiting Nigeria and Ghana. Two patients (one Irish, one Japanese) died of falciparum malaria after visiting tropical Africa. In both hospitals the immigrant patients had seldom taken prophylactic drugs, and the few who had, ceased to do so on arrival in the UK and sometimes before leaving the malarious country. Apparently immigrants who visit their homeland do not consult their general practitioners before travelling, are given inappropriate advice, or do not take appropriate advice when given. Since the incidence of imported falciparum malaria in the UK is rising, the following points should be considered: the infection may be lethal, particularly in patients lacking immunity; it can mimic other diseases, which may lead to delayed diagnosis; severe disease may be associated with few parasites on a blood film, and even if the result is negative further tests should be performed; clinicians and hospital pharmacists should be aware of the need to keep permanent stocks of parenteral chloroquine and quinine preparations.
Ellis, C J; Eykyn, S J; Watkins, P; Bell, M; Geddes, A M
Strabismus may result in impaired stereopsis, diplopia, undesirable appearance, amblyopia and negative psychological impact. This study provides epidemiological and surgical outcome information about patients attending University College Hospital Galway requiring strabismus surgery. We report a retrospective analysis of 75 consecutive patients, who underwent horizontal strabismus surgery. Sixty-one (81.3%) patients had clinically significant refractive errors, hyperopia being the most common. Thirty-four (45.3%) patients had amblyopia and nine (12%) required further treatment. A cosmetically acceptable result with a post-operative ocular deviation within 25 prism dioptres of straight (grade 2) was achieved in 70/75 (93.3%) of patients. The overall mean change in ocular deviation per mm of muscle operated was 3.25 prism dioptre/mm. The outcomes of strabismus surgery in an Irish hospital compare very favourably with other jurisdictions. This data will help plan service delivery. PMID:24988834
Idrees, Z; Dooley, I; Fahy, G
Hospital management and researchers are increasingly using electronic databases to study utilization, effectiveness, and outcomes of healthcare provision. Although several studies have examined the accuracy of electronic databases developed for general administrative purposes, few studies have examined electronic databases created to document the care provided by individual hospitals. In this study, we assessed the accuracy of an electronic database in a major teaching hospital in Eastern Province, Saudi Arabia, in documenting the 17 comorbidities constituting the Charlson index as recorded in paper charts by care providers. Using the hospital electronic database, the researchers randomly selected the data for 1,019 patients admitted to the hospital and compared the data for accuracy with the corresponding paper charts. Compared with the paper charts, the hospital electronic database did not differ significantly in prevalence for 9 conditions but differed from the paper charts for 8 conditions. The kappa (K) values of agreement ranged from a high of 0.91 to a low of 0.09. Of the 17 comorbidities, the electronic database had substantial or excellent agreement for 10 comorbidities relative to paper chart data, and only one showed poor agreement. Sensitivity ranged from a high of 100.0 percent to a low of 6.0 percent. Specificity for all comorbidities was greater than 93 percent. The results suggest that the hospital electronic database reasonably agrees with patient chart data and can have a role in healthcare planning and research. The analysis conducted in this study could be performed in individual institutions to assess the accuracy of an electronic database before deciding on its utility in planning or research.
Youssef, Adel; Alharthi, Hana
Background: During the last three decades, ethics committees have been formed with a growing trend. These committees have a satisfactory and effective impact on the pattern of patient care and its performance. The medical ethics committee is considered one of the most active committees in hospitals, having the aim of providing necessary approaches for the optimal use of the findings in empirical science and diagnostic treatment and observance of Islamic noble values in performing medical affairs. Objectives: The aim of this study is to assess the performance of the ethics committees, in the teaching hospitals affiliated with Mashhad University of Medical Sciences, in Mashhad. Patients and Methods: Subjects of this study include teaching hospitals in Mashhad, affiliated with Mashhad University of Medical Sciences and the tool used in gathering the data was a questionnaire, completed based on the information provided by the proceedings of the meetings held by the ethics committees. Also, for the purpose of gathering the suggestions, specifically on the improvement of the performance, a meeting was held with the representatives from hospitals' ethics committees. During the meeting, work reports were presented and recommendations made, based on those presentations. . Results: Findings of the present study suggest that all hospitals under study, have an ethics committee, of which 85.7% operate in combination with other committees. The composition of the members of the committees, in 57.1% of the hospitals, was based on the guidelines for hospital evaluation. Conclusions: For the performance of the medical ethics committees to improve, it is recommended that the hospital administration and evaluation section, hold regular meetings and oblige members to participate more actively.
Meraji, Marziyhe; Sadoughi, Farahnaz; Ramezan Ghorbani, Nahid; Nezami, Azar
St Vincent's Hospital Melbourne cautiously prescribes thalidomide as a treatment for recalcitrant dermatoses. The guidelines used for prescribing and monitoring thalidomide for dermatological conditions at this institution are presented. Fourteen patients were treated with thalidomide (11 women, three men) over a 5-year period. The diagnoses of patients treated were actinic prurigo, prurigo nodularis, lupus erythematosus and Behçet's syndrome. A clinical improvement was noted in 10 patients (71.4%) prescribed thalidomide. Cessation of thalidomide treatment occurred in seven patients (50%) because of adverse effects. Of the patients with adverse effects, four developed abnormal nerve conduction studies and three developed intolerable adverse events (such as dizziness and vomiting). Adverse effects from thalidomide treatment are common but, through vigilant treatment planning, patient education and regular monitoring, the risk of permanent peripheral neuropathy and teratogenicity from thalidomide toxicity can be minimized. PMID:12423435
Crouch, Rohan B; Foley, Peter A; Ng, Jonathan C H; Baker, Christopher S
Key roles in teaching evidence-based practice (EBP) are of interest to many hospital and academic librarians. This article describes how three academic librarians, in collaboration with the academic medical center's EBP Nursing Council, developed a seminar consisting of three credit hours of instruction in the basics of evidence-based practice. The seminar consists of three core elements: basic principles of EBP and finding literature, clinical experience and integration of knowledge into the hospital setting, and patient education and participation. Emphasis is placed upon analysis of the literature, institutional models of practice change, and the importance of patient roles in guideline development. PMID:23394424
Blake, Lindsay; Ballance, Darra
Illustrates how the implementation of the internal customer concept has assisted United Leeds Teaching Hospitals NHS Trust to establish a culture for quality. Explains the conceptual framework on which the notion of the internal customer is derived. Describes how, from 1992 to date, the Trust's quality management approach was designed to apply these management principles in a large teaching hospital setting. Outlines how this quality management approach has been successful in enabling departmental managers to recognize, develop and improve internal customer/supplier relationships. Concludes by explaining that business process re-engineering is now being applied as a prime quality tool to help deliver a major culture change throughout the organization. PMID:10142012
Lewisohn, C; Reynoso, J
The internal medicine unit of the Royal Victoria Hospital in Montreal was created in 1979 to improve the training of residents and the care of patients. The practices of four internists were brought together in one part of the institution, and within 2 years there were 10 attending staff and 6 residents. The unit now provides continuing care for 2500 patients, many of whom have multisystem or potentially lethal problems. Residents and attending staff share the responsibility of providing 24-hour coverage. The group handles 5000 outpatient visits per year (20% of them being consultations) and provides a general medical consulting service for other hospital departments, with about 300 consultations per year. The creation of the unit, with highly visible role models, appears to have given new prestige to general internists in the hospital. The unit has served as a model for the reorganization of the other medical clinics and provides a base for research in health care delivery.
Kong, H. H.; Flegel, K. M.; Coke, W.; Hoey, J. R.
This investigation compared the use of computed tomography (CT) of the head at a large primary medical-school-affiliated hospital and at a large community hospital. There were two aims: first, to study the intrinsic characteristics of the patients in an attempt to determine the protential for developing accurate discrimination algorithms; and second, to study the patterns of neurodiagnostic tests used at these facilities. The results indicated that separability of patients into normal and abnormal categories at both institutions was extremely small. In addition, there was no significant difference in the numbers or types of ancillary tests used at both institutions. Overall, these data once more confirm the difficulty of altering CT usage patterns in primary or secondary hospitals without significantly affecting the number of abnormal patients identified.
McNeil, B.J.; Kirkwood, J.R.; Hanley, J.A.; Polak, J.; Wilkinson, R.; Funkenstein, H.H.
A computer generated report (Practice Profile) summarizing epidemiologic, demographic and utilization data from a general internal medicine practice, was developed and implemented in a teaching hospital setting. Using a computerized medical record system, the Profile displays individual and group practice data. It is used for enhancing the physicians' understanding of their ambulatory practices and for raising important quality assurance issues. The Practice Profile is also used for improving educational activities in the residency program and for stimulating research opportunities within the practice.
Retchin, Sheldon M.; Blish, Christine S.
Treatment of hypertension among hospitalized patients represents an opportunity to improve blood pressure recognition and treatment. To address this issue, the authors examined patterns of antihypertensive medication prescribing among 5668 hypertensive inpatients. Outcomes were treatment with any antihypertensive medication and treatment with first-line therapy, defined as angiotensin-converting enzyme inhibitors, beta-blockers, thiazide diuretics, or calcium channel blockers. Logistic regression models adjusting for age, sex, race, length of stay, service line, and comorbidity were used for all comparisons. The multivariate-adjusted odds ratios for treatment were higher for men (1.4, P<.001), older patients (2.5 for age older than 80 vs 1.0 for age younger than 40; P<.001), non-white race (1.2 vs 1.0 for white race; P<.004), and generalist service line (1.4 vs 1.0 for all other services; P<.001). Multivariate-adjusted odds ratios for receiving first-line agents were higher for older patients and generalist service line. Among surgical patients, receipt of medical consultation was only marginally associated with higher odds of antihypertensive or first-line treatment after adjustment for relevant clinical variables. Demographic factors and service line appear to play a major role in determining the likelihood of inpatient hypertension treatment. Understanding and addressing these disparities has the potential to incrementally improve hypertension control rates in the population. PMID:20433545
Axon, R Neal; Nietert, Paul J; Egan, Brent M
Treatment of hypertension among hospitalized patients represents an opportunity to improve blood pressure recognition and treatment. To address this issue, we examined patterns of antihypertensive medication prescribing among 5,668 hypertensive inpatients. Outcomes were treatment with any antihypertensive medication and treatment with first line therapy, defined as ACE inhibitor, beta blocker, thiazide diuretic, or calcium channel blocker. Logistic regression models adjusting for age, sex, race, length of stay (LOS), service line, and co-morbidity were used for all comparisons. The multivariate-adjusted odds ratios for treatment were higher for men (1.4, p<0.001), older patients (2.5 for age >80 vs. 1.0 for age < 40, p<0.001), non-white race (1.2 vs. 1.0 for white race, p<0.004), and generalist service line (1.4 vs. 1.0 for all other services, p<0.001). Multivariate-adjusted odds ratios for receiving first-line agents were higher for older patients and generalist service line. Among surgical patients, receipt of medical consultation was only marginally associated with higher odds of antihypertensive or first-line treatment after adjustment for relevant clinical variables. Demographic factors and service line appear to play a major role in determining the likelihood of inpatients hypertension treatment. Understanding and addressing these disparities has the potential to incrementally improve hypertension control rates in the population.
Axon, R. Neal; Nietert, Paul J.; Egan, Brent M.
Background: A cross-sectional study on work-related stressors among nurses in a public teaching hospital had also attempted to explore functions of coping strategies in determining stress. Materials and Methods: A structured bilingual questionnaire (English-Malay) on symptoms and sources of stress, and coping style measure was disseminated to medical and surgical nurses working in a teaching hospital in Kuala Lumpur. Socio
ZA Emilia; I Noor Hassim
Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. Methods This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Results Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6%) was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9%) was most frequently disagreed. In the event of a medical error, majority (67.7%) were ready to disclose their error to the patient. The most common perceived reason for not disclosing the error was threat of a claim or assault (90.9%). Majority (68.3%) believed that malpractice had a negative effect on reputation. Only 13(4.1%) had received at least one legal claim for damages. Only about three-fourths (75.5%) had the habit of frequently obtaining informed consent from the patients. 83(26.0%) expressed reluctance in accepting a case that was deemed to be difficult. Financial gains and liabilities were responsible for biased approach in 8.5% and 12.2% of the respondents respectively. Conclusion There is a dire need of programs aimed at increasing awareness among practicing surgeons in our setup. Proactive measures are required for the formulation of an efficient system of litigation. Physician accountability will not only arouse a greater sense of responsibility in them, but will also augment the confidence placed by patients on the healthcare system.
In India, very few reports on the cost of adverse drug reactions (ADRs) are available. There is a need to study this aspect of health care in order to understand the economic burden imposed by ADRs. The aim of the current work was to study the costs associated with documented ADRs in a tertiary care teaching hospital. This study was conducted in medical wards of a south Indian tertiary care teaching hospital over a 6-month period. The study protocol was assessed and approved by the institutional ethics committee. A total of 317 ADRs from 246 patients were identified during the study period. The present study used an intensive monitoring method to detect ADRs and assessed an incidence of 32.7% adverse reactions in the monitored group. The causality, severity, predictability, and preventability of the documented ADRs were assessed. The total cost to the hospital due to ADRs was found to be Rs. 1,567,397 (US$36 451). The average cost per patient hospitalized with an ADR was Rs. 4,945 (US$115). The cost per reaction was found to be higher in the Indian context, as the per capita annual expenditure on health in this country is around US$109. PMID:21505086
Rajakannan, Thiyagu; Mallayasamy, Surulivelrajan; Guddattu, Vasudeva; Kamath, Asha; Vilakkthala, Rajesh; Rao, Padma G M; Bairy, Laxminarayana K
This paper reports on five years of experience with computer-assisted instruction (CAI) at Winthrop-University Hospital, a major affiliate of the SUNY at Stony Brook School of Medicine. It compares CAI programs available from Ohio State University and Massachusetts General Hospital (accessed by telephone and modem), and software packages purchased from the Health Sciences Consortium (MED-CAPS) and Scientific American (DISCOTEST). The comparison documents one library's experience of the cost of these programs and the use made of them by medical students, house staff, and attending physicians. It describes the space allocated for necessary equipment, as well as the marketing of CAI. Finally, in view of the decision of the National Board of Medical Examiners to administer the Part III examination on computer (the so-called CBX) starting in 1988, the paper speculates on the future importance of CAI in the community teaching hospital. PMID:3518839
McCorkel, J; Cook, V
This paper reports on five years of experience with computer-assisted instruction (CAI) at Winthrop-University Hospital, a major affiliate of the SUNY at Stony Brook School of Medicine. It compares CAI programs available from Ohio State University and Massachusetts General Hospital (accessed by telephone and modem), and software packages purchased from the Health Sciences Consortium (MED-CAPS) and Scientific American (DISCOTEST). The comparison documents one library's experience of the cost of these programs and the use made of them by medical students, house staff, and attending physicians. It describes the space allocated for necessary equipment, as well as the marketing of CAI. Finally, in view of the decision of the National Board of Medical Examiners to administer the Part III examination on computer (the so-called CBX) starting in 1988, the paper speculates on the future importance of CAI in the community teaching hospital.
McCorkel, J; Cook, V
Bacteraemia is an important cause of morbidity and mortality in the intensive care unit. In this study the distribution of organisms causing bacteraemic episodes in patients in the adult intensive care unit of a large teaching hospital was determined. Particular emphasis was placed on the type of organisms isolated from community- and hospital-acquired bacteraemia, the suspected source of infection, the
M. Crowe; P. Ispahani; H. Humphreys; T. Kelley; R. Winter
Bacteraemia is an important cause of morbidity and mortality in the intensive care unit. In this study the distribution of organisms causing bacteraemic episodes in patients in the adult intensive care unit of a large teaching hospital was determined. Particular emphasis was placed on the type of organisms isolated from community- and hospital-acquired bacteraemia, the suspected source of infection, the
M. Crowe; P. Ispahani; H. Humphreys; T. Kelley; R. Winter
The goal of this study was to examine the adult surgical emergencies seen at the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, with a view to proffering preventive solutions where appropriate and improving outcome. From the register of patients seen at the Casualty department and from the operations register in the main operation room of NAUTH, names and hospital numbers
Gabriel U. Chianakwana; Chima C. Ihegihu; Pius I. S. Okafor; Stanley N. C. Anyanwu; Okechukwu O. Mbonu
Background The optimal structure of an internal medicine ward team at a teaching hospital is unknown. We hypothesized that increasing the ratio of attendings to housestaff would result in an enhanced perceived educational experience for residents. Methods Harbor-UCLA Medical Center (HUMC) is a tertiary care, public hospital in Los Angeles County. Standard ward teams at HUMC, with a housestaff?attending ratio of 5?1, were split by adding one attending and then dividing the teams into two experimental teams containing ratios of 3?1 and 2?1. Web-based Likert satisfaction surveys were completed by housestaff and attending physicians on the experimental and control teams at the end of their rotations, and objective healthcare outcomes (e.g., length of stay, hospital readmission, mortality) were compared. Results Nine hundred and ninety patients were admitted to the standard control teams and 184 were admitted to the experimental teams (81 to the one-intern team and 103 to the two-intern team). Patients admitted to the experimental and control teams had similar age and disease severity. Residents and attending physicians consistently indicated that the quality of the educational experience, time spent teaching, time devoted to patient care, and quality of life were superior on the experimental teams. Objective healthcare outcomes did not differ between experimental and control teams. Conclusions Altering internal medicine ward team structure to reduce the ratio of housestaff to attending physicians improved the perceived educational experience without altering objective healthcare outcomes.
Spellberg, Brad; Lewis, Roger J.; Sue, Darryl; Chavoshan, Bahman; Vintch, Janine; Munekata, Mark; Kim, Caroline; Lanks, Charles; Witt, Mallory D.; Stringer, William; Harrington, Darrell
Carbapenems are first-line agents for the treatment of serious nosocomial infections caused by multidrug-resistant Enterobacteriaceae. However, resistance to carbapenems has increased dramatically among Enterobacteriaceae in our hospital. In this study, we report clonal dissemination caused by carbapenem-resistant Enterobacter aerogenes (CREA). In 2011, CREA was identified from 12 patients admitted to the neurosurgical ward. All 12 clinical isolates were non-susceptible to cefotaxime, ceftazidime, cefoxitin, ertapenem, imipenem or meropenem. All isolates carried the gene encoding Klebsiella pneumoniae carbapenemase-2 (KPC-2), except for the isolate E4. However, a remarkably lower expression level of the porin OmpF was detected in the non-KPC-2-producing isolate E4 on SDS-PAGE compared with the carbapenem-susceptible isolate. Epidemiological and molecular investigations showed that a single E. aerogenes strain (PFGE type A), including seven KPC-2-producing clinical isolates, was primarily responsible for the first isolation and subsequent dissemination. In a case-control study, we identified risk factors for infection/colonization with CREA. Mechanical ventilation, the changing of sickbeds and previous use of broad-spectrum antibiotics were identified as potential risk factors. Our findings suggest that further studies should focus on judicious use of available antibiotics, implementation of active antibiotic resistance surveillance and strict implementation of infection-control measures to avoid the rapid spread or clonal dissemination caused by carbapenem-resistant Enterobacteriaceae in healthcare facilities. PMID:24273320
Qin, Xiaohua; Yang, Yang; Hu, Fupin; Zhu, Demei
As part of a new automated ambulatory medical record, a computerized outpatient medication system was developed for a teaching hospital general medicine group practice. Seven months after its implementation, the system was evaluated to determine physician acceptance and approval. Practice physicians were surveyed, and 94% of the respondents approved of the system. Over 90% thought that the computerized system had improved the completeness and accuracy of medication information as well as their own efficiency in prescription writing. Eighteen percent thought it had influenced their prescribing patterns. These perceived improvements in medication information and the prescription process may mean that patient care has improved as a result of the new computerized system.
Blish, Christi; Proctor, Rita; Fletcher, Suzanne W.; O'Malley, Michael
Veterinary students at two large veterinary referral teaching hospitals were surveyed on their perceptions of competition with interns and residents for learning experiences during clinical instruction. Their responses led to an additional survey of a cohort of clinical educators on how this competition might be managed, what impedes effective management, and how progress toward an improved clinical learning environment might be measured. This article describes the results of the survey and discusses the nature of the competition and factors affecting the competitive learning environment. The results of this study should be expanded to include a larger cohort of veterinary students and an assessment of house officers' and faculty members' perceptions. PMID:18339948
Kochevar, Deborah T; Peycke, Laura E
A high incidence of dental disease has been reported in Nepal. Previous studies, both in the Manipal Teaching Hospital, Pokhara, Nepal, and other centers revealed problems in the use of medicines in dentistry. A number of initiatives to improve prescribing have been carried out. The study presented here was undertaken to assess the impact of these initiatives on drug utilization among dental outpatients. The study was conducted among patients attending the dental outpatient department of the hospital over a six-month period. Demographic details were studied. The drug classes and individual drugs prescribed were recorded. The cost of drugs was calculateS using the outpatient pharmacy price list. The prescriptions were analyzed using the WHO/INRUD prescribing indicators. Anomalies were noted in prescribing. Improvement was noted in certain parameters compared to previous studies. The educational initiatives should be strengthened. Managerial interventions can be considered. Further studies are required. PMID:18402382
Palaian, Subish; Shankar, P Ravi; Hegde, Chatura; Hegde, Manjunath; Ojha, Pradip; Mishra, Pranaya
Veterinary nosocomial infections caused by antibiotic resistant bacteria cause increased morbidity, higher cost and length of treatment and increased zoonotic risk because of the difficulty in treating them. In this study, an individual-based model was developed to investigate the effects of movements of canine patients among ten areas (transmission points) within a veterinary teaching hospital, and the effects of these movements on transmission of antibiotic susceptible and resistant pathogens. The model simulates contamination of transmission points, healthcare workers, and patients as well as the effects of decontamination of transmission points, disinfection of healthcare workers, and antibiotic treatments of canine patients. The model was parameterized using data obtained from hospital records, information obtained by interviews with hospital staff, and the published literature. The model suggested that transmission resulting from contact with healthcare workers was common, and that certain transmission points (housing wards, diagnostics room, and the intensive care unit) presented higher risk for transmission than others (lobby and surgery). Sensitivity analyses using a range of parameter values demonstrated that the risk of acquisition of colonization by resistant pathogens decreased with shorter patient hospital stays (P<0.0001), more frequent decontamination of transmission points and disinfection of healthcare workers (P<0.0001) and better compliance of healthcare workers with hygiene practices (P<0.0001). More frequent decontamination of heavily trafficked transmission points was especially effective at reducing transmission of the model pathogen.
Suthar, Neeraj; Roy, Sandip; Call, Douglas R.; Besser, Thomas E.; Davis, Margaret A.
Objective To characterise the prescription of non-formulary drugs to children and neonates at a Brazilian teaching hospital and identify adverse drug reactions (ADRs), drug interactions, and prescription of potentially hazardous medicines. Methods A prospective exploratory study was carried out between January and May 2011 at the general paediatric wards and paediatric oncology, paediatric intensive care, and neonatal care units of the study hospital. Non-formulary drugs were categorised as approved, off-label, or not approved for use in children according to Brazilian compendia. Electronic health records were actively searched for ADRs and the possibility of moderate to severe interactions between non-formulary drugs and other medicines was determined with the Micromedex® database. Results Overall, 109 children or neonates received non-formulary drugs. Of these drugs, 54% were approved for use in children, 12.2% were used off-label, and 33.8% were not approved for use in children. Non-formulary drugs accounted for 13.4% of total prescriptions; 5.3% of drugs had a potential for interactions and five were possibly associated with ADRs. Conclusions Prescription of non-formulary drugs not approved for use in children was common at the study hospital. Studies such as this provide information on the use of medicines for special indications and permit assessment of the relevance of hospital formularies for the paediatric population.
Tramontina, Mariana Y.; Heineck, Isabela; Dos Santos, Luciana
Objective: Supporting a therapeutic approach and medication therapy management, the pharmacy information system (PIS) acts as one of the pillars of hospital information system. This ensures that medication therapy is being supported with an optimal level of safety and quality similar to other treatments and services. Materials and Methods: The present study is an applied, cross-sectional study conducted on the PIS in use in selected hospitals. The research population included all users of PIS. The research sample is the same as the research population. The data collection instrument was the self-designed checklist developed from the guidelines of the American Society of Health System Pharmacists, Australia pharmaceutical Society and Therapeutic guidelines of the Drug Commission of the German Medical Association. The checklist validity was assessed by research supervisors and PIS users and pharmacists. Findings: The findings of this study were revealed that regarding the degree of meeting the standards given in the guidelines issued by the Society of Pharmacists, the highest rank in observing input standards belonged to Social Services hospitals with a mean score of 32.75. Although teaching hospitals gained the highest score both in process standards with a mean score of 29.15 and output standards with a mean score of 43.95, the private hospitals had the lowest mean score of 23.32, 17.78, 24.25 in input, process and output standards, respectively. Conclusion: Based on the findings, it can be claimed that the studied hospitals had a minimal compliance with the input, output and processing standards related to the PIS.
Saghaeiannejad-Isfahani, Sakineh; Mirzaeian, Razieh; Jannesari, Hasan; Ehteshami, Asghar; Feizi, Awat; Raeisi, Ahmadreza
Traumatic, injuries arising from high velocity means of mobility, increased industrialization, frequent ethnic and religious classes and terrorist activities by way of bomb blasts, etc., often result in sudden unexpected mass casualty presenting to a given secondary or tertiary health institution. The successful management of such situation involves multidimensional and multidisciplinary approach anchored on awareness, preplanning and alertness. In response to the challenge, the orthopaedic and trauma unit of Jos University Teaching Hospital worked out the "Jos Protocol" which embodies the principle and strategy for mass casualty management and response to field distress call to the hospital within the practical limitations of our infrastructure. On the sixth of April, 1997 a vehicular collision in a neighbouring village resulted in twenty nine severely injured patients being rushed to the hospital's accident and emergency unit. By activating the protocol and utilizing the cascade call our system, mutual aid, hospital mobilization, reach out system, modified hospital triage, team work, effective manoeuvers and treatment modification, the immediate rescucitation and stabilization of patients was achieved in five hours. The working team comprised fifteen doctors and some hospital workers who could be reached on a weekend. Out of the mortality of 6 patients, 3 died in the triage zone while 3 were brought in dead. The difficulties encountered during the management and recommendation for improved immediate mass casualty management are discussed. Further, we believe that it has become necessary for every secondary and tertiary health institution to work out a mass casualty management protocol adapted to its peculiar working circumstances. A case is made for the establishment of regional disaster committees. PMID:11126091
Nwadiaro, H C; Yiltok, S J; Kidmas, A T
Objective: Patients' attitude towards medical students' presence during treatment depends on the cultural values of the society. This study was conducted to find out the patients' receptiveness in our society to be involved in teaching process for medical students during consultation in out patient department of a teaching hospital in Karachi Pakistan. Methodology: This cross sectional study was conducted in the surgical Out Patient Department (OPD) at Dow University Hospital from May 2012 to June 2012. Four hundred and eleven patients consented for participation through non probability purposive sampling, in which 279 patients were from morning clinics in the presence of students for clinical teaching, while 132 patients participated through evening clinics of surgery, when students were not present for comparison in specific dimensions of care for patients' satisfaction. Results: Majority of patients 293 (71%) agreed with the teaching of students during consultation and they feel they are contributing in future doctor's teaching, only 24% patients disagreed. Fifty two percent of patients who disagreed reported interference in privacy, 34% reported interference in consultation and 43% felt it resulted in prolong waiting time due to teaching. Conclusion: Majority of the patients agree to be part of teaching for medical students and this study can be used to assess the educational interventions designed to improve the patient based teaching. PMID:24353555
Laiq-Uz-Zaman Khan, Muhammad; Jawaid, Masood; Hafeez, Kamran
The Nigerian Enugu and Polish Bellview coals were subjected to proximate analysis and Gray-King coke assay type tests. Proximate analysis gave the ash content as 7.57 and 5.56%, the volatile content as 51.76 and 31.06%, respectively for Enugu and Bellview coals. For the Gray-King coke type assay test, the coke types of B and G, the percentage coke yield of 71.70 and 80.40% and percentage tar yield of 23.30 and 11.40%, respectively, were determined for Enugu and Bellview coals. The coke type, the ash content and percentage coke yield confirms Bellview coal as a medium coking coal, suitable for cokemaking but with a volatile content that exceeds the upper limit of 30.3% for cokemaking at Ajaokuta and Enugu coal as a high volatile non-caking coal. However, the higher yield of tar from Enugu coal may be an advantage in its use as a binder in producing formed coke.
Adeleke, A. O.; Makan, R. S.; Ibitoye, S. A.
Objective To record nosocomial and community-acquired accounts of antibiotic resistance in Escherichia coli (E. coli) strains, isolated from clinical samples of a teaching hospital by surveillance, over a period of 39 months (November 2009-January 2013). Methods Clinical samples from nosocomial sources, i.e., wards and cabins, intensive care unit (ICU) and neonatal intensive care unit (NICU), and community (outpatient department, OPD) sources of the hospital, were used for isolating strains of E. coli, which were subjected for testing for production of ‘extended spectrum beta-lactamase’-(ESBL) enzyme as well as determining antibiotic sensitivity pattern with 23 antibiotics. Results Of the total 1642 (100%) isolates, 810 (49.33%) strains were from OPD and 832 (50.66%) were from hospital settings. Occurrence of infectious E. coli strains increased in a mathematical progression in community sources, but in nosocomial infections, such values remained almost constant in each quarter. A total of 395 (24.05%) ESBL strains were isolated from the total 810 isolates of community; of the total of 464 (28.25%) isolates of wards and cabins, 199 (12.11%) were ESBL strains; and among the total of 368 (22.41%) isolates of ICU and NICU, ESBLs were 170 (10.35%); the total nosocomial ESBL isolates, 369 (22.47%) were from the nosocomial total of 832 (50.66%) isolates. Statistically, it was confirmed that ESBL strains were equally distributed in community or hospital units. Antibiogram of 23 antibiotics revealed progressive increases of drug-resistance against each antibiotic with the maximum resistance values were recorded against gentamicin: 92% and 79%, oxacillin: 94% and 69%, ceftriaxone: 85% and 58%, and norfloxacin 97% and 69% resistance, in nosocomial and community isolates, respectively. Conclusions This study revealed the daunting state of occurrence of multidrug resistant E. coli and its infection dynamics in both community and hospital settings.
Rath, Shakti; Dubey, Debasmita; Sahu, Mahesh C.; Padhy, Rabindra N
BACKGROUND Delays in the care of hospitalized patients may lead to increased length of stay, iatrogenic complications, and costs. No study has characterized delays among general medicine inpatients in the current prospective payment era of care. OBJECTIVE To quantify and characterize delays in care which prolong hospitalizations for general medicine inpatients. DESIGN Prospective survey of senior residents. SETTING Urban tertiary care university-affiliated teaching hospital. PARTICIPANTS Sixteen senior residents were surveyed regarding 2,831 patient-days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data were collected on 97.6% (2,762) of patient-days eligible for evaluation. Three hundred seventy-three patient-days (13.5% of all hospital days) were judged unnecessary for acute inpatient care, and occurred because of delays in needed services. Sixty-three percent of these unnecessary days were due to nonmedical service delays and 37% were due to medical service delays. The vast majority of nonmedical service delays (84%) were due to difficulty finding a bed in a skilled nursing facility. Medical service delays were most often due to postponement of procedures (54%) and diagnostic test performance (21%) or interpretation (10%), and were significantly more common on weekend days (relative risk [RR], 1.49; P=.02). Indeed, nearly one fourth of unnecessary patient-days (24% overall, 88 patient-days) involved an inability to access medical services on a weekend day (Saturday or Sunday). CONCLUSIONS At our institution, a substantial number of hospital days were judged unnecessary for acute inpatient care and were attributable to delays in medical and nonmedical services. Future work is needed to develop and investigate measures to decrease delays.
Carey, Mark R; Sheth, Heena; Scott Braithwaite, R
Abstract Background: Several studies have explored the effect of the presence of medical students on patient satisfaction. However, nearly all of these studies took place in hospitals where medical students had been involved in patient care for many years. Less is known about patients' perceptions of care in a hospital moving toward becoming a teaching facility with undergraduate students. No research has explored patient satisfaction before and after the introduction of medical students. Objective: To assess patient satisfaction as an indicator of quality of care (QoC) from the patients' perspective, before and after the presence of medical students in a general hospital setting. Methods: This observational, cross-sectional study was conducted at Hospital Universitario-Fundación Santa Fe de Bogotá (HU-FSFB) in Bogotá, Colombia. The study had two phases. In 2006, prior to HU-FSBF becoming a teaching hospital, 385 subjects were asked to fill out a closed-question questionnaire addressing patients' satisfaction and perception of QoC provided by attending physicians. During the second period in 2009, 372 patients answered the same questionnaire when medical students were involved in their care. Results: Patients' perceptions of QoC provided by attending physicians improved in five aspects when medical students were present: friendliness (p?=?0.003), competence providing medical care (p?=?0.049), quality of information provided (p?=?0.025), amount of time spent with the patient (p?0.001) and availability to personally provide care (p?0.001). Overall patient satisfaction also significantly increased (p?0.001). Conclusions: The presence of medical students does not negatively affect patients' perceptions of QoC, on the contrary, these results provide evidence of improved patient satisfaction in several aspects of care when medical students were involved. The relevance of this study lies in its unique way of comparing patient satisfaction before and after the introduction of medical students. This setting helps elucidate the real effect of the presence of medical students on patient satisfaction. PMID:24796239
Esguerra, Roberto; Toro, Jaime; Ospina, José Miguel; Porras, Alexandra; Díaz, Camilo; Reyes, Saúl
During the period 11 November 1985 - 21 February 1986, 12 cases of Legionnaires' disease were identified at a Johannesburg teaching hospital. Only 2 patients definitely acquired the disease in hospital. Both responded well to treatment. An epidemiological investigation was initiated to determine the source of infection and mode of transmission of the causative agent (Legionella pneumophila), which may be recovered from a wide variety of water sources. Although L. pneumophila was cultured from the hospital hot-water system, there was no association between the location of patients and culture-positive water sites. Cases were clustered in the medical and surgical intensive care units. Being on a ventilator was a significant risk factor for acquiring Legionnaires' disease (relative risk 18,4; 95% confidence interval 2,4 - 142,2). The potential role of ventilators in the transmission of the disease is discussed together with the infection control measures adopted to interrupt the outbreak. To our knowledge this is the first investigation of an outbreak of Legionnaires' disease in South Africa. PMID:3162619
Strebel, P M; Ramos, J M; Eidelman, I J; Tobiansky, L; Koornhof, H J; Küstner, H G
Objective: Clinical pharmacy services are improving in hospitals. For assessing the impact of these services, first it is important to exactly describe them by categorizing into types, severity, resolution, and accuracy. The objective of this study is to provide a detailed analysis of the clinical pharmacists’ services performed on in-patients in a teaching hospital during 28 months. Setting: Masih Daneshvari hospital, Tehran, Iran. Methods: This is a descriptive study. The authors retrospectively reviewed the notes of all services and entered them in a designed SPSS sheet. Documentation was carried out based on the “findings, assessment, resolution, and monitoring” method. The data were descriptively analyzed. Main outcome measure: Types, subtypes, severities, resolutions, and accuracies of services were defined, documented, and analyzed. Findings: In total 3152 records (2227 interventions and 925 visits with no intervention) were classified and analyzed in this study. Among all types of interventions, “improper medication use” (36.2%) was the most frequent intervention and among categories (subgroups) of “improper medication use,” “untreated indication” was the most frequent (23.7%). From the aspect of severity, 75.4% of interventions were estimated as of minor potential inconvenience to the patient (severity degree 1). Most interventions (78%) were finally recommended to the prescriber and 97.6% of interventions were considered accurate on further evaluation. Conclusion: Clinical pharmacists’ interventions are highly demanded in the hospitals. Based on the results of this study, conditions needing medication to prevent later complications in the course of therapy are sometimes ignored, which emphasizes the positive role of the clinical pharmacists’ involvements in clinical teams to improve outcome.
Allameh, Zahra; Mehrpooya, Maryam; Baniasadi, Shadi; Fahimi, Fanak
Background Length of stay (LOS) is one of the most important quantitative indexes that measures health service utilization within a hospital. Many studies have examined the association of three major stroke categories with LOS. Our aim is to investigate the differences of LOS among ischemic stroke subtypes, results from which are helpful to healthcare providers and government agencies to improve health care delivery efficiency. Methodology/Principal Findings Using the Beijing Municipal Health Bureau’s hospitalization summary reports, we performed a retrospective study among first-ever in-hospital patients with ischemic stroke (ICD-10 I63) in three general teaching hospitals in Beijing, China, from 2006 to 2010 with generalized linear model. In our study, 5,559 patients (female, 36.0%; age, 64.4±12.9 years) were included. The estimated mean LOS of ischemic stroke was 17.4±1.8 days. After adjusting for confounders, LOS of lacunar infarction (14.7 days; p<0.001) and LOS of small cerebral infarction (17.0 days; p?=?0.393) were shorter than that of single cerebral infarction (17.9 days, p<0.001). LOS of multi-infarct (19.0 days; p?=?0.028), brainstem infarction (19.3 days; p?=?0.045), basal ganglia infarction (18.5 days; p?=?0.452) and other subtypes of ischemic stroke (18.9 days; p?=?0.327) were longer than that of single cerebral infarction. Conclusions LOS of ischemic stroke patient differes across single cerebral infarction, lacunar infarction, multi-infarct and brainstem infarction patients. The ascending order of LOS was lacunar infarction, small cerebral infarction, single cerebral infarction, basal ganglia infarction, other subtypes of ischemic stroke, multi-infarct and brainstem infarction.
Li, Yi; Liu, Hui; Wang, Jing; Li, Yan; Yu, Guo-Pei; Ma, Xie-Min; Liang, Ming-Hui; Zhang, Jun; Zhao, Lue Ping
This study aimed at evaluating the results, direct costs and investment of a training program on microbiological test material collection at a teaching hospital. Test collections that did not follow the established criteria (failure) were considered as the result measure. Variable and absorption costing were used to calculate direct costs and investments, respectively. Of the 11,893 collected materials, failures were evidenced in 59 (0.5%). Direct cost corresponded to R$ 154.10 and R$ 2,431.29 was invested in training. These findings revealed that the evidenced number of anomalies (failures) represented a low percentage in relation to the total collected material for microbiological exams. Therefore, this should not be considered a critical point that justifies the continuity of the training and, consequently, the investment. PMID:17117261
Jericó, Marli de Carvalho; Castilho, Valéria; Perroca, Márcia Galan
This study describes the profile of 100 cases of diabetic ketoacidosis (DKA) at a teaching hospital in 1 Benghazi, Libyan Arab Jamahiriya. DKA was more frequent in young women with type 1 diabetes and mostly due to preventable causes, e.g., disrupted insulin treatment and/or infection. DKA also occurred in type 2 diabetics, with a higher mortality rate, as they were older patients with co-morbidity. Polyurea, fatigue, abdominal pain and vomiting were the most common clinical features, while coma was rarer. A high number of cases were first presentations of type 1 diabetes; hence this diagnosis should be considered in all patients with acute abdomen or decreased level of consciousness. The reasons for high mortality rate in this study (10%) were multifactorial. PMID:20795443
Elmehdawi, R R; Elmagerhei, H M
The present study aimed to find out prevalence and severity of viral hepatitis during pregnancy in the department of Obstetrics and Gynaecology, Nepal Medical College Teaching Hospital. Out of 5602 pregnant women admitted in the ward from 2001-2007; viral hepatitis was seen in 29 cases. HBV was detected in 18/29 (62.0%), HEV in 6/29 (20.6%) and viral hepatitis of undetected serology was seen in 5/29 (17.2%). Serology was undetected in these cases because of financial constraints. The mortality rate was 8/29 (27.5%). Three out of eight cases who expired were HEV positive and five were of undetected serology. Seven out of 8 maternal deaths were in preterm gestation and undelivered. Fulminant hepatitis with hepatic encephalopathy was the commonest cause of death. Hepatitis E was the commonest etiological agent in those who had fulminant disease during pregnancy and was associated with high mortality rate. PMID:20334069
Shrestha, P; Bhandari, D; Sharma, D; Bhandari, B P
Background: The choice of radiological investigations in head trauma in Africa is influenced by factors such as cost. Some patients who require computed tomography (CT) scan elsewhere are either managed blindly or do not present for it at the appropriate time. This paper evaluates the CT scan findings as they are obtained in cases of head trauma in a region of Nigeria. Methods: Prospectively recorded data of all head injury patients who presented for CT scan between January 2009 and April 2010 at Memfys Hospital for Neurosurgery (MHN), Enugu, Nigeria, were analyzed. Mobile CereTom 8-Slice CT was used in all cases. New and follow-up cases were included. Results: There were 204 CT scans for head trauma (171 new, 33 follow-up), accounting for about 34% of all head CT scans performed with this unit. The male to female ratio was 3.5:1. About 33.9% of the patients were in the third and fourth decades of life. In 19.9% cases, CT was unremarkable, while 80.1% cases had abnormal CT findings. The CT diagnosis was not in keeping with the indication of head trauma in 7%, and 13% had more than one finding. The most common CT findings were: subdural hematoma 30%, cerebral contusions and edema 30.7%, skull fractures 23.4% and extradural hematoma 8.0%. About 64% of the CT findings required surgical interventions. The overall mortality was 11.1%, but amongst the 137 patients who had abnormal CT findings, it was 13.9%. Conclusion: The high yield and diversity of CT scan findings in head trauma patients support the indication for the appropriate use of CT in diagnosis and management of head trauma even in developing countries.
Ohaegbulam, Samuel C.; Mezue, Wilfred C.; Ndubuisi, Chika A.; Erechukwu, Uwadiegwu A.; Ani, Chinenye O.
BACKGROUND: Tuberculosis (TB) is an established occupational disease affecting health care workers (HCWs). Determining the risk of TB among HCWs is important to enable authorites to take preventative measures in health care facilities and protect HCWs. This study was designed to assess the incidence of TB in a teaching hospital in Istanbul, Turkey. This study is retrospective study of health
Caglar Cuhadaroglu; Mustafa Erelel; Levent Tabak; Zeki Kilicaslan
During a 13-month period, 11 equine patients visiting a veterinary teaching hospital for various diagnostic and surgical procedures developed postprocedural infections from which methicillin (oxacillin)-resistant Staphylococcus aureus (MRSA) strains were isolated. The S. aureus isolates were identified by conventional methods that included Gram staining, tests for colonial morphology, tests for clumping factor, and tests for coagulase and urease activities and
JENNIFER C. SEGUIN; ROBERT D. WALKER; JOHN P. CARON; WESLEY E. KLOOS; CAROL G. GEORGE; RICHARD J. HOLLIS; RONALD N. JONES; MICHAEL A. PFALLER
In the ongoing effort to control costs, comparisons among hospitals' efficiency levels, if valid, can help identify "best practices" across institutions and uncover situations that need corrective intervention. The authors present an extension of the "adjusted cost per equivalent discharge" approach, which incorporates case-mix-severity differences, regional labor cost differentials, and inpatient/outpatient mix, but does not take into account such factors as the differences in hospital sizes, extents of the teaching mission, or quality of care delivered. The alternative approach yields information that suggests where an institution's total operating costs might be reduced with no change in any of the hospital's outputs or operating environment, through comparison with a "peer group" of other hospitals, matched according to the subject hospital's number of beds, the quality of care the hospital delivers, the extent of medical education carried out, the level of case-mix-adjusted discharges, and outpatient activities. A difficulty with this approach (as with others) is that measurement of some of the additional facets (e.g., quality of care) is still evolving, so its main contribution at this time is to provide a construct and method capable of incorporating these important added considerations. Hospital rankings achieved by applying the current and alternative approaches to a real set of teaching hospitals operating in FY 1987 are compared. While the rankings produced by the two approaches are loosely similar, the authors show that some significant differences do appear and can be at least partially explained by the incorporation of the additional factors mentioned above. PMID:10667873
Morey, R C; Retzlaff-Roberts, D L; Fine, D J; Loree, S W
Background Unsafe health care provision is a main cause of increased mortality rate amongst hospitalized patients all over the world. A system approach to medical error and its reduction is crucial that is defined by clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury. The aim of this study was to develop and implement a risk management system in a large teaching hospital in Iran, especially of the basis of WHO guidelines and patient safety context. Methods WHO draft guideline and patient safety reports from different countries were reviewed for defining acceptable framework of risk management system. Also current situation of mentioned hospital in safety matter and dimensions of patient safety culture was evaluated using HSOPSC questionnaire of AHRQ. With adjustment of guidelines and hospital status, the conceptual framework was developed and next it was validated in expert panel. The members of expert panel were selected according to their role and functions and also their experiences in risk management and patient safety issues. The validated framework consisted of designating a leader and coordinator core, defining communications, and preparing the infrastructure for patient safety education and culture-building. That was developed on the basis of some values and commitments and included reactive and proactive approaches. Results The findings of reporting activities demonstrated that at least 3.6 percent of hospitalized patients have experienced adverse events and 5.3 percent of all deaths in the hospital related with patient safety problems. Beside the average score of 12 dimensions of patient safety culture was 46.2 percent that was considerably low. The “non-punitive responses to error” had lowest positive score with 21.2 percent. Conclusion It is of paramount importance for all health organizations to lay necessary foundations in order to identify safety risks and improve the quality of care. Inadequate participation of staff in education, reporting and analyzing, underreporting and uselessness of aggregated data, limitation of human and financial resources, punitive directions and management challenges for solutions were the main executive problems which could affect the effectiveness of system.
Background Cultural barriers including allegiance to traditional models of ward care and fear of criticism may restrict use of a medical emergency team (MET) service, particularly by nursing staff. A 1?year preparation and education programme was undertaken before implementing the MET at the Austin Hospital, Melbourne, Australia. During the 4?years after introduction of the MET, the programme has continued to inform staff of the benefits of the MET and to overcome barriers restricting its use. Objective To assess whether nurses value the MET service and to determine whether barriers to calling the MET exist in a 400?bed teaching hospital. Methods Immediately before hand?over of ward nursing, we conducted a modified personal interview, using a 17?item Likert agreement scale questionnaire. Results We created a sample of 351 ward nurses and obtained a 100% response rate. This represents 50.9% of the 689 ward nurses employed at the hospital. Most nurses felt that the MET prevented cardiac arrests (91%) and helped manage unwell patients (97%). Few nurses suggested that they restricted MET calls because they feared criticism of their patient care (2%) or criticism that the patient was not sufficiently unwell to need a MET call (10%). 19% of the respondents indicated that MET calls are required because medical management by the doctors has been inadequate; many ascribed this to junior doctors and a lack of knowledge and experience. Despite hospital MET protocol, 72% of nurses suggested that they would call the covering doctor before the MET for a sick ward patient. However, 81% indicated that they would activate the MET if they were unable to contact the covering doctor. In line with hospital MET protocol, 56% suggested that they would make a MET call for a patient they were worried about even if the patient's vital signs were normal. Further, 62% indicated that they would call the MET for a patient who fulfilled MET physiological criteria but did not look unwell. Conclusions Nurses in the Austin Hospital value the MET service and appreciate its potential benefits. The major barrier to calling the MET appears to be allegiance to the traditional approach of initially calling parent medical unit doctors, rather than fear of criticism for calling the MET service. A further barrier seems to be underestimation of the clinical significance of the physiological perturbations associated with the presence of MET call criteria.
Jones, D; Baldwin, I; McIntyre, T; Story, D; Mercer, I; Miglic, A; Goldsmith, D; Bellomo, R
Background: The aim of this study was to evaluate pain management in paediatric surgery at Sylvanus Olympio University Teaching Hospital, Lome. Patients and Methods: A prospective descriptive study was conducted in the Department of Anaesthesiology and Intensive Care at Sylvanus Olympio teaching hospital from 1 January to 30 June 2012. Data collected include: demography, type of surgery, American Society of Anaesthesiologists (ASA) classification, anaesthetic protocol, analgesia technique, post-operative complications and cost of analgesia. Results: The study includes 106 post-operative children. Abdominal surgery was performed in 41.5% and orthopaedic surgery in 31.1%. A total of 75% of patients were classified ASA 1. General anaesthesia (GA) was performed in 88%. Anaesthetists supervised post-operative care in 21.7% cases. Multimodal analgesia was used in every case and 12% of patients received a regional block. The most frequently unwanted effects of analgesics used were nausea and/or vomiting in 12.3%. At H24, child under 7 years have more pain assessment than those from 7 to 15 years (46% vs 24%) and this difference was statistically significant (chi-square = 4.7598; P = 0.0291 < 0.05). The average cost of peri-operative analgesia under loco regional analgesia (LRA) versus GA during the first 48 h post-operative was US $23 versus $46. Conclusion: Our study showed that post-operative pain management in paediatric surgery is often not well controlled and paediatric loco regional analgesia technique is under practiced in sub Saharan Africa. PMID:24841019
Sama, Hamza Doles; Bang'na Maman, Aboudoul Fataou Ouro; Djibril, Mohaman; Assenouwe, Marcellin; Belo, Mofou; Tomta, Kadjika; Chobli, Martin
Background Mortuary workers like other health workers are exposed to blood borne pathogens at work. A baseline assessment is important to plan for programmes to safeguard the health of workers. The aim of this study is to determine exposure rates to blood among mortuary workers in teaching hospitals in South West Nigeria. Methods A descriptive cross sectional study was carried out between March and May 2008. All mortuary workers working in six (6) teaching hospitals, 80 in total were included in the study. Data was collected with the aid of a 15- item self administered questionnaire. Data was analysed with the aid of EPI-INFO 2002. Statistical associations were explored using odds ratio and confidence intervals. Results A total of 76 respondents completed questionnaire giving a response rate of 95%; 3 males and 1 female declined to participate, the mean age of respondents was 38.2 years, 48(72.6%), 53(85.5%) and 50(73.5%) of the workers had been exposed to blood through cuts, blood splash and needle stick injury. Duration at work was significantly associated with blood splash. Workers who had worked 5years and above were 0.10 times (95% confidence interval 0.00–.0.78) as likely to experience blood splash compared to those who had worked under 5 years. Only 5(10.4%) of workers with needle stick injury had completed three doses of Hepatitis B vaccine. The specific confirmation by antibody titre was however not done in this study. Conclusion Exposure to blood was very common with blood splash emerging as the most common route of exposure. There is a need for vaccination of all mortuary workers with three doses of Hepatitis B Vaccine to protect their health. In addition, education of workers on risks and institution of standard operating procedure are crucial to safeguard the health of mortuary workers.
Ogunnowo, Babatunde; Anunobi, Charles; Onajole, Adebayo; Odeyemi, Kofoworola
Background Airborne microorganisms within the hospital environment can potentially cause infection in susceptible patients. The objectives of this study were to identify, quantify, and determine the nosocomial potential of common airborne microorganisms present within a small animal teaching hospital. Methods Bioaerosol sampling was done initially in all 11 rooms and, subsequently, weekly samples were taken from selected rooms over a 9-week period. Samples were collected twice (morning and afternoon) at each site on each sampling day. The rooms were divided into two groups: Group 1, in which morning sampling was post-cleaning and afternoon sampling was during activity, and Group 2, in which morning sampling was pre-cleaning and afternoon sampling was post-cleaning. The total aerobic bacterial plate counts per m3 and bacterial identification were done using standard microbiological methods. Results A total of 14 bacterial genera were isolated with the most frequent being Micrococcus spp. followed by species of Corynebacterium, Bacillus, and Staphylococcus. There was a significant interaction between location and time for rooms in Group 1 (p=0.0028) but not in Group 2 (p>0.05). Microbial counts for rooms in Group 2 were significantly greater in the mornings than in the afternoon (p=0.0049). The microbial counts were also significantly different between some rooms (p=0.0333). Conclusion The detection of significantly higher airborne microbial loads in different rooms at different times of the day suggests that the probability of acquiring nosocomial infections is higher at these times and locations.
Harper, Tisha A. M.; Bridgewater, Shelley; Brown, Latoya; Pow-Brown, Patricia; Stewart-Johnson, Alva; Adesiyun, Abiodun A.
Background: Antibiotic resistance is not only a problem for the individual patient; it also reduces the effectiveness of established treatment and has become a major threat to public health by increasing the complexity and cost of treatment and reducing the probability of a successful outcome. Aim: A prospective cross sectional study was carried out with the aim of identifying prescription pattern of antibiotics in a tertiary care teaching hospital in Northern India. Materials and Methods: A total of 300 prescriptions were collected, collated and analysed from the indoor patients of MG hospital, Jaipur, India from the department of Medicine, Surgery and Orthopaedics. The prescribing and dispensing details of antibiotics from each prescription were recorded in the tabular form as mentioned in Data Acquisition form. Comparison of antibiotic prescribing practices among all the three departments was made by using Percentage method. Results: Majority of prescriptions (51%) with single drug was prescribed in Medicine department, followed by 16% in surgery and only 2% in Orthopaedics. Prescriptions with 3 drugs were prescribed mostly in Orthopaedics (66%) followed by 46% in Surgery and 10% in Medicine. 51% prescriptions in Orthopaedics department were of Ceftriaxone+ Sulbactam+ Amikacin. Thirty four percent prescriptions in Medicine department were of Ceftriaxone. 18% prescriptions in Surgery department were of Ceftriaxone+ Sulbactam+ Tobramycin. Conclusion: This study clearly highlights the practice of Poly-Pharmacy and injudicious usage of antibiotics in hospital settings. The Government of India is planning to revise the antibiotic policy issued in 2011 and put a ban on over the counter availability of third generation antibiotics. General public awareness and sensitization of doctors and revision of clinical drug policy is the need of the hour to bring the changes at all possible level for the longterm and better clinical outcome in medical practice.
Abhijit, Kumar; Jain, Pushpawati; Jain, Shipra
Objective To measure the incidence of maternal and early neonatal mortality in women who gave birth at Moi Teaching and Referral Hospital (MTRH) in Kenya and describe clinical and other characteristics and circumstances associated with maternal and neonatal deaths following deliveries at MTRH. Methods A retrospective audit of maternal and neonatal records was conducted with detailed analysis of the most recent 150 maternal deaths and 200 neonatal deaths. Maternal mortality ratios and early neonatal mortality rates were calculated for each year from January 2004 to December 2011. Results Between 2004 and 2011, the overall maternal mortality ratio was 426 per 100,000 live births and the early neonatal mortality rate (<7?days) was 68 per 1000 live births. The Hospital record audit showed that half (51%) of the neonatal mortalities were for young mothers (15–24?years) and 64% of maternal deaths were in women between 25 and 45?years. Most maternal and early neonatal deaths occurred in multiparous women, in referred admissions, when the gestational age was under 37?weeks and in latent stage of labour. Indirect complications accounted for the majority of deaths. Where there were direct obstetric complications associated with the delivery, the leading cause of maternal death was eclampsia and the leading cause of early neonatal death was pre-mature rupture of membranes. Pre-term birth and asphyxia were leading causes of early neonatal deaths. In both sets of records the majority of deliveries were vaginal and performed by midwives. Conclusion This study provides important information about maternal and early neonatal mortality in Kenya’s second largest tertiary hospital. A range of socio demographic, clinical and health system factors are identified as possible contributors to Kenya’s poor progress towards reducing maternal and early neonatal mortality.
In the era of slowly increasing laboratory budgets, identifying usage patterns can be an important first step in decreasing unnecessary laboratory testing. From January 1, 1998, through December 27, 2002, we studied inpatient laboratory utilization at the University of Alberta Hospital, a large Canadian teaching hospital (665 inpatient beds with an almost 100% continuous occupancy rate). The daily numbers of complete blood cell count (CBC), CBC with differential (CBCD), international normalized ratio, activated partial thromboplastin time, vitamin B12, and red cell folate (FOL) tests were correlated with regularly occurring hospital events, such as weekends, statutory holidays, and resident changeover dates. Testing for hematological monitoring (CBC, CBCD) at our institution has been increasing at an average of 2% to 6% per year with a recent (2001 onward) rate of increase in hematological diagnostic testing (vitamin B12 and FOL) of close to 10%. As expected, laboratory usage was statistically significantly higher on weekdays compared with weekends. During the weekdays, ordering frequencies on Monday and Friday were shown to be statistically significantly higher than on the other days. A nadir occurred on Thursday and on the weekend. This finding was postulated to be due to a combination of attending physician unfamiliarity and defensive testing. Resident changeovers did not contribute to an increase in Monday laboratory testing, as was initially thought, nor did holidays. We believe that we can use our findings to decrease laboratory use. First, weekend or midweek use might become the appropriate standard for frequency of testing. Second, we must alert attending physicians (and residents who are soon to be attending physicians) about their subliminal need to increase testing during changeovers. PMID:14649463
Cheng, Calvino Ka-Wing; Lee, Terry; Cembrowski, George S
Summary Background.Burn injuries frequently occur in our homes and workplaces and during travels. They are a common presentation at the National Orthopaedic Hospital, Enugu, Nigeria, which is a regional centre for burns care and for plastic surgery, orthopaedic surgery, and trauma patients. Most burn injuries are preventable, and campaigns to arouse greater awareness are necessary to reduce the number of occurrences. Objectives.The objectives of this study are to highlight the causes of burn injuries and to characterize age and sex incidences, as also the severity of burn injuries. It is hoped that formidable preventive measures will be suggested to aid public enlightenment campaigns in fighting the scourge of burn injuries. Materials and method. A retrospective review of patient's folders from Jan. 2000 to Dec. 2005 showed that 414 cases of burn-injured patients were treated at the emergency unit of the National Orthopaedic Hospital, Enugu. Results. Flame burns accounted for 48.3% of burn injuries followed by scalds with 40.6%; chemical burns accounted for 6.3%, while electrical and friction burns accounted for 4.6% and 1.0% respectively. Males made up 60.4% of the cases and females 39.6% (ratio, 1.5:1). The age group most commonly affected was that of children aged between 0 and 10 yr, accounting for 37.2% of cases, followed by the 21-30 yr age group with 22.7%. Altogether, 95.0% of the patients were aged less than 50 yr. With regard to flame burns, 51.5% were due to petrol flames (premium motor spirit), while 33.0% were due to kerosene. Cooking gas explosions accounted for 7.5% of the cases and diesel (automotive gas oil) 1.0%. Of the scalds, hot water accounted for 89.3% and hot oil 7.7%. As to chemical burns, 84.6% were due to acids, with alkalis, corrosive creams, and others making up the rest. With regard to electrical injury, current passage accounted for 63.2% of cases and flash burns for 36.8%.
Nnabuko, R.E.E.; Ogbonnaya, I.S; Otene, C.I.; Ogbonna, U.; Amanari, O.C.; Opara, K.O.
Background.Burn injuries frequently occur in our homes and workplaces and during travels. They are a common presentation at the National Orthopaedic Hospital, Enugu, Nigeria, which is a regional centre for burns care and for plastic surgery, orthopaedic surgery, and trauma patients. Most burn injuries are preventable, and campaigns to arouse greater awareness are necessary to reduce the number of occurrences. Objectives.The objectives of this study are to highlight the causes of burn injuries and to characterize age and sex incidences, as also the severity of burn injuries. It is hoped that formidable preventive measures will be suggested to aid public enlightenment campaigns in fighting the scourge of burn injuries. Materials and method. A retrospective review of patient's folders from Jan. 2000 to Dec. 2005 showed that 414 cases of burn-injured patients were treated at the emergency unit of the National Orthopaedic Hospital, Enugu. Results. Flame burns accounted for 48.3% of burn injuries followed by scalds with 40.6%; chemical burns accounted for 6.3%, while electrical and friction burns accounted for 4.6% and 1.0% respectively. Males made up 60.4% of the cases and females 39.6% (ratio, 1.5:1). The age group most commonly affected was that of children aged between 0 and 10 yr, accounting for 37.2% of cases, followed by the 21-30 yr age group with 22.7%. Altogether, 95.0% of the patients were aged less than 50 yr. With regard to flame burns, 51.5% were due to petrol flames (premium motor spirit), while 33.0% were due to kerosene. Cooking gas explosions accounted for 7.5% of the cases and diesel (automotive gas oil) 1.0%. Of the scalds, hot water accounted for 89.3% and hot oil 7.7%. As to chemical burns, 84.6% were due to acids, with alkalis, corrosive creams, and others making up the rest. With regard to electrical injury, current passage accounted for 63.2% of cases and flash burns for 36.8%. PMID:21991150
Nnabuko, R E E; Ogbonnaya, I S; Otene, C I; Ogbonna, U; Amanari, O C; Opara, K O
An investigation was carried out during October 2005–September 2006 to determine the prevalence of bloodstream infections in patients attending the outpatient department of the HIV/AIDS clinic at the Lagos University Teaching Hospital in Nigeria. Two hundred and one patients—86 males and 115 females—aged 14-65 years were recruited for the study. Serological diagnosis was carried out on them to confirm their HIV status. Their CD4 counts were done using the micromagnetic bead method. Twenty mL of venous blood sample collected from each patient was inoculated into a pair of Oxoid Signal blood culture bottles for 2-14 days. Thereafter, 0.1 mL of the sample was plated in duplicates on MacConkey, blood and chocolate agar media and incubated at 37 °C for 18-24 hours. The CD4+ counts were generally low as 67% of 140 patients sampled had <200 cells/?L of blood. Twenty-six bacterial isolates were obtained from the blood samples and comprised 15 (58%) coagulase-negative staphylococci as follows: Staphylococcus epidermidis (7), S. cohnii cohnii (1), S. cohnii urealyticum (2), S. chromogenes (1), S. warneri (2), S. scuri (1), and S. xylosus (1). Others were 6 (23%) Gram-negative non-typhoid Salmonella spp., S. Typhimurium (4), S. Enteritidis (2); Pseudomonas fluorescens (1), Escherichia coli (1), Ochrobactrum anthropi (1), Moraxella sp. (1), and Chryseobacterium meningosepticum. Results of antimicrobial susceptibility tests showed that coagulase-negative staphylococci had good sensitivities to vancomycin and most other antibiotics screened but were resistant mainly to ampicilin and tetracycline. The Gram-negative organisms isolated also showed resistance to ampicillin, tetracycline, chloramphenicol, and septrin. This study demonstrates that co-agulase-negative staphylococci and non-typhoidal Salmonellae are the most common aetiological agents of bacteraemia among HIV-infected adults attending the Lagos University Teaching Hospital, Nigeria. The organisms were resistant to older-generation antibiotics often prescribed in this environment but were sensitive to vancomycin, cefotaxime, cefuroxime, and other new-generation antibiotics.
Sulaiman, Akanmu A.; Solomon, Bamiro B.; Chinedu, Obosi A.; Victor, Inem A.
An investigation was carried out during October 2005-September 2006 to determine the prevalence of bloodstream infections in patients attending the outpatient department of the HIV/AIDS clinic at the Lagos University Teaching Hospital in Nigeria. Two hundred and one patients--86 males and 115 females--aged 14-65 years were recruited for the study. Serological diagnosis was carried out on them to confirm their HIV status. Their CD4 counts were done using the micromagnetic bead method. Twenty mL of venous blood sample collected from each patient was inoculated into a pair of Oxoid Signal blood culture bottles for 2-14 days. Thereafter, 0.1 mL of the sample was plated in duplicates on MacConkey, blood and chocolate agar media and incubated at 37 degrees C for 18-24 hours. The CD4+ counts were generally low as 67% of 140 patients sampled had < 200 cells/microL of blood. Twenty-six bacterial isolates were obtained from the blood samples and comprised 15 (58%) coagulase-negative staphylococci as follows: Staphylococcus epidermidis (7), S. cohnii cohnii (1), S. cohnii urealyticum (2), S. chromogenes (1), S. warneri (2), S. scuri (1), and S. xylosus (1). Others were 6 (23%) Gram-negative non-typhoid Salmonella spp., S. Typhimurium (4), S. Enteritidis (2); Pseudomonas fluorescens (1), Escherichia coli (1), Ochrobactrum anthropi (1), Moraxella sp. (1), and Chryseobacterium meningosepticum. Results of antimicrobial susceptibility tests showed that coagulase-negative staphylococci had good sensitivities to vancomycin and most other antibiotics screened but were resistant mainly to ampicilin and tetracycline. The Gram-negative organisms isolated also showed resistance to ampicillin, tetracycline, chloramphenicol, and septrin. This study demonstrates that coagulase-negative staphylococci and non-typhoidal Salmonellae are the most common aetiological agents of bacteraemia among HIV-infected adults attending the Lagos University Teaching Hospital, Nigeria. The organisms were resistant to older-generation antibiotics often prescribed in this environment but were sensitive to vancomycin, cefotaxime, cefuroxime, and other new-generation antibiotics. PMID:20824974
Adeyemi, Adeleye I; Sulaiman, Akanmu A; Solomon, Bamiro B; Chinedu, Obosi A; Victor, Inem A
The Zambian Association of Gynecology and Obstetrics is one of the International Federation of Gynecology and Obstetrics (FIGO) member societies participating in the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences from the East, Central, and Southern Africa region. The activities included in this country's plan of action were to provide access to safe abortion within the full extent of the law to women receiving care at the University Teaching Hospital in Lusaka, and to increase the proportion of women leaving the hospital with a contraceptive method. Zambian law regarding abortion is liberal, but in general it was not applied until very recently. The proportion of legal terminations of pregnancy among patients receiving abortion care at the hospital increased from 3.2% in 2009 to 7.7% in 2011, while the percentage of women leaving the hospital with a contraceptive method increased from 25.3% to 69.4% over the same period. PMID:24786142
Macha, Swebby; Muyuni, Mutinta; Nkonde, Scholastica; Faúndes, Anibal
Background: This study aimed to investigate and compare the bacterial safety of handmade and commercial ready-to-use enteral feeding formulas used in an Iranian teaching hospital. Methods: In this experimental study, a total number of 70 samples (21 handmade formulas sampled at two sampling times, i.e. the time of preparation and 18 h after preparation, and 28 commercial ready-to-use formulas) were studied. Total count of viable microorganisms, coliform count and Staphylococcus aureus count for all samples were conducted. Results: Out of 42 handmade samples, 16 samples (76%) had total viable counts greater than 103 CFU/g in the first sampling time and 17 samples (81%) had total viable counts greater than 103 CFU/g in the second sampling time. Also, 11 (52%) had coliform contamination in the first sampling time which reached 76% (16 samples) in the second sampling time. Regarding contamination with S. aureus, 5 samples (24%) were contaminated in the first- and 13 samples (62%) were contaminated in the second-sampling time. Out of 28 commercial formulas, 27 samples (96%) had total viable counts greater than 103 CFU/g. Also, 24 samples (86%) were contaminated with S. aureus and 27 samples (96%) were contaminated with coliforms. In order to compare these two formulas, the results of Mann-Whitney test showed that contamination of ready-to-use formulas in all three microbiological samples was significantly more than that for handmade samples. Conclusions: The results of the present study indicate that the microbial safety of enteral feeding solutions in this hospital is much lower than standard values, demonstrating that the development of protocols for clean techniques in the preparation, handling and storage of both commercial and handmade enteral feeds is necessary.
Baniardalan, Mahtash; Sabzghabaee, Ali Mohammad; Jalali, Mohammad; Badri, Shirinsadat
Objective: A prospective medicine usage evaluation based on prescription monitoring was conducted in the medicine OPD of our university teaching hospital to know prescribing trends of different categories of medicines. Materials and Methods: A total of 600 patients were included in the study comprising of 339 (56.5%) males and 261 (43.5%) females. The data were recorded within the OPD by a registered pharmacist on a medicine usage evaluation form, approved by The University Institutional Review Board (IRB). Results: A total of 2365 medicines were prescribed to 600 patients during the 3 months study period. The mean number of medicines per prescription were found to be 3.94. Medicines were most frequently prescribed as solid dosage forms (85.62%), especially tablets (70.82%), and liquid formulations (14.12%). Oral route (96.17%) was the most preferred mode of administration, followed by topical (2.11%) and parenteral (1.60%) routes. Combination therapy (94.33%) was more prevalent than monotherapy (5.66%). An overwhelming tendency for prescribing medicines by brand names (99%) was observed by the physicians. The most frequently prescribed class of medicines were antimicrobials > analgesics > cardiovascular > gastrointestinal agents. The most prescribed individual medicines among various therapeutic classes included isoniazid (antimicrobial), amlodipine (cardiovascular), metformin (hypoglycemic), cetirizine (antiallergic), rabeprazole (GI medicine), atorvastatin (hypolipidemic), dextromethorphan (respiratory medicine), alprazolam (sedative-hypnotic), paracetamol (analgesic). Conclusions: There is a considerable scope of improvement in the existing prescribing practice, especially prescribing by generic names, needs to be encouraged and a hospital formulary has to be developed for the purpose. The number of medicines to be included per prescription should be judged rationally and polypharmacy ought to be curbed. Use of antimicrobial also needs to be rationalized as over usage of antibiotics may lead to the problems such as medicine resistance and noncompliance.
Aqil, M.; Bhadana, V.; Alam, M.S.; Pillai, K. K.; Kapur, P.
Objective: Consultation-liaison (CL) psychiatry interfaces between psychiatry and other medical disciplines to promote integrated care of patients. The purpose of this study is evaluation of attitudes and practice of Mazandaran University of Medical Sciences physicians of teaching hospitals regarding CL psychiatry. Methods:In this descriptive study, all of the general practitioners, specialist and subspecialist physicians and assistants working in teaching hospitals of Mazandaran University of Medical Sciences were requested to fill in a questionnaire which was designed based on previous studies and observations to assess their attitudes and practice. Data were analysed by SPSS-16 software, using chi square. Results: One hundred and forty nine (62.6%) physicians had very positive attitudes and 89 cases (37.4%) had positive attitudes; 234 physicians (98.3%) had acceptable practice, and 4 cases (1.7%) had unacceptable practice. There were no significant differences between physicians with positive and very positive attitudes and between physicians with acceptable and unacceptable practice regarding gender, age, education, specialty and place of work (hospital). The most common reasons of physicians for not requesting psychiatric consultation were lack of time, forgetfulness, lack of access to psychiatrist, and lack of belief in the need for psychiatric consultation respectively. Conclusion: The findings of this study indicate the successful psychiatric educations and psychiatrists practice in formation of positive attitudes and acceptable practice regarding CL Psychiatry in these university hospitals. No significant differences between different specialties and work place hospitals indicate that they are similarly affected.
Zarghami, Mehran; Farnia, Samaneh; Khalilian, Ali-Reza; Amirian, Tahereh
All 64 dentists working in a teaching hospital of New Delhi participated in a survey. A pre-tested self-administered questionnaire was used to assess knowledge and practices of biomedical waste management and infection control among these dentists. The results show that not all dentists were aware of the risks they were exposed to and only half of them observed infection control practices. In addition to this, majority of them were not aware of proper hospital waste management. The dentists need to be educated on Biomedical Waste (Management & Handling) Rules, 1998 through extensive training programme. PMID:11307639
Kishore, J; Goel, P; Sagar, B; Joshi, T K
Objective To evaluate the utilization of chloral hydrate (CH) for sedation in pediatric intensive care and the incidence of adverse\\u000a drug reactions.\\u000a \\u000a \\u000a \\u000a Methods This was a cohort study including patients with prescription of chloral hydrate hospitalized in the pediatric intensive care\\u000a unit (PICU) of a university-affiliated, general, tertiary teaching hospital. Data were collected from a spreadsheet for daily\\u000a monitoring, and clinical events
Jacqueline Kohut Martinbiancho; Paulo Roberto Antonacci Carvalho; Eliana de Andrade Trotta; Ana Paula Schweiger; Renata Rau; Leila Beltrami Moreira
The transition to electronic medical records (EMRs) often includes the transition from paper to electronic documentation, a topic less well described in the literature than other aspects of EMR adoption. As part of a broader EMR project, we have participated in the transition to electronic notes on the Medicine service of a teaching hospital affiliated with the University of Washington. During a one year period beginning in February 2005 we adopted the use of semi-structured documentation templates permitting both encoded and narrative text components for admission, progress, and procedure notes, and for some discharge summaries. Currently over 1400 notes are entered each week. Fifty eight percent are entered by residents, 20% by attending physicians, and the remainder by other trainees and staff. The period of greatest change from paper to electronic notes occurred (by design) during the late spring and summer. Leadership, application functionality, speed, note writing time requirements, data availability, training needs, and other factors influenced adoption of this important part of our EMR.
Payne, Thomas H.; Perkins, Monica; Kalus, Robert; Reilly, Dom
This study was conducted to find out the prevalence of intestinal parasitic infection among patients attending Nepal Medical College Teaching Hospital, Kathmandu from July 2011 to February 2012. A total of 312 stool samples collected in a clean, dry screw capped plastic container were examined using the formal-ether concentration and sucrose-flotation techniques. Overall parasite positivity rate was 30.1% with significant difference between males (34.2%) and Female (26.3%) (p < 0.05). Out of total positive, 90.4% had single parasitism whereas 9.6% had multiple parasitism. Children aged < or = 5 years were found to be highly infected (35.8%), followed by 6-15 years (32.1%) and > 15 years old (26.9%). Rate of infection was significantly higher among patients from inside Kathmandu Valley (31.1%) than outside valley (17.4%) (p < 0.05). E. histolytica (38.5%) and Hookworm (10.6%) were the commonest protozoa and helminthes respectively. Other parasites detected were G. lamblia (26.0%), E. coli (1.0%), T. trichiura (7.7%), A. lumbricoides (6.7%), H. nana (5.8%) and Taenia species (3.8%). Out of total parasites detected, 65.4% were protozoa and 34.6% were helminthes. Positive rate was higher in Dalit (37.5%) and Aadibasi-Janjati (34.3%) than Brahman-Chhetri (22.6%) (p < 0.05). PMID:23671951
Agrawal, P K; Rai, S K; Khanal, L K; Ghimire, G; Banjara, M R; Singh, A
Background: Hypertension in Nigeria is a widespread problem of immense social and economic importance because of its high prevalence and the severity of its complications. Aim: To define the morbidity and mortality pattern of hypertension at the University of Port Harcourt Teaching Hospital (UPTH). Method: Records of all patients admitted to the medical wards of the UPTH over a 5-year period with essential hypertension or any of its complications were retrieved from the ward and medical records and reviewed. Result: A total of 780 hypertensive patients were reviewed, constituting 28.2% of all medical admissions. Only 424 (15.2%) had complete records and were analyzed. Record keeping was poor. There were 173 (41%) males and 251 (59%) females with a male to female ratio of 1:1.5. The ages ranged from 18 years to 100 years with a mean of 56.5 ± 16.2. Stroke was responsible for 169 (39.9%) hypertensive complications. Heart failure occurred in 97 (22%) cases while renal failure and encephalopathy accounted for 40 (9.4%) and 7 (1.7%) hypertensive complications respectively. There were 99 deaths out of which 51 (51.5%) were due to stroke, 14 (14.12%) were due to heart failure, and 12 (12.1%) were due to renal failure. Conclusion: The contribution of systemic hypertension to the morbidity and mortality of adults at UPTH is quite significant.
Onwuchekwa, Arthur C; Chinenye, Sunday
Health records should be readily accessed by authorised persons for diagnosis, treatment and legal security purposes during patient's lifetime and thereafter for research and training purposes. Technology makes difficult the preservation of digital material, because of rapid changes in information media, hardware and software evolution, and because of the multiplicity of its location as well as the complexity of its environment. A committee in a large teaching hospital in Belgium, recommends two complementary approaches: (1) After a patient departure, all his health information should be managed by a unique organisation that would update regularly accesses to all data bases concerned by this patient. Health archives should be formatted using XML (Extensible Mark up Language) software family, and set on supports such as DVD-ROM, to be upgraded or updated when needed. This archive media is fast but not safe. (2) Computer output microfilm (COM) and scanners for non electronic data to be preserved appears to be also needed, as it is storage safe for at least 250 years and readable directly by eye. This archive media is safe but not fast. PMID:11187630
France, F H; Beguin, C; van Breugel, R; Piret, C
Background and Objectives: The practice of emergency medicine has the primary mission of evaluating, managing and providing treatment to those patients with unexpected injury or illness. Instituting appropriate therapy is necessary for safety of the patients and to decrease mortality and morbidity. The objectives were to study the drug utilization pattern and direct cost of therapy in emergency medicine department of a tertiary care teaching hospital. Materials and Methods: Data of the patients admitted to emergency medicine department was collected prospectively for 48 h from the time of admission over 2 months. The prescriptions were analyzed for drug use pattern and direct cost of therapy was calculated. Results: A total of 156 patients received 1635 drugs with the mean of 9.99 ± 2.55 drugs/patient. Most common diagnosis was acute coronary syndrome 35 (21.79%). Ondansetron 135 (86.53%) was most frequently prescribed drug followed by pantoprazole 133 (85.25%) and furosemide 68 (43.58%). Amongst antimicrobials ceftriaxone 51 (32.69%) was the most commonly prescribed drug. Direct cost of treatment per patient for the first 48 h was ? 4051 ± 1641. Conclusion: Ondansetron and pantoprazole were the most commonly prescribed drugs in the emergency department. However, their use in all patients was not justified. Polypharmacy was prevalent. A closer look at the rationality of therapy would help in highlighting issues involved and would be helpful to authorities in deciding prescribing policies.
Barot, Preksha A.; Malhotra, Supriya D.; Rana, Devang A.; Patel, Varsha J.; Patel, Kamlesh P.
The development of Policy Standards for Termination that both protect and support residents while safeguarding sponsoring institutions has become increasingly necessary. To date, however, there has been little in the literature that discusses policies that have undergone thorough testing to the highest levels of the U.S. judicial system. Berkshire Medical Center (BMC), an acute-care community teaching hospital affiliated with the University of Massachusetts Medical School, developed a set of specific policies to cope fairly with the resident dismissal process. The authors describe a nine-year legal test of these policies in the case of a resident whose disruptive behavior required their implementation. Also presented is a summary of due process as it applies in such cases. The dismissed resident tested the policies through the Courts of the Commonwealth of Massachusetts all the way to the United States Supreme Court, the Equal Employment Opportunity Commission, and the Massachusetts Department of Industrial Accidents. At every level the termination action was upheld. The resident had previously been in two graduate medical education programs at other institutions, and neither of them had communicated issues of concern that would have forewarned BMC's program about potential problems. A plea for honest and open communication between programs is made. This may help to avoid the lengthy, expensive, and potentially serious consequences of such situations. However, the authors emphasize that when such situations arise, strong policies serve as an ultimate legal protection. PMID:11704510
Tulgan, H; Cohen, S N; Kinne, K M
Purpose We wanted to analyze the use of nutrition support for terminal cancer patients, the effect of discussing withdrawal of nutrition support and do-not-resuscitate (DNR) consent on the use of intravenous nutrition during the patient's last week of life and at the time of death. Materials and Methods The study involved 362 patients with terminal cancer from four teaching hospitals, and they all died between January 1 2003 and December 31 2005. The basic demographic data, the use of intravenous nutrition during the patient's last week of life and at death, discussion of terminal nutrition withdrawal and DNR consent were evaluated. Results In the week before death, the patients received artificial nutrition such as total parenteral nutrition (31%), intravenous albumin infusion (25%), and feeding tube placements (9%). A discussion concerning withdrawal of nutrition support was limited to 25 (7%) patients. DNR consent was obtained from 294 (81%) patients. None of the patients were directly involved in any of these decisions. The discussion about withdrawal of terminal nutrition and DNR consent with the patient's surrogates did not have any effect on reducing the use of parenteral nutrition. Conclusion The majority of patients dying of terminal cancer were still given potentially futile nutritional support. Modern clinical guidelines and ethical education about nutritional support at the end of life care is urgently needed in Korean medical practice to provide proper administration of terminal nutrition for end of life care.
Kim, Do Yeun; Lee, Sang Min; Lee, Kyoung Eun; Lee, Hye Ran; Kim, Jee Hyun; Lee, Keun-Wook; Lee, Jong Seok
Introduction: The art of forceps delivery though existing for centuries has earned a disreputation due to the possibility of poor maternal and fetal outcome. However, its safe use can reduce the rising cesarean section rates in the present times. This study is to see the outcome of its use in a teaching hospital over a 2 year period. Materials and Methods: In this retrospective observational study, 120 cases of forceps delivery were studied for maternal outcome such as injuries, postpartum hemorrhage, and fetal outcome such as Apgar score at birth, neonatal intensive care unit admissions, injury, and mortality. Results: The most common indication was fetal distress (47.5%). A total of 15 cases (12.5%) of maternal injuries occurred, with 2 uterine ruptures one of which was in a previous lower segment caesarean section case, 4 complete perineal tears and 9 minor cervical and vaginal lacerations. A total of 12 babies (10%) had poor Apgar scores who recovered after resuscitation and one out of them died, which was a case of multiple instrumentation. Conclusion: Forceps is a reasonable option for the obstetrician to reduce the caesarean section rates; however, extreme caution, proper expertise and judicial use of this instrument are required to prevent undue risk to mother and fetus.
John, Lopamudra B.; Nischintha, S.; Ghose, Seetesh
Objective: To evaluate the prescribing patterns of hypolipidaemic drugs which were prescribed to patients who visited the department of General Medicine in a tertiary care teaching hospital of southern India. Materials and Methods: A cross-sectional study was done for three months in the department of General Medicine. A total of 506 prescriptions of hypolipidaemic drugs were evaluated, based on the various inclusion and exclusion criteria. The different disease patterns, the types of drugs which were prescribed in those diseases and the WHO prescription indicators, Anatomical Therapeutic Classification as well as the PDD (prescribing daily dose) /DDD (daily defined dose) ratio were calculated. Results: While analyzing the prescriptions, it was found that patients having abnormal lipid profiles (56.9%) and normal lipid profiles (43.1%) were prescribed hypolipidaemic drugs. Diabetes with hypertension (37%) was the most common disease for which hypolipidaemic drugs were prescribed. The average number of drugs per prescription was 3.3±1.33. Atorvastatin was the most common hypolipidaemic drug which was prescribed as monotherapy (53.4%), whereas atorvastatin with aspirin was the most common drug which was prescribed as combination therapy (20%). Atorvastatin was prescribed as underdosed and Rosuvastatin was prescribed as overdosed. Conclusion: This study depicts the use of statins in various disease conditions, both as primary and secondary preventive measures. Such studies should be done to educate the physicians on good prescribing practices and on rational use of hypolipidaemic drugs. PMID:24959461
Raja, Sangeetha; Mohapatra, Satyajit; Kumar, J S; Rani, R Jamuna
Background: Consumer’s knowledge and perception towards adverse drug reactions (ADR) can play an important role in ensuring a healthy lifestyle and proper use of medicines. Aims: This study aimed to assess the knowledge and perception towards pharma covigilance in general and consumer pharmacovigilance in particular among out patients in a teaching hospital of Nepal. Settings and Design: A descriptive cross-sectional study using qualitative and quantitative methods was carried out from 1st May to 3 June 2013. Methods: Every fifth patient visiting the outpatient pharmacy was interviewed using a semi-structured questionnaire. Gender, age, educational qualification, profession and ethnicity were noted. Twenty-three patients were interviewed. Results: There were 10 males and 13 females. The age of the respondents ranged from 11 to 50 years with a mean age of 27.8 (SD = 5.61) years. Seven (30.43%) respondents were students studying in different levels. Thirteen (56.52%) participants were from the Newar community. Majority of the patients (86.95%) knew ADRs may be caused by the medicines they consume and 18 (78.26%) were of the opinion that ADRs should be reported to doctors and other health care professionals including pharmacists. Conclusion: Knowledge and perception were low in certain areas. There is a need for educational interventions for improving the awareness of patients and general public for ensuring medicine safety and promoting rational use of medicines.
Jha, Nisha; Rathore, Devendra S; Shankar, P Ravi; Gyawali, Sudesh
This article seeks to analyze the intention of mothers to breastfeed and the prospects for introduction of complementary food in the first year of life. A cross-sectional study was conducted from September to December 2010 at the Teaching Hospital of the Federal University of Pelotas in the state of Rio Grande do Sul, Brazil. Data were obtained through a standardized questionnaire, containing questions about socioeconomic conditions, breastfeeding and complementary feeding. 170 mothers were enlisted, with a mean age of 26.5 ± 5.8 years old. Among them, 99% had received prenatal medical care and only 49% recalled having received information about breastfeeding and/or supplementary feeding during the care. All of the mothers intended to breastfeed exclusively for a mean time of 5.5 ±1.6 months. Years of schooling, mothers who do not work outside the home, lower maternal age and receiving information about breastfeeding during prenatal care were associated with longer duration of exclusive breastfeeding. Regarding complementary food, bean soup was the food most intended for the child's first year of life, with an acceptance of 99.41%, while tea was the one with the earliest intention. The duration of breastfeeding was below the WHO guidelines, and complementary food was considered to be misguided. PMID:25014278
Machado, Adriana Kramer Fiala; Elert, Vanessa Winkel; Pretto, Alessandra Doumid Borges; Pastore, Carla Alberici
Intestinal parasites are a serious problem in developing countries, but should not be underestimated in industrialised countries either. Between January 2006 and December 2011, stool specimens and the scotch tests of 5323 Italian and non Italian patients (adults and children) attending the laboratory of our Infectious Diseases Clinic in a teaching Hospital at Ancona were analyzed specifically for intestinal parasites. The present study shows that, over a six-year period, of a total of 5323 patients 305 harboured at least one species of parasite (5.7%). Among the pathogenic protozoa Giardia lamblia was the most common, the overall prevalence of giardiasis being 1.8 % (99/5323). Helminths were found in 0.9% of the patients (48/5323). In particular, Hymenolepis nana, Strongyloides stercoralis and Trichuris trichiura were most commonly recovered in non-Italian children, suggesting that certain intestinal parasites are restricted to endemic areas in the tropics. Eighteen of the 305 infected patients had more than one parasite in their stools. Our study demonstrates that intestinal parasites must be considered even in industrialised areas and stool examination should be supported by epidemiological data and clinical features. PMID:23524899
Silvestri, Carmela; Greganti, Gianfranco; Arzeni, Daniela; Morciano, Angela; Castelli, Pamela; Barchiesi, Francesco; Cirioni, Oscar; Giacometti, Andrea
Objective: To evaluate the prescribing patterns of hypolipidaemic drugs which were prescribed to patients who visited the department of General Medicine in a tertiary care teaching hospital of southern India. Materials and Methods: A cross-sectional study was done for three months in the department of General Medicine. A total of 506 prescriptions of hypolipidaemic drugs were evaluated, based on the various inclusion and exclusion criteria. The different disease patterns, the types of drugs which were prescribed in those diseases and the WHO prescription indicators, Anatomical Therapeutic Classification as well as the PDD (prescribing daily dose) /DDD (daily defined dose) ratio were calculated. Results: While analyzing the prescriptions, it was found that patients having abnormal lipid profiles (56.9%) and normal lipid profiles (43.1%) were prescribed hypolipidaemic drugs. Diabetes with hypertension (37%) was the most common disease for which hypolipidaemic drugs were prescribed. The average number of drugs per prescription was 3.3±1.33. Atorvastatin was the most common hypolipidaemic drug which was prescribed as monotherapy (53.4%), whereas atorvastatin with aspirin was the most common drug which was prescribed as combination therapy (20%). Atorvastatin was prescribed as underdosed and Rosuvastatin was prescribed as overdosed. Conclusion: This study depicts the use of statins in various disease conditions, both as primary and secondary preventive measures. Such studies should be done to educate the physicians on good prescribing practices and on rational use of hypolipidaemic drugs.
Mohapatra, Satyajit; Kumar, J.S; Rani, R Jamuna
Background: Consumer's knowledge and perception towards adverse drug reactions (ADR) can play an important role in ensuring a healthy lifestyle and proper use of medicines. Aims: This study aimed to assess the knowledge and perception towards pharma covigilance in general and consumer pharmacovigilance in particular among out patients in a teaching hospital of Nepal. Settings and Design: A descriptive cross-sectional study using qualitative and quantitative methods was carried out from 1(st) May to 3 June 2013. Methods: Every fifth patient visiting the outpatient pharmacy was interviewed using a semi-structured questionnaire. Gender, age, educational qualification, profession and ethnicity were noted. Twenty-three patients were interviewed. Results: There were 10 males and 13 females. The age of the respondents ranged from 11 to 50 years with a mean age of 27.8 (SD = 5.61) years. Seven (30.43%) respondents were students studying in different levels. Thirteen (56.52%) participants were from the Newar community. Majority of the patients (86.95%) knew ADRs may be caused by the medicines they consume and 18 (78.26%) were of the opinion that ADRs should be reported to doctors and other health care professionals including pharmacists. Conclusion: Knowledge and perception were low in certain areas. There is a need for educational interventions for improving the awareness of patients and general public for ensuring medicine safety and promoting rational use of medicines. PMID:24783073
Jha, Nisha; Rathore, Devendra S; Shankar, P Ravi; Gyawali, Sudesh
In this study, we reviewed autopsy records for clinical data and autopsy findings from patients aged 70 or more, over a 10-year period (1993 to 2002) in an urban university hospital. For that period, there were a total of 772 autopsy cases of which 180 (23%) patients were aged 70 years or older. We found that despite a marked decrease in total autopsy rates, there has been a perceptible rise in geriatric cases. Cardiovascular and infectious diseases in this age group are the leading causes of death as reported nationally. We found that women died more of acute myocardial infarctions than men, even though hypertensive and atherosclerotic cardiovascular diseases not otherwise specified were more prevalent in men. It is our conclusion that at our institution: 1) despite a marked decrease in the total autopsy rate, the geriatric autopsy rate is rising; 2) infectious and cardiovascular diseases are the leading causes of death in elderly patients; 3) Myocardial infarcts as a cause of death are more often seen in women for this age group. It is also our impression that better autopsy reporting is needed for maximal utilization of autopsy findings in medical auditing and teaching and for improvements in the quality of patient care in general and the geriatric patient in particular. Images Figure 1
Shokrani, Babak; Fidelia-Lambert, Marie N.
Purpose This study evaluates the relative frequency of benign eyelid lesions presented to a teaching hospital in Saudi population. Patients and methods Charts of patients with benign eyelid lesions were retrospectively reviewed from January 2003 to December 2008. Clinical details included demographic data, symptoms and signs, surgical findings, primary diagnosis, and indication for biopsy were analyzed in a histopathologically confirmed benign eyelid lesions. Eyelid lesions were arranged according to their order of frequencies. Results A total of 222 biopsies were evaluated from 181 patients (male 39.2% and female 60.8%). The age of the patient at the time of biopsy ranged from 2 to 87 years old. The most common benign eyelid lesion encountered in our practice was sweat gland hidrocystoma followed by chalazion, skin tag, epidermal cyst, nevus, seborrheic keratosis, xanthelasma, and molluscum contagiosum respectively. Histopathological studies confirmed the clinical diagnosis in 95.9% (213/222) of specimens and was different from the clinical diagnosis in 4.1% (9/222) of the lesions which included seborrheic keratosis (n = 3), pilomatrixoma, steatocystoma, hemangioendothelioma, juvenile xanthogranuloma, calcinosis cutis, and syringocystadenoma papilliferum. No malignant lesion was labeled as benign. Conclusion Epidemiology of benign eyelid lesions in Saudi population is different from Far East or Western populations. Sweat gland hidrocystoma with classical clinical features and straightforward diagnosis is the most frequent lesion in our series which could be due to characteristic dry climate.
Al-Faky, Yasser H.
Background Abdominal surgical site infections are among the most common complications of inpatient admissions and have serious consequences for outcomes and costs. Different risk factors may be involved, including age, sex, nutrition and immunity, prophylactic antibiotics, operation type and duration, type of shaving, and secondary infections. This study aimed to determine the risk factors affecting abdominal surgical site infections and their incidence at Imam Khomeini, a major referral teaching hospital in Iran. Methods Patients (n = 802) who had undergone abdominal surgery were studied and the relationships among variables were analyzed by Student's t and Chi-square tests. The subjects were followed for 30 days and by a 20-item questionnaire. Data were collected through pre- and post-operative examinations and telephone follow-ups. Results Of the 802 patients, 139 suffered from SSI (17.4%). In 40.8% of the cases, the wound was dirty infected. The average age for the patients was 46.7 years. The operations were elective in 75.7% of the cases and 24.7% were urgent. The average duration of the operation was 2.24 hours, the average duration of pre-operative hospital stay 4.31 days and the average length of (pre- and post-operation) hospital stay 11.2 days. Three quarters of the cases were shaved 12 hours before the operation. The increased operation time, increased bed stay, electivity of the operation, septicity of the wound, type of incision, the administration of prophylactic antibiotic, type of operation, background disease, and the increased time lapse between shaving and operation all significantly associated with SSI with a p-value less than 0.001. Conclusion In view of the high rate of SSI reported here (17.4% compared with the 14% quoted in literature), this study suggests that by reducing the average operation time to less than 2 hours, the average preoperative stay to 4 days and the overall stay to less than 11 days, and approximating the timing of shaving to the operation and substituting cefazolin for cefaluthin when prophylactic antibiotic is to be administered, the SSI may be reduced to a more acceptable level.
Razavi, Seyd Mansour; Ibrahimpoor, Mohammad; Sabouri Kashani, Ahmad; Jafarian, Ali
Background. Acute kidney injury in adults is a common cause of hospitalization, associated with high morbidity and mortality especially in developing countries. In spite of RRT the in-hospital mortality rates remain high even in the developed countries. Though a proportion of our patients receive renal replacement therapy as part of their management, data on outcomes are sparse. Study Objective. To determine the clinical outcomes of dialysis-treated AKI in our hospital. Methods. A retrospective analysis of the clinical data of all adult AKI patients treated with haemodialysis at the University of Teaching Hospital during an interrupted six-year period was conducted. Analysis was done using SPSS version 17.0. Results. 34 males and 28 females with mean age of 41.3?±?18.5 years were studied. The leading causes of AKI were sepsis (22.7%), acute glomerulonephritis (20.5%), acute gastroenteritis (15.9%), and toxic nephropathies (11.4%) and presented with mean e-GFR of 14.7 ± 5.8?mls/min/1.73?m2. Of the 62 patients, 29 (46.8%) were discharged from the hospital, 27 (43.5%) died in hospital, while 6 (9.7%) absconded from treatment. Survivors had better Rifle grade than those who died (P < 0.001). Conclusion. Hospital mortality rate of dialysis-treated AKI patients is high and the severity of renal damage at presentation may be an important factor.
Emem-Chioma, Pedro Chimezie; Alasia, Datonye Dennis; Wokoma, Friday Samuel
...CERTAIN SETTINGS Physician Services in Teaching...Conditions of payment: Assistants at surgery in teaching...available to serve as an assistant at surgery. (b) Definition. Assistant at surgery means a physician who actively...
This report evaluates the Department of Health and Human Services PATH (Physicians at Teaching Hospitals) initiative involving audits of Medicare billing processes and procedures. The PATH audits resulted from concerns that medical records did not adequately document the direct involvement of teaching physicians in services provided by resident…
General Accounting Office, Washington, DC. Health, Education, and Human Services Div.
Since 1986 medical students at the University Children's Hospital Essen are trained as peers in a two week intensive course in order to teach basic paediatric examination techniques to younger students. Student peers are employed by the University for one year. Emphasis of the peer teaching program is laid on the mediation of affective and sensomotorical skills e.g. get into contact with parents and children, as well as manual paediatric examination techniques. The aim of this study is to analyse whether student peers are able to impart specific paediatric examination skills as good as an experienced senior paediatric lecturer. 123 students were randomly assigned to a group with either a senior lecturer or a student peer teacher. Following one-hour teaching-sessions in small groups students had to demonstrate the learned skills in a 10 minute modified OSCE. In comparison to a control group consisting of 23 students who never examined a child before, both groups achieved a significantly better result. Medical students taught by student peers almost reached the same examination result as the group taught by paediatric teachers (21,7±4,1 vs. 22,6±3,6 of 36 points, p=0,203). Especially the part of the OSCE where exclusively practical skills where examined revealed no difference between the two groups (7,44±2,15 vs. 7,97±1,87 of a maximum of 16 points, p=0,154). The majority of students (77%) evaluated peer teaching as stimulating and helpful. The results of this quantitative teaching study reveal that peer teaching of selected skills can be a useful addition to classical paediatric teaching classes. PMID:23737922
Büscher, Rainer; Weber, Dominik; Büscher, Anja; Hölscher, Maite; Pohlhuis, Sandra; Groes, Bernhard; Hoyer, Peter F
Since 1986 medical students at the University Children’s Hospital Essen are trained as peers in a two week intensive course in order to teach basic paediatric examination techniques to younger students. Student peers are employed by the University for one year. Emphasis of the peer teaching program is laid on the mediation of affective and sensomotorical skills e.g. get into contact with parents and children, as well as manual paediatric examination techniques. The aim of this study is to analyse whether student peers are able to impart specific paediatric examination skills as good as an experienced senior paediatric lecturer. 123 students were randomly assigned to a group with either a senior lecturer or a student peer teacher. Following one-hour teaching-sessions in small groups students had to demonstrate the learned skills in a 10 minute modified OSCE. In comparison to a control group consisting of 23 students who never examined a child before, both groups achieved a significantly better result. Medical students taught by student peers almost reached the same examination result as the group taught by paediatric teachers (21,7±4,1 vs. 22,6±3,6 of 36 points, p=0,203). Especially the part of the OSCE where exclusively practical skills where examined revealed no difference between the two groups (7,44±2,15 vs. 7,97±1,87 of a maximum of 16 points, p=0,154). The majority of students (77%) evaluated peer teaching as stimulating and helpful. The results of this quantitative teaching study reveal that peer teaching of selected skills can be a useful addition to classical paediatric teaching classes.
Buscher, Rainer; Weber, Dominik; Buscher, Anja; Holscher, Maite; Pohlhuis, Sandra; Groes, Bernhard; Hoyer, Peter F.
Objective To access nosocomial and community accounts of multidrug resistant strains of Staphylococcus aureus (S. aureus) isolated by surveillance in a teaching hospital, over a period of 30 months. Methods Clinical samples from nosocomial sources, i.e., wards and cabins, intensive care unit (ICU) and neonatal intensive care unit (NICU) sources, as well as community or outpatient department (OPD) sources of a hospital were used for isolating strains of S. aureus resistant to methicillin/oxacillin and vancomycin, over a period, November 2009-April 2012. Results Of a total of 1?507 S. aureus isolates, 485 strains from community and 1?022 isolates were from nosocomial sources; Out of 485 (100%) OPD S. aureus isolates, 390 (80.41%) were MRSA strains. Similarly, from wards and cabins of 564 (100%) isolates, 461 (81.73%) strains were MRSA; whereas of 458 (100%) isolates obtained from ICU and NICU, 363 (79.25%) strains were MRSA. It was ascertained with ?2-tests of independence that MRSA strains were equally distributed in “community” or “wards and cabins” or “ICU and NICU” sources, alike rest other drug-resistant S. aureus strains. Antibiotic sensitivity patterns of isolated strains with 16 antibiotics were ascertained. Out of 390 (100%) MRSA strains isolated from OPD, 80 (20.51%) were vancomycin resistant (VRSA) and 173 (44.35%) strains were moderately sensitive to vancomycin or called, vancomycin intermediate strains (VISA). Similarly, from nosocomial sources, out of 461 (100%) MRSA isolates obtained from wards and cabins, 110 (23.86%) strains were VRSA and 208 (45.11%) were VISA strains, whereas out of 363 MRSA isolates obtained from ICU and NICU, 61 (16.8%) VRSA strains and 164 (45.17%) VISA strains were found. A progressive increase of percent values of drug resistance to 16 antibiotics used for antibiotic profiling revealed its subtle infection dynamics. Conclusions This study revealed the appalling state of occurrence of MRSA and VRSA in a resource-limited setting. A progressive increase of percent values of drug resistance to 16 antibiotics used revealed its subtle infection dynamics.
Dubey, Debasmita; Rath, Shakti; Sahu, Mahesh C.; Pattnaik, Lolly; Debata, Nagen K.; Padhy, Rabindra N.
An intensive care unit (ICU) is for critically ill patients who are likely to benefit from the expertise care provided. The outcome is dependent on the available human and material resources. The University of Calabar Teaching Hospital is a 410-bed hospital. It has a 3-bed general ICU consisting of 2 adult and 1 pediatric beds. A retrospective analysis of all ICU admissions as well as the mortality rate during a 12-month period that spans April 2009 and March 2010 was done. The data were collected from the ICU admissions and nurses' report books. The data extracted were the patients ages, stratified to pediatric (0-18 years) and adult (>18 years); the source of admission, primary diagnosis, the duration of admission, and the patients who were ventilated were also noted. The outcome in terms of mortality was examined in relation to parameters stated above. Eighty-five patients were admitted during the 1-year period, with a bed occupancy rate of 23%. There were 11 (12.9%) pediatric patients and 74 (87.1%) adult patients. Sources of admissions were 64 (75.3%) patients from the operating room, 8 (9.4%) from the inpatient wards, and 13 (15.3%) from the accident and emergency department. Among the adult patients, there were 23 (31%) patients with trauma. There were 45 (61%) surgical patients and 6 (8%) medical patients. Sixteen (19%) patients were mechanically ventilated. The overall mortality was 28 (32.9%). Sixty-four percent of the mortality occurred during the first 24 hours of admission. A mortality rate of 83.3% was recorded among medical patients and 62.5% in those referred from the wards. In mechanically ventilated patients, the mortality rate was 62.5%. Ventilator malfunction, power failure, and oxygen exhaustion led to the unfavorable outcome in patients who were ventilated. In pediatric patients, the mortality rate was 45.5%. Early identification and referral of critically ill patients from the wards, availability of ventilator with battery backup, and maintenance of functioning equipment would reduce the high mortality rate recorded in the study. PMID:22304993
Ilori, Iniabasi U; Kalu, Queeneth N
Pregnancy in teenage period of life is often associated with maternal complications as well as preterm delivery, low birth weight babies and small for date babies. The purpose of this study was to know the immediate outcome of neonates delivered by adolescent pregnant mother at Nepal Medical College Teaching Hospital (NMCTH), Attarkhel, Kathmandu. A retrospective comparative study was carried out in 350 adolescent pregnant mother who had delivered newborn at NMCTH from April 2005 to February 2009. Data were obtained from the case record register from Archive. Prevalence of adolescent pregnancy was 11.1%. Majority of adolescent mother were aged between 17-19 years, belonging to Mongolian ethnicity, Hindu by belief and residing within Kathmandu Valley. More than 90.0% mothers were primigravida and 85.4% had complete antenatal check up (ANC). Normal vaginal delivery was the predominant mode of delivery in both group (84.6% vs 80.0%), followed by lower section caesarean section (LSCS) (14.0% vs 18.8%) and instrumental delivery (1.1% Vs 1.2%). In newborn, male outnumbered female (59.7% vs 40.3%). A reasonable number of preterm (10.9% Vs 6.3% p = 0.029), low birth weight (12.3% vs 9.1% P = 0.259) and small for gestational age babies (7.4% vs 5.1% p = 0.318)) and birth asphyxia (10.3% Vs 5.1% p = 0.009%) were found in this study. These newborns are often associated with high morbidity and mortality. Therefore, it is imperative to prevent teenage pregnancy by providing adequate access to health facilities and raising awareness about the sex and reproductive health amongst this population. PMID:24696930
Lama, L; Shrestha, S; Sharma, A; Upadhyay, S; Pathak, M R
Cancer of the cervix is the commonest genital tract malignancy in the female, and it has been ranked second to breast cancer. It has positive association with infection of human papillomavirus. Cervical cancer incidence and mortality have declined substantially in western countries following the introduction of screening programmes. This present study investigated the knowledge, attitude and practice of nurses in Lagos University Teaching Hospital (LUTH) towards cervical cancer screening as they are important health personnel that are suppose to educate women on the need for cervical cancer screening. The study is a descriptive cross-sectional survey of the knowledge, attitude and practice of 200 nurses in LUTH towards cervical cancer screening. The results obtained showed that 99% of the respondents were aware of cervical cancer and that 92% of the respondents were also aware of the causative organism of cervical cancer (human papillomavirus). Their major sources of information were through electronic media (43.9%) and health professionals (37.4%). Furthermore, the respondents were quiet aware of Pap smear (91%) as one of the screening techniques of cervical cancer and had good attitudes (89%) towards Pap smear, but most of them had never done it before. The study further revealed that majority of the respondents did not know colposcopy as one of the screening techniques for cervical cancer. Finally, it has been made known from this study that nurses have good knowledge of cervical cancer but have limited understanding of the types of cervical cancer screening techniques and poor disposition towards undergoing cervical cancer screening. It may thus be recommended that institutions should periodically organise seminars and training for health personnel especially the nurses which form a group of professionals that should give health education to women about cervical cancer. This training may be done as part of the orientation programme to newly employed staff. PMID:21222192
Awodele, O; Adeyomoye, A A A; Awodele, D F; Kwashi, V; Awodele, I O; Dolapo, D C
OBJECTIVE: To determine the effect of a preprinted perioperative antimicrobial prophylaxis order form on the appropriateness, standardization and cost of surgical prophylaxis. DESIGN: A pre- and postintervention prospective study with evaluation of drug acquisition costs in selected surgical procedures. SETTING: A 420-bed teaching hospital in the Hamilton-Wentworth region. PATIENTS: A three-month survey of 901 consecutive patients followed by a two-month trial period of 725 consecutive patients undergoing general surgery, orthopedic and urological procedures. INTERVENTION: A perioperative antimicrobial prophylaxis order form was developed based on guidelines from the literature and input from physician and nursing staff. The form was introduced through educational inservices and put into operation. MEASUREMENT: The measurement of antimicrobial perioperative prophylaxis appropriateness and drug acquisition costs were assessed pre- and postintroduction of the order form. Subsequently, prescriber compliance and satisfaction with the program were also evaluated. RESULTS: Appropriateness of perioperative antimicrobial surgical prophylaxis was increased from 36% in the baseline period to 79% in the trial period (P<0.0001). A reduction of $440.71 ($23.20/procedure) in drug acquisition costs was observed for 19 matched hip and knee prosthetic surgical procedures between the baseline and trial periods. In addition, compliance with the perioperative order form rose steadily during the trial period. Physician prescribers reported that the form was used, and was appropriate and user-friendly but that it did not influence their prescribing habits. Nurses responded that the form was helpful and improved the timing of prophylaxis. CONCLUSIONS: The perioperative antimicrobial prophylaxis order form standardized antimicrobial administration time and resulted in an increase in appropriateness. A reduction in antimicrobial costs for surgical procedures was realized. This quality improvement project has enhanced the quality of patient care.
Au, Paul; Salama, Suzette; Rotstein, Coleman
The introduction of modern heartworm, flea, and tick preventatives has provided a safe and effective means of controlling companion animal endoparasites, but achieving good owner compliance remains an ongoing challenge for the veterinary profession. Based on a sample of patients from the veterinary teaching hospital at the University of Pennsylvania, this study retrospectively examined factors associated with preventative use and areas of potential weakness in client communication. Between 1999 and 2006, records of 5,276 canine and 1,226 feline patients were searched for signalment, survey results for heartworm, flea, and tick preventative use, date of visit, presenting complaint, vaccination history, and owner zip code. Data were analyzed using bivariate and multivariate techniques. Overall, only 13 - 23 % of patients were questioned about heartworm, flea, or tick preventative use during routine medical history taking. Patients with a prior history of parasites, younger patients, or those presenting with signs of cardiac disease were no more likely to be questioned about preventative use than healthy animals. Patients presenting to a specialty service were also less likely to be questioned. Approximately 74 - 79% of dogs and 12 – 38 % of cats in the sample were on preventative products at any given time. There was a distinct seasonality to preventative use corresponding to the heartworm transmission season from June through November in the northeastern United States. Only 50% of patients seen for a yearly physical examination in winter were reported to be using preventative products when surveyed later in the year, compared to the roughly 85% on patients in heartworm preventatives when they received their routine physical exam in spring. Month of presentation and neuter status were the only signalment factors significantly (P<0.05) associated with preventative use in the multivariate analysis. Findings from this study emphasize target areas for increasing owner compliance.
Gates, Maureen C.; Nolan, Thomas J.
The main aim of this study was to determine the medication errors among geriatrics at the outpatient pharmacy in a teaching hospital in Kelantan and the strategies to minimize the prevalence. A retrospective study was conducted that involved screening of prescription for a one-month period (March 2001). Only 15.35% (1601 prescription) of a total 10,429 prescriptions were for geriatrics. The prescriptions that were found to have medication errors was 403. Therefore, the prevalence of medication errors per day was approximately 20 cases. Generally, the errors between both genders were found to be comparable and to be the highest for Malays and at the age of 60–64 years old. Administrative errors was recorded to be the highest which included patient’s particulars and validity of the prescriptions (70.22%) and drugs that available in HUSM (16.13%). Whereas the total of prescribing errors were low. Under prescribing errors were pharmaceutical error (0.99%) and clinical error (8.68%). Sixteen cases or 3.98% had more than 1 error. The highest prevalence went to geriatrics who received more than nine drugs (32.16%), geriatrics with more than 3 clinical diagnosis (10.06%), geriatrics who visited specialist clinics (37.52%) and treated by the specialists (31.07%). The estimated cost for the 403 medication errors in March was RM9,327 or RM301 per day that included the cost of drugs and humanistic cost. The projected cost of medication errors per year was RM 111,924. In conclusion, it is very clear that the role of pharmacist is very great in preventing and minimizing the medication errors beside the needs of correct prescription writing and other strategies by all of the heath care components.
Abdullah, Dellemin Che; Ibrahim, Noor Shufiza; Ibrahim, Mohamed Izham Mohamed
The introduction of modern heartworm, flea, and tick preventatives has provided a safe and effective means of controlling companion animal endoparasites, but achieving good owner compliance remains an ongoing challenge for the veterinary profession. Based on a sample of patients from the veterinary teaching hospital at the University of Pennsylvania, this study retrospectively examined factors associated with preventative use and areas of potential weakness in client communication. Between 1999 and 2006, records of 5276 canine and 1226 feline patients were searched for signalment, survey results for heartworm, flea, and tick preventative use, date of visit, presenting complaint, vaccination history, and owner zip code. Data were analyzed using bivariate and multivariate techniques. Overall, only 13-23% of patients were questioned about heartworm, flea, or tick preventative use during routine medical history taking. Patients with a prior history of parasites, younger patients, or those presenting with signs of cardiac disease were no more likely to be questioned about preventative use than healthy animals. Patients presenting to a specialty service were also less likely to be questioned. Approximately 74-79% of dogs and 12-38% of cats in the sample were on preventative products at any given time. There was a distinct seasonality to preventative use corresponding to the heartworm transmission season from June through November in the northeastern United States. Only 50% of patients seen for a yearly physical examination in winter were reported to be using preventative products when surveyed later in the year, compared to the roughly 85% on patients in heartworm preventatives when they received their routine physical examination in spring. Month of presentation and neuter status were the only signalment factors significantly (P<0.05) associated with preventative use in the multivariate analysis. Findings from this study emphasize target areas for increasing owner compliance. PMID:19931925
Gates, Maureen C; Nolan, Thomas J
Objective: Computerized physician documentation (CPD) has been implemented throughout the nation's Veterans Affairs Medical Centers (VAMCs) and is likely to increasingly replace handwritten documentation in other institutions. The use of this technology may affect educational and clinical activities, yet little has been reported in this regard. The authors conducted a qualitative study to determine the perceived impacts of CPD among faculty and housestaff in a VAMC. Design: A cross-sectional study was conducted using semistructured interviews with faculty (n = 10) and a group interview with residents (n = 10) at a VAMC teaching hospital. Measurements: Content analysis of field notes and taped transcripts were done by two independent reviewers using a grounded theory approach. Findings were validated using member checking and peer debriefing. Results: Four major themes were identified: (1) improved availability of documentation; (2) changes in work processes and communication; (3) alterations in document structure and content; and (4) mistakes, concerns, and decreased confidence in the data. With a few exceptions, subjects felt documentation was more available, with benefits for education and patient care. Other impacts of CPD were largely seen as detrimental to aspects of clinical practice and education, including documentation quality, workflow, professional communication, and patient care. Conclusion: CPD is perceived to have substantial positive and negative impacts on clinical and educational activities and environments. Care should be taken when designing, implementing, and using such systems to avoid or minimize any harmful impacts. More research is needed to assess the extent of the impacts identified and to determine the best strategies to effectively deal with them.
Embi, Peter J.; Yackel, Thomas R.; Logan, Judith R.; Bowen, Judith L.; Cooney, Thomas G.; Gorman, Paul N.
Background Informed consent in medical practice is essential and a global standard that should be sought at all the times doctors interact with patients. Its intensity would vary depending on the invasiveness and risks associated with the anticipated treatment. To our knowledge there has not been any systematic review of consent practices to document best practices and identify areas that need improvement in our setting. The objective of the study was to evaluate the informed consent practices of surgeons at University teaching Hospitals in a low resource setting. Methods A cross-sectional study conducted at three university teaching hospitals in Uganda. Self-guided questionnaires were left at a central location in each of the surgical departments after verbally communicating to the surgeons of the intention of the study. Filled questionnaires were returned at the same location by the respondents for collection by the research team. In addition, 20 in-depth interviews were held with surgeons and a review of 384 patients’ record files for informed consent documentation was done. Results A total of 132 (62.1%) out of 214 questionnaires were completed and returned. Respondents were intern doctors, residents and specialists from General surgery, Orthopedic surgery, Ear, Nose and Throat, Ophthalmology, Dentistry, Obstetrics and Gynaecology departments. The average working experience of respondents was 4.8 years (SD 4.454, range 0–39 years). 48.8% of the respondents said they obtained consent all the time surgery is done while 51.2% did not obtain consent all the time. Many of the respondents indicated that informed consent was not obtained by the surgeon who operated the patient but was obtained either at admission or by nurses in the surgical units. The consent forms used in the hospitals were found to be inadequate and many times signed at admission before diagnosing the patient’s disease. Conclusions Informed consent administration and documentation for surgical health care is still inadequate at University teaching hospitals in Uganda.
Results of the review and comment procedure applied to the Certificate of Need application for a 486-bed teaching hospital for the New Jersey College of Medicine and Dentistry are presented in this report of the Hospital and Health Planning Council of Met...
Hydrogeological studies of the Enugu coal mining area were carried out which included hydrogeochemical analyses of water samples.\\u000a These analyses revealed high sulphate and iron content in the acid mine drainage water as well as high total dissolved solids’\\u000a (TDS) and low pH (acidity) values. The water issues from the Ajali Sandstone formation and the underlying carbonaceous Mamu\\u000a Formation and
H. I. Ezeigbo; B. N. Ezeanyim
Purpose: To determine the prevalence and pattern of leukemic ophthalmopathy among adults at the University of Nigeria Teaching Hospital (UNTH), Enugu, south-eastern, Nigeria. Materials and Methods: This prospective, observational case series surveyed adult leukemia patients presenting at UNTH’s departments of Hematology/Immunology and Ophthalmology from July 2003 to August 2008. The demographic profile, clinical data from for each individual in the cohort were statistically collated and analyzed. A P <0.05 was considered as statistically significant. Results: There were 72 participants (45 males and 27 females), aged 32.7 ± 9.8 years (range, 18 years to 72 years). Leukemic ophthalmopathy was present in 77.8% of subjects. The leading ophthalmic manifestations of leukemia were retinal vascular abnormalities in 50.0% of subjects, conjunctival pallor in 27.8% of subjects, sub-conjunctival hemorrhage in 19.4% of subjects, and retinal hemorrhage in 16.7% of subjects. Ocular co-morbidity was present in 47.2% of subjects. Vision loss occurred in 37.5% of subjects, of which 32.1% was leukemia related, and the remaining due to ocular co-morbidity. Leukemic ophthalmopathy was more prevalent in chronic leukemia (P <0.05), frequently affected the ocular posterior segment (P < 0.05), and often resulted from secondary hematologic complications (P <0.05). There was no gender difference in the prevalence of leukemia (P = 0.0822) or leukemic ophthalmopathy (P = 0.6624). Conclusion: The prevalence of leukemic ophthalmopathy in Enugu is high. It is often associated with significant ocular co-morbidity and vision loss. These have implications for clinicians involved in leukemia management. Early diagnosis and regular ophthalmic examinations are recommended to optimize treatment outcomes.
Eze, Boniface I.; Ibegbulam, Godswill O.; Ocheni, Sunday
Background A retrospective utilization study was performed to evaluate utilization patterns for enteral nutrition in a university teaching hospital. Methods Enteral nutrition was divided into three types according to the nitrogen source, ie, total protein type [Nutrison Fibre®, Fresubin Energy Fibre®, Fresubin®, Supportan® (a special immunonutrition for cancer patients or patients with increased demands for omega-3 fatty acids), Fresubin Diabetes® (a diabetes-specific formula), Ensure®]; short peptide type (Peptison®); and amino acid type (Vivonex®). A pharmacoeconomic analysis was done based on defined daily dose methodology. Results Among hospitalized patients taking enteral nutrition, 34.8% received enteral nutrition alone, 30% concomitantly received parenteral nutrition, and 35.2% received enteral nutrition after parenteral nutrition. Combined use of the different formulas was observed in almost all hospitalized patients receiving enteral nutrition. In total, 61.5% of patients received triple therapy with Nutrison Fibre, Fresubin Diabetes, and Supportan. Number of defined daily doses (total dose consumed/defined daily dose, also called DDDs) of formulas in descending order were as follows: Nutrison Fibre, Fresubin Energy Fibre, Fresubin Diabetes > Supportan > Peptison, Ensure > Vivonex, Fresubin. The ratio of the cumulative DDDs for the three types of enteral nutrition was 35:2.8:1 (total protein type to short peptide type to amino acid type). Off-label use of Fresubin Diabetes was also observed, with most of this formula being prescribed for patients with stress hyperglycemia. Only 2.1% of cancer patients received Supportan. There were 35 cases of near misses in dispensing look-alike or sound-alike enteral nutrition formulas, and one adverse drug reaction in an elderly malnourished patient who did not receive vitamin K1-enriched enteral nutrition during treatment with cefoperazone. After 4 months of the trial intervention, off-label use of Fresubin Diabetes was no longer endorsed by the Drug and Therapeutics Committee for nondiabetic patients, and the proportion of this formula prescribed for patients with stress hyperglycemia decreased by 20%, with a 10-fold increase in the amount of Supportan prescribed for cancer patients. Near misses in dispensing look-alike or sound-alike enteral nutrition were successfully abolished, and no severe coagulation disorders occurred after prophylactic administration of vitamin K1-enriched enteral nutrition in elderly malnourished patients receiving cefoperazone. Conclusion This utilization study indicates that continuous quality improvement is necessary and that a Drug and Therapeutics Committee can play an important role in promoting rational and safe use of enteral nutrition. Appropriateness of this therapy still needs to be improved, especially in addressing the issues of non-evidence-based combined use of multiple enteral nutrition formulas, the relatively high rate of concomitant use of enteral and parenteral nutrition, off-label use of diabetes-specific Fresubin Diabetes, insufficient use of Supportan in cancer patients, and unnecessary use of Supportan in intensive care patients not suffering from cancer.
Zhu, Xiu-Ping; Zhu, Ling-Ling; Zhou, Quan
Background: Intestinal helminthiasis is common in our environment and antihelminthic drugs are specie specific. Thus, need to identify and characterize the species cannot be overemphasized. Objective: To determine the prevalence of Ascaris Lumbricoides in Enugu Metropolis. Methods: A cross-sectional survey of 361 subjects in Enugu metropolis was carried out in this study. A single stool sample was collected for examination from the subjects, using appropriately labelled clean specimen containers. The prevalence of Ascaris Lumbricodes was determined using the kato-katz method. Data was obtained using questionnaires which were administered by the researchers to mothers and extended family members living in the same household. Results: Out of the 361 single stool samples collected, from the subjects (made up of 154 samples from mothers, 156 samples from children, and 51 samples from extended family members), 69 subjects (made up of 30 mothers, 27 children and 12 extended family members) were infected with Ascaris lumbricoides, giving an overall prevalence of 19.1%. Prevalence among the mothers, children and extended family members were 19.5%, 17.3% and 23.5% respectively. Conclusion: There is a high prevalence of intestinal Ascaris lumbricoides among subjects living in Enugu metropolis. Attention should be given by the government to periodically carry out mass deworming exercise among households involving mothers, children and extended family members and indeed the whole members of each household.
Chijioke, IR; Ilechukwu, GC; Ilechukwu, GCA; Okafor, CI; Ekejindu, IM; Sridhar, MKC
Objective: To investigate the incidence of Nosocomial Infection (NI) and type of bacteriological isolates among the patients admitted in the medical and surgical wards of a non-teaching secondary care hospital in north India. Materials and Methods: This was a cross-sectional hospital based study conducted in the Wards of General Medicine, General Surgery and Orthopaedic of the hospital. The patient were admitted in the department for various surgical procedures, without evidence of initial infection, were included in the study. Results: A total of 176 patients were included in the study of which 82 were from Medical and 94 from Surgical ward. Overall incidence of NI was found to be 26.1% (Medical ward=28%, Surgical ward=24.5%., p=0.58). The isolation rate of Acinetobacter baumanii was (p=0.15) higher among the patients of medical ward (95.7%) than surgical ward (82.6). Escherichia coli was isolated in 89.1% and no significant difference was observed between medical and surgical wards. Klebsiella pneumoniae was isolated in 50% patients and was almost similar (p=0.37) in medical surgical wards. The isolation rate of Pseudomonos aeruginosa, Enterococcus faecalis, Staphylococcus aureus and Coagulase negative staphylococci were 43.5%, 73.9%, 34.8% and 17.4% respectively. A significant difference was observed in the isolation rate of Enterococcus faecalis (p=0.007) and Coagulase negative staphylococci (p=0.002) between medical and surgical wards. Overall, among the patients who developed NI, 27.2% patient’s bacterial isolates were Gram positive (Surgical=64.1, Medical=80%). Conclusion: The incidence of NI is increasing in the hospitals, so extensive that more care has to be taken in cleaning the wards of the hospitals.
Ginawi, I.; Saleem, Mohd; Sigh, Mastan; Vaish, A.K.; Ahmad, I.; Srivastava, V.K.; Abdullah, A. Fahad M.
Objective: To investigate the incidence of Nosocomial Infection (NI) and type of bacteriological isolates among the patients admitted in the medical and surgical wards of a non-teaching secondary care hospital in north India. Materials and Methods: This was a cross-sectional hospital based study conducted in the Wards of General Medicine, General Surgery and Orthopaedic of the hospital. The patient were admitted in the department for various surgical procedures, without evidence of initial infection, were included in the study. Results: A total of 176 patients were included in the study of which 82 were from Medical and 94 from Surgical ward. Overall incidence of NI was found to be 26.1% (Medical ward=28%, Surgical ward=24.5%., p=0.58). The isolation rate of Acinetobacter baumanii was (p=0.15) higher among the patients of medical ward (95.7%) than surgical ward (82.6). Escherichia coli was isolated in 89.1% and no significant difference was observed between medical and surgical wards. Klebsiella pneumoniae was isolated in 50% patients and was almost similar (p=0.37) in medical surgical wards. The isolation rate of Pseudomonos aeruginosa, Enterococcus faecalis, Staphylococcus aureus and Coagulase negative staphylococci were 43.5%, 73.9%, 34.8% and 17.4% respectively. A significant difference was observed in the isolation rate of Enterococcus faecalis (p=0.007) and Coagulase negative staphylococci (p=0.002) between medical and surgical wards. Overall, among the patients who developed NI, 27.2% patient's bacterial isolates were Gram positive (Surgical=64.1, Medical=80%). Conclusion: The incidence of NI is increasing in the hospitals, so extensive that more care has to be taken in cleaning the wards of the hospitals. PMID:24701489
Ginawi, I; Saleem, Mohd; Sigh, Mastan; Vaish, A K; Ahmad, I; Srivastava, V K; Abdullah, A Fahad M
Objective: To find out if there was a difference between hospital consultants, all trained in acute general medicine, in length of stay (LOS), re-admission rates, resource utilisation, and diagnostic coding, among patients admitted as emergencies to St James' Hospital (SJH) Dublin. Methods: A retrospective analysis was performed of data on discharges from hospital, recorded in the hospital in-patient enquiry (HIPE) system, relating to 9204 episodes among 6968 emergency medical patients admitted to SJH between 1 January 2002 and 31 October 2003. For comparative analysis, four physician groups were defined consisting of gastroenterology (GI, n = 4), respiratory (n = 3), general internal medicine (GIM, n = 2), or specialty (n = 5). Results: GIM consultants had the shortest LOS (median 5 days); GIM and respiratory consultants were less likely to have long stay patients (> 30 days, p<0.0001). Patients re-admitted under the same consultant had a longer LOS than those re-admitted under a different consultant (p<0.0001). Endoscopy and GI radiology investigations were used most by GI consultants, computed tomography of the thorax by respiratory, ECHO by respiratory and specialty, and computed tomography of brain by GIM and specialty consultants. GI diagnostic codings were more frequent with GI consultants (p<0.0001), respiratory diagnoses and malignancy with respiratory (p<0.0001 for both), diabetes and hypertension with specialty (p = 0.0017), and heart failure more with GIM consultants (p = 0.001). Conclusions: This study found that the HIPE database was very powerful in predicting differences between hospital consultants in LOS, re-admission rates, resource utilisation, and disease coding. It would be of interest to examine the extent to which protocols and guidelines could reduce such variations.
Moloney, E; Smith, D; Bennett, K; O'Riordan, D; Silke, B
Background and Aim: Ideally, the period of patients admitting in the Emergency Department (ED) should not exceed 6 hours. Prolonged of the patients admitting time affects the ED overcrowding, quality of patient care and patient satisfaction. To evaluate the efficacy of new programs and suggest new strategies to reduce the overcrowding in a typical overcrowded ED of general teaching hospital in Tehran city. Materials and Methods: In this descriptive case study, charts of patients held over 24 hours, in Imam Hossein Hospital affiliated to the Shaheed Beheshti Medical University, were reviewed from April 21rd on August 23rd, 2008. Results: Of 15,477 patients, 151 (1%) have been held in the ED over 24 hours. Reasons for this long-stay included:lack of available bed in Intensive Care Unit (ICU) (125 patients), lack of available bed in related wards (18 patients), poor final decision — making by physician (eight patient) Conclusion: Long-term stay of patients in ED of teaching hospital is a major problem. The most frequent cause is a limitation of inpatient beds. The long stay time had not been affected by paraclinic procedures, multispecialities involvement or the lack of obvious diagnosis. The following solution is proposed: (1) creation of a holding unit, (2) active inter-facility transfer and (3) governing admittance of patients who need ICU care to related wards.
Talleshi, Z.; Hosseininejad, S. M.; Khatir, Goli; Bozorghi, F.; Gorji, A. M. Heidari; Gorji, M. A. Heidari
Staphylococcus epidermidis is a leading cause of hospital-acquired infections, mostly associated with the use of medical devices in seriously ill or immunocompromised patients. Currently, the clonal characteristics of S. epidermidis in the hospital environment in China are unknown; neither is it known why these sequence types are easily disseminated in the hospital setting. In this study, multilocus sequence typing (MLST)
Min Li; Xing Wang; Qian Gao; Yuan Lu
Aim: Drug-drug interaction (DDI) is of major concern in patients with complex therapeutic regimens. The involvement of cardiovascular medicines in drug interaction is even higher. However, reports of DDI between these groups of drugs are few. The study aims to identify the potential DDI among hospitalized cardiac patients. Furthermore, we assessed the possible risk factors associated with these interactions. Subjects and Methods: The Type of study prospective observational study was conducted from May 2012 to August 2012 among hospitalized cardiac patients. Cardiac patients who were taking at least two drugs and who had a hospital stay of at least 24 h were enrolled. The medications of the patients were analyzed for possible interactions using the standard drug interaction database - Micromedex -2 (Thomson Reuters) × 2.0. Results: From a total of 150 enrolled patients, at least one interacting drug combination was identified among 32 patients. The incidence of potential DDI was 21.3%. A total of 48 potentially hazardous drug interactions were identified. Atorvastatin/azithromycin (10.4%), enalapril/metformin (10.4%), enalapril/potassium chloride (10.4%), atorvastatin/clarithromycin (8.3%) and furosemide/gentamicin (6.3%) were the most common interacting pairs. Drugs most commonly involved were atorvastatin, enalapril, digoxin, furosemide, clopidogrel and warfarin. Majority of interactions were of moderate severity (62.5%) and pharmacokinetic (58.3%) in nature. Increased number of medicines, prolonged hospital stays and comorbid conditions were the risk factors found associated with the potential DDI. Conclusions: This study highlighted the need of intense monitoring of patients who have identified risk factors to help detect and prevent them from serious health hazards associated with drug interactions.
Sharma, Sushmita; Chhetri, Himal Paudel; Alam, Kadir
Aim: To determine the types of functional disabilities in adult and paediatric burns survivors, with specific emphasis on potential risk and socio-economic factors of burn disabilities present in Ghana. Patients and Methods: The descriptive study was carried out in Komfo Anokye Teaching Hospital, Kumasi, Ghana from May 2011 to April 2012. Burn survivors who came for follow-up visits after been discharged home and had functional disability were the participants of the study. They were physically examined and interviewed using a pre-tested questionnaire after their informed consent/or that of their parents (in the cases of paediatrics burns survivors) was sought. Results: A total of 70 participants consented for the study. Their ages ranged from 8/12 – 78 years, with a mean age of 12±1.7 years. Majority (60.0%, N=42) of the participants had third degree burns. The nature of disabilities of participants were mostly scar contractures (42.9%, N=30) of which 36.7% (N=11) had impeded arm elevation; 23.3% (N=7) could not fold the palm or move the digits. From the multiple regression analysis risk factors for burn victim to have disability were paediatric age (OR=11.1, P=0.043), third degree of burn (OR=6.2, P=0.001) and anatomical part affected (OR=18.3, P=0.031). Socio-economic factors that affected burn disability victims were nuclear family compensation (OR=4.2, P=0.021), community mockery/stigmatization (OR=0.1, P=0.052) and caretakers time and finance (OR=5.2, P=0.033). Conclusion: The commonest functional disabilities recorded were scar contractions of the axilla region which had impeded the ability of the patients to lift the arm. Risk factors for burns disability included childhood age, third degree of burn incurred and anatomical part affected. Social factors influencing the lives of burn survivors with disability were good family and negative community interactions. Significant economical factors recorded were caretakers’ time and financial constrains.
Background Van der Woude syndrome (VWS), an autosomal dominant condition associated with clefts of the lip and/or palate and lower lip pits and is caused by mutations in interferon regulatory factor six gene. It is reported to be the most common syndromic cleft worldwide. Non-penetrance for the lip pit phenotype is found in at least 10% of affected individuals and those without the pits are phenocopies for non-syndromic clefting. The aim of this study is to present the phenotypic characteristic of VWS seen at the Lagos University Teaching Hospital (LUTH) cleft clinic. Materials and Methods A review of cases of patients with VWS that attended the cleft lip and palate clinic at the LUTH Idi-Araba, Lagos, from January 2007 to December 2012 was conducted. Data analyses included sex of affected patients, types of cleft, presence of lower lip pits and history of lower lip pits/cleft in the family. Results A total of 11 cases were seen during the period (male = 4; female = 7). Age at presentation ranged between 1 week and 12 years, with majority (n = 10) less than 2 years of age. Bilateral cleft lip and palate (BCLP) was seen in six patients, isolated soft palatal cleft (n = 3) and unilateral cleft lip and alveolus (n = 1) and cleft of hard and soft palate (n = 1). Bilateral lower lips were presented in 10 out of the 11 cases. The mother of the only patient without lip pits presented with bilateral lower lip pits. No family history of cleft/lip pits was elicited in 10 other cases. Conclusion Most of the cases of VWS presented with BCLP and lower lip pits. Non-penetrance for the lip pits was seen in one out of 11 cases. Our study emphasizes the need to screen family members in all cleft cases, especially clinically diagnosed non-syndromic cases who may be VWS with no lip pits. Future studies are required to investigate the genetic causes of this syndrome in our population.
James, Olutayo; Adeyemo, Wasiu L.; Emeka, Christian I.; Ogunlewe, Mobolanle O.; Ladeinde, Akinola L.; Butali, Azeez
Background Diarrheal diseases are the major causes of morbidity and mortality in developing world. Understanding the etiologic agents of diarrheal diseases and their association with socio-demographic characteristics of patients would help to design better preventive measures. Thus, this study was aimed to determine the prevalence of intestinal parasites and enteropathogenic bacteria in diarrheic patients. Methods A cross-sectional study involving 384 consecutive diarrheal patients who visited Gondar teaching hospital, Gondar, Ethiopia from October 2006 to March 2007 was conducted. Stool specimens were collected and examined for intestinal parasites and enteropathogenic bacteria following standard parasitological and microbiological procedures. Results Intestinal parasites were diagnosed in 36.5% of the patients. The most frequently encountered protozoan parasite was Entamoeba histolytica/dispar (7.3%) followed by Giardia lamblia (5.0%), Cryptosporidium parvum (1.8%) and Isospora belli (1.3%). The dominant helminthic parasite identified was Ascaris lumbricoides (5.5%) followed by Strongyloides stercoralis and Schistosoma mansoni (3.1% each), hookworm infection (1.8%), and Hymenolepis species (1.3%). Multiple infections of intestinal parasites were also observed in 6.3% of the patients. Among the enteropathogenic bacteria Shigella and Salmonella species were isolated from 15.6% and 1.6%, respectively, of the patients. Escherichia coli O57:H7 was not found in any of the stool samples tested. Eighty eight percent and 83.3% of the Shigella and Salmonella isolates were resistant to one or more commonly used antibiotics, respectively. Intestinal parasitosis was higher in patients who live in rural area, in patients who were washing their hands after visiting toilet either irregularly with soap and without soap or not at all, in patients who used well and spring water for household consumption, and in patients who had nausea (P < 0.05). Statistically significant associations were also observed between Shigella infections and patients who were using well and spring water for household consumption, and patients who had dysentery and mucoid stool (P < 0.05). Conclusions The high prevalence of intestinal parasites and Shigella species in diarrheic patients calls for institution of appropriate public health intervention measures to reduce morbidity and mortality associated with these diseases. The rational use of antibiotics should also be practiced.
A cross-sectional study was performed to assess the frequency of burnout in healthcare workers of a university teaching hospital in Rome (Italy), by means of the Maslach Burnout Inventory. In total 142 healthcare workers participated in the study. Average levels of emotional exhaustion and depersonalization were observed in the study population. Working in emergency care services was found to be correlated with lower levels of personal accomplishment with respect to working in other services. Monitoring burnout in social service and healthcare workers is an effective tool for identifying critical situations in the workplace. PMID:18379605
Agostinelli, Alessandro; La Torre, Giuseppe; Bevilacqua, Francesca; Chiaradia, Giacomina; Specchia, Maria Lucia; Ricciardi, Walter
Manual medical record mining and data analysis were performed at a tertiary care university teaching hospital to establish the rate of occurrence of and risk factors for infection with methicillin-resistant Staphylococcus aureus (MRSA). Patients with surgical site infections had the highest rate of MRSA infection, representing 59% of the MRSA infections recorded. The mortality rate in patients with relapsed MRSA was 45% (13 of 30), compared with no deaths in 149 new MRSA cases. The majority of deaths in patients with relapsed MRSA occurred in the intensive care unit. PMID:21864946
Gomes, Sheldon; Altafi, Sohail; Garcia, Kristine M; Emery, Christopher L; Hamilton, Richard; Brooks, Ari D; Joshi, Suresh G
The pattern of congenital malformation of the central nervous system (CNS) as seen in Jos University Teaching Hospital (JUTH) is slightly different from that seen in Europe, Japan and Southern Nigeria. Not all the various types of CNS malformations reported from these centres have been seen in JUTH. Myelomeningocele was the commonest anomaly of the CNS seen and it accounted for more than 60% of all cases. Bilateral talipes equinovarus deformity was the commonest associated anomaly found. No case of anencephaly was seen in this study. PMID:1637744
Binitie, O P
Pressure ulcers have been identified as a major burden of hospitalization worldwide, and nurses are at the forefront of prevention. The purpose of this study was to determine the nurses' knowledge and practices regarding risk factors, prevention, and management of pressure ulcers at a teaching hospital in Uganda. The study employed a descriptive cross-sectional design. Fifty-six Ugandan registered practicing nurses were sampled. A composite self-administered questionnaire and an observation checklist were utilized. The nurses had limited knowledge about critical parameters of pressure ulcers. Prevention practices were observed to be unreliable and uncoordinated related to a significant shortage of staff and logistics for pressure ulcer prevention. Nurses had poor access to current literature on pressure ulcer prevention. Translation of nurses' knowledge into practice is possible if barriers like staff shortage, pressure relieving devices provision, and risk assessment tools are addressed at Mulago.
Mwebaza, Ivan; Katende, Godfrey; Groves, Sara; Nankumbi, Joyce
Among 15,174 non-duplicated Enterobacteriaceae isolates, the prevalence of carbapenem-nonsusceptible Enterobacteriaceae (CNSE) was about 2.5% at a teaching hospital in Taiwan during 2010. Among 117 available isolates of CNSE, 8.6% carried genes encoding carbapenemases. Tigecycline and colistin were the most active agents against carbapenemase-producing and non-producing isolates. Patients infected with CNSE had an all-cause in-hospital mortality of 37.3%, and mortality was similar for infections from carbapenemase producers and non-producers (14-day mortality rates: 22.2% and 21.5%; 30-day mortality rates: 22.2% and 32.3%, respectively). Continuous surveillance of CNSE is recommended in Taiwan. PMID:24016614
Lai, Chung-Chih; Wu, Un-In; Wang, Jann-Tay; Chang, Shan-Chwen
Cerebral toxoplasmosis is common opportunistic infections of central nervous system in AIDS. It occurs most often in case of severe immunosuppression. The aim of this study is to investigate the general characteristics of cerebral toxoplasmosis during HIV infection and AIDS in hospital area in Bamako. It is a retrospective study of 5 years (form January 2001 to December 2005), conducted in the infectious diseases department of Point G Teaching Hospital of Bamako. It concerned all patients infected with HIV, hospitalized for cerebral toxoplasmosis. The diagnosis of cerebral toxoplasmosis was based on clinical, C T and therapeutic arguments. A total of 745 patients investigated, 26 met cerebral toxoplasmosis diagnostic criteria (14 men and 12 women). The rate of cerebral toxoplasmosis in the study population was 3.5%. The average age was 38.1 years (18-58 years). Focused neurological deficit (73.07%), intracranial hypertension signs (69.20%), meningeal syndrome (15.40%), seizures (57.69%) and consciousness disorders (30.80%) were the clinical characteristics. Hypodensity with or without peripheral enhancement images (93.75%) were found on CT. The average rate of CD4 T cells was 98.7cells/mm3 (5-473 cells/mm3). Oropharyngeal candidiasis in 61.53% of cases, intestinal cryptosporidiosis (11.53%), herpes zoster (3.84%) and Pott's disease (3.84%) were the opportunistic infections associated. Cotrimoxazole was used in 88.46% of patients and 3 patients (11.54%) received the standard treatment (Sulfadiazine-Pyrimethamine). Antitoxoplasmic treatment led to a clinical improvement in 84.61% and 4 deaths (15.39%). were recorded. The technical platform for etiological diagnosis of toxoplasmosis is not available at the Point-G Teaching Hospital, so in case of encephalitis signs in a HIV positive patient, CT should be urgently perform and a treatment trial must begin without delay. PMID:22765969
Goïta, D; Karambe, M; Dembélé, J P; Sogoba, D; Sidibé, A F; Diaby, S; Cisse, I A; Fongoro, S; Dao, S
Since 1950, when the number of hospitals started to increase in Rio Grande do Sul and Brazil, the treatment of illnesses has been the main focus of hospitals. This study aimed at analyzing how Nursing training influenced the institutionalized relationships in the hospital. This was a qualitative study, based on Archeology, Genealogy, and oral History, including training nurses that were students at that time. Analysis of discourse was used to study the documents. Among other aspects, findings indicated that the focus on the treatment of illnesses by the hospital still places Health Education in a lesser position. PMID:18464463
Corbellini, Valéria Lamb
INTRODUCTION: Hospital medical emergency teams (METs) have been implemented to reduce cardiac arrests and hospital mortality. The timing and system factors associated with their activation are poorly understood. We sought to determine the circadian pattern of MET activation and to relate it to nursing and medical activities. METHOD: We conducted a retrospective observational study of the time of activation for
Daryl Jones; Samantha Bates; Stephen Warrillow; Helen Opdam; Donna Goldsmith; Geoff Gutteridge; Rinaldo Bellomo
Background and Purpose: Bloodstream infections are an important cause of morbidity and mortality among hospitalized patients and the surveillance of etiological agents in these infections is important for their prevention and treatment. Data on common organisms isolated from blood cultures from Malaysia are limited, and our aim was to identify the common bloodstream isolates in hospitalized patients at the University
Rina Karunakaran; Nadeem Sajjad Raja; Kee Peng Ng; Parasakthi Navaratnam
Background Diabetes mellitus is becoming one of the major causes of premature adult mortality in developing countries. However, there is a very little documentation of the morbidity trend in such countries. Objective To assess the ten-year trend of diabetes mellitus at Gondar University Teaching Referral Hospital, northwest Ethiopia. Methods A hospital-based retrospective record review was done at the main referral hospital in northwest Ethiopia. Data were obtained from medical records of all registered diabetic patients in the Diabetic Follow up Clinic between 2000 and 2009. An Extended Mantel-Haenzel chi-square test for the linear trend was used to examine the trend over time. Result Out of the total 354,524 patients who visited the Outpatient Department of the hospital during the study period, 1553 (4.4/1000) were diabetes patients, of which 50.1% was type 1 and 49.9% type 2 diabetes mellitus. The average increase in the proportion of both Type 1 and Type 2 diabetes mellitus cases between 2000 and 2009 was 125%. The mean (±SD) age for Type 1 diabetes mellitus was 29.1 (±12), and 53.5 (±12) for Type 2 diabetes. Overall 42.5% of the diabetes mellitus patients were female and 31.7% were rural residents. The mean body mass index for both type of diabetes mellitus increased from 15.9 to 18.3 kg for type 1 and from 23.8 to 24.6 for type 2 between 2000 and 2009, respectively. Conclusion The number of diabetes mellitus cases seen at Gondar Referral Hospital is rising steadily. A comprehensive diabetes prevention, treatment, and care program is needed to improve the quality of life of the increasing diabetes mellitus cases in Ethiopia.
Abebe, Solomon Mekonnen; Berhane, Yemane; Worku, Alemayehu; Alemu, Shitay
Background Lassa fever is a viral hemorrhagic fever endemic in West Africa. However, none of the hospitals in the endemic areas of Nigeria has the capacity to perform Lassa virus diagnostics. Case identification and management solely relies on non-specific clinical criteria. The Irrua Specialist Teaching Hospital (ISTH) in the central senatorial district of Edo State struggled with this challenge for many years. Methodology/Principal Findings A laboratory for molecular diagnosis of Lassa fever, complying with basic standards of diagnostic PCR facilities, was established at ISTH in 2008. During 2009 through 2010, samples of 1,650 suspected cases were processed, of which 198 (12%) tested positive by Lassa virus RT-PCR. No remarkable demographic differences were observed between PCR-positive and negative patients. The case fatality rate for Lassa fever was 31%. Nearly two thirds of confirmed cases attended the emergency departments of ISTH. The time window for therapeutic intervention was extremely short, as 50% of the fatal cases died within 2 days of hospitalization—often before ribavirin treatment could be commenced. Fatal Lassa fever cases were older (p?=?0.005), had lower body temperature (p<0.0001), and had higher creatinine (p<0.0001) and blood urea levels (p<0.0001) than survivors. Lassa fever incidence in the hospital followed a seasonal pattern with a peak between November and March. Lassa virus sequences obtained from the patients originating from Edo State formed—within lineage II—a separate clade that could be further subdivided into three clusters. Conclusions/Significance Lassa fever case management was improved at a tertiary health institution in Nigeria through establishment of a laboratory for routine diagnostics of Lassa virus. Data collected in two years of operation demonstrate that Lassa fever is a serious public health problem in Edo State and reveal new insights into the disease in hospitalized patients.
Hass, Meike; Gabriel, Martin; Olschlager, Stephan; Becker-Ziaja, Beate; Folarin, Onikepe; Phelan, Eric; Ehiane, Philomena E.; Ifeh, Veritas E.; Uyigue, Eghosasere A.; Oladapo, Yemisi T.; Muoebonam, Ekene B.; Osunde, Osagie; Dongo, Andrew; Okokhere, Peter O.; Okogbenin, Sylvanus A.; Momoh, Mojeed; Alikah, Sylvester O.; Akhuemokhan, Odigie C.; Imomeh, Peter; Odike, Maxy A. C.; Gire, Stephen; Andersen, Kristian; Sabeti, Pardis C.; Happi, Christian T.; Akpede, George O.; Gunther, Stephan
SummaryThere is the need to adequately inform patients about their disease, treatment options, surgery and post-operative complications. Adequate pain relief after surgery leads to less morbidity. Two important aspects of surgical practice are being addressed in this paper, the need for informed consent and post operative pain relief.A questionnaire survey was carried out in 100 patients on the four general surgical wards of the Korle Bu Teaching Hospital, just before they were discharged from hospital. They were asked what they knew or had been informed about their diagnosis, operation and complications of surgery. On pain relief, patients were asked about their experiences on the first post-operative day and what relief they had from analgesics.Twenty four did not know the diagnosis and 36 were not told what operation they were going to have before surgery. Although 75 were eventually told what operation they had, only 64 said they knew the operation. Sixty eight did not know what to expect after surgery; 87 did not know about possible complications. On the first post-operative day there was significant pain (scores 4 and 5) felt by 24 patients at rest and 46 on movement. The most frequently prescribed analgesic was pethidine.Patient information in General surgery at the Korle Bu Teaching Hospital is unsatisfactory. Post-operative analgesia is also poor. There is the need for surgeons to either train doctors to administer consent or administer it themselves. Anaesthetists should assume a leading role in managing post-operative pain. PMID:17299545
Clegg-Lamptey, Jna; Hodasi, Wm
Aim To monitor the adverse drug reactions (ADRs) caused by antihypertensive medicines prescribed in a university teaching hospital. Methods The present work was an open, non-comparative, observational study conducted on hypertensive patients attending the Medicine OPD of Majeedia Hospital, Jamia Hamdard, New Delhi, India by conducting patient interviews and recording the data on ADR monitoring form as recommended by Central Drugs Standard Control Organization (CDSCO), Government of India. Results A total of 21 adverse drug reactions were observed in 192 hypertensive patients. Incidence of adverse drug reactions was found to be higher in patients more than 40?years in age, and females experienced more ADRs (n = 14, 7.29%) than males, 7 (3.64%). Combination therapy was associated with more number of adverse drug reactions (66.7%) as against monotherapy (33.3%). Calcium channel blockers were found to be the most frequently associated drugs with adverse drug reactions (n = 7), followed by diuretics (n = 5), and ?-blockers (n = 4). Among individual drugs, amlodipine was found to be the commonest drug associated with adverse drug reactions (n = 7), followed by torasemide (n = 3). Adverse drug reactions associated with central nervous system were found to be the most frequent (42.8%) followed by musculo-skeletal complaints (23.8%) and gastro-intestinal disorders (14.3%). Conclusions The present pharmacovigilance study represents the adverse drug reaction profile of the antihypertensive medicines prescribed in our university teaching hospital. The above findings would be useful for physicians in rational prescribing. Calcium channel blockers were found to be the most frequently associated drugs with adverse drug reactions.
Background: The national policy on malaria control recommends use of intermittent preventive treatment with sulfadoxine/pyrimethamine (IPT-SP) for chemoprophylaxis against malaria in pregnancy; and use of quinine and arthemisinin-based combination therapy (ACT) for acute treatment of malaria in the first, and second/third trimesters, respectively. In Nigeria, a large proportion of pregnant women are seen by the general practitioners (GPs). Objective: To determine the pattern of anti-malaria prescription in pregnancy among GPs in Enugu state, and access the level of conformity with the national policy on malaria control. Materials and Methods: Questionnaires were administered to a cross-section of 147 GPs that attended the 2010 Enugu state branch of the Nigeria Medical Association Scientific Conference/Annual General Meeting/Election. Results: The mean age of the GPs was 37 ± 3.6 (range 27-70) years. Quinine was the commonly (45.6% (n = 67)) prescribed anti-malaria drug in the first trimester while in the second/third trimester ACT was commonly (48.3% (n = 71)) prescribed. Seventy-six (51.7%) practitioners prescribed IPT-SP for chemoprophylaxis against malaria while the rest (48.3%) prescribed other drugs. GPs who obtained MBBS qualification less than or equal to 5 years prior to the survey were more likely to comply with the national policy on malaria control in their prescriptions (P < 0.05). Conclusion: The pattern of anti-malaria prescription among GPs in Enugu state is varied, and conformed poorly to the evidence-based national policy on malaria control. There is need for continuing professional development to keep the GPs abreast with current trends in malaria treatment during pregnancy.
Ugwu, Emmanuel Onyebuchi; Iferikigwe, E. S.; Obi, S. N.; Ugwu, A. O.; Agu, P. U.; Okezie, O. A.
...medical services to all patients, for example, utilization...services to individual patients $25,000 Allowable...solely for improvement of care of hospital patients or for educational or...and other scientific research). (i) No...
...medical services to all patients, for example, utilization...services to individual patients $25,000 Allowable...solely for improvement of care of hospital patients or for educational or...and other scientific research). (i) No...
Objective: This study in a tertiary care teaching center with 361 beds was conducted to assess use, misuse, and abuse of antibiotics.Materials and Methods: Every day of the study, a computer program was used to compile a list of patients' bedside records. On a specific day, the bedside charts of selected patients were reviewed to determine whether: (1) a justification
Yamileth Mora; María L. Avila-Agüero; María A. Umaña; Ana L. Jiménez; María M. París; Idis Faingezicht
Background Teaching sessions for medical students during ward rounds are an essential component of bedside teaching, providing students with the opportunity to regard patients as actual people, and to observe their physical conditions directly, allowing a better understanding of illnesses to be developed. We aim to explore medical students’ perceptions regarding medical and surgical ward rounds within the Faculty of Medicine at Kuwait University, and to evaluate whether this teaching activity is meeting the expectation of learners. Methods A pretested questionnaire was used to collect data from 141 medical students during the 2012–2013 academic year. They were asked to provide their current and expected ratings about competencies that were supposed to be gained during ward rounds, on a scale from 1 (lowest) to 5 (highest). Mean scores were calculated, and the Student t-test was used to compare results. P < 0.05 was the cut-off level for significance. Results Only 17 students (12.1%) declined to participate in the study. The students’ current competency scores (for competencies taught within both disciplines – medical and surgical) were significantly lower than the scores indicating students’ expectations (P < 0.001). The best-taught competency was bedside examination, in both medical (mean: 3.45) and surgical (mean: 3.05) ward rounds. However, medical ward rounds were better than surgical rounds in covering some competencies, especially the teaching of professional attitude and approach towards patients (P < 0.001). Conclusion Both medical and surgical ward rounds were deficient in meeting the students’ expectations. Medical educators should utilize the available literature to improve the bedside teaching experience for their students.
AlMutar, Sara; AlTourah, Lulwa; Sadeq, Hussain; Karim, Jumanah; Marwan, Yousef
Background: The emergency department of every tertiary care teaching hospital is the backbone of community health care service. Aims: This study was undertaken to identify the pattern of emergencies in the hospital, and to identify the risk factors associated with these emergencies. Materials and Methods: This was a retrospective record analysis of the emergency department from Jan 2010 to Dec 2010. The data were analyzed for various types of medical emergencies presented at the hospital at Guru Gobind Singh Medical College and Hospital, Faridkot. Results: A total of 2310 patients presented in the emergency department of which nearly half were males; a great majority were in the age group of 15–40 years. The diseases related to the cardiovascular system, 367 (15.89%), topped the list of which hypertension was noted in 267 (11.56%) cases. This was followed by morbidities related to the neurological system, diabetes, hepatobiliary, respiratory, renal 168 (7.27%), poisoning, pyrexia of unknown origin, and multi-organ involvement. With regard to the specific diseases, the majority were contributed by coronary artery disease 217 (9.39%), stroke 178 (7.71%), alcoholic liver disease 160 (6.93%), and chronic obstructive lung diseases 90 (3.90%). In our series, we noted that a great majority of cases were in the 41–60 age groups except poisoning (majority less than 40 years). The age groups were significantly related with selected morbidities. Conclusions: There are transparent evidence that we need an organized emergency care system in India as relatively the younger age group (15–40 years) comprised nearly half cases.
Garg, Ravinder; Aggarwal, Simmi; Singh, Harpreet; Kajal, Krishan Singh; Garg, Ramneesh; Pal, Ranabir
Background: Trauma is the most common cause of morbidity and mortality in people younger than 45 years and head injury is mostly highly weighted predictor of outcome in trauma population, anything than can improve the outcome from severe head injury has the potential of improving the lives of many accident victims. Objective: A study regarding factors influencing outcome of traumatic brain injury patients was conducted at a tertiary care hospital of Srinagar (India). The basic predictors in this study included age, sex, rural/urban, time taken from site of trauma to arrival at hospital, mode of transportation, referral from other hospitals, referral to other hospitals, and Glasgow Coma Scale. Methods: Traumatic Brain Injury (TBI) patients (n 547) were taken prospectively by simple random sampling method for a period of one year (2004) for this study. Results: Majority of patients belonged to age group 0 to 10 years (25.5%) and a maximum death (8) were seen in age group 51 to 60 years. Maximum number of patients were males (75.9%) and (71.1%) TBI patients were from rural areas. (26.7%) reached this hospital within a period of one hour. (66%) were shifted through ambulance service. 6.4% expired after treatment. Conclusion: Factors responsible for improved outcome in severe head injury patients are improvement in early recognition, resuscitation and triage, coupled with prompt computed tomography (CT) scanning and aggressive surgical management.
Yattoo, G H; Tabish, S A; Afzal, Wani M.; Kirmani, Altaf
Introduction: Review of opioid prescriptions in a hospital provides valuable information to health care professionals which may contribute to proper pain management; opioid utilization studies may help uncover factors that can be improved for better prescribing. To evaluate the use of opioid analgesics in a university hospital, a review of opioids prescribed in hospitalized patients was developed. Methods: Information was obtained from the pharmacy database and medical records. The study period was 1 month. Results: Medical records of 1156 patients admitted in July 2009 were analyzed. The most widely prescribed opioid was tramadol; the preferred administration route was intravenous; the main indication was severe pain; and major prescribers were from surgical departments. Discussion: Underutilization of potent opioids for acute and chronic pain seems to occur. Conclusion: Most prescribers prefer weak opioids, given intravenously to treat acute and chronic pain, while some patients may benefit from the prescription of more potent opioids.
Moyano, Jairo; Figueras, Albert
Objectives: We have herein reported our experience with the pattern of presentation of cases of acute organophosphorus (OP) poisoning cases in a tertiary care hospital. Materials and Methods: This retrospective study evaluated the hospital records of patients with acute OP poisoning. In a pre-structured proforma, data regarding age, sex, time elapsed after intake, circumstances of poisoning, duration of hospitalization, severity, complications, and outcome of the patients were recorded. The data were presented as mean ± standard deviation, entered in the open office datasheet, and analyzed with PSPP software. Results: A total 101 patients were included in the study. Young adult males were more commonly involved than females (M:F 2.5:1). The mean age of the patients was 28 years (range 2-72 years, SD ± 14.3 years). Mean time to receive treatment was 5.2 ± 7.4 (range 1-48 h). About 45.5% patients received first aid before coming to the hospital. The reason was suicide in 88.1% cases and accident in 12 (11.9%, all children). Seventy-nine patients received pralidoxime (PAM) and the mean duration was 1.7 ± 1.1 (range 1-4 days). Atropine was given in all patients. Mean duration was 5.1 ± 3.1 (range 1-19 days). Mean hospital stay was 7.5 ± 4.7 days (range 1-26 days). Mortality was 9.9% in the present series. Conclusion: Although the present study contribute substantial information regarding the epidemiology and outcome of acute OP poisoning in a tertiary care teaching hospital at a district level, its relatively small sample size and the retrospective record-based nature are the major limitations of the present study. There is a further need for prospective studies to understand the underlying socio-economic factors responsible for acute OP poisoning in our population, and, accordingly, address the problems to reduce the incidence of acute OP poisoning cases. PMID:24705111
Kumar, M Rajesh; Vignan Kumar, G P; Babu, P Ramesh; Kumar, S Satish; Subrahmanyam, B V; Veeraprasad, M; Rammohan, P; Srinivas, M; Agrawal, Amit
Background Parents and Health Care Workers have traditionally attributed a variety of symptoms to teething in young children. Some of these symptoms may however connote underlying serious medical condition in a child. There is little evidence to support these beliefs despite their implications on management of a symptomatic teething child. This study therefore seeks determine the beliefs and problems mothers associate with teething in Enugu, South-east Nigeria. Findings A cross-sectional survey involving sixty mothers presenting at a Children's clinic in Enugu metropolis using questionnaire. More than 90% of the respondents thought that babies can experience medical problems as a result of teething. The commonest medical problems perceived to be associated with teething were fever (71.7%), loose stools (58.3%) and vomiting (35%). Conclusion Mothers still associate a variety of symptoms of childhood illnesses to teething and this association is not evidence based and could lead to delayed interventions, increased morbidity and mortality of children. It is important therefore that mothers and health workers caring for young children are educated on the need to seek prompt medical attentions in a symptomatic child.
Background Maternal mortality is high the world over, especially in sub-Saharan Africa, including Nigeria. Nigeria has consistently demonstrated one of the most abysmally poor reproductive health indices in the world, maternal mortality inclusive. This is a sad reminder that, unless things are better organized, Southeast Nigeria, which Nnamdi Azikiwe University Teaching Hospital (NAUTH) represents, may not join other parts of the world in attaining Millennium Development Goal 5 to improve maternal health in 2015. Objectives This study was conducted to assess NAUTH’S progress in achieving a 75% reduction in the maternal mortality ratio (MMR) and to identify the major causes of maternal mortality. Materials and methods This was a 10-year retrospective study, conducted between January 1, 2003 and December 31, 2012 at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeast Nigeria. Results During the study period, there were 8,022 live births and 103 maternal deaths, giving an MMR of 1,284/100,000 live births. The MMR was 1,709 in 2003, reducing to 1,115 in 2012. This is to say that there was a 24.86% reduction over 10 years, hence, in 15 years, the reduction should be 37%. This extrapolated reduction over 15 years is about 38% less than the target of 75% reduction. The major direct causes of maternal mortality in this study were: pre-eclampsia/eclampsia (27%), hemorrhage (22%), and sepsis (12%). The indirect causes were: anemia, anesthesia, and HIV encephalopathy. Most of the maternal deaths occurred in unbooked patients (98%) and within the first 48 hours of admission (76%). Conclusion MMRs in NAUTH are still very high and the rate of reduction is very slow. At this rate, it will take this health facility 30 years, instead of 15 years, to achieve a 75% reduction in maternal mortality.
Obiechina, NJ; Okolie, VE; Okechukwu, ZC; Oguejiofor, CF; Udegbunam, OI; Nwajiaku, LSA; Ogbuokiri, C; Egeonu, R
Purpose: To provide the types, frequency and clinical information on common cranial nerve palsies seen at the Eye Clinic at the University of Port Harcourt Teaching Hospital. Materials and Methods: A chart review was performed of patients who presented with cranial nerve palsy at the Eye Clinic over a 3-year period (January 2009-December 2011). Data were collected on age, sex, type of cranial nerve palsy, a history of systemic disease such as diabetes mellitus (DM), hypertension and cerebrovascular disease. Exclusion criteria included medical charts with incomplete data. Data was analyzed using Epi-info Version 6.04D. Statistical significance was indicated by P < 0.05. Results: Twenty-four patients had cranial nerve palsies. There were 11 males and 13 females with a mean age of 34.50 ± 18.41 years. Four patients (26.6%) had exotropia while three patients (20%) had esotropia. Complete ophthalmoplegia was noted in two patients (13.3%). The 3rd and 6th cranial nerves were affected in seven patients each (29.2%) and five patients (20.8%) had 7th cranial nerve palsy. Approximately 38% of patients with cranial nerve palsies had systemic disorders (16.7% systemic hypertension; 12.5% DM). The relationship between cranial nerve palsy and systemic disorder was statistically significant (P < 0.01). Conclusion: This is the first study in the literature on ocular cranial nerve palsies in Southern Nigeria. Third and sixth cranial nerve palsies were the most common cases to present to the University of Port Harcourt Teaching Hospital Eye Clinic. There was a statistically significant association to systemic disorders such as hypertension and DM and majority of cases with 6th cranial nerve palsy.
Pedro-Egbe, Chinyere Nnenne; Fiebai, Bassey; Awoyesuku, Elizabeth Akon
A total of 1,870 nonduplicate clinical Enterobacteriaceae from 13 teaching hospitals located in 11 provinces of mainland China from 2011 to 2012 were screened for the presence of the blaNDM gene. The high-throughput MiSeq sequencing method and comparative genomics were used to analyze the genetic environment of blaNDM among these isolates. Three blaNDM-1-carrying Klebsiella pneumoniae (0.16%, 3/1,870), isolated from a teaching hospital in Xi'an, exhibited high levels of resistance to all ?-lactams, but remained susceptible to amikacin, tigecycline, and polymyxin B. These three isolates, belonging to ST147, presented an identical pulsed-field gel electrophoresis pattern. The IncX3 plasmid, pNDM-SX04 (KC876051) showed 99% identity with plasmid pNDM-HN380 (JX104760). Comparative analysis of the genetic environment of blaNDM-1 with previously published plasmids revealed the same 7,830-bp basic mobile element, which may have been derived from Acinetobacter spp. Partial ISAba125, ISAba125 promoter, blaNDM-1, and bleMBL could serve as the minimal mobile vehicle facilitating horizontal transfer of the blaNDM-1 gene. To our knowledge, this is the first report of an outbreak of blaNDM-1-carrying ST147 K. pneumoniae. Although the prevalence spread by the blaNDM-1 gene prevalence is at a low frequency in mainland China, a dynamic national surveillance of this gene is needed due to its potential transferability. PMID:24199986
Wang, Xiaojuan; Xu, Xiuli; Li, Zongwei; Chen, Hongbin; Wang, Qi; Yang, Peihong; Zhao, Chunjiang; Ni, Ming; Wang, Hui
Background A well-constructed and properly operating influenza surveillance scheme is essential for public health. This study was conducted to evaluate the distribution of respiratory viruses in patients with influenza-like illness (ILI) through the first teaching hospital-based surveillance scheme for ILI in South Korea. Methods Respiratory specimens were obtained from adult patients (?18 years) who visited the emergency department (ED) with ILI from week 40, 2011 to week 22, 2012. Multiplex PCR was performed to detect respiratory viruses: influenza virus, adenovirus, coronavirus, respiratory syncytial virus, rhinovirus, human metapneumovirus, parainfluenza virus, bocavirus, and enterovirus. Results Among 1,983 patients who visited the ED with ILI, 811 (40.9%) were male. The median age of patients was 43 years. Influenza vaccination rate was 21.7% (430/1,983) during the 2011–2012 season. At least one comorbidity was found in 18% of patients. The positive rate of respiratory viruses was 52.1% (1,033/1,983) and the total number of detected viruses was 1,100. Influenza A virus was the dominant agent (677, 61.5%) in all age groups. The prevalence of human metapneumovirus was higher in patients more than 50 years old, while adenovirus was detected only in younger adults. In 58 (5.6%) cases, two or more respiratory viruses were detected. The co-incidence case was identified more frequently in patients with hematologic malignancy or organ transplantation recipients, however it was not related to clinical outcomes. Conclusion This study is valuable as the first extensive laboratory surveillance of the epidemiology of respiratory viruses in ILI patients through a teaching hospital-based influenza surveillance system in South Korea.
Noh, Ji Yun; Song, Joon Young; Cheong, Hee Jin; Choi, Won Suk; Lee, Jacob; Lee, Jin-Soo; Wie, Seong-Heon; Jeong, Hye Won; Kim, Young Keun; Choi, Sung Hyuk; Han, Seung Baik; So, Byung-Hak; Kim, Hyun; Kim, Woo Joo
Background: Tobacco-attributable mortality in India is estimated to be at least 10%. Tobacco cessation is more likely to avert millions of deaths before 2050 than prevention of tobacco use initiation. Objective: To describe the clinico-epidemiological profile of attendees of a tobacco cessation clinic in a teaching hospital in Bangalore city. Materials and Methods: A descriptive study of 189 attendees seen over 2 years in the Tobacco Cessation Clinic of a tertiary-care teaching hospital in Bangalore, with information on socio demographic characteristics, tobacco-use details, nicotine dependence, family/medical history, past quit attempts, baseline stage-of-change, and treatment initiated. Results: Only 5% were ‘walk-in’ patients; 98% of attendees were smokers; 97% were males. The mean (±SD) age of attendees was 48.0 (±14.0) years. Most participants were married (88%), and predominantly urban (69%). About 62% had completed at least 8 years of schooling. Two-thirds of smokers reported high levels of nicotine dependence (Fagerström score >5/10). About 43% of patients had attempted quitting earlier. Four-fifths (79%) of tobacco-users reported a family member using tobacco. Commonly documented comorbidities included: Chronic respiratory disease (44%), hypertension (23%), diabetes (12%), tuberculosis (9%), myocardial infarction (2%), stroke (1%), sexual dysfunction (1%) and cancer (0.5%). About 52% reported concomitant alcohol use. At baseline, patients’ motivational stage was: Precontemplation (14%), contemplation (48%), preparation/action (37%) and maintenance (1%). Treatment modalities started were: Counseling alone (41%), nicotine replacement therapy alone (NRT) (34%), medication alone (13%), and NRT+medication (12%). Conclusions: This is the first study of the baseline profile of patients attending a tobacco cessation clinic located within a chest medicine department in India. Important determinants of outcome have been captured for follow-up and prospective documentation of outcomes.
D'Souza, George; Rekha, Dorothy P.; Sreedaran, Priya; Srinivasan, K.; Mony, Prem K.
We reviewed 80 adult cases of measles seen in a Parisian hospital during the French 2010-2011 outbreak. Fifty per cent had at least one complication: pneumonia and hepatitis were the most frequent. Forty per cent of hospitalized cases did not have any complications, suggesting clinically poor tolerance of measles in adults. The outcome was always favourable. Subjects were younger, were more often French nationals and had a higher socio-economic status than the overall population. This report suggests that immunity resulting from natural disease in patients from an area where the disease is endemic is protective in the long term. PMID:24707854
Caseris, M; Houhou, N; Longuet, P; Rioux, C; Lepeule, R; Choquet, C; Yazdanpanah, Y; Yeni, P; Joly, V
This paper describes how an acute tertiary referral hospital moved away from a "culture of blame", using change management principles aligned with the concept of the learning organisation. I outline the process of change, and describe its outcomes. The result is summarised as an improvement in desired attributes of the organisation's culture, as evidenced by consistent improvement in the results of a proprietary staff survey. I conclude that the concept of the learning organisation is a useful one for hospitals that seek to improve the organisational culture. PMID:16646772
Rowley, Stuart D
Background: The outbreak of severe acute respiratory syndrome (SARS) in Toronto, which began on Mar. 7, 2003, resulted in extraordinary public health and infection control measures. We aimed to describe the psychological and occupational im- pact of this event within a large hospital in the first 4 weeks of the outbreak and the subsequent administrative and mental health response. Methods:
Robert Maunder; Jonathan Hunter; Leslie Vincent; Jocelyn Bennett; Nathalie Peladeau; Molyn Leszcz; Joel Sadavoy; Lieve M. Verhaeghe; Rosalie Steinberg; Tony Mazzulli
Objectives: To analyze the relative frequencies of various epileptic seizures and to study the age at onset of different seizure types in Nepalese children. Design: Prospective study. Setting: Hospital outpatient based in Kathmandu, Nepal, between November 2001 to October 2002. Participants: 50 children diagnosed as epilepsy excluding neonatal and febrile seizures. Main outcome measure: Diagnosis and classification of cases according
Shakya KN; Shrestha R
Antibiotic guidelines have proven to be a simple and effective intervention to guide the choice of appropriate empiric antibiotic regimens. The goals of this study were to evaluate adherence to guidelines and streamlining of antibiotics. Hospital records of hospitalized patients in infectious diseases ward Imam Khomeini Hospital, Tehran, Iran, from May 2008 to September 2009 were reviewed. Adherence to guideline was defined as the use of empiric antibiotic in accordance with the clinical diagnosis and local guideline recommendations. In this study, 528 patients with a confirmed infectious disease diagnosis were considered for analysis. The four most frequent diagnoses were skin and soft tissue infections, tuberculosis, respiratory tract infections, and HIV associated opportunistic infections. The most frequent prescribed antibiotic was ceftriaxone. Overall adherence to guideline was 70.8% and the adherence for the most frequent diagnosis was 68%. Frequency of compatibility with the guidelines for were administrated regimes on the basis of drug selection, dosage form and drug dosing were 86.2%, 97% and 84.7%, respectively. The mean lag time between patients' hospital admission and starting empiric therapy was 1.69 ± 4.9 days. In general, physicians' adherence with guidelines for empiric antibiotic therapy was high in infectious disease ward with a justified delay. Larger studies are required to establish these conclusions. PMID:22267379
Khalili, Hossein; Elyasi, Sepideh; Hatamkhani, Shima; Dashti-Khavidaki, Simin
Background: Cultural barriers including allegiance to traditional models of ward care and fear of criticism may restrict use of a medical emergency team (MET) service, particularly by nursing staff. A 1-year preparation and education programme was undertaken before implementing the MET at the Austin Hospital, Melbourne, Australia. During the 4 years after introduction of the MET, the programme has continued
D Jones; I Baldwin; T McIntyre; D Story; I Mercer; A Miglic; D Goldsmith; R Bellomo
During the period 1981 to 1992, 4,473 fecal specimens collected from children hospitalized with acute gastroenteritis at the Royal Children's Hospital, Melbourne, Australia, were examined by electron microscopy. A monoclonal antibody enzyme immunoassay for enteric adenovirus (EAd) types 40 (Ad40) and 41 (Ad41) was used when adenoviruses were visualized. Fecal samples were positive for adenovirus by both electron microscopy and enzyme immunoassay in 138 patients (3.1%). Ad40 was identified in 19 children (14%), and Ad41 was identified in 119 children (86%). These EAd were identified during each of the 12 years surveyed. EAd were present year-round, but the annual number of hospitalizations was not constant. Yearly prevalence varied from 0.7% (1981) to 6.5% (1985). This was associated with monthly fluctuations in Ad41 activity, with overall peak monthly prevalence in May (late autumn). By contrast, Ad40 numbers remained low and constant year-round. The frequency of Ad41 relative to Ad40 increased from 25% in 1981 to exceed 75% after 1983. Children admitted with EAd infection were more likely to have diarrhea for more than 5 days (P < 0.001) but less likely to be febrile or dehydrated (P < 0.05) than children with rotavirus infection. EAd are responsible for enteric symptoms of only a fraction of hospitalized children with infectious diarrhea but result in a more-protracted illness than rotavirus. Their relationship to persistent diarrhea requires further investigation.
Grimwood, K; Carzino, R; Barnes, G L; Bishop, R F
Handwashing is the most important and least expensive measure for preventing the transmission of hospital-acquired infection. Compliance, however, rarely exceeds 40%, even in intensive care units. The present study evaluated the effectiveness of the authors' infection control programme in relation to handwashing compliance of healthcare workers. Ten nursing students observed 300 uninformed staff members and recorded their handwashing practices throughout
R. Sharir; N. Teitler; I. Lavi; R. Raz
Background: The objective of this study is to describe the bacteriological, clinical and laboratory features of community acquired bacterial meningitis in adults admitted to a Singapore tertiary-care hospital. Methods: Two hundred sixty-nine cases of meningitis or meningoencephalitis admitted between 1993 and 2000 were identified by their discharge diagnosis codes. All case records except for 57 which could not be retrieved
Y C Chan; A Wilder-Smith; B K C Ong; G Kumarasinghe; E Wilder-Smith
The rapid growth in internationalisation of education has led to the point where Australia has become a world leader in transnational education. Simultaneously, the provision of hospitality and tourism management education has developed rapidly from its inception in 1974 with numbers of international students rising steadily. Although robust research into the international student experience has been conducted, the impact of
Background Malaria treatment policy recommends regular monitoring of drug utilization to generate information for ensuring effective use of anti-malarial drugs in Nigeria. This information is currently limited in the retail sector which constitutes a major source of malaria treatment in Nigeria, but are characterized by significant inappropriate use of drugs. This study analyzed the use pattern of anti-malarial drugs in medicine outlets to assess the current state of compliance to policy on the use of artemisinin-based combination therapy (ACT). Methods A prospective cross-sectional survey of randomly selected medicine outlets in Enugu urban, southeast Nigeria, was conducted between May and August 2013, to determine the types, range, prices, and use pattern of anti-malarial drugs dispensed from pharmacies and patent medicine vendors (PMVs). Data were collected and analyzed for anti-malarial drugs dispensed for self-medication to patients, treatment by retail outlets and prescription from hospitals. Results A total of 1,321 anti-malarial drugs prescriptions were analyzed. ACT accounted for 72.7%, while monotherapy was 27.3%. Affordable Medicines Facility-malaria (AMFm) drugs contributed 33.9% (326/961) of ACT. Artemether-lumefantrine (AL), 668 (50.6%) was the most used anti-malarial drug, followed by monotherapy sulphadoxine-pyrimethamine (SP), 248 (18.8%). Median cost of ACT at $2.91 ($0.65-7.42) per dose, is about three times the median cost of monotherapy, $0.97 ($0.19-13.55). Total cost of medication (including co-medications) with ACT averaged $3.64 (95% CI; $3.53-3.75) per prescription, about twice the mean cost of treatment with monotherapy, $1.83 (95% CI; $1.57-2.1). Highest proportion 46.5% (614), of the anti-malarial drugs was dispensed to patients for self-treatment. Treatment by retail outlets accounted for 35.8% while 17.7% of the drugs were dispensed from hospital prescriptions. Self-medication, 82%, accounted for the highest source of monotherapy and a majority of prescriptions, 85.6%, was adults. Conclusion Findings suggest vastly improved use of ACT in the retail sector after eight years of policy change, with significant contributions from AMFm drugs. However the use of monotherapy, particularly through self-medication remains significant with increasing risk of undermining treatment policy, suggesting additional measures to directly target consumers and providers in the sector for improved use of anti-malarial drugs in Nigeria.
This retrospective study reviews the medical records of 301 reptiles with dermatological lesions that were examined at the Veterinary Medical Teaching Hospital, University of California at Davis (VMTH-UCD) and the Unité de Dermatologie-Parasitologie-Mycologie, Ecole Nationale Vétérinaire de Nantes (UDPM-ENVN) from 1 January 1992 to 1 July 2008. The most common reptile groups differed between the two hospitals, with lizards being the most common at the VMTH-UCD and chelonians at the UDPM-ENVN. At the VMTH-UCD, boa constrictors (Boa constrictor), ball pythons (Python regius) and other Python species were over-represented, and box turtles (Terrapene carolina) were under-represented in the dermatological lesion caseload. When institutional data were combined, 47% of all reptiles at both institutions with confirmed or suspected cases of sepsis had petechiae, with the highest association seen in chelonians at 82%. Dependent on institution and reptile group, from 29% to 64% of the cases had underlying husbandry issues. Sixty-two per cent of all cases were alive at final status. Veterinarians treating reptiles with skin disease should be aware of the following: (i) that boa constrictors and Python species may be predisposed to dermatological lesions; (ii) that client education is important for proper husbandry; and (iii) that there is a possible association between petechiae and sepsis, especially in chelonians. The conjectural association between certain skin lesions and sepsis remains to be confirmed by systematically derived data that demonstrate a causal relationship between the two. PMID:20887405
White, Stephen D; Bourdeau, Patrick; Bruet, Vincent; Kass, Philip H; Tell, Lisa; Hawkins, Michelle G
Introduction: The Laundry Department plays an important role in preventing the spread of infection and continuously supplying clean linen to various departments in any hospital. Objectives of the Study: To identify existing practices and occupational safety and health (OSH) measures in the Laundry Department and to assess the use of personal protective equipments (PPEs) among health care workers. Materials and Methods: A cross-sectional study was carried out in a private tertiary care teaching hospital. An observation checklist was developed, which was partially based on occupational hazard checklist of OSHA for Laundry Department. This was field tested and validated for applicability for this study. Results: The potential biological hazards are infections through exposure to aerosols, spills and splashes during various activities, fungal infection due to wet clothes and environment and infections through fomites. The potential physical hazards are injuries due to slips and falls, exposure to heat, humidity, dust, noise, and vibration. The potential chemical hazards are contact dermatitis and allergic asthma due to exposure to detergents, phenyl solution, bleaching powder, and soap oil solution. The potential ergonomic hazards are musculoskeletal diseases and repetitive stress injuries at the shoulder, elbow, and small joints of the hands. PPEs were not used consistently in most areas of the department.
Kumar, M. Shashi; Goud, B. Ramakrishna; Joseph, Bobby
This study estimated the incidence of viral hepatitis in children treated for cancer, to identify variables that could affect this incidence and to assess the role of hepatitis B virus (HBV) vaccination in preventing infection. Between September 2007 and June 2008, 256 children in the haemato-oncology unit at the Children's Welfare Teaching Hospital, Baghdad, were studied prospectively. Demographic and clinical data and vaccination history were recorded. Patients were tested for HBV at the time of diagnosis (all were negative) and after starting chemotherapy. On admission to the unit, 231 patients (90.2%) were revaccinated. At reassessment after treatment for cancer, HBV infection was found in 70 patients (27.3%). The variables that significantly increased the risk for HBV infection were a diagnosis of leukaemia and receiving more than 3 units of blood. A higher number of HBV vaccinations in hospital reduced the risk for HBV infection. The high rate of acquisition of HBV infection found in this study indicates the need for better screening of blood products and adherence to aseptic techniques in management of this group of patients. PMID:23516822
Al-Jadiry, M F; Al-Khafagi, M; Al-Darraji, A F; Al-Saeed, R M; Al-Badri, S F; Al-Hadad, S A
Background Gastrointestinal and urinary tract pathogenic infections are aggravating the incidence and progression of the Human Immunodeficiency Virus (HIV) infection into Acquired Immune Deficiency Syndrome (AIDS) more especially in the developing countries. This study was conducted to assess the common gastrointestinal and urinary infections among HIV/AIDS patients at the Komfo Anokye Teaching Hospital (KATH) in Ghana between April and December 2008. Findings This work reports on gastrointestinal and urinary tract pathogenic infections among 500 HIV seropositive and 300 HIV seronegative patients. There was a 35% (175/500) prevalence of intestinal parasites among HIV seropositive patients compared to 4.3% (13/300) in HIV seronegative patients. Giardia lamblia and Cryptosporidium accounted for 19% (95/500) and 14% (70/500) respectively, while Schistosoma mansoni, Strongyloides stercoralis and hookworm together accounted for 2% (10/500) of intestinal parasitic infections among the HIV seropositive patients. There was no significant difference (p?>?0.05) in urinary parasitic infection between HIV seropositive 1% (2/500) and seronegative patients 0.7% (2/300). Most, 60 (86%) out of 70, of the urinary tract infection among the HIV seropositive patients was due to bacteria with E. coli being the most predominant isolate, 28 (47%) out of 60. There was no significant difference in infections based on age and gender. Conclusion G. lamblia and Cryptosporidium were the most common gastrointestinal parasites detected while bacteria accounted for majority of the urinary tract infections among the HIV seropositive patients at the hospital.
Background and Introduction: Depression is a prevalent mental disorder and the 4th leading cause of disability in the world as per the World Health Organization (WHO). The adverse Drug Reactions (ADRs) to antidepressants are common and they can lead to a non compliance or even a discontinuation of the therapy. This study entitled us to monitor the ADR profile of the antidepressants in a tertiary care teaching hospital. Patients and Methods: A longitudinal, observational study was conducted in the Outpatients Department of Psychiatry in S.C.B. Medical College and Hospital l in collaboration with the I.M.S and SUM Hospital. A total of 160 cases were studied for ADRs by using a predesigned CDSCO form. The patients who were on TCAs, SSRIs and newer antidepressants (SNRIs/NDRIs) were assessed by doing physical examinations, neurological examinations and relevant lab tests. The causalities were assessed by the criteria of the WHO-UMC. The analysis of ADRs was done by using the Chi square test. Results: Among the 160 patients who took antidepressants, 26.87% reported ADRs, with at least one possible causality.None were labeled as certain, as a rechallenge was not performed.ADRs were mostly observed in polytherapy (14.37%) and with antidepressants like TCAs (58.84%). Conclusions: Agitation, anxiety and insomnia were the common ADRs which were associated with the use of antidepressants. This study offers a representative profile of the ADRs which can be expected in the Psychiatry Outpatients Department and due care must be taken to avoid these ADRs.
Mishra, Swati; Swain, Trupti Rekha; Mohanty, Manjushree
Objective: The objective of the following study is to determine the incidence of retinal vein occlusion (RVO) and identify the risk factors in RVO in patients presenting to a tertiary hospital in Rivers State. Materials and Methods: The medical records of consecutive patients with RVO who presented to the retina clinic of the eye Department of University of Port Harcourt Teaching Hospital over a 5 year period were retrieved. Information extracted from the data included the demographic data of patients, presenting visual acuity, history of systemic and ocular disease, blood pressure and intraocular pressure. Data was analyzed using the Statistical Package for Social Sciences 20.0. (IBM Corporation and its licensors 1989,2011). Results: Out of the 364 patients seen at the retina clinic during this period, 27 (7.4%) had RVO. Seven patients had bilateral disease. The incidence of RVO in the retinal clinic was 7.4%. Systemic hypertension, diabetes mellitus, hyperlipidemia and glaucoma were the main risk factors recorded in our patients. Central retinal vein occlusion (CRVO) 20 (74%) was more predominant than branch retinal vein occlusion (BRVO) 7 (26%). 21 eyes of patients with CRVO had visual acuities of < 3/60, while 7 eyes of patients with BRVO had visual acuities less than 3/60. Vitreous hemorrhage 10 (52.6%) was the most common complication encountered. All cases of non-perfused vein occlusion 4 (14.8%) were seen in patients who had CRVO. Conclusion: The incidence of RVO in our hospital is high. RVO is a significant cause of visual impairment, with CRVO being more common. Identifying associated risk factors and treating these could help reduce the incidence of RVO. PMID:24909470
Fiebai, B; Ejimadu, C S; Komolafe, R D
Background Since October 2002 in the UK Primary Care Trusts (PCTs) have had statutory responsibility for having and maintaining a Major Incident plan and since 2005 they have been obliged to co-operate with other responders to an incident. We aimed to establish the number of beds in our Trust which could be freed up over set periods of time in the event of a major incident and the nature and quantity of support which might be required from PCTs in order to achieve this. Methods Repeated survey over 12 days in 3 months of hospital bed occupancy by type of condition and discharge capacity in an 855-bed UK tertiary teaching hospital also providing secondary care services. Outcome measures were bed spaces which could be generated, timescale over which this could happen and level and type of PCT support which would be required to achieve this. Results Mean beds available were 78 immediately, a further 69 in 1–4 hours and a further 155 in 4–12 hours, generating a total of 302 beds (36% of hospital capacity) within 12 hours of an incident. This would require support from a PCT of 150,000 population of 10 nursing care beds, 20 therapy-supported intermediate care beds, and 25 care packages in patients' own homes. Conclusion In order to fulfill the requirements of the Civil Contingencies Act 2004, PCTs should plan to have surge capacity in the order of 30 residential placements and 25 community support packages per 150,000 population to support Acute Trusts in the event of a major incident.
Challen, Kirsty; Walter, Darren
A one year prospective study was carried out to compare clinical diagnosis antemortem with autopsy diagnosis post-mortem in all patients coming to autopsy. In the study period a total of 612 deaths occurred in the hospital out of which 179 came to autopsy representing an autopsy ratio of 29%. Of the 179 cases, 100 (56%) were cases referred to the coroner. A total of 143 cases were analyzed and the concordance rate between clinical and autopsy diagnosis was found to be 54%. We find the autopsy ratio abysmally low and recommend that all effort be made to increase it to 75% and that autopsy audit be officially adopted as a means of quality control in hospitals. We also believe that all concerned should work towards improving our clinical diagnostic ability in order to attain and maintain a concordance rate well above 90%. PMID:9814096
Diegbe, I T; Idaewor, P E; Igbokwe, U O
Abstract Concurrent to reports of zoonotic and nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in veterinary settings, recent evidence indicates that the environment in veterinary hospitals may be a potential source of MRSA. The present report is a cross-sectional study to determine the prevalence of MRSA on specific human and animal contact surfaces at a large veterinary hospital during a nonoutbreak period. A total of 156 samples were collected using Swiffers® or premoistened swabs from the small animal, equine, and food animal sections. MRSA was isolated and identified by pre-enrichment culture and standard microbiology procedures, including growth on Mueller-Hinton agar supplemented with NaCl and oxacillin, and by detection of the mecA gene. Staphylococcal chromosome cassette mec (SCCmec) typing and pulsed-field gel electrophoresis profile were also determined. MRSA was detected in 12% (19/157) of the hospital environments sampled. The prevalence of MRSA in the small animal, equine, and food animal areas were 16%, 4%, and 0%, respectively. Sixteen of the MRSA isolates from the small animal section were classified as USA100, SCCmec type II, two of which had pulsed-field gel electrophoresis pattern that does not conform to any known type. The one isolate obtained from the equine section was classified as USA500, SCCmec type IV. The molecular epidemiological analysis revealed a very diverse population of MRSA isolates circulating in the hospital; however, in some instances, multiple locations/surfaces, not directly associated, had the same MRSA clone. No significant difference was observed between animal and human contact surfaces in regard to prevalence and type of isolates. Surfaces touched by multiple people (doors) and patients (carts) were frequently contaminated with MRSA. The results from this study indicate that MRSA is present in the environment even during nonoutbreak periods. This study also identified specific surfaces in a veterinary environment that need to be targeted when designing and executing infection control programs.
Johnson, Amanda; Nava-Hoet, Rocio C.; Bateman, Shane; Hillier, Andrew; Dyce, John; Gebreyes, Wondwossen A.; Wittum, Thomas E.
University Hospital "L. Sacco" had started in 2006 a two-year project in order to set up a "Health and Safety Management System (HSMS)" referring to the technical guideline OHSAS 18001:1999 and the UNI and INAIL "Guidelines for a health and safety management system at workplace". So far, the following operations had been implemented: Setting up of a specific Commission within the Risk Management Committee; Identification and appointment of Departmental Representatives of HSMS; Carrying out of a training course addressed to Workers Representatives for Safety and Departmental Representatives of HSMS; Development of an Integrated Informative System for Prevention and Safety; Auditors qualification; Inspection of the Occupational Health Unit and the Prevention and Safety Service: reporting of critical situations and monitoring solutions adopted. Short term objectives are: Self-evaluation through check-lists of each department; Sharing of the Improvement Plan among the departments of the hospital; Planning of Health and Safety training activities in the framework of the Hospital Training Plan; Safety audit. PMID:18409761
Mariani, F; Bravi, C; Dolcetti, L; Moretto, A; Palermo, A; Ronchin, M; Tonelli, F; Carrer, P
Context As a patient safety measure, laboratories are required to have a critical values policy by regulatory agencies. Unfortunately, little information is available on repeat critical values for the same analyte(s) on the same patient. Objective To investigate the occurrence and distribution of repeat critical values and the relationship between the frequency of such values and patient outcome to provide information for hospitals on improving reporting policies. Methods Eleven laboratory critical value lists, including chemistry and hematology analytes, were selected from a tertiary hospital in China in the year 2010. The distribution and interval time for each repeat critical value were calculated. Serum potassium and platelet count were used as examples to illustrate the relationship between the frequency of the repeat critical values and patient outcome. Results All test items on the critical value list were prone to the occurrence of repeat critical values. On average, each patient who experienced critical values had 2.10 occurrences. The median interval time for each repeat critical value varied, with most being longer than 8 hours. For those patients who had repeat critical values of serum potassium and platelet count, along with the increased frequency, the patients had a longer hospital stay and a generally worse outcome. Conclusions Patient can have a number of repeat critical values and the frequency of these values is closely related to patient outcome. A careful evaluation is warranted if a laboratory chooses to adopt a policy of not reporting each repeat critical value.
Yang, Dagan; Zhou, Yunxian; Yang, Chunwei
Background Pharmacist interventions are one of the pivotal parts of a clinical pharmacy service within a hospital. This study estimates the cost avoidance generated by pharmacist interventions due to the prevention of adverse drug events (ADE). The types of interventions identified are also analysed. Methods Interventions recorded by a team of hospital pharmacists over a one year time period were included in the study. Interventions were assigned a rating score, determined by the probability that an ADE would have occurred in the absence of an intervention. These scores were then used to calculate cost avoidance. Net cost benefit and cost benefit ratio were the primary outcomes. Categories of interventions were also analysed. Results A total cost avoidance of €708,221 was generated. Input costs were calculated at €81,942. This resulted in a net cost benefit of €626,279 and a cost benefit ratio of 8.64: 1. The most common type of intervention was the identification of medication omissions, followed by dosage adjustments and requests to review therapies. Conclusion This study provides further evidence that pharmacist interventions provide substantial cost avoidance to the healthcare payer. There is a serious issue of patient’s regular medication being omitted on transfer to an inpatient setting in Irish hospitals.
The goal of this study was to assess the overtreatment of asymptomatic bacteriuria (ASB) in hospitalized patients, calculate the total costs of inappropriate treatment, and determine if a multi-faceted educational intervention was effective in reducing the overtreatment of ASB in a resource-limited community hospital. The study encompassed three phases: a retrospective pre-intervention assessment of the baseline cost and treatment of ASB, the implementation of a multi-faceted educational intervention, and a prospective post-intervention assessment of the efficacy of the intervention. A positive urine culture was defined by bacterial counts ?105 cfu/mL. In the pre-intervention group, 64 (83%) of 109 patients were asymptomatic: 30 (47%) were treated. In the post-intervention group, 13 (17%) of 55 patients were asymptomatic: 2 (15%) were treated, (p=0.04). Fewer urine cultures were collected during the post-intervention period than the pre-intervention period (3,127 and 3,419, respectively) (p<0.001). The total cost of inappropriately treating ASB in the pre-intervention group was $1200 compared to $600 in the post-intervention group. The results demonstrated a significant decrease in the inappropriate treatment of ASB and the associated costs.
Chowdhury, Farhana; Sarkar, Kumkum; Branche, Angela; Kim, Juliette; Dwek, Philip; Nangit, Angelica; Tompkins, David; Visconti, Ernest
Banked blood is a limited resource in Nigeria. We sought to evaluate factors that may further limit the effective utilisation of donor blood in a tertiary hospital in Benin City. The records of the blood transfusion unit of the hospital were studied to identify the methods of blood procurement and utilisation from January 1, 2000 to December 31, 2002. A total of 11,021 units of blood were received in the blood transfusion unit within this period out of which 1491 (13.5%) donor blood samples were found unfit for transfusion and, hence, discarded. Commercial blood donation accounted for 95.3%, compared to 4.7% from replacement and volunteer donors. Commercial blood donation was a major risk factor for likely disposal of donor blood (chi2 = 74.3, p < 0.0001, OR = 21.1. 95% CI = 7.8-56.7). Expired units of blood with low PCV were discarded for lack of infrastructure to fractionate and store them. Over 0.8million naira (US$6000.00) is wasted annually on discarded units of donor blood mainly from commercial donors. A policy on blood procurement to include subgroup selection of donors and improved funding of blood banking services may enhance efficient and effective utilisation of donor blood. PMID:15623119
Enosolease, M E; Imarengiaye, C O; Awodu, O A
Background: The management of Diabetes Mellitus and its important complication Diabetic Ketoacidosis is very crucial in today’s world where the prevalence of Diabetes is very high. Medical students are the pillars of our future healthcare system and it is important to evaluate and update their knowledge and awareness regarding these both conditions. Materials and Methods: This study was a cross-sectional; Questionnaire based observational study conducted in a tertiary care hospital. The respondents were final year MBBS students of that college. Study instrument was a self developed, pre-validated, semi-structured questionnaire. Results: A total of 73 questionnaires were considered for analysis, giving a response rate of 90.12% with 43.83% and 56.16% were male and female respondents respectively. About 81.25% and 90.24% of male and female respondents gave correct answer to question related to the best indicator of glycemic control. Lack of knowledge was seen regarding the world Diabetes day. Approximately 37% of the respondent’s parents were diabetic. Only 12 out of 73 respondents were aware about the factors leading to DKA.8 out of 73 were aware about investigations to be done in DKA. Around 43.84% of responders knew regarding the proper screening duration in person with risk of diabetes. Conclusion: From the study it was concluded that most of the students have basic knowledge regarding diabetes mellitus, its clinical features and management etc but only 50 % of the respondent were aware about DKA and further teaching and post teaching evaluation are needed in future direction.
Thangaraju, Pugazhenthan; Kumar, Suresh; Aravindan, U; Balasubramanian, Hariharan; Selvan, Tamil
The maternal mortality ratio and other maternal health indicators are worse for developing countries than for the developed world due to improved access to quality care during pregnancy and especially at delivery in the industrialized world. This study was carried out to identify the factors which influenced choice of place of delivery by pregnant women in Enugu, southeastern Nigeria, and to recommend ways to improve women's access to skilled attendants at delivery. A pre-tested questionnaire was administered by interviewers to women who had delivered within 3 months prior to date of data collection. The response rate was 75.5% (n=1098). Of the respondents, 52.9% delivered outside health institutions and 47.1% in health institutions. The major factors influencing choice of place of delivery included promptness of care, competence of midwife/doctor, affordability, health education, 24 h presence of doctors, team work among doctors and presence of specialist obstetricians. There were statistically significant associations between choice of institutional or non-institutional deliveries and socio-demographic/economic factors such as place of residence (urban/rural), religion, educational status, tribe, marital status, occupational level, husband's occupational and educational levels, age and parity (p<0.05). We conclude that factors which will positively influence women to deliver in health institutions in Enugu, Nigeria include a variety of interacting social, economic and health system factors, which operate at various levels-the household, community, the health institutions and the larger social and political environment. Attention to these factors will not only improve maternity utilization but, hopefully, also will reduce the high maternal mortality and improve other maternal health indicators in the study area. PMID:16766107
Onah, Hyacinth Eze; Ikeako, Lawrence C; Iloabachie, Gabriel C
To identify key socio-demographic and knowledge factors associated with compliance with recommended use of commodities for preventing malaria in pregnancy (MIP) in Enugu State, Nigeria. Cross-sectional study of 720 women who delivered within 6 months preceding the survey in three local government areas in Enugu State was conducted using a structured questionnaire. About half (51.6 %) of the women used IPTp1 while 25.9 % took IPTp2 as recommended during their most recent pregnancy. Forty-one percent of the women slept under insecticide treat nets (ITN) during the most recent pregnancy but only 15.4 % did so as recommended every night. Socio-demographic and knowledge factors associated with compliance were identified. Compliance with intermittent presumptive treatment in pregnancy (IPTp) recommendation was more common among those in the rural setting (26.9 %) compared to the peri-urban (20.3 %) and urban (17.3 %) (P = 0.032). Those with good knowledge of the causes, effects and prevention of malaria during pregnancy complied more (23.7 %) than those with poor knowledge (17.0 %) (P = 0.020). With respect to sleeping under ITN, more of those with post secondary education, good knowledge of MIP and currently living with a partner used ITN every night during the last pregnancy. Knowledge about the MIP issues and having a partner influence compliance with relevant preventives. Efforts to increase compliance with recommended practices to prevent MIP should focus on providing health education to pregnant women and their partners, who reinforce what the women are told during antenatal care. More qualitative studies need to be conducted on this subject. PMID:24043556
Onyeneho, Nkechi G; Idemili-Aronu, Ngozi; Okoye, Ijeoma; Ugwu, Chidi; Iremeka, Felicia U
WHO reports estimate poisoning as one of the most common causes of increased morbidity and mortality rate world-wide. Various agents such as pesticides, drugs have been used for intentional and accidental poisoning in different countries. In the Indian scenario, pesticides are the most commonly used poisoning agents. To assess the prevalence and mortality incidence rate due to various poisoning agents a retrospective and prospective study conducted over a period of nine months in a tertiary care teaching hospital. Retrospective data of poisoning cases was collected from the medical records section and the prospective data of poisoning cases was collected from the emergency and causality departments. A total of 1045 poisoning related admissions were identified during the period January 2005 to September 2008. Among them, 68.40% of cases were due to intentional poisoning and 31.60% were due to accidental poisoning. Of the poisoning related admissions, 84.4% of patients recovered, whereas in 7.6% of cases condition did not improve. Mortality rate was observed 4%. Intentional poisoning was observed more in male population (60.2%) in the age group of 18-29 years. Accidental poisoning was seen more in children in the age group of 1-3 years. Incidence of overall poisoning cases were high due to pesticides (39.5%) followed by medicines (26.1%), household products (22.1%), environmental poisoning (12.1%) and heavy metals (0.2%). It was observed that availability of centralised poison information centre and treatment protocols will improvise poison management practices in tertiary care hospitals by the clinicians.
Jesslin, J.; Adepu, R.; Churi, S.
Objective: The purpose of this study is to analyze the antibiotic sensitivity pattern of microorganisms, to study the antibiotic usage pattern, and to conduct a cost-effectiveness analysis (CEA) for the antibiotics prescribed in a tertiary care teaching hospital in south India. Methods: This prospective study was carried out in the General Medicine and Pulmonology departments of the hospital for a period of 6 months. The study was carried out in three phases: A prospective analysis to check the sensitivity pattern of microorganisms to various antibiotics, data extraction and determining the cost of antibiotics and finally evaluation of the sensitivity pattern of microorganisms and the antibiotic usage. A total of 796 documented records were analyzed. Findings: It was found that Escherichia coli was the major organism identified in 36.4% of the isolated specimens, followed by Klebsiella sp. (18.9%), Streptococcus pneumoniae (15.8%), Staphylococcus aureus (12.4%), and Pseudomonas (9.3%). The sensitivity pattern data of the prospective study revealed that E. coli was highly sensitive to Amikacin (99.3%), Klebsiella to Amikacin (93.8%), Pseudomonas to Meropenem (97.6%), and S. pneumoniae to Ofloxacin (93.8%). In the prescribing pattern study, it was found that the most common disease (21.2%) was found to be lower respiratory tract infection in 51 patients. Cephalosporins (73%), in particular Ceftriaxone (63.5%) was highly prescribed, followed by fluoroquinolones (53.9%). In the CEA, it was revealed that Ceftriaxone was the cost-effective antibiotic with a cost-effectiveness ratio (CER) of 78.27 compared to Levofloxacin, which had a CER of 95.13. Conclusion: Continuous surveillance of susceptibility testing is necessary for cost-effective customization of empiric antibiotic therapy. Furthermore, reliable statistics on antibiotic resistance and policies should be made available.
Sriram, Shamungum; Aiswaria, Varghese; Cijo, Annie Eapen; Mohankumar, Thekkinkattil
This study was aimed at identifying the Technical Safety Index (ITS, in the Portuguese acronym) of the nursing team of the University of São Paulo's Hospital Universitário's Pediatrics Unit (2001-2005). Percentages for each type of absence of nursing professionals were obtained from the Nursing Department or calculated based on the equations found in the literature. Absences due to days off were the highest percentage. Total percentages of unplanned absences were lower than those referring to planned absences, which contradict nurses who report this type of absence as the main cause for health institutions understaffing. IST variation highlights the importance of carrying out systematic evaluations of the nursing team's absences, as well as of identifying specific indexes for each unit, as subsidies for the evaluation of the personnel in health organizations. PMID:18193625
Rogenski, Karin Emilia; Fugulin, Fernanda Maria Togeiro
There is an extreme paucity of studies examining cost of burn care in the developing world when over 85% of burns take place in low and middle income countries. Modern burn care is perceived as an expensive, resource intensive endeavour, requiring specialized equipment, personnel and facilities to provide optimum care. If 'burn burden' of low and middle income countries (LMICs) is to be tackled deftly then besides prevention and education we need to have burn centres where 'reasonable' burn care can be delivered in face of resource constraints. This manuscript calculates the cost of providing inpatient burn management at a large, high volume, tertiary burn care facility of North India by estimating all cost drivers. In this one year study (1st February to 31st January 2012), in a 50 bedded burn unit, demographic parameters like age, gender, burn aetiology, % TBSA burns, duration of hospital stay and mortality were recorded for all patients. Cost drivers included in estimation were all medications and consumables, dressing material, investigations, blood products, dietary costs, and salaries of all personnel. Capital costs, utility costs and maintenance expenditure were excluded. The burn unit is constrained to provide conservative management, by and large, and is serviced by a large team of doctors and nurses. Entire treatment cost is borne by the hospital for all patients. 797 patients (208 <12 years old) with acute burn were admitted with a mean age of 23.04 years (range 18 days to 83 years). The mean BSA burn was 42.26% (ranging from 2% to 100%). 378/797 patients (47.43%) sustained up to 30% BSA burns, 216 patients (27.1%) had between 31 and 60% BSA and 203 patients (25.47%) had >60% BSA burns. 258/797 patients died (32.37%). Of these deaths 16, 68 and 174 patients were from 0 to 30%, 31 to 60% and >60% BSA groups, respectively. The mean length of hospitalization for all admissions was 7.86 days (ranging from 1 to 62 days) and for survivors it was 8.9 days. There were 299 operations carried out in the dedicated burns theatre. The total expenditure for the study period was Indian Rupees (Rs) 46,488,067 or US$ 845,237. At 1 US$=Rs 55 it makes the cost per patient to be US$ 1060.5. Almost 70% of cost of burn management resulted from salaries, followed by investigations (11.56%) and dressings (8.24%). The mean cost of investigations per patient was Rs 6742.46 (US$ 122.59). Only 147/797 patients received 322 units of blood. Thus, the average cost of blood transfusion for all admissions was Rs 521.17 (US$ 9.47). Our study is evidence to direct costs of providing burn care in a tertiary centre of a low income country, and the large number of patients in our study while averaging the costs also validates the estimates. The 'reasonability' of care being delivered is defined by adequate resuscitation, daily topical dressings, appropriate surgery (escharotomy, debridement, and skin grafting), adequate nutrition and physical therapy. The 'reasonability' of outcomes can be measured by mortality figures. The bottom line of management is strict observation by burn staff. The low mean hospital stay also reflects our admission and discharge policy which is to benefit the maximum number of patients who require resuscitative/intensive care, and who have extensive and deep wounds, or injury of critical nature. We conclude that providing burn care based on our model can be emulated in other LICs as the costing is driven by 'necessity of expense' rather than 'ability to spend'. PMID:23523069
Ahuja, Rajeev B; Goswami, Prasenjit
OBJECTIVES--(1) To introduce a partial shift system to reduce the hours of work of preregistration house surgeons to an average of 64 a week to comply with the New Deal for junior doctors; (2) to test linking the partial shift concept to an existing structure of "on call" firms. DESIGN--Formal assessment after three months of a pilot partial shift system for eight house surgeons on three firms instituted on 1 November 1991, followed by questionnaire and interview evaluation at three and six months of a revised system implemented on 1 February 1992. SETTING--Department of general surgery at St Bartholomew's Hospital, London. SUBJECTS--24 house surgeons attached to three surgical firms. RESULTS--In eight weeks each house surgeon worked one week (five shifts) of night duty, one week of "cover" (afternoon and evening) duty, and six weeks of normal daytime hours. Each weekday a house surgeon from the firm on call worked an extended daytime on call shift until 10 pm. Weekend duties were split between two house surgeons from the firm on call. A computer generated graphical display of the rota was used to facilitate leave planning. Average working hours were reduced to below 64 per week, including prospective cover, without detriment to patient care and educational standards. Within the shift system individual house surgeons could be on call with their own firm by day and at weekends. Opinions were equally divided among junior staff as to their preference for either on call or partial shift systems. CONCLUSIONS--The principles of this partial shift system are generally applicable and the model can readily be adopted by district general hospitals.
Vassallo, D. J.; Chana, J.; Clark, C. L.; Smith, R. E.; Wood, R. F.
Our retrospective study presents and evaluates clinical ethics consultations (CECs) in pediatrics as a structure for implementing hospital-wide ethics. We performed a descriptive and statistical analysis of clinical ethics decision making and its implementation in pediatric CECs at Zurich University Children's Hospital. Ninety-five CECs were held over 5 years for 80 patients. The care team reached a consensus treatment recommendation after one session in 75 consultations (89 %) and on 82 of 84 ethical issues (98 %) after two or more sessions (11 repeats). Fifty-seven CECs recommended limited treatment and 23 maximal treatment. Team recommendations were agreed outright by parents and/or patient in 59 of 73 consultations (81 %). Initial dissensus yielded to explanatory discussion or repeat CEC in seven consultations (10 %). In a further seven families (10 %), no solution was found within the CEC framework: five (7 %) required involvement of the child protection service, and in two families, the parents took their child elsewhere. Eventual team-parent/patient consensus was reached in 66 of 73 families (90 %) with documented parental/patient decisions (missing data, n?=?11). Patient preference was assessable in ten CECs. Patient autonomy was part of the ethical dilemma in only three CECs. The Zurich clinical ethics structure produced a 98 % intra-team consensus rate in 95 CECs and reduced initial team-parent dissensus from 21 to 10 %. Success depends closely on a standardized CEC protocol and an underlying institutional clinical ethics framework embodying a comprehensive set of transparently articulated values and opinions, with regular evaluation of decisions and their consequences for care teams and families. PMID:24323344
Streuli, Jürg C; Staubli, Georg; Pfändler-Poletti, Marlis; Baumann-Hölzle, Ruth; Ersch, Jörg
Aim. To perform a thorough and step-by-step assessment of operating room (OR) time utilization, with a view to assess the efficacy of our practice and to identify areas of further improvement. Materials and Methods. We retrospectively analyzed the most ordinary general surgery procedures, in terms of five intervals of OR time utilization: anaesthesia induction, surgery preparation, duration of operation, recovery from anaesthesia, and transfer to postanaesthesia care unit (PACU) or intensive care unit (ICU). According to their surgical impact, the procedures were defined as minor, moderate, and major. Results. A total of 548 operations were analyzed. The mean (SD) time in minutes for anaesthesia induction was 19 (9), for surgery preparation 13 (8), for surgery 115 (64), for recovery from anaesthesia 12 (8), and for transfer to PACU/ICU 12 (9). The time spent in each step presented an ascending escalation pattern proportional to the surgical impact (P = 0.000), which was less pronounced in the transfer to PACU/ICU (P = 0.006). Conclusions. Albeit, our study was conducted in a teaching hospital, the recorded time estimates ranged within acceptable limits. Efficient OR time usage and outliers elimination could be accomplished by a better organized transfer personnel service, greater availability of anaesthesia providers, and interdisciplinary collaboration.
Stavrou, George; Tsouskas, John; Tsaousi, Georgia; Kotzampassi, Katerina
Background. Anaemia with an estimated prevalence of 35–75% among pregnant women is a major cause of maternal deaths in Nigeria. Objective. To determine the prevalence of anaemia, associated sociodemographic factors and red cell morphological pattern among pregnant women during booking at the University Teaching Hospital, Uyo. Material and Methods. A cross-sectional analytical study of 400 women at the booking clinic over a 16-week period. The packed cell volume and red cell morphology of each pregnant woman were determined. Their biodata, obstetric and medical histories, and results of other routine investigations were obtained with questionnaires and analyzed with SPSS Package version 17.0. Results. The mean packed cell volume was 31.8% ±3.2 and 54.5% of the women were anaemic. The commonest blood picture was microcytic hypochromia and normocytic hypochromia suggesting iron deficiency anaemia. Anaemia was significantly and independently related to a history of fever in the index pregnancy (OR = 0.4; P = 0.00; 95% CI = 0.3–0.7), HIV positive status (OR = 0.2; P = 0.01; 95% CI = 0.1–0.6), and low social class (OR = 0.3; P = 0.00; 95% CI = 0.2–0.7). Conclusion. Women need to be economically empowered and every pregnant woman should be encouraged to obtain antenatal care, where haematinics supplementation can be given and appropriate investigations and treatment of causes of fever and management of HIV can be instituted.
Olatunbosun, Olujimi A.; Abasiattai, Aniekan M.; Bassey, Emem A.; James, Robert S.; Morgan, Anyiekere
Objectives: The paper describes and evaluates the success of a zero-based collection development approach to print serials in a community teaching hospital. Methods: The authors first assessed the environmental factors that would determine future needs of the medical library and its customers. Liaisons to various departments and constituencies were substantially involved in the data-gathering phase. Using newly defined collection parameters, a list of journals to consider was compiled and each journal was categorized justifying its inclusion. Any title not having a strong fit in at least one category was eliminated from further consideration. Results: Overall, 21 subscriptions were cancelled and 34 were added. Despite a 15% increase in total subscription costs, mostly due to normal annual journal price increases, the average cost per journal went down from $344 to $327. Journal usage went up over 30%, interlibrary loan lending went down 25%, and borrowing went up 20%. Conclusion: As resources available to libraries decline, it becomes critical that collections and services are continually and systematically reviewed with a view to keeping them aligned with the mission of the organization, needs of the customers, and emerging trends. Zero-based collection development can be a valuable tool in bringing a print journal collection into closer alignment with the needs of library customers.
Thompson, Lora L.; Toedter, Lori J.; D'Agostino, Frank J.
Background: Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our environment. However, its benefit in women aged 40 years and above remains debatable. Materials and Methods: An 11-year prospective study was conducted involving 98 women, aged 40 years and above, who had abdominal myomectomy for the treatment of uterine fibroid at the University of Maiduguri Teaching Hospital, Maiduguri. They were followed up regularly for 1–6 years to detect conception, resolution of symptoms and obstetrics performance. Data were analyzed using SPSS version 13. Results: The mean age of the patients was 42.6±2.9 years and 77 (78.6%) of them were nulliparous. Lower abdominal swelling was the commonest clinical presentation and the mean uterine size was 18.6±8.5 weeks. Infertility with uterine fibroids was the indication for myomectomy in majority of the cases [48 (48.9%)], while pregnancy complications accounted for 11.2% (11) of the cases Fertility restoration was 10.4% among the infertile patients. There was complete resolution of symptoms in 35.9% of those who required symptomatic relief, and term pregnancies were recorded in 72.7% of patients with pregnancy complications. Conclusion: Myomectomy is the recommended treatment of uterine fibroids in women aged 40 years and above with infertility and who wish to become pregnant. If there is no need for further fertility preservation, hysterectomy should be offered.
Obed, Jesse Y.; Bako, Babagana; Kadas, Saidu; Usman, Joshua D.; Kullima, Abubakar A.; Moruppa, Joel Y.
Background: Bloodstream infections are associated with a significant patient morbidity and mortality. The detection of microorganisms in the patients’ blood has a great diagnostic and prognostic significance. The early positive results provide valuable diagnostic information, based on which the appropriate antimicrobial therapy can be initiated. Objective: To know the aetiology of the bloodstream infections in the Kathmandu Medical College, Nepal and the antibiotic sensitivity patterns of the causative organisms. Materials and Methods: The blood specimens which were received from May 2010 to October 2010 in Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal, were processed and all the positive isolates were included in the study. The isolates were identified by the standard laboratory procedures. The antibiotic susceptibility patterns were determined by the modified Kirby Bauer antibiotic sensitivity method. Result: Of the 1089 blood cultures which were received with the suspected cases of blood stream infections, 138 (12.6 %) were bacteriologically positive. Salmonella serotypes were isolated in 42.7% cases of blood stream infections, followed by Klebsiella pneumoniae in 19.5%, Staphylococcus aureus in 15.9% and others in the rest of the cases. All the gram-negative bacilli isolates showed lower degrees of resistance to amikacin and ofloxacin. All the gram positive isolates were sensitive to amikacin, oxacillin and vancomycin. Conclusion: This study stresses on the need for a continued screening and surveillance in the routine blood culture technique for starting with the empiric therapy for blood borne infections.
Pandey, Santwana; Raza, Shahid; Bhatta, Chandra Prakash
Vancomycin-resistant enterococci (VRE) are common nosocomial pathogens; however, until now they have been rarely encountered in Hungary. In the present study, we investigated the prevalence of VRE in the teaching hospitals of the University of Debrecen. Of 7,271 Enterococcus-containing clinical samples collected between 2004 and 2009, we identified 16 VRE. Species-specific polymerase chain reaction was used to detect Enterococcus faecalis, Enterococcus faecium, Enterococcus casseliflavus, and Enterococcus gallinarum. Multiplex polymerase chain reaction was performed to identify the vancomycin resistance genes: vanA, vanB, vanC1/C2, vanD, vanE, and vanG. Restriction digestion with SalI and HindIII was introduced to differentiate the vanC1 and vanC2 genes from each other. Genetic relationships between the strains were investigated by pulsed-field gel electrophoresis. Overall, we identified the vanC1 resistance gene in 14 E. gallinarum and the vanC2 resistance gene in two E. casseliflavus strains. Except for two samples, the isolates had different pulsed-field gel electrophoresis types, suggesting sporadic emergence of the resistant bacteria. In addition, antibiotic resistance profile was determined by E-test. Three E. gallinarum strains proved to be resistant to gentamicin because of the presence of the aacA-aphD gene. Although the prevalence of VRE in Debrecen is rather low, the appearance of multiple resistances is of concern. PMID:21649462
Dombrádi, Zsuzsanna; Dobay, Orsolya; Nagy, Károly; Kozák, Anita; Dombrádi, Viktor; Szabó, Judit
Background Hirschsprung’s disease (HD) is the commonest cause of functional intestinal obstruction in children and poses challenges to pediatricians and pediatric surgeons practicing in resource-limited countries. This study describes the clinical characteristics and outcome of management of this disease in our setting and highlights challenges associated with the care of these patients and proffer solutions for improved outcome. Methods This was a descriptive prospective study of children aged ? 10 years who were histologically diagnosed and treated for HD at our centre between July 2008 and June 2013. Results A total of 110 patients (M: F ratio= 3.6:1) with a median age of 24 months were studied. Six (5.5%) patients were in the neonatal period. Sixty-four (58.2%) patients had complete intestinal obstruction whereas 42 (38.2%) and 4 (3.6%) patients had chronic intestinal obstruction and intestinal perforation respectively. No patient had enterocolitis. Constipation (94.5%) was the most common complaints. 109 (99.1%) patients had colostomy prior to the definitive pull-through. The median duration of colostomy before definitive pull-through was 4 months. The majority of patients (67.3%) had short segment of aganglionosis localized to the recto-sigmoid region. The definitive pull-through was performed in 94 (85.5%) patients (Swenson’s pull-through 76 (80.9%), Duhamel’s pull-through (12.8%) and Soave’s pull-through 4 (4.3%) patients). Postoperative complication rate was 47.3%. The median length of hospital stay was 26 days. Patients who developed complications stayed longer in the hospital and this was statistically significant (p <0.001). Mortality rate was 21.8%. The age < 4 weeks, delayed presentation and surgical site infection were the main predictors of mortality (p < 0.001). During the follow-up period, the results of Swenson’s and Duhamel’s pull through procedures were generally good in 87.8% and 42.9% of patients respectively. The result of Soave’s procedures was generally poor in this study. Conclusion HD remains the commonest cause of functional intestinal obstruction in children and contributes significantly to high morbidity and mortality in our setting. The majority of patients present late when the disease becomes complicated. Early diagnosis and timely definitive pull through procedure are essential in order to decrease the morbidity and mortality associated with this disease.
Quinolone resistance is an emerging problem in China. To investigate the prevalence of the plasmid- mediated quinolone resistance genes qnr and aac(6)-Ib-cr, a total of 265 clinical isolates of Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, and Enterobacter cloacae with ciprofloxacin MICs of >0.25 g\\/ml were screened at nine teaching hospitals in China. The qnrA, qnrB, qnrS, and aac(6)-Ib genes were
Hong Yang; Hongbin Chen; Qiwen Yang; Minjun Chen; Hui Wang
We have determined the frequency and the genetic diversity of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from inpatients of a South West German teaching hospital. The frequency of primary MRSA isolates remained constant over the two-year surveillance period: 108 of the total number of 1450 S. aureus isolates (7.5%) were MRSA in 2001 and the corresponding figures were 110 MRSA
Iatrogenic errors producing serious and often preventable injury occur frequently in hospitalized patients, particularly in children. Little is known about the epidemiology of analgesic medication errors in patients being discharged from the hospital. The goal of this study was to describe the epidemiology of controlled substance prescription errors by physicians-in-training for children being discharged from the hospital. We conducted a
Benjamin H. Lee; Christoph U. Lehmann; Eric V. Jackson; Sabine Kost-Byerly; Sharon Rothman; Lori Kozlowski; Marlene R. Miller; Peter J. Pronovost; Myron Yaster
Objectives The study was carried out with the aim of evaluation of the adverse drug reaction profile of anti-snake venom serum (ASV) in a rural tertiary care hospital. Methods An observational study was conducted in SRTR Medical College, Ambajogai, Maharashtra, India. A total number of 296 indoor case papers of snake bite from February to September 2011 and June to August 2012 were retrieved from the record section and the antivenom reactions were assessed. In addition, basic epidemiological data and prescribing practices of ASV were also analyzed. Results Vasculotoxic snake bites were more common (50.61%) than neuroparalytic ones (22.56%). Mild envenomation was the commonest presentation. A total of 92 (56.10%) patients who received ASV suffered from antivenom reactions. The most common nature of reaction was chills, rigors (69.56%) followed by nausea and vomiting (34.8%). 10-15% patients suffered from moderate to severe reactions like hypotension and sudden respiratory arrest. We did not find any dose response relationship of ASV to risk of reactions (odds ratio 0.37). Intradermal sensitivity test was performed in about 72% cases. Conclusion Our study showed a higher incidence of reactions to ASV at our institute.
Deshpande, Rushikesh Prabhakar; Motghare, Vijay Motiram; Padwal, Sudhir Laxman; Pore, Rakesh Ramkrishna; Bhamare, Chetanraj Ghanshyam; Deshmukh, Vinod Shivaji; Pise, Harshal Nutan
The multidrug-resistant rate of Klebsiella pneumoniae has risen rapidly worldwide. To better understand the multidrug resistance situation and molecular characterization of Klebsiella pneumoniae, a total of 153 Klebsiella pneumoniae isolates were collected, and drug susceptibility test was performed to detect its susceptibility patterns to 13 kinds of antibiotics. Phenotypic tests for carbapenemases ESBLs and AmpC enzyme-producing strains were performed to detect the resistance phenotype of the isolates. Then PCR amplification and sequencing analysis were performed for the drug resistance determinants. The results showed that 63 strains harbored blaCTX-M gene, and 14 strains harbored blaDHA gene. Moreover, there were 5 strains carrying blaKPC gene, among which 4 strains carried blaCTX-M, blaDHA and blaKPC genes, and these 4 strains were also resistant to imipenem. Our data indicated that drug-resistant Klebsiella pneumoniae were highly prevalent in the hospital. Thus it is warranted that surveillance of epidemiology of those resistant isolates should be a cause for concern, and appropriate drugs should be chosen.
Liu, Helu; Lu, Dongyue; Liang, Hong; Dou, Yuhong
OBJECTIVES: This study was undertaken to characterize the neuroinfection profile in a tertiary neurological ward. INTRODUCTION: Neuroinfection is a worldwide concern and bacterial meningitis, tetanus and cerebral malaria have been reported as the commonest causes in developing countries. METHODS: From 1999 to 2007, all patients admitted to the Neurology Ward of Hospital das Clínicas, S?o Paulo University School of Medicine because of neuroinfection had their medical records reviewed. Age, gender, immunological status, neurological syndrome at presentation, infectious agent and clinical outcome were recorded. RESULTS: Three hundred and seventy four cases of neuroinfectious diseases accounted for 4.2% of ward admissions and the identification of infectious agent was successful in 81% of cases. Mean age was 40.5±13.4 years, 63.8% were male, 19.7% were immunocompromised patients and meningoencephalitis was the most common clinical presentation despite infectious agent. Viruses and bacteria were equally responsible for 29.4% of neuroinfectious diseases; parasitic, fungal and prion infections accounted for 28%, 9.6% and 3.5% respectively. Human immunodeficiency virus (HIV), herpes simplex virus 1 (HSV1), Mycobacterium tuberculosis, Treponema pallidum, Taenia solium, Schistosoma mansoni, Cryptococcus neoformans and Histoplasma capsulatum were the more common infectious pathogens in the patients. Infection mortality rate was 14.2%, of which 62.3% occurred in immunocompetent patients. CONCLUSION: Our institution appeared to share some results with developed and developing countries. Comparison with literature may be considered as quality control to health assistance.
Marchiori, Paulo E; Lino, Angelina M M; Machado, Luis R; Pedalini, Livia M; Boulos, Marcos; Scaff, Milberto
Introduction: The clean bedding and clean clothes installs psychological confidence in the patients and the public and enhances their faith in the services rendered by the hospital. Being an important Component in the management of the patients, a study was carried out to find out the current quality status and its conformity with the known standards and identify the areas of intervention in order to further increase the patient and staff satisfaction regarding the services provided by linen and laundry department Methods: Quality control practised in the Linen and Laundry Service was studied by conducting a prospective study on the concept of Donabedian model of structure, process and outcome. Study was done by pre-designed Proforma along with observation / Interviews / Questionnaire and study of records. The input studied included physical facilities, manpower, materials, equipments and environmental factors. The various elements of manpower studied consisted of number of staff working, their qualification, training, promotion avenues, motivation and job satisfaction. Process was studied by carrying out observations in linen and laundry service through a predesigned flow chart which was supplemented by interviews with different category of staff. Patient satisfaction, staff satisfaction and microbial count of laundered linen (quality dimensions) were studied in the outcome. Results: The current study found that in spite of certain deficiencies in the equipment, manpower and process, the linen and laundry service is providing a satisfactory service to its users. However the services can be further improved by removing the present deficiencies both at structure and process level.
Singh, Dara; Qadri, GJ; Kotwal, Monica; Syed, AT; Jan, Farooq
We performed a retrospective review of all patients admitted to two large University Hospitals in the United Kingdom over a 24-month period from January 2008 to January 2010 to identify the incidence of atypical subtrochanteric and femoral shaft fractures and their relationship to bisphosphonate treatment. Of the 3515 patients with a fracture of the proximal femur, 156 fractures were in the subtrochanteric region. There were 251 femoral shaft fractures. The atypical fracture pattern was seen in 27 patients (7%) with 29 femoral shaft or subtrochanteric fractures. A total of 22 patients with 24 atypical fractures were receiving bisphosphonate treatment at the time of fracture. Prodromal pain was present in nine patients (11 fractures); 11 (50%) of the patients on bisphosphonates suffered 12 spontaneous fractures, and healing of these fractures was delayed in a number of patients. This large dual-centre review has established the incidence of atypical femoral fractures at 7% of the study population, 81% of whom had been on bisphosphonate treatment for a mean of 4.6 years (0.04 to 12.1). This study does not advocate any change in the use of bisphosphonates to prevent fragility fractures but attempts to raise awareness of this possible problem so symptomatic patients will be appropriately investigated. However, more work is required to identify the true extent of this new and possibly increasing problem. PMID:22371548
Thompson, R N; Phillips, J R A; McCauley, S H J; Elliott, J R M; Moran, C G
Background Previous studies have investigated factors that are influential on the choice of training hospitals among residency physicians, but the effect of salary was not conclusive. In this study, we aimed to examine whether a higher salary attracted more residents to non-university hospitals participating in the Japanese Residency Matching Programme. Methods Data on 475 hospitals/programmes between 2006 and 2009 were available for analysis. We first conducted an ordinary least squares regression analysis on the ratio of the number of applicants to the residency programme quota as an index of resident’s choice, for comparison with previous studies. We further performed panel data analysis to better control for unobserved heterogeneity across hospitals, which could be confounded by the amount of salary. We also performed stratified analysis by the population size of the hospital location. Results In ordinary least squares regression, salary showed a positive, but not significant association, with the ratio of the number of applicants to the programme quota, while the results of a fixed effect model exhibited a positive and significant effect of salary (?= 0.4995, P = 0.015) on the ratio. Analysis stratified by city size showed that the elasticity of salary was comparable (?= 1.9089, P = 0.016 in large cities versus ?= 1.9185, P = 0.008 in small cities), while that of the number of teaching physicians was larger in large cities (?= 1.9857, P = 0.009) compared with that in small cities (?= 1.6253, P = 0.033). The number of teaching physicians had a significant and negative effect modification on salary, implying an antagonistic effect between these two attributes (?= ?1.5223, P = 0.038). Conclusions Our results indicate that the amount of salary influences the choice of training hospitals among medical graduates who choose non-university settings. Use of a monetary reward in a residency programme could be a feasible tactic for hospitals to attract residents.
BACKGROUND: Ureteric lithiasis is a common urological problem in Kuwait. Because of the different interventional approaches, we carried out an audit on the morbidity associated with the surgical management of the disorder. PATIENTS AND METHODS: The surgical records were reviewed of all patients with the diagnosis of ureteric lithiasis that were managed surgically by ureteroscopy or ureterolithotomy in Mubarak Al-Kabeer Hospital in Kuwait between January 1996 and December 1999. Patients' bio-data, location of calculi, indications for surgical intervention, types of therapeutic interventions, operating surgeon and complications were analysed. Patients managed primarily and successfully by extracorporeal shockwave lithotripsy were excluded from this analysis. RESULTS: A total of 1383 patients with ureteric calculus were managed in the period under review--775 (56%), 567 (41%), and 41 (3%) patients were managed by extracorporeal shockwave lithotripsy, ureteroscopy and ureterolithotomy, respectively. The 608 patients managed by ureteroscopy or ureterolithotomy had a total of 710 operations. The commonest surgical procedure performed was ureteroscopy with Dormia basket with or without double 'J' stenting and this accounted for 418 (58.9%) operations. The least common procedure was ureteric meatotomy with Dormia basket and with or without double 'J' stenting in 9 (1.3%) patients. The overall complication rate was 110 out of 710 (15.5%) operations. Of the complications, 101 (92%) were minor (e.g. haematuria, fever, and mucosal injury). Nine (8%) complications were major complications (e.g. ureteric perforation and ureteric avulsions). Ureterolithotomy and ureteroscopy with intracorporeal lithotripsy were associated with the highest complication rates. CONCLUSIONS: This analysis has shown that with technological advances, the treatment of ureteric lithiasis has improved and major complications have decreased. However, with so many therapeutic options to choose from, there is a need to audit the various therapeutic options and select those associated with the least morbidity rates in each urology unit.
Kehinde, E. O.; Al-Awadi, K. A.; Al-Hunayan, A.; Okasha, G. H.; Al-Tawheed, A.; Ali, Y.
Context: Tobacco is a leading cause of disease and premature death. Most of the smokers visit a doctor for various health related ailments and thus such clinic visits provide many opportunities for interventions and professional tobacco cessation advice. Aims: The primary aim of the following study is to assess the physician practices, perspectives, resources, barriers and education relating to tobacco cessation and their perceived need for training for the same. The secondary aim is to compare the physician's cessation practices from patient's perspective. Settings and Design: A descriptive study was conducted in a hospital attached to Medical College in Mysore city, Karnataka. Materials and Methods: Information about doctor's practices, perspectives and their perceived need for training in tobacco cessation were collected using pre-structured self-administered Questionnaire, which were distributed in person. Patient's practices and perspectives were assessed using a pre-structured Oral Questionnaire. Results: Almost 95% of physicians said that they ask patients about their smoking status and 94% advise them to quit smoking, but only 50% assist the patient to quit smoking and only 28% arrange follow-up visits. Thus, they do not regularly provide assistance to help patients quit, even though 98% of the physicians believed that helping patients to quit was a part of their role. Only 18% and 35% of the physicians said that Undergraduate Medical Education and Post Graduate Medical Education respectively prepared them very well to participate in smoking cessation activities. Conclusions: Tobacco cessation requires repeated and regular assistance. Such assistance is not being provided to patients by attending doctors. Our medical education system is failing to impart the necessary skills to doctors, needed to help patients quit smoking. Reforms in education are needed so as to prepare the physician to effectively address this problem.
Saud, Mohammed; Madhu, B; Srinath, K M; Ashok, N C; Renuka, M
Background Several studies have investigated attitudes to and compliance with smoking bans, but few have been conducted in healthcare settings and none in such a setting in Portugal. Portugal is of particular interest because the current ban is not in line with World Health Organization recommendations for a "100% smoke-free" policy. In November 2007, a Portuguese teaching-hospital surveyed smoking behaviour and tobacco control (TC) attitudes before the national ban came into force in January 2008. Methods Questionnaire-based cross-sectional study, including all eligible staff. Sample: 52.9% of the 1, 112 staff; mean age 38.3 ± 9.9 years; 65.9% females. Smoking behaviour and TC attitudes and beliefs were the main outcomes. Bivariable analyses were conducted using chi-squared and MacNemar tests to compare categorical variables and Mann-Whitney tests to compare medians. Multilogistic regression (MLR) was performed to identify factors associated with smoking status and TC attitudes. Results Smoking prevalence was 40.5% (95% CI: 33.6-47.4) in males, 23.5% (95% CI: 19.2-27.8) in females (p < 0.001); 43.2% in auxiliaries, 26.1% in nurses, 18.9% among physicians, and 34.7% among other non-health professionals (p = 0.024). The findings showed a very high level of agreement with smoking bans, even among smokers, despite the fact that 70.3% of the smokers smoked on the premises and 76% of staff reported being frequently exposed to second-hand smoke (SHS). In addition 42.8% reported that SHS was unpleasant and 28.3% admitted complaining. MLR showed that smoking behaviour was the most important predictor of TC attitudes. Conclusions Smoking prevalence was high, especially among the lower socio-economic groups. The findings showed a very high level of support for smoking bans, despite the pro-smoking environment. Most staff reported passive behaviour, despite high SHS exposure. This and the high smoking prevalence may contribute to low compliance with the ban and low participation on smoking cessation activities. Smoking behaviour had greater influence in TC attitudes than health professionals' education. Our study is the first in Portugal to identify potential predictors of non-compliance with the partial smoking ban, further emphasising the need for a 100% smoke-free policy, effective enforcement and public health education to ensure compliance and promote social norm change.
Background Diabetic foot ulcers (DFUs) pose a therapeutic challenge to surgeons, especially in developing countries where health care resources are limited and the vast majority of patients present to health facilities late with advanced foot ulcers. A prospective descriptive study was done at Bugando Medical Centre from February 2008 to January 2010 to describe our experience in the surgical management of DFUs in our local environment and compare with what is known in the literature. Findings Of the total 4238 diabetic patients seen at BMC during the period under study, 136 (3.2%) patients had DFUs. Males outnumbered females by the ratio of 1.2:1. Their mean age was 54.32 years (ranged 21-72years). Thirty-eight (27.9%) patients were newly diagnosed diabetic patients. The majority of patients (95.5%) had type 2 diabetes mellitus. The mean duration of diabetes was 8.2 years while the duration of DFUs was 18.34 weeks. Fourteen (10.3%) patients had previous history of foot ulcers and six (4.4%) patients had previous amputations. The forefoot was commonly affected in 60.3% of cases. Neuropathic ulcers were the most common type of DFUs in 57.4% of cases. Wagner's stage 4 and 5 ulcers were the most prevalent at 29.4% and 23.5% respectively. The majority of patients (72.1%) were treated surgically. Lower limb amputation was the most common surgical procedure performed in 56.7% of cases. The complication rate was (33.5%) and surgical site infection was the most common complication (18.8%). Bacterial profile revealed polymicrobial pattern and Staphylococcus aureus was the most frequent microorganism isolated. All the microorganisms isolated showed high resistance to commonly used antibiotics except for Meropenem and imipenem, which were 100% sensitive each respectively. The mean hospital stay was 36.24 ± 12.62 days (ranged 18-128 days). Mortality rate was 13.2%. Conclusion Diabetic foot ulceration constitutes a major source of morbidity and mortality among patients with diabetes mellitus at Bugando Medical Centre and is the leading cause of non-traumatic lower limb amputation. A multidisciplinary team approach targeting at good glycaemic control, education on foot care and appropriate footware, control of infection and early surgical intervention is required in order to reduce the morbidity and mortality associated with DFUs. Due to polymicrobial infection and antibiotic resistance, surgical intervention must be concerned.
Background Marjolin's ulcer is a rare but highly aggressive squamous cell cancer that is most often associated with chronic burn wounds. Although many individual case reports exist, no comprehensive evaluation of Marjolin's ulcer patients has been conducted in our setting. This study was conducted to describe the clinicopathological presentation and treatment outcome of this condition in our local setting and to identify predictors of outcome. Methods This was a retrospective study of histologically confirmed cases of Marjolin's ulcer seen at Bugando Medical Centre over a period of 10-years between January 2001 and December 2010. Data were retrieved from patients' files and analyzed using SPSS computer software version 15.0 Results A total of 56 patients were studied. Male to female ratio was 2.1:1. Burn scars (89.3%) were the most common causative lesions of Marjolin's ulcer. The mean latent period between original injury and diagnosis of Marjolin's ulcer was 11.34 ± 6.14 years. Only 12.0% of the reported cases were grafted at the time of injury (P < 0.00). Most patients (48.2%) presented between one and five years of onset of illness. The lower limb (42.9%) was the most frequent site for Marjolin's ulcers. The median tumor size at presentation was 8 cm and the vast majority of patients (85.7%) presented with large tumors of ? 5 cm in diameter. Lymph node metastasis at the time of diagnosis was recorded in 32.1% of cases and distant metastasis accounted for 26.9% of cases. Squamous cell carcinoma (91.1%) was the most common histopathological type. Wide local excision was the most common surgical procedure performed in 80.8% of cases. Post-operative complication rate was 32.1% of which surgical site infection was the most common complication in 38.9% of patients. Local recurrence was noted in 33.3% of cases who were treated surgically. The mean length of hospital stay for in-patients was 7.9 ± 2.3 days. Mortality rate was 7.1%. According to multivariate logistic regression analysis, stage and grade of the tumor and presence of local recurrence were the main predictors of death (P < 0.001). Conclusion Marjolin's ulcers are not rare in our environment and commonly occur in burn scars that were not skin grafted and were left to heal secondarily. A high index of suspicion is required in the management of chronic non-healing ulcers and all suspected lesions should be biopsed. Early recognition and aggressive treatment of Marjolin's ulcers and close follow-up are urgently needed to improve outcomes in our environment.
Background: International osteoporosis foundation described severe or established osteoporosis as an osteoporotic individual with a fragility fracture. Orthopaedic surgeons frequently manage fractures, but we believe that large gaps are prevalent in the medical management of osteoporosis after fractures are fixed. Aim: The aim of this analysis is to assess the investigations and gaps in the management of osteoporosis in patients admitted with a fragility fracture of femur at King Fahd Hospital of the University, AlKhobar, Saudi Arabia. Materials and Methods: A retrospective analysis of all admission and discharge; medical and pharmacy records database of patients over ? 50 years with fragility fracture between January 2001 and December 2011. The outcome measures assessed were investigations such as serum calcium, phosphorous, alkaline phosphatase, parathormone, 25 hydroxy vitamin D (25OHD) levels and a dual energy X-ray absorptiometry (DEXA). Secondly once the fracture was fixed what medications were prescribed, calcium and vitamin D, antiresorptives and anabolic agents. Results: There were 207 patients admitted during the study period with an average age of 69.2 (12.1) years and 118 were females. In 169 (81.6%) patients, the fracture site was proximal femur. Vitamin D (25OHD) was requested in 31/207 (14.9%). DEXA scan was ordered in 49/207 (24.1%). A total of 78/207 (37.6%) patients received calcium and vitamin D3 and 94/207 (45.4%) either got calcium or vitamin D3. Bisphosphonates was used in 35, miacalcic nasal spray in 25 and anabolic agent teriparatide was prescribed in 21 patients. Post-fixation 126/207 (60.8%) patients did not receive any anti-osteoporotic medication. In untreated group, there were 87 males and 39 females. Conclusions: The study found that in patients, who sustained a fragility fracture, confirmation of osteoporosis by DEXA was very low and ideal treatment for severe osteoporosis was given out to few patients. More efforts are needed to fill this large gap in the correct management of osteoporosis related fractures by orthopaedic surgeons.
Sadat-Ali, Mir; Al-Omran, AS; Al-Bakr, WI; Azam, Md Quamar; Tantawy, AM; Al-Othman, AA
Background Comparing patterns of resource utilization between hospitals is often complicated by biases in community and patient populations. Stroke patients treated with tissue plasminogen activator (tPA) provide a particularly homogenous population for comparison because of strict eligibility criteria for treatment. We tested whether resource utilization would be similar in this homogenous population between two hospitals located in a single Midwestern US community by comparing use of diagnostic testing and associated outcomes following treatment with t-PA. Methods Medical records from 206 consecutive intravenous t-PA-treated stroke patients from two teaching hospitals (one university, one community-based) were reviewed. Patient demographics, clinical characteristics and outcome were analyzed, as were the frequency of use of CT, MRI, MRA, echocardiography, angiography, and EEG. Results Seventy-nine and 127 stroke patients received t-PA at the university and community hospitals, respectively. The two patient populations were demographically similar. There were no differences in stroke severity. All outcomes were similar at both hospitals. Utilization of CT scans, and non-invasive carotid and cardiac imaging studies were similar at both hospitals; however, brain MR, TEE, and catheter angiography were used more frequently at the university hospital. EEG was obtained more often at the community hospital. Conclusions Utilization of advanced brain imaging and invasive diagnostic testing was greater at the university hospital, but was not associated with improved clinical outcomes. This could not be explained on the basis of stroke severity or patient characteristics. This variation of practice suggests substantial opportunities exist to reduce costs and improve efficiency of diagnostic resource use as well as reduce patient exposure to risk from diagnostic procedures.
Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important zoonotic and nosocomial pathogen in veterinary settings. Even though human risk factors for MRSA infection and colonization are well known, this information in animals is lacking. The objective of this study was to identify risk factors associated with MRSA carrier dogs on their arrival at a veterinary teaching hospital. A total of 435 dogs were enrolled in the MRSA active surveillance program at The Ohio State University-Veterinary Medical Center over a 1-year period. Dogs were screened for MRSA on arrival, regardless of health status, sex, breed, or age. In addition, an epidemiological survey and medical history were obtained for each dog to identify potential risk factors up to 1 year prior to the appointment. Of 435 dogs included in the study, 25 (5.7%) were MRSA positive, with 86.5% of the isolates classified staphylococcal chromosome cassette mec (SCCmec) type II and USA100. Four of the 25 MRSA carrier dogs were healthy, 20 had health issues unrelated to MRSA, and 1 had an active MRSA infection. MRSA was detected in the nares (72%, 18/25), skin lesions (24%, 6/25), and the perianal area (16%, 4/25). Except for previous surgery <90 days (odds ratio [OR]=4.9; 95% confidence interval [CI] 1.4-17.6; p value 0.01), none of the variables related to the previous medical history, dog's management, home environment, and other potential exposures were associated with the MRSA carrier status. However, the profession of the owner was significantly associated, and dogs owned by veterinary students were 20.5 times (95% CI 4.5-93.6; p value?0.01) more likely to be MRSA positive than dogs owned by clients with different occupations. MRSA-positive dogs were dispersed in different categories, preventing the creation of an epidemiological profile that would allow their early recognition upon arrival to a veterinary hospital. However, the association between veterinary students with MRSA-positive dogs is a concern that deserves further evaluation. PMID:23473222
Hoet, Armando E; van Balen, Joany; Nava-Hoet, Rocio C; Bateman, Shane; Hillier, Andrew; Dyce, Jonathan; Wittum, Thomas E
Background Bloodstream infections in neonates and infants are life-threatening emergencies. Identification of the common bacteria causing such infections and their susceptibility patterns will provide necessary information for timely intervention. This study is aimed at determining the susceptibilities of bacterial etiological agents to commonly-used antimicrobial agents for empirical treatment of suspected bacterial septicaemia in children. Methods This is a hospital based retrospective analysis of blood cultures from infants to children up to 14 years of age with preliminary diagnosis of sepsis and admitted to the Neonatal Intensive Care Unit (NICU) and Paediatric Wards of the Teaching Hospital Tamale from July 2011 to January 2012. Results Out of 331 blood specimens cultured, the prevalence of confirmed bacterial sepsis was 25.9% (86/331). Point prevalence for confirmed cases from NICU was 44.4% (28/63) and 21.6% (58/268) from the Paediatric ward. Gram positive cocci (GPC) were the predominant isolates with Coagulase positive (32.2%) and Coagulase-negative (28.7%) Staphylococci accounting for 60.9% of the total isolates. Gram negative rods (GNR) comprised 39.1% of all isolates with Klebsiella, E.coli and Salmonella being the most common organisms isolated. Klebsiella was the most frequent GNR from the NICU and Salmonella typhi was predominantly isolated from the paediatric ward. Acinetobacter showed 100.0% susceptibility to Ceftriaxone and Cefotaxime but was resistant (100.0%) to Ampicillin, Tetracycline and Cotrimoxazole. Escherichia coli and Klebsiella were 80.0% and 91.0% susceptible to Ceftriaxone and Cefotaxime respectively. Klebsiella species showed 8.3% susceptibility to Tetracycline but was resistant to Ampicillin and Cotrimoxazole. Escherichia coli showed 40.0% susceptibility to Ampicillin, Chloramphenicol and Cotrimoxazole; 20.0% susceptibility to Tetracycline and 80.0% susceptible to Gentamicin and Cefuroxime. Coagulase negative Staphylococci was susceptible to Gentamicin (72.0%) but Coagulase positive Staphylococci showed intermediate sensitivity to Gentamicin (42.9%). Conclusion Coagulase Negative, Coagulase Positive Staphylococci, Salmonella and Klebsiella were the aetiological agents of bloodstream infection among children at TTH. While gram-positive and gram-negative bacteria showed low susceptibility to Ampicillin, Tetracycline and Cotrimoxazole, the GNR were susceptible to Gentamicin and third-generation cephalosporins.
The aim of this study was to investigate the prevalence of ?-lactamase-negative ampicillin-resistant (BLNAR) Haemophilus influenzae isolated from patients of a teaching hospital in Thailand. Eighty-eight isolates of H. influenzae were collected between September 2005 and March 2008. All isolates were identified and characterized for biotypes and capsular types. The ?-lactamase production of these isolates was examined, and their susceptibility to the following 12 antimicrobial agents was determined: ampicillin (AMP), amoxicillin-clavulanate (AMC), cefotaxime (CTX), cefuroxime (CXM), meropenem (MEM), clarithromycin (CLR), telithromycin (TEL), tetracycline (TET), ciprofloxacin (CIP), levofloxacin (LEV), trimethoprim-sulfamethoxazole (SXT), and chloramphenicol (CHL). Of the 88 H. influenzae isolates, 69 (78.4%), 13 (14.8%), 4 (4.5%), and 2 (2.3%) were from the respiratory tract, pus, the genital tract, and blood, respectively. Half of the isolates were biotype II (44 isolates, 50%). The other half comprised biotypes I (23 isolates, 26.1%), III (15 isolates, 17.1%), and IV (6 isolates, 6.8%). All isolates were capsular non-typeable, except for 2 isolates that were type f. Antimicrobial susceptibility showed that all isolates were susceptible to AMC, CTX, MEM, TEL, CIP, and LEV (100%), whereas 96.6%, 94.3%, 80.7%, 68.2%, 50.0%, and 44.3% were susceptible to CXM, CLR, CHL, TET, AMP, and SXT, respectively. The ?-lactamase-production rate of H. influenzae isolates was 40.9%, and the prevalence of BLNAR was 18.2%. PMID:22446118
Lulitanond, Aroonlug; Chanawong, Aroonwadee; Pienthaweechai, Keskaew; Sribenjalux, Pipat; Tavichakorntrakool, Ratree; Wilailuckana, Chotechana; Puang-Ngern, Pirom; Saetung, Pairshompoo
Background: Appropriate infant feeding is the key to optimum infant and child development and survival. This study investigates age-appropriate infant feeding practices and nutritional status of infants attending the immunization and child welfare clinic at Aminu Kano Teaching Hospital. Materials and Methods: Using a cross-sectional descriptive design, a sample of 300 sets of infants (age ?12 months) and caregivers was systematically selected and studied. The data were analyzed using the MINITAB® 12.21 (USA) statistical software. Results: All the infants studied were still on breast milk. Most of the mothers demonstrated correct body positioning (89.9) and attachment (78.7%) during breastfeeding, and effective suckling was demonstrated in 77.0%. Interestingly, none of the infants was either exclusively breastfed for 6 months or currently on exclusive breastfeeding. Furthermore, only 64 (58.2%) of the 110 infants that were more than 6 months of age had appropriately been started on complementary feeding from 6 months of age. Overall, most caregivers (88.7%) had “fair” to “good” infant feeding practices. The practices were significantly associated with their level of education, and their relationship with the infants. Up to 40.0% and 73.7% of the infants had varying degrees of wasting and stunting respectively. Infant feeding practices and the age of the infants emerged as the only factors significantly associated with stunting, while both the caregivers’ practices and age of the infants emerged as significant predictors of wasting in the infants. Conclusion and Recommendations: Barely 3 years to the 2015 target of the millennium development goals (MDGs), infant feeding and nutritional status still poses a serious threat to the dream of realizing the MDG-4. The Ministry of Health and relevant developing partners in this region should as a matter of urgency, formulate and implement a strong community-based public health intervention program to improve the knowledge and practices of mothers on infant feeding.
Lawan, Umar M.; Amole, Gboluwaga T.; Jahum, Mahmud G.; Sani, Abdullahi
Background & objectives: H1N1 influenza is a recognized cause of febrile respiratory infection worldwide. There are not many studies to show its impact on pregnancy. In the present study we aimed to assess clinical characteristics, obstetric and perinatal outcome of pregnant women with H1N1 infection. Methods: A retrospective observational study was conducted at a tertiary care teaching hospital in New Delhi, India. A total of 24 pregnant women microbiologically positive for H1N1 were included. Maternal characteristics and outcome were recorded. Perinatal outcome which was defined as presence of any of the indicators such as abortion, preterm delivery, intrauterine death and neo natal death was noted. Results: The mean age of the study group was 25.2 ± 3 yr with a mean gestational age of 34.9 ± 4.6 wk. Six patients (25%) had associated co-morbidities. Nine patients (37.5%) presented within 48 h of onset of symptoms and 15 (62.5%) reported after 48 h. In 17 (70.83%) patients treatment was delayed by >48 h. ICU admission was needed in 20.8 per cent patients and mortality rates was 8.3 per cent. There were seven cases of adverse perinatal outcome. Interpretation & conclusions: The presenting symptoms of pregnant women with H1N1 were similar to that of general population. Acquiring infection in late trimester, late initiation of antiviral treatment and presence of co-morbid illness were high risk factors for developing critical illness. Pregnant women with suspected H1N1 influenza should be started on antiviral therapy at the earliest. This is likely to help reduce the ICU admission rates and mortalities in this group of women.
Singhal, Seema; Sarda, Nivedita; Arora, Renu; Punia, Nikky; Jain, Anil
Background: Diabetes mellitus is a significant cause of visual impairment, hence adequate knowledge on this condition and its ocular manifestations is of immense importance to diabetic patients. Aim: To assess the knowledge of diabetic patients on the disorder and its ocular manifestations, and their attitude towards ocular examinations. Materials and Methods: A cross-sectional survey involving the use of a structured interview was conducted among diabetic patients attending the Diabetic Clinic of the Korle-Bu Teaching Hospital. Using Fishers Exact Chi-square (?2) and Odds Ratios (ORs), data obtained was analyzed. Results: Only 103 (26.4%) patients knew the type of diabetes mellitus they were suffering from. Knowledge on ocular effects of diabetes mellitus was low and only 15 (3.8%) knew that it could affect the ocular refraction with no patient mentioning that diabetes mellitus could cause cataract or diabetic retinopathy. Attitude to routine eye examination was poor. As much as 135 (34.6%) had never had an eye examination since being diagnosed of diabetes. Knowledge of the type of diabetes mellitus the individual had or any ocular complication of this disorder was significantly related (OR: 4.22; P < 0.001 and OR: 2.55; P < 0.001) respectively to their attitude to seeking eye care. Conclusion: Diabetic patients’ knowledge on diabetes mellitus and its ocular manifestations, and the attitude of diabetic patients towards eye examination were poor. Intensive health education by diabetes care givers and leaders of the Ghana Diabetic Association for diabetic patient is therefore required to improve attitude towards eye care to prevent visual impairment.
Ovenseri-Ogbomo, Godwin O.; Abokyi, Samuel; Koffuor, G. A.; Abokyi, Eric
Background: Recent guidelines recommend a vancomycin trough (predose) level between 15 and 20 mg/L in the treatment of invasive gram-positive infections, but most initial dosing nomograms are designed to achieve lower targets (5–15 mg/L). Clinicians need guidance about appropriate initial dosing to achieve the higher target. Objective: To develop and validate a high-target vancomycin dosing nomogram to achieve trough levels of 15–20 mg/L. Methods: A retrospective study was conducted at 2 teaching hospitals, St Paul’s Hospital and Vancouver General Hospital in Vancouver, British Columbia. Patients who were treated with vancomycin between January 2008 and June 2010 and who had achieved a trough level of 14.5–20.5 mg/L were identified. Demographic and clinical data were collected. Multiple linear regression was used to develop a vancomycin dosing nomogram for each hospital site. An integrated nomogram was constructed by merging the data from the 2 hospitals. A unique set of patients at each institution was used for validating their respective nomograms and a pooled group of patients for validating the integrated nomogram. Predictive success was evaluated, and a nomogram was deemed significantly different from another nomogram if p < 0.05 via “?2 testing. Results: Data from 78 patients at one hospital and 91 patients at the other were used in developing the respective institutional nomograms. For each hospital’s data set, both age and initial serum creatinine were significantly associated with the predicted dosing interval (p < 0.001). Validation in a total of 105 test patients showed that the integrated nomogram had a predictive success rate of 56%. Conclusions: A novel vancomycin dosing nomogram was developed and validated at 2 Canadian teaching hospitals. This integrated nomogram is a tool that clinicians can use in selecting appropriate initial vancomycin regimens on the basis of age and serum creatinine, to achieve high-target levels of 15–20 mg/L. The nomogram should not replace clinical judgment for patients with unstable and/or reduced renal function.
Thalakada, Rosanne; Legal, Michael; Lau, Tim T Y; Luey, Tiffany; Batterink, Josh; Ensom, Mary H H
This article provides an introduction to the use of students' business skills in optimizing teaching opportunities, student learning, and client satisfaction in a primary health care setting at a veterinary teaching hospital. Seven veterinary-student members of the local chapter of the Veterinary Business Management Association (VBMA) evaluated the primary-care service at the University of Georgia (UGA) veterinary teaching hospital and assessed six areas of focus: (1) branding and marketing, (2) client experience, (3) staff and staffing, (4) student experience, (5) time management, and (6) standard operating procedures and protocols. For each area of focus, strengths, weaknesses, opportunities, and threats were identified. Of the six areas, two were identified as areas in need of immediate improvement, the first being the updating of standard operating protocols and the second being time management and the flow of appointments. Recommendations made for these two areas were implemented. Overall, the staff and students provided positive feedback on the recommended changes. Through such a student-centered approach to improving the quality of their education, students are empowered and are held accountable for their learning environment. The fact that the VBMA functions without a parent organization and that the primary-care service at UGA functions primarily as a separate entity from the specialty services at the College of Veterinary Medicine allowed students to have a direct impact on their learning environment. We hope that this model for advancing business education will be studied and promoted to benefit both veterinary education and business practice within academia. PMID:24531532
Poon, W Y Louisa; Covington, Jennifer P; Dempsey, Lauren S; Goetgeluck, Scott L; Marscher, William F; Morelli, Sierra C; Powell, Jana E; Rivers, Elizabeth M; Roth, Ira G
Problem In-hospital cardiac arrest often represents failure of optimal clinical care. The use of medical emergency teams to prevent such events is controversial. In-hospital cardiac arrests have been reduced in several single centre historical control studies, but the only randomised prospective study showed no such benefit. In our hospital an important problem was failure to call the medical emergency team
Michael Buist; Julia Harrison; Ellie Abaloz; Susan Van Dyke
Background Information about antibiotic use and resistance patterns of common microorganisms are lacking in hospitals in Western Nepal. Excessive and inappropriate use of antibiotics contributes to the development of bacterial resistance. The parameter: Defined daily dose/100 bed-days, provides an estimate of consumption of drugs among hospital in-patients. This study was carried out to collect relevant demographic information, antibiotic prescribing patterns and the common organisms isolated including their antibiotic sensitivity patterns. Methods The study was carried out over a 3-month period (01.04.2002 to 30.06.2002) at the Manipal Teaching Hospital, Western Nepal. The median number of days of hospitalization and mean ± SD cost of antibiotics prescribed during hospital stay were calculated. The use of antibiotics was classified for prophylaxis, bacteriologically proven infection or non-bacteriologically proven infection. Sensitivity patterns of the common organisms were determined. Defined daily dose/100 bed-days of the ten most commonly prescribed antibiotics were calculated. Results 203 patients were prescribed antibiotics; 112 were male. Median duration of hospitalization was 5 days. 347 antibiotics were prescribed. The most common were ampicillin, amoxicillin, metronidazole, ciprofloxacin and benzylpenicillin. Mean ± SD cost of antibiotics was 16.5 ± 13.4 US$. Culture and sensitivity testing was carried out in 141 patients. The common organisms isolated were H. influenzae, E. coli, K. pneumoniae and S. aureus. Conclusions Antibiotic resistance is becoming a problem in the Internal Medicine ward. Formulation of a policy for hospital antibiotic use and an educational programme especially for junior doctors is required.
Shankar, Ravi Pathiyil; Partha, Praveen; Shenoy, Nagesh Kumar; Easow, Joshy Maducolil; Brahmadathan, Kottallur Narayanan
Objectives To date, experiences of leaders in the implementation of Lean after a Lean Training Programme have not been systematically investigated within teaching hospitals. Existing studies have identified barriers and facilitators only from an improvement programme perspective and have not considered the experiences of leaders themselves. This study aims to bridge this gap. Design Semistructured, indepth interviews. Setting One of largest teaching hospitals in the Netherlands. Participants 31 medical, surgical and nursing professionals with an average of 19.2?years of supervisory experience. All professionals were appointed to a Lean Training Programme and were directly involved in the implementation of Lean. Results The evidence obtained in this study shows that, from the perspectives of participants, leadership management support, a continuous learning environment and cross-departmental cooperation play a significant role in successful Lean implementation. The results suggest that a Lean Training Programme contributed to positive outcomes in personal and professional skills that were evident during the first 4?months after programme completion. Conclusions Implementing Lean in a teaching hospital setting is a challenge because of the ambiguous and complex environment of a highly professionalised organisation. The study found that leadership management support and a continuous learning environment are important facilitators of Lean implementation. To increase the successful outcomes of leadership actions, training should be supplemented with actions to remove perceived barriers. This requires the involvement of all professionals, the crossing of departmental boundaries and a focus on meaning-making processes rather than simply ‘implementing’ facts. Therefore, this research suggests that programme participants, such as staff members and leaders, can mutually explore the meanings of Lean thinking and working for their own contexts. By entering this shared learning process (eg, learning on the job) the ownership of Lean implementation could also increase.
Aij, Kjeld Harald; Simons, Frederique Elisabeth; Widdershoven, Guy A M; Visse, Merel
Background Previous studies of anti-hypertensive medicines utilization pattern in Nigeria showed that Angiotensin converting enzyme inhibitors (ACEIs) were often the least prescribed. However, the appropriate use of ACEIs in the black population achieves good blood pressure control and provides additional long term cardio- and renovascular protection benefits. Objective To assess the current utilization pattern of antihypertensive medicines with specific emphasis on identifying possible shift in the frequency of use of ACEIs. Methods A prospective cross-sectional assessment of the current utilization pattern of anti-hypertensive medicines was conducted among 300 randomly selected cohort at a 900-bed premier Teaching Hospital located in Ibadan, Southwestern Nigeria. The current utilization pattern was compared with the results of a study conducted at the same site and published 10 years ago. Results Of the 300 random cohorts, a majority (79%) were females (237) with mean age 58.7 years (SD=2.81 years. Stage 2 hypertension was the most frequent diagnosis (54.3%). The utilization of ACEIs and long acting CCB (amlodipine) significantly increased from 8.6% and 21% (Ten years ago) to 29.93% and 36.68% respectively (p < 0.0001). The use of thiazide diuretic and methyldopa declined significantly from 39.4% and 23.3% (Ten years ago) to 16.12% and 9.7% respectively (p < 0.0001). Adverse drug reactions due to ACEIs were documented in 1.5% (3), while laboratory monitoring of serum potassium, urea and creatinine was conducted in only 37% (111) of cohort. Potentially harmful drug-drug interactions were identified in 25% (75) of cohorts, and the most frequent were ACEIs + NSAIDs (53.3%), ACEIs + amiloride / hydrochlorothiazide (22.6%). Conclusions Anti-hypertensive medicines utilization has significantly shifted towards the increased use of ACEIs and long acting dihydropyridine CCBs. The use of thiazides and methyldopa has declined significantly. Physicians appeared more cognizant of the long term cardio- and renovascular benefits inherent in using ACEIs in a high cardiovascular risk group such as black hypertensive.
Eshiet, Unyime I.; Yusuff, Kazeem B.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common human enzyme deficiencies in the world. It is particularly common in populations living in malaria-endemic areas, affecting more than 400 million people worldwide. This present study was conducted with the aim of determining the prevalence of G6PD deficiency among children visiting the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital for pediatric-related care. The study included 118 children, made up of 77 (65.3%) males and 41 (34.7%) females aged ?5 years with mean age of 3.26 ± 1.90 years. Randox G6PD quantitative in vitro test screening was used for the diagnosis of G6PD deficiency. Of the 118 children tested, 17 (14.4%) were G6PD-deficient. Prevalence of G6PD deficiency was concentrated predominantly among male children (22.1%). Male sex was significantly correlated with G6PD deficiency among the children studied (r = 7.85, P = 0.01). The highest prevalence occurred among children in the 2- to 5-year age-group. Of the 17 G6PD-deficient children, twelve (70.2%) were moderately deficient, while five (29.4%) were severely deficient. Blood film from G6PD-deficient children indicated the following morphological changes; Heinz bodies, schistocytes, target cells, nucleated red cells, spherocytes, and polychromasia. This present study has shown a high prevalence of G6PD deficiency among children residing in Sokoto in the northwestern geopolitical zone of Nigeria. The study indicated a male sex bias in the prevalence of G6PD deficiency among the children studied. There is a need for the routine screening of children for G6PD deficiency in our environment, to allow for evidence-based management of these children and to ensure the avoidance of food, drugs, and infective agents that can potentially predispose these children to oxidative stress as well as diseases that deplete micronutrients that protect against oxidative stress. There is need to build capacity in our setting among pediatricians to ensure the effective management of children with G6PD deficiency.
Isaac, IZ; Mainasara, AS; Erhabor, Osaro; Omojuyigbe, ST; Dallatu, MK; Bilbis, LS; Adias, TC
IntroductionThere are scarce descriptions of hospital drug procurement in the primary literature. The aim of this study was to analyse the drug tender led by a clinical pharmacologist in a 1200-bed university hospital in Serbia, a developing country in socio-economic transition, and to give recommendations for future steps in hospital drug policy.Procedure and outcomesDrug tendering was conducted according to the
Dragan R. Milovanovic; Radomir Pavlovic; Miroslav Folic; Slobodan M. Jankovic
Transcranial Doppler ultrasound scan is a noninvasive method of evaluating the major intracranial vessels. It is becoming an important screening tool for predicting high-risk sickle cell patients for developing cerebrovascular disease. This study evaluates the patients' characteristics, common indications, and findings on Doppler ultrasound of the middle cerebral arteries of sickle cell patients performed at Aminu Kano Teaching Hospital, Kano, Nigeria.This is a preliminary report of an ongoing review of the transcranial Doppler scans done at Aminu Kano Teaching Hospital. The records of all patients, the indications for Doppler examination, and major findings on the middle cerebral arteries were documented.There are 60 patients, consisting of 22 males and 38 females. Their ages ranged from 1.0 to 41.0 years, with mean of 11.58 ± 7.30 years. About a third of the patients were asymptomatic (38.3%). Those with headache constituted 20.0%, whereas those with past cerebral syndrome constituted 8.3%. Other indications include stroke (11.67%) and transient ischemic attack (3.3%).The mean peak systolic velocity of the middle cerebral artery measured 204.8 cm/s (±80 cm/s) and 208.8 (±79 cm/s) on the respective right and left side. This right-to-left difference was statistically significant (P = 0.046). Symptomatic and female patients showed higher mean peak systolic velocity values when compared with males, although the difference was not statistically significant. PMID:23370781
Tabari, Abdulkadir M; Ismail, Anas
Objective: This study was designed to determine the frequency and causative agent(s) of urinary tract infections (UTIs) in individuals with symptoms of urinary tract infections in Enugu State of Southeast Nigeria, and to determine the antibiotic susceptibility pattern of microbial agents isolated from urine culture. Methods: The study involved 211 individuals (149 females and 62 males) clinically suspected for UTI. Urine samples were collected by the mid-stream ‘clean catch’ method and tested using standard procedures. Antibiotic susceptibility of the isolated pathogens was tested using the Kirby-Bauer technique according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Microscopy of centrifuged urine samples showed 16 patients had pyuria while 54 had pus cells. Calcium oxalate crystals were found in 14 samples. Urinalysis performed with urine samples showed 17 had protein; seven were nitrite positive and three had moderate to high glucose concentration. Fifty-four urine samples (36.2%) from females and 12 (19.4%) from males showed significant growth upon culture. Gram stain and biochemical tests identified nine different organisms with Escherichia coli as the most common isolated species. Forty three randomly selected strains were further tested for their susceptibility against a panel of antibiotics. Thirty isolates (81.08%) were resistant to four or more antibiotics with the highest resistance shown by E. coli (76.67%). All the Gram- negative isolates were resistant to Ampicilox, Cefuroxime and Amoxicillin. Conclusion: Urinary tract infections were found more in females in the area under study. As found in other studies, E. coli was the most predominant isolate, although other organisms seem to be on the increase.
Dibua, Uju M.E.; Onyemerela, Ifeoma S.; Nweze, Emeka I.
The use of antimicrobial agents in poultry production results in their accumulation in the body tissues and products such as milk and egg. The subsequent accumulation of these drugs and their metabolites in body cells is known as drug residue. This study was designed to determine the prevalence of antimicrobial residues in eggs from poultry farms and retail outlets in Enugu State, Nigeria. Eggs from 25 selected commercial farms and ten retail outlets were screened for the prevalence of antimicrobial residue. Also, structured questionnaires were administered to 25 commercial farms in the state to determine the management practices and the most widely used antimicrobial drugs in farms and possible association between the management practices and the occurrence of antimicrobial residues in eggs from these farms. All the 25 farms surveyed use oxytetracycline. Eggs from nine of the surveyed farms tested positive for antimicrobial residue and three of the ten surveyed farms also tested positive for antimicrobial residue. No association was observed (p?0.05; Fisher's exact test) between the occurrence of antibiotic residues in eggs and farm size, feed source and housing systems. This study was able to demonstrate the presence of antimicrobial residues in eggs destined for human consumption. Drugs like nitrofurans which has been banned for use in food animals are still very much in use in Enugu State, Nigeria. Antibiotics given as feed additives may give rise to drug residues in food animals. PMID:21104128
Ezenduka, Ekene V; Oboegbulem, Steve I; Nwanta, John A; Onunkwo, Joseph I
BACKGROUND: Pain is under-recognised and undertreated. Although standards now exist for pain management, it is not known if this has improved care of hospitalized children. OBJECTIVES: To benchmark pain prevalence, pain intensity, pain assessment documentation and pharmacological treatment of pain. The aim was to highlight areas of good practice, identify areas for improvement and inform development of hospital standards, education, future audits and the research agenda. METHODS: The present prospective cross-sectional survey of all medical and surgical inpatient units took place on a single day at the Hospital for Sick Children (Toronto, Ontario), a Canadian tertiary and quaternary pediatric hospital. A structured, verbally administered questionnaire was used to obtain information on patient demographics, pain before admission, pain intensity during admission and pain treatment. Charts were reviewed to establish frequency of documented pain assessment, the pain assessment tool used and analgesics given. Subgroup analysis was included for age, sex, visible minority or fluency in English, medical versus surgical services and acute pain service input. RESULTS AND CONCLUSIONS: Two hundred forty-one (83%) of the 290 inpatients or their carergivers were interviewed. It was found that 27% of patients usually had pain before admission, and 77% experienced pain during admission. Of these, 23% had moderate or severe pain at interview and 64% had moderate or severe pain sometime in the previous 24 h. Analgesics were largely intermittent and single-agent, although 90% of patients found these helpful. Fifty-eight per cent of those with pain received analgesics in the preceding 24 h but only 25% received regular analgesia. Only 27% of children had any pain score documented in the preceding 24 h. It was concluded that pain was infrequently assessed, yet occurred commonly across all age groups and services and was often moderate or severe. Although effective, analgesic therapy was largely single-agent and intermittent. Widespread dissemination of results to all professional groups has resulted in the development of a continuous quality assurance program for pain at the Hospital for Sick Children. A re-audit is planned to evaluate changes resulting from the new comprehensive pain strategies.
Taylor, Elsa M; Boyer, Kristina; Campbell, Fiona A
Limited resources and capacity constraints force Ben Taub General Hospital (BTGH) to optimize patient throughput in order to minimize Emergency Center overcrowding and ambulance diversions. The purpose of this study was to identify impeding systematic del...
S. E. Elarton
Background Hospitals have a role to play in supporting, protecting and promoting breastfeeding. The aim of this study was to describe hospital breastfeeding policy and practices and breastfeeding rates among mothers attending General Paediatric Outpatient Clinic at a tertiary hospital in Lagos, Nigeria. Methods This was a cross-sectional study involving paediatric nurses and doctors, as well as the mothers who brought their child to the General Paediatric Outpatient Clinic. Two sets of questionnaires, different in content, were administered to doctors and nurses, and to mothers of children aged 6-24 months, to assess hospital policy and breastfeeding rates, respectively. Stepwise multiple logistic regression analysis was used to examine factors associated with duration of breastfeeding. Results Although the hospital had a written breastfeeding policy copies of the policy were not clearly displayed in any of the units in the Paediatric department. Almost half the staff (48%; 60/125) were not aware of the policy. The hospital had no breastfeeding support group. Nearly three quarters (92/125) of the staff had received lactation management training. 36% (112/311) of mothers exclusively breastfed for six months, 42% (129/311) had stopped breastfeeding at the time of the survey. 67% (207/311) of babies were given infant formula, 85% (175/207) before 6 months. Women who had antenatal care in private hospitals and were Christian were more likely to breastfeed exclusively for 6 months. Low maternal education was the only factor associated with breastfeeding longer than 12 months. Conclusion Breastfeeding practices and policy implementation at this outpatient clinic were suboptimal. We have identified a need for interventions to increase knowledge of the benefits of breastfeeding and to provide support for its longer term duration. We suggest that BFHI be considered across all facilities concerned with infant and early child health to disseminate appropriate information and promote an increase in exclusive breastfeeding for six months as well as the duration of breastfeeding.
Hazardous health-care waste poses a great danger to public health and the environment if it is not properly managed. There is need for health-care workers involved in its management to understand the integral link between human health and environmental health. This study was done to identify gaps in knowledge, attitude and practice among the healthcare workers involved in its management hence endangering public health and polluting the environment. A self administered questionnaire was used in both Kenyatta National Hospital, Nairobi and Moi Teaching and Referral Hospital, Eldoret to clinicians, nurses, laboratory technologists and hospital attendants to identify the gaps with a focus on their knowledge, attitude and practice. It was found that health and safety in health-care waste management, was not included in most of the curricula for training the three healthcare professionals. Most of them acquired this through on-job training from seminars and informally through organized talks at work-places. The hospital attendants had also an opportunity to acquire the knowledge through organized training at work places. The training improved the workers' compliance to hepatitis B vaccinations and use of personal protective equipment when handling health-care waste. There was also reduction on injuries from health-care waste. This study therefore concludes that it is necessary for healthcare workers training curricula to include health and safety issues while managing hazardous health-care waste as well as establishes the need for healthcare institutions to conduct continuing education on health and safety in the management of health-care waste. PMID:22752531
Nkonge Njagi, A; Mayabi Oloo, A; Kithinji, J; Magambo Kithinji, J
Ceftazidime-avibactam, aztreonam-avibactam, and comparators were tested by reference broth microdilution against 372 nonrepetitive Gram-negative bacilli (346 unselected plus 26 selected meropenem-nonsusceptible Enterobacteriaceae isolates) collected from 11 teaching hospitals in China in 2011 and 2012. Meropenem-nonsusceptible isolates produced extended-spectrum ?-lactamases (ESBLs; e.g., CTX-M-14/3), AmpCs (e.g., CMY-2), and/or carbapenemases (e.g., KPC-2 and NDM-1). Avibactam potentiated the activity of ceftazidime against organisms with combinations of ESBLs, AmpCs, and KPC-2. Aztreonam-avibactam was active against all ?-lactamase producers (including producers of NDM-1 and IMP-4/8) except blaOXA-containing Acinetobacter baumannii and some Pseudomonas aeruginosa isolates. PMID:24342639
Wang, Xiaojuan; Zhang, Feifei; Zhao, Chunjiang; Wang, Zhanwei; Nichols, Wright W; Testa, Raymond; Li, Henan; Chen, Hongbin; He, Wenqiang; Wang, Qi; Wang, Hui
The clinical performance of 832 resin-retained bridges and splints provided in the adult fixed prosthodontic clinic of a post-graduate teaching hospital was reviewed. Recall data was available for 58.4% of cases and the median survival was 7 years and 10 months. Analysis of clinical variables influencing survival revealed that the design and retainer coverage were significant factors. The experience of the operator carrying out treatment also had a pronounced effect which was not readily explained in terms of the distribution of other significant factors. Resin-retained restorations made with minimal tooth preparation are shown to be capable of extended clinical service and their failure rarely resulted in adverse consequences for the patient. Patient satisfaction with their treatment was reportedly high. PMID:10232858
Djemal, S; Setchell, D; King, P; Wickens, J
This prospective study was conducted at a tertiary care teaching hospital in South India over a period of 7 years and included 90 patients with incisional hernia (n?=?90; 76 females and 14 males), operated over 2 years (January 2004 to December 2005), and followed-up for 5 years postoperatively (2005-2009). As per the surgical unit preference, patients underwent different methods of hernia repair-onlay mesh repair (n?=?45, 50 %), underlay mesh repair (n?=?18, 20 %), and anatomical repair (i.e., without mesh) (n?=?27, 30 %). Parameters studied included seroma formation, wound infection, postoperative pain, and hernia recurrence. Although the first two parameters were statistically not significant, postoperative pain was found to be more in patients who underwent an underlay repair. A significant difference in the hernia recurrence rate was observed between mesh repair and anatomical repair groups. Hence, we conclude that all incisional hernias should be repaired with a mesh (meshplasty). PMID:24426451
Kumar, Vikram; Rodrigues, Gabriel; Ravi, Chandni; Kumar, Sampath
Background The Community Directed Interventions (CDI) strategy has proven effective in increasing access to health services in sedentary populations. It remains to be seen if CDI strategy is feasible among nomads given the dearth of demographic and medical data on the nomads. This study thus characterized the nomadic populations in Enugu State, Nigeria and outlined the potentials of implementing CDI among nomads. Study design and methods This exploratory study adopted qualitative methods. Forty focus group discussions (FGD) were held with members of 10 nomadic camps in 2 LGAs in Enugu State, as well as their host communities. Thirty in-depth interviews (IDIs) were held with leaders of nomadic camps and sedentary populations. Ten IDIs with traditional healers in the nomadic camps and 14 key informant interviews with health workers and programme officers were also conducted. Documents and maps were reviewed to ascertain the grazing routes of the nomads as well as existing health interventions in the area. Results Like sedentary populations, nomads have definable community structures with leaders and followers, which is amenable to implementation of CDI. Nomads move their cattle, in a definite pattern, in search of grass and water. In this movement, the old and vulnerable are left in the camps. The nomads suffer from immunization preventable health problems as their host communities. The priority health problems in relation to CDI include malaria, measles, anemia, and other vaccine preventable infections. However, unlike the sedentary populations, the nomads lack access to health interventions, due to the mutual avoidance between the nomads and the sedentary populations in terms of health services. The later consider the services as mainly theirs. The nomads, however, are desirous of the modern health services and often task themselves to access these modern health services in private for profit health facilities when the need arises. Conclusion Given the definable organizational structure of the nomads in Enugu State and their desire for modern health intervention, it is feasible to test the CDI strategy for equitable healthcare delivery among nomads. They are willing and capable to participate actively in their own health programmes with minimal support from professional health workers.
Analysis of direct costs to teach a 10-week Introduction to Clinical Medicine course to 26 students in the spring of 1995 found that attending physicians worked a total of 736.5 hours, for a cost of $37,303; residents worked 314 hours, at a cost of $4,396; and miscellaneous costs totaled $2,019. The per-student cost was $1,681. (Author/MSE)
Tai, Lee W.; Tulley, John E.
This study examines the relationship between hospital structural characteristics and patient satisfaction with hospital care. Teaching hospitals and private hospitals were expected to receive higher ratings of patient satisfaction than were nonteaching and government-controlled hospitals, because they generally are reputed to be technologically superior. Results show that, in general, most patients are satisfied with their hospital stays, but they are clearly more dissatisfied with their stays in teaching hospitals. Although a number of other correlates of patient satisfaction with the hospital stay are identified, no measure succeeds in reducing to insignificance the strong relationship between teaching status and dissatisfaction. Some suggestions are made as to why teaching hospital receive relatively poor evaluations from their patients.
Fleming, G V
The apparent prevalence of endoparasitic infections of cats and dogs presented to the small animal Veterinary Hospital of the University of Pennsylvania was measured between 1984 and 1991. Two thousand feline and 8077 canine fecal samples were examined along with 6830 canine blood samples. The overall mean monthly prevalence of feline infections was 16% for ascarids, 0.9% for hookworms, 4.0%
Thomas J. Nolan; Gary Smith
The study sought to describe the quality-of-life impairments in newly diagnosed HIV/AIDS-infected adult patients with cutaneous lesions. This was a hospital-based, cross-sectional, descriptive study of 160 newly diagnosed HIV/AIDS-infected adult patients attending the HIV/AIDS clinic of University of Ilorin Teaching Hospital (UITH). Systemic random sampling technique was used in recruiting respondents for the study. The Dermatology Life Quality Index (DLQI) was used to gauge the quality-of-life impairments. The study showed high prevalence of cutaneous lesions in HIV/AIDS-infected patients. Majority of the respondents (83.7%) scored more than 10 in DLQI score. This signifies that the skin lesions had large negative effects on their quality of life. The assessment of the impact of dermatoses on patients' quality of life is important for clinical management. It is pertinent to detect patients at higher risk of experiencing worse quality of life in order to treat them holistically. PMID:23771869
Shittu, R O; Odeigah, L O; Mahmoud, Abdulraheem O; Sani, M A; Bolarinwa, O A
International study on antidepressant prescription pattern at 20 teaching hospitals and major psychiatric institutions in East Asia: Analysis of 1898 cases from China, Japan, Korea, Singapore and Taiwan.
The purpose of the present study was to review the prescription patterns of antidepressants in different countries in East Asia. The survey was conducted in China, Japan, Korea, Singapore and Taiwan from October 2003 to March 2004 using the unified research protocol and questionnaire. Twenty teaching hospitals and major psychiatric hospitals participated and a total of 1898 patients receiving antidepressants were analyzed. The survey provided a number of interesting characteristics on the prescription patterns of antidepressant in East Asia. Out of 56 antidepressants listed in the Anatomical Therapeutic Chemical Classification (ATC) index by the World Health Organization (WHO) Collaborating Center for Drug Statistics Methodology (Oslo), only 26 antidepressants were prescribed in participating countries in East Asia. On average 38.4% of prescriptions of antidepressants were for patients with diagnoses other than depressive disorders. The availability and commonly prescribed antidepressants varied greatly by country. The selective serotonin re-uptake inhibitors (SSRI) and other newer antidepressants were prescribed in approximately 77.0% of all cases. At the time of the survey, only two SSRI medications were available in Japan. However, five types of SSRI were available and were often prescribed in Korea. PMID:17875031
Uchida, Naoki; Chong, Mian-Yoon; Tan, Chay Hoon; Nagai, Hiroshi; Tanaka, Mariko; Lee, Min-Soo; Fujii, Senta; Yang, Shu-Yu; Si, Tainmei; Sim, Kang; Wei, Hao; Ling, He Yan; Nishimura, Ryoji; Kawaguchi, Yoshichika; Edwards, Glen; Sartorius, Norman; Shinfuku, Naotaka
The aim of this study was to assess the extent of poly-pharmacy, occurrence, and associated factors for the occurrence of drug–drug interaction (DDI) and potential adverse drug reaction (ADR) in Gondar University Teaching Referral Hospital. Institutional-based retrospective cross-sectional study. This study was conducted on prescriptions of both in and out-patients for a period of 3 months at Gondar University Hospital. Both bivariate analysis and multivariate logistic regression were used to identify risk factors for the occurrence of DDI and possible ADRs. All the statistical calculations were performed using SPSS® software. A total of 12,334 prescriptions were dispensed during the study period of which, 2,180 prescriptions were containing two or more drugs per prescription. A total of 21,210 drugs were prescribed and the average number of drugs per prescription was 1.72. Occurrences of DDI of all categories (Major, Moderate, and Minor) were analyzed and DDI were detected in 711 (32.6%) prescriptions. Sex was not found to be a risk factor for the occurrence of DDI and ADR, while age and number of medications per prescription were found to be significant risk factors for the occurrence of DDI and ADR. The mean number of drugs per prescription was 1.72 and hence with regard to the WHO limit of drugs per prescription, Gondar hospital was able to maintain the limit and prescriptions containing multiple drugs supposed to be taken systemically. Numbers of drugs per prescription as well as older age were found to be predisposing factors for the occurrence of DDI and potential ADRs while sex was not a risk factor.
Admassie, Endalkachew; Melese, Tesfahun; Mequanent, Woldeselassie; Hailu, Wubshet; Srikanth, B Akshaya
A prospective observational study was conducted at a multi-disciplinary, super-specialty corporate hospital. The total study population was 268, in the group of patients suffering from generalized tonic-clonic seizures, sodium valproate was the most frequently prescribed AED(Anti-Epileptic Drugs), followed by carbamazepine and phenytoin. In generalized tonic seizures, sodium valproate was commonly prescribed followed by carbamazepine, topiramate, oxcarbazepine and clobazam. In generalized
K. S. G. ArulKumaran; S. Palanisamy; A. Rajasekaran
In the wake of the devastation Sandy wreaked along the Atlantic Coast, some hospitals were forced to close. But others took on new roles, whether as makeshift phone-charging stations or dealing with healthcare needs patients usually turned to outpatient centers for. "The biggest challenge is making up for the other services that are not available in the community," says Steven Littleson, of Jersey Shore University Medical Center. PMID:23198308
Evans, Melanie; Carlson, Joe; Barr, Paul; Kutscher, Beth; Zigmond, Jessica
Objective To determine the prevalence, clinical significance and the associated risk factors of potential drug-drug interactions (DDIs) at internal medicine ward of University of Gondar (UOG) hospital. Method A prospective cross-sectional study was conducted on patients treated in internal medicine ward of UOG hospital from April 29, 2013 to June 2, 2013. Data was collected from medical records and by interviewing the patients face to face. Descriptive analysis was conducted for back ground characteristics and logistic regression was used to determine the associated risk factors. Result In our study, we have identified a total number of 413 potential DDIs and 184 types of interacting combinations with 4.13 potential DDIs per patient. Among 413 potential DDIs most were of moderate interactions 61.2% (n=253) followed by 26% (n=107) of minor interactions and 12.8% (n=53) of major interactions. There was significant association of occurrence of potential DDIs only with taking three or more medications. Conclusion We have recorded a high rate of prevalence of potential DDI in the internal medicine ward of UOG hospital and a high number of clinically significant DDIs which the most prevalent DDI were of moderate severity. Careful selection of drugs and active pharmaceutical care is encouraged in order to avoid negative consequences of these interactions.
Bhagavathula, Akshaya Srikanth; Berhanie, Alemayehu; Tigistu, Habtamu; Abraham, Yishak; Getachew, Yosheph; Khan, Tahir Mehmood; Unakal, Chandrashekhar
Background: Among natural calamities Earthquakes are more devastating, as much of the life and property is affected. Methods: The study was carried- out in Accident & Emergency Department of SKIMS, to determine personnel and medical profile of earthquake victims of October 2005, when the state was rattled by a major tremor. Data was obtained from Accident & Emergency Department. Total no of patients Admitted were 166, which were followed from admission to discharge/Death. Each patient was subjected to a pretested questionnaire indicating age, sex, rural/urban distribution, Glasgow coma score, out come of treatment and referral to other care facility. Results: The study revealed that children were mostly affected, being the valnerable group. Most of the patients had head and bone injuries. 143 patients out of 166 patients had a Glasgow coma score of 15. Only 9 patients died. The reason for better end result was because of initial first Aid, Rapid transportatation to Hospital and prompt treatment in the Hospital. Conclusion: As Jammu and Kashmir falls in seismic zone 5, it needs a central trauma centre, having all the specialties and sub specialties under one roof. This will save precious time, as cross referral to other hospitals will not be needed
Yatoto, GH; Syed, AT; Rangrez, RA; Singh, Dara
This paper describes management by objectives (MBO) as an approach by which organisations can be managed, with particular reference to health care institutions. An evaluation of MBO is presented and the disadvantages of MBO are discussed. A more comprehensive performance management system than MBO is advocated. The experience of St Vincent's Hospital, Sydney, in designing and implementing a goal-directed performance management program which builds on MBO methodology, is described. This experience provides guidelines by which senior managers may successfully implement goal-directed performance management programs in health care institutions in order to enhance organisational effectiveness and the goal-oriented behaviour of managers. PMID:10116921
Braithwaite, J; Westbrook, J I; Lansbury, R D
Objective To investigate the infection of hospital- and community-acquired “erythromycin-induced clindamycin resistant” strains or D-test positives of clinical isolates of Staphylococcus aureus (S. aureus) (with and without methicillin resistance) in a hospital. Methods Strains of S. aureus isolated from clinical specimens were subjected to D-test and antibiotic profiling. Results Of the total 278 isolates, 140 (50.35%) were D-test positives and the rest were D-test negatives. Further, of 140 (100%) positives, 87 (62.14%) and 53 (37.85%) strains were from males and females, respectively. Of 140 (100%) positives, 117 (83.57%) were methicillin resistant S. aureus and 23 (16.42%) were methicillin sensitive S. aureus; of 140 strains, 103 (73.57%) strains from persons with and 37 (26.42%) were without related infections; of 140 strains, 91 (65%) and 49 (35%) were from hospital- and community-acquired samples, respectively. In 140 strains, 118 (84.28%) with comorbidities and 22 (15.71%) without comorbidities cases were recorded; similarly, persons with prior antibiotic uses contributed 108 (77.14%) and without 32 (22.85%) positive strains. These binary data of surveillance were analyzed by a univariate analysis. It was evident that the prior antibiotic uses and comorbidities due to other ailments were the determinative factors in D-test positivity, corroborated by low P values, P=0.001?1 and 0.002?4, respectively. All isolates (278) were resistant to 17 antibiotics of nine groups, in varying degrees; the minimum of 28% resistance for vancomycin and the maximum of 97% resistance for gentamicin were recorded. Further, of 278 strains, only 42 (15.1%) strains were resistant constitutively to both antibiotics, erythromycin resistant and clindamycin resistant, while 45 (16.2%) strains were constitutively sensitive to both antibiotics (erythromycin sensitive and clindamycin sensitive). Further, of the rest 191 (68.7%) strains were with erythromycin resistant and clindamycin resistant, of which only 140 (50.35%) strains were D-test positives, while the rest 51 (18.34%) strains were D-test negatives. Conclusions In view of high prevalence of D-test positive S. aureus strains, and equally high prevalence of multidrug resistant strains both in community and hospital sectors, undertaking of D-test may be routinely conducted for suppurative infections.
Dubey, Debasmita; Rath, Shakti; Sahu, Mahesh C.; Rout, Subhrajita; Debata, Nagen K.; Padhy, Rabindra N.
Acinetobacter spp. is a known nosocomial pathogen causing a wide range of clinical diseases mainly pneumonia, wound infections and blood stream infections (BSI). A cross sectional descriptive study was performed to determine the prevalence of Acinetobacter infection in Hospital Universiti Sains Malaysia, Kelantan (HUSM). The risk factors of Acinetobacter BSI were determined by 1:1 case control analytical study, involving fifty-eight confirmed cases of Acinetobacter BSI patients compared to the cases caused by Gram-negative bacteria. The prevalence of Acinetobacter BSI in the HUSM was 6.11% (95% CI 4.88-7.53%). The attack rate of Acinetobacter BSI was 2.77 episodes per 1000 hospital admissions. Acinetobacter BSI patients were mostly located in intensive care unit and had a longer intensive care unit stay. In univariate analysis, the risk factors for Acinetobacter BSI include prior exposure to antimicrobial agents such as penicillins, aminoglycosides and cephalosporins, mechanical ventilation, presence of nasogastric tube, arterial catheter and urinary catheter. In multivariate analysis, the independent risk factors for Acinetobacter BSI were prior treatment with cephalosporins (OR 3.836 95% CI 1.657-8.881 p=0.002) and mechanical ventilation (OR 3.164 95% CI 1.353-7.397 p=0.008). This study revealed that rational use of antimicrobial agents is of paramount importance to control Acinetobacter BSI. PMID:19901898
Deris, Zakuan Zainy; Harun, Azian; Omar, Mahamarowi; Johari, Md Radzi
Background Pneumococcal vertebral osteomyelitis (PVO) is a rare disease whose clinical characteristics have not been clarified. This study aimed to investigate the clinical features and outcomes of patients with PVO. Methods We retrospectively evaluated all adult patients diagnosed with PVO at three teaching hospitals in Japan from January 2003 to December 2011. All cases were identified through a review of the medical records of patients with invasive pneumococcal disease (IPD). Results Among 208 patients with IPD, we identified 14 with PVO (6.4%; 95% CI, 3.5–10%). All 14 patients (nine male, five female; median age 69 years) had acquired PVO outside the hospital and had no recent history of an invasive procedure or back injury. Five patients (36%) had diabetes mellitus, and four (29%) had heavy alcohol intake. Fever (n?=?13; 93%) or back pain/neck pain (n?=?12; 86%) were present in most patients. The lumbar spine was affected in nine patients (64%) but the cervical spine was the site of infection in four patients (29%). All patients except one had a positive blood culture for Streptococcus pneumoniae, and there were no distant infected sites in most patients (n?=?10; 71%). Intravenous beta-lactam therapy was initiated within 1 week after the onset of symptoms in 11 patients (79%). No patients died within 30 days, but one patient died from aspiration pneumonia on day 37 after admission. Conclusions PVO was relatively common among adult patients with IPD, and mortality was low in this study. S. pneumoniae may be the causative pathogen of vertebral osteomyelitis, especially among community-onset cases without a history of invasive procedures or back injury.
Nigeria has the highest population of sickle cell anemia (SCA) patients in the whole world. This condition manifests with frequent episodes of aches and pains, recurrent infections, and frequent hospitalization. Prenatal screening is one of the methods of reducing the prevalence of this disease. The study aimed to determine the awareness and acceptability of prenatal screening for SCA among health professionals and students at the Lagos University Teaching Hospital. It was a descriptive and cross-sectional study carried out between August and September 2006, involving 403 health professionals and students using structured questionnaires. The study revealed that 91.3% of the respondents had heard about prenatal screening for SCA, whereas 8.7% of the respondents had not. In addition, the majority of the respondents (75.3%) knew that SCA can be prevented by prenatal screening for SCA, whereas 13.7% and 11.3% were not aware or not sure, respectively. Up to 48.2% of the respondents were not aware that prenatal screening for SCA is available in Nigeria with the nurses being the least aware (?=11.9, P=0.00). 42.1% of the respondents will not allow preventive termination of pregnancy if prenatal screening confirms SCA. For those who will not allow preventive termination, up to 79% of them decided on the basis of their religious beliefs. There is a poor level of awareness of the availability of prenatal screening services in Nigeria among health workers in Lagos, and religion is a major factor militating against its acceptability. PMID:22538322
Adeola Animasahun, Barakat; Nwodo, Urowoli; Njokanma, Olisamedu Fidelis
Background Nontyphoidal Salmonella (NTS) species are important food-borne pathogens that cause gastroenteritis and bacteremia, and are responsible for a huge global burden of morbidity and mortality. The aim of this study was to investigate the prevalent serogroups and antibiotic resistance of NTS in our region. Methods We reviewed the serogroup distribution and antimicrobial susceptibility patterns of NTS strains obtained from 158 stool specimens of patients with acute diarrheal infection attending the outpatient and inpatient department at a university hospital in the Eastern Province of Saudi Arabia in the period from September, 2008 to April, 2011. A retrospective analysis of the 158 patients with NTS infection was conducted to determine the most prevalent NTS serogroups causing acute gastroenteritis and their antimicrobial susceptibility patterns. Results At this teaching hospital, a total of 17,436 fecal samples were analyzed during the 2008–2011 study period. Of these specimens, 158 tested positive for NTS, giving an overall prevalence of 9.06 per 1,000. Of 158 NTS cases, serogroup D1 (25.3%) was the most prevalent, followed by serogroup B (19.6%), and serogroup C1 (18.9). One third of all NTS serogroup strains tested were resistant to tetracycline. The NTS strains showed resistance to ampicillin (31.3%), amoxicillin/clavulanic acid (29.9%), trimethoprim/sulfamethoxazole (20.9%), and cefotaxime (14.93%). Conclusion The findings of this study support the concern that use of antibiotics in animal feeds may contribute to acquisition of resistance in food-borne bacteria, such as Salmonella. Our study also concludes that the prevalence of NTS in the Eastern Province of Saudi Arabia is very low compared with other studies worldwide.
Elhadi, Nasreldin; Aljindan, Reem; Aljeldah, Mohammed
An outbreak of Klebsiella pneumoniae carbapenamase (KPC)-producing K. pneumoniae occurred at our institution. Multiresistant Pseudomonas aeruginosa could have acquired this transmissible resistance mechanism, going unnoticed because its phenotypic detection in this species is difficult. We compared P. aeruginosa isolates obtained before and after the KPC-producing K. pneumoniae outbreak. No bla(KPC) genes were detected in the isolates obtained before the outbreak, whereas 33/76 (43%) of the isolates obtained after the outbreak harboured the bla(KPC) gene. P. aeruginosa may thus become a reservoir of this transmissible resistance mechanism. It is very important to understand the epidemiology of these multiresistant isolates, in order to achieve early implementation of adequate control measures to contain and reduce their dissemination in the hospital environment. PMID:23831767
García Ramírez, Dolores; Nicola, Federico; Zarate, Soledad; Relloso, Silvia; Smayevsky, Jorgelina; Arduino, Sonia
The purpose of triage is to prevent the delay of treatment for patients in real emergencies due to excessive numbers of patients in the hospital. This study uses the data of patients of consistent triage to develop the triage prediction model. By integrating Principal Component Analysis (PCA) and Support Vector Machine (SVM), the anomaly detection (overestimate and underestimate) prediction accuracy rate can be 100 %, which is better than the accuracy rate of SVM (about 89.2 %) or Back- propagation Neural Networks (BPNN) (96.71 %); afterwards, this study uses Support Vector Regression (SVR) to adopt Genetic Algorithm (GA) to determine three SVR parameters to predict triage. After using the scroll data predictive values, we calculate the Absolute Percentage Error (APE) of each scroll data. The resulting SVR's Mean Absolute Percentage Error (MAPE) is 3.78 %, and BPNN's MAPE is 5.99 %; therefore, the proposed triage prediction model of this study can effectively predict anomaly detection and triage. PMID:23990379
The Adult Literacy Program at Hawaii State Hospital utilized techniques drawn from the Morningside Model of Generative Instruction. In a study involving psychiatric inpatients, participants were taught reading, mathematics, or both over a 6- to 8-month time span. Using the Woodcock-Johnson Psychoeducational Battery-Revised, it was determined that nearly half of the participants demonstrated academic gains during the study period. Further, a behavioral observation system indicated that participants were on-task 80% of the observation time and staff engaged in positive interactions nearly 20% of the observation time. This study is the first of its kind to document any efficacy for academic instruction with a psychiatric inpatient population. PMID:15690738
Schirmer, Todd N; Meyer, Kim A; Samarasinghe, Roshani
Summary Tuberculosis (TB) is an occupational disease of healthcare workers (HCWs). Administrative and engineering interventions simultaneously implemented in hospitals of developed countries have reduced the risk of nosocomial transmission of M. tuberculosis. We have studied the impact of administrative infection control measures on the risk for latent TB infection (LTBI) among HCWs in a resource-limited, high-burden country. An intervention study was undertaken in a university-affiliated, inner-city hospital in Rio de Janeiro, where routine serial tuberculin skin test (TST) is offered to all HCWs. From October 1998 to February 2001, the following administrative infection control measures were progressively implemented: isolation of TB suspects and confirmed TB inpatients, quick turnaround for acid-fast bacilli sputum tests and HCW education in use of protective respirators. Among 1336 initially tested HCWs, 599 were retested. The number of TST conversions per 1000 person-months during and after the implementation of these measures was reduced from 5.8/1000 to 3.7/1000 person-months (P = 0.006). The most significant reductions were observed in the intensive care unit (from 20.2 to 4.5, P < 0.001) and clinical wards (from 10.3 to 6.0, P < 0.001). Physicians and nurses had the highest reductions (from 7.6 to 0, P < 0.001; from 9.9 to 5.8, P = 0.001, respectively). We conclude that isolated administrative measures for infection control can significantly reduce LTBI among HCWs in high-burden countries and should be implemented even when resources are not available for engineering infection control measures.
da Costa, P. Albuquerque; Trajman, A.; de Queiroz Mello, F. Carvalho; Goudinho, S.; Silva, M.A. Monteiro Vieira; Garret, D.; Ruffino-Netto, A.; Kritski, A. Lineu
Adverse drug reactions (ADR) are a significant cause of morbidity and mortality, often identified only post-marketingly. Improvement in current ADR reporting, including utility of underused or innovative methods, is crucial to improve patient safety and public health. Hospital-based monitoring is one of the methods used to collect data about drug prescriptions and adverse events. The aims of this study were to identify the most frequent ADRs recognized by the attending physicians, study their nature, and to target these ADRs in order to take future preventive measures. A prospective study was conducted over a 7-month period in an internal medicine department using stimulated spontaneous reporting for identifying ADRs. Out of the 254 admissions, 32 ADRs in 37 patients (14.56%) were validated from the total of 36 suspected ADRs in 41 patients. Female predominance was noted over males in case of ADRs. Fifty percent of total ADRs occurred due to multiple drug therapy. Dermatological ADRs were found to be the most frequent (68.75%), followed by respiratory, central nervous system and gastrointestinal ADRs. The drugs most frequently involved were antibiotics, anti-tubercular agents, antigout agents, and NSAIDs. The most commonly reported reactions were itching and rashes. Out of the 32 reported ADRs, 50% of the reactions were probable, 46.87% of the reactions were possible and 3.12% of the reactions were definite. The severity assessment done by using the Hartwig and Seigel scale indicated that the majority of ADRs were 'Mild' followed by 'Moderate' and 'Severe' reactions, respectively. Out of all, 75% of ADRs were recovered. The most potent management of ADRs was found to be drug withdrawal. Our study indicated that hospital based monitoring was a good method to detect links between drug exposure and adverse drug reactions. Adequate training regarding pharmacology and optimization of drug therapy might be helpful to reduce ADR morbidity and mortality. PMID:24170978
Patidar, Dindayal; Rajput, Mithun S; Nirmal, Nilesh P; Savitri, Wenny
Adverse drug reactions (ADR) are a significant cause of morbidity and mortality, often identified only post-marketingly. Improvement in current ADR reporting, including utility of underused or innovative methods, is crucial to improve patient safety and public health. Hospital-based monitoring is one of the methods used to collect data about drug prescriptions and adverse events. The aims of this study were to identify the most frequent ADRs recognized by the attending physicians, study their nature, and to target these ADRs in order to take future preventive measures. A prospective study was conducted over a 7-month period in an internal medicine department using stimulated spontaneous reporting for identifying ADRs. Out of the 254 admissions, 32 ADRs in 37 patients (14.56%) were validated from the total of 36 suspected ADRs in 41 patients. Female predominance was noted over males in case of ADRs. Fifty percent of total ADRs occurred due to multiple drug therapy. Dermatological ADRs were found to be the most frequent (68.75%), followed by respiratory, central nervous system and gastrointestinal ADRs. The drugs most frequently involved were antibiotics, anti-tubercular agents, antigout agents, and NSAIDs. The most commonly reported reactions were itching and rashes. Out of the 32 reported ADRs, 50% of the reactions were probable, 46.87% of the reactions were possible and 3.12% of the reactions were definite. The severity assessment done by using the Hartwig and Seigel scale indicated that the majority of ADRs were ‘Mild’ followed by ‘Moderate’ and ‘Severe’ reactions, respectively. Out of all, 75% of ADRs were recovered. The most potent management of ADRs was found to be drug withdrawal. Our study indicated that hospital based monitoring was a good method to detect links between drug exposure and adverse drug reactions. Adequate training regarding pharmacology and optimization of drug therapy might be helpful to reduce ADR morbidity and mortality.
Rajput, Mithun S.; Nirmal, Nilesh P.; Savitri, Wenny
This article describes an extensive online criterion-referenced evaluation system for the assessment of veterinary students' achievement during their final year's Doctor of Veterinary Medicine (or equivalent) clinical education. Data are reported for the 2001 to 2009 University of California at Davis veterinary graduates, for a total of more than 1,100 students. These criterion-referenced evaluations extensively document the level of clinical skills attained and demonstrated during the individual clinical rotations that comprise the fourth-year curriculum. On average, in each of the 17,500 clinical rotations undertaken during this time period, student performance was assessed in at least 11 separate areas of skills, knowledge, and professional attributes. This provided more than 200,000 criterion-referenced judgments of the individual clinical attributes of graduates over nine years. The system is based on a previously detailed and validated definition of the skills, knowledge, and professional attributes that students should have demonstrated before graduation. The extensive database that this system has provided has established that this system, termed VOLES (VMTH [Veterinary Medicine Teaching Hospital] On-Line Evaluation System), is an effective tool to assess the clinical capabilities of veterinary students and their achievement of the "Day One" skills required for entering clinical practice. These expected proficiencies are balanced according to the differing expectations that each area of veterinary clinical practice demands. PMID:22430080
Zeck, Steven; Wall, Judy A; Smith, Bradford P; Wilson, W David; Walsh, Donal A
Aims. To quantify the presence of SCCmec types and virulence genes among Staphylococcus aureus colonizing and infecting patients from a teaching hospital. Methods. We analyzed 225 and 84 S. aureus isolates recovered from surveillance and clinical cultures, respectively. Strains were studied for the presence and type of SCCmec, as well as for several virulence genes. Univariate and multivariable analysis were performed in order to identify predictors of invasiveness (defined as isolation from clinical cultures). Results. The presence of SCCmec types III (OR, 2.19, 95% CI, 1.08–4.45) and IV (OR, 5.28 95% CI, 1.35–20.63) and of genes coding for exfoliative toxin B (etb, OR, 6.38, 95% CI, 1.48–27.46) and Panton-Valentine leukocidin (pvl, OR, 2.38, 95% CI, 1.16–4.86) was independently associated with invasiveness. Conclusions. SCCmec types III and IV and virulence genes are associated with greater invasiveness of S. aureus. Patients colonized with methicillin-resistant S. aureus, as well as with strains harboring etb or pvl, may be prone to develop invasive disease. Infection-preventing strategies should be more intensively applied to this group.
Rodrigues, Marcus Vinicius Pimenta; Branco Fortaleza, Carlos Magno Castelo; Martins Souza, Camila Sena; Teixeira, Natalia Bibiana; Ribeiro de Souza da Cunha, Maria de Lourdes
Background Bowel obstruction resulting from intestinal tuberculosis has been reported to be more prevalent in developing countries including Tanzania. This study was undertaken to describe the clinicopathological profile, surgical management and outcome of tuberculous intestinal obstruction in our local setting and to identify factors responsible for poor outcome among these patients. Methods This was a prospective descriptive study of patients operated for tuberculous intestinal obstruction at Bugando Medical Centre (BMC) in northwestern Tanzania from April 2008 to March 2012. Ethical approval to conduct the study was obtained from relevant authorities. Statistical data analysis was performed using SPSS version 17.0. Results A total of 118 patients with tuberculous intestinal obstruction were studied. The male to female ratio was 1.8: 1. The median age was 26 years (range 11-67 years). The modal age group was 21-30 years. Thirty-one (26.3%) patients had associated pulmonary tuberculosis and 25 (21.2%) patients were HIV positive with a median CD4+ count of 225 cells /?l. Small bowel strictures were the most common operative findings accounting for 72.9% of cases. The ileo-caecal region was the commonest area of involvement in 68 (57.6%) patients. The right hemicolectomy with ileo-transverse anastomosis was the most frequent surgical procedure performed in 66 (55.9%) patients. Postoperatively all the patients received antituberculous drugs for a period of one year. Postoperative complication rate was 37.3% and surgical site infection (SSI) was the most frequent complication in 42.8% of cases. HIV positivity and low CD4+ count were the main predictors of SSI (p?0.001). The overall median length of hospital stay was 24 days. Patients who had postoperative complications stayed longer in the hospital and this was statistically significant (p?=?0.011). Mortality rate was 28.8% and it was significantly associated with co-existing medical illness, delayed presentation, HIV positivity, low CD 4 count (<200 cells/?l), ASA class and presence of complications (p?0.001). The follow up of patients was generally poor as more than fifty percent of patients were lost to follow up. Conclusion Tuberculous bowel obstruction remains rampant in our environment and contributes significantly to high morbidity and mortality. The majority of patients present late when the disease becomes complicated. A high index of suspicion, proper evaluation and therapeutic trial in suspected patients is essential for an early diagnosis and timely definitive treatment, in order to decrease the morbidity and mortality associated with this disease.
Background and purpose Surveillance studies evaluating antimicrobial susceptibilities are of great value in preventing the spread of resistant pathogens by elucidating the trend of resistance in commonly used antibiotics and as a consequence providing information for prescribing the most appropriate agent. This study is a longitudinal antimicrobial resistance surveillance study designed to evaluate the trend in antimicrobial resistance to gram negative microorganisms from 2007 to 2010. Method During a four-year period (2007–2010) isolates derived from all patients admitted to infectious diseases ward of Imam Khomeini Hospital, the major referral center for infectious disease in Iran with the highest admission rates, were evaluated. Based on disk diffusion method and zone of inhibition size, the microorganism was regarded as to be sensitive, resistant or has intermediate susceptibility to the antimicrobial agents. Results The widest spread Gram-negative microorganism in all of isolates taken together in our study was E.coli (30%) followed by Stenotrophomonas maltophilia in 28.6% and Enterobacter spp. in 11.9%, respectively. The susceptibility to amikacin, imipenem, piperacillin/tazobactam, and nitrofurantoin was equal or above 50% for all microorganisms over four years. However, the susceptibility to ampicillin, ampicillin/sulbactam, cefotaxim, and ceftriaxone was less than 50% in derived isolates during the study period. Conclusion In conclusion, the finding of the present study revealed that resistance rate to common antimicrobial agents in Iran is growing and isolates were susceptible mostly to broad-spectrum antibiotics including imipenem and piperacillin/tazobactam.
Congenital Talipes Equinovarus (CTEV) is one of the most common congenital limb deformities. We reviewed the records of infants who had received treatment for structural CTEV between 1 January 2007 and 30 November 2012. This was cross-referenced with the prenatal scans of mothers over a corresponding period of time. We investigated the sensitivity, specificity, and positive and negative predictive values of the fetal anomaly scan for the detection of CTEV and explored whether the publication of Fetal Anomaly Screening Programme guidelines in 2010 affected the rate of detection. During the study period there were 95 532 prenatal scans and 34 373 live births at our hospital. A total of 37 fetuses with findings suggestive of CTEV were included in the study, of whom 30 were found to have structural CTEV at birth. The sensitivity of screening for CTEV was 71.4% and the positive predictive value was 81.1%. The negative predictive value and specificity were more than 99.5%. There was no significant difference between the rates of detection before and after publication of the guidelines (p = 0.5). We conclude that a prenatal fetal anomaly ultrasound screening diagnosis of CTEV has a good positive predictive value enabling prenatal counselling. The change in screening guidance has not affected the proportion of missed cases. This information will aid counselling parents about the effectiveness and accuracy of prenatal ultrasound in diagnosing CTEV. Cite this article: Bone Joint J 2014;96-B:984-8. PMID:24986955
Pullinger, M; Southorn, T; Easton, V; Hutchinson, R; Smith, R P; Sanghrajka, A P
Aim: The rising HIV infection rates among women especially of child bearing age particularly in Sub-Saharan Africa expose children to increased HIV risk even before they are born. Without effective measures or awareness campaigns to deal with mother-to-child transmission, 390 000 out of the global 430 000 children newly infected with HIV during 2008 were from sub-Saharan Africa This study was undertaken to assess HIV/AIDS related knowledge, attitude and risk perception among pregnant women in Tertiary hospital, Southwestern Nigeria Method: The study was carried out using a 43- item self administered questionnaire, pretestd and administered to 403 pregnant women during ante-natal clinic sessions Results: High HIV/AIDS awareness level (97%) was recorded, 77.7% had correct knowledge of the cause of the disease but knowledge on the modes of vertical transmission during pregnancy (57.5%) and prevention during breast-feeding (62.3%) was not encouraging A lot of misconceptions about the cause of the HIV/AIDS, modes of contact, transmission, prevention and anti-retroviral therapy were recorded Conclusion: The survey revealed that a lot needed to be done to improve the knowledge, attitude, perception and behavioral changes among the populace especially in this particular group. This calls for urgent and proper response in order to stem the tide of HIV/AIDS.
Ojieabu, Winifred Aitalegbe; Femi-Oyewo, M. N.; Eze, Uchenna I.
OBJECTIVE To determine the prevalence, topics, methods, and intensity of ongoing faculty development (FD) in teaching skills. DESIGN Mailed survey. PARTICIPANTS Two hundred and seventy-seven of the 386 (72%) U.S. teaching hospitals with internal medicine residency programs. MEASUREMENTS Prevalence and characteristics of ongoing FD. RESULTS One hundred and eight teaching hospitals (39%) reported ongoing FD. Hospitals with a primary medical school affiliation (university hospitals) were more likely to have ongoing FD than nonuniversity hospitals. For nonuniversity hospitals, funding from the Health Resources Services Administration and >50 house staff were associated with ongoing FD. For university hospitals, >100 department of medicine faculty was associated. Ongoing programs included a mean of 10.4 topics (standard deviation, 5.4). Most offered half-day workshops (80%), but 22% offered ?1-month programs. Evaluations were predominantly limited to postcourse evaluations forms. Only 14% of the hospitals with ongoing FD (5% of all hospitals) had “advanced” programs, defined as offering ?10 topics, lasting >2 days, and using ?3 experiential teaching methods. These were significantly more likely to be university hospitals and to offer salary support and/or protected time to their FD instructors. Generalists and hospital-based faculty were more likely to receive training than subspecialist and community-based faulty. Factors facilitating participation in FD activities were supervisor attitudes, FD expertise, and institutional culture. CONCLUSIONS A minority of U.S. teaching hospitals offer ongoing faculty development in teaching skills. Continued progress will likely require increased institutional commitment, improved evaluations, and adequate resources, particularly FD instructors and funding.
Clark, Jeanne M; Houston, Thomas K; Kolodner, Ken; Branch, William T; Levine, Rachel B; Kern, David E
The aims of the study were to determine the in vitro activity of doripenem, a new carbapenem, against a large number of bacterial pathogens and to propose zone diameter breakpoints for clinical categorization in France according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) minimum inhibitory concentration (MIC) breakpoints. The MICs of doripenem were determined by the broth microdilution method against 1,547 clinical isolates from eight French hospitals. The disk diffusion test was performed (10-?g discs) according to the Comité de l'Antibiogramme de la Société Française de Microbiologie (CASFM) method. The MIC(50/90) (mg/L) values were as follows: methicillin-susceptible Staphylococcus aureus (MSSA) (0.03/0.25), methicillin-resistant Staphylococcus aureus (MRSA) (1/2), methicillin-susceptible coagulase-negative staphylococci (MSCoNS) (0.03/0.12), methicillin-resistant coagulase-negative staphylococci (MRCoNS) (2/8), Streptococcus pneumoniae (0.016/0.25), viridans group streptococci (0.016/2), ?-hemolytic streptococci (?0.008/?0.008), Enterococcus faecalis (2/4), Enterococcus faecium (128/>128), Enterobacteriaceae (0.06/0.25), Pseudomonas aeruginosa (0.5/8), Acinetobacter baumannii (0.25/2), Haemophilus influenzae (0.12/0.25), and Moraxella catarrhalis (0.03/0.06). According to the regression curve, the zone diameter breakpoints were 24 and 19 mm for MICs of 1 and 4 mg/L, respectively. This study confirms the potent in vitro activity of doripenem against Pseudomonas aeruginosa, Acinetobacter, Enterobacteriaceae, MSSA, MSCoNS, and respiratory pathogens. According to the EUCAST MIC breakpoints (mg/L) ?1/>4 for Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter, and ?1/>1 for streptococci, pneumococci, and Haemophilus, the zone diameter breakpoints could be (mm) ?24/<19 and ?24/<24, respectively. PMID:21088861
Lascols, C; Legrand, P; Mérens, A; Leclercq, R; Armand-Lefevre, L; Drugeon, H B; Kitzis, M D; Muller-Serieys, C; Reverdy, M E; Roussel-Delvallez, M; Moubareck, C; Lemire, A; Miara, A; Gjoklaj, M; Soussy, C-J
The aims of this study were to determine the in vitro activity profile of ceftobiprole, a pyrrolidinone cephalosporin, against a large number of bacterial pathogens and to propose zone diameter breakpoints for clinical categorisation according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) minimum inhibitory concentration (MIC) breakpoints. MICs of ceftobiprole were determined by broth microdilution against 1548 clinical isolates collected in eight French hospitals. Disk diffusion testing was performed using 30 ?g disks according to the method of the Comité de l'Antibiogramme de la Société Française de Microbiologie (CA-SFM). The in vitro activity of ceftobiprole, expressed by MIC(50/90) (MICs for 50% and 90% of the organisms, respectively) (mg/L), was as follows: meticillin-susceptible Staphylococcus aureus, 0.25/0.5; meticillin-resistant S. aureus (MRSA), 1/2; meticillin-susceptible coagulase-negative staphylococci (CoNS), 0.12/0.5; meticillin-resistant CoNS, 1/2; penicillin-susceptible Streptococcus pneumoniae, ? 0.008/0.03; penicillin-resistant S. pneumoniae, 0.12/0.5; viridans group streptococci, 0.03/0.12; ?-haemolytic streptococci, ? 0.008/0.016; Enterococcus faecalis, 0.25/1; Enterococcus faecium, 64/128; Enterobacteriaceae, 0.06/32; Pseudomonas aeruginosa, 4/16; Acinetobacter baumannii, 0.5/64; Haemophilus influenzae, 0.03/0.12; and Moraxella catarrhalis, 0.25/0.5. According to the regression curve, zone diameter breakpoints could be 28, 26, 24 and 22 mm for MICs of 0.5, 1, 2 and 4 mg/L respectively. In conclusion, this study confirms the potent in vitro activity of ceftobiprole against many Gram-positive bacteria, including MRSA but not E. faecium, whilst maintaining a Gram-negative spectrum similar to the advanced-generation cephalosporins such as cefepime. Thus ceftobiprole appears to be well suited for the empirical treatment of a variety of healthcare-associated infections. PMID:21295447
Lascols, C; Legrand, P; Mérens, A; Leclercq, R; Muller-Serieys, C; Drugeon, H B; Kitzis, M D; Reverdy, M E; Roussel-Delvallez, M; Moubareck, C; Brémont, S; Miara, A; Gjoklaj, M; Soussy, C-J
To find the incidence, characteristics, method of treatment, and outcome of synovial fluid culture-positive septic arthritis, all newly admitted cases of synovial fluid culture-positive septic arthritis to King Khalid University Hospital, Riyadh, Saudi Arabia were studied prospectively during August 2005 to July 2006 and only those with positive synovial fluid culture septic arthritis were included in the analysis. Demographic, clinical, hematological, biochemical, microbiological, radiological, and histopathological data along with the interventional and surgical procedures and the functional outcome related to the joint involved were recorded. Of the 42 patients admitted, only 12 fulfilled the study criteria of having positive synovial fluid culture. Annual incidence was estimated to be 2.13 per 100,000 inhabitants. The mean disease duration before diagnosis and treatment was 10.42 +/- 2.9 days. The affected joints were six knees, three hips, two shoulders, and one with hip and knee involvement. Two patients had rheumatoid arthritis, two had osteoarthritis, and one had sickle cell disease. The most common infecting organism was Staphylococcus aureus, which caused eight of the infections (66.7%), one Salmonella, one Staphylococcus epidermidis, one Enterobacter cloacae, and one Mycobacterium tuberculosis. The septic arthritis in 4 (33.3%) cases followed previous orthopedic intervention. Blood cultures were positive in three patients, all with S. aureus. White blood cell count was elevated in 3 (25%) patients. All patients received intravenous antibiotic for the initial 2 weeks, the most commonly used antibiotic was flucloxacillin. There were no deaths due to septic arthritis. The functional outcome was excellent to good. Septic arthritis is less prevalent in our community, and the most frequent organism is Staphylococcus. However, special risk factors favor other organisms such as Salmonella and Enterobacter. Previous orthopedic intervention is an important risk factor. Mortality due to septic arthritis is lower than reported elsewhere. PMID:18584268
Al Arfaj, Abdurahman Saud
Before the advent of the Acquired Immune Deficiency Syndrome (AIDS), many countries of the world transfused blood without seriously considering the potential risks of transmission of infectious agents. Even after it was shown that the Human Immunodeficiency virus(HIV) could be transmitted through blood and blood products, many hospitals and clinics in Nigeria still continue to transfuse unscreened blood. This study was therefore initiated to highlight the risks of transmitting infectious agents through blood transfusion and the category of infectious agents which could be transfused in blood in this area. A total of 364 healthy blood donors were counselled, bled and screened for HIV-1, HIV-2, HBsAg, Treponema pallidum, Plasmodium falciparum and microfilaria. The results show that the three most common infections transmissible through blood transfusion are Hepatitis B(14.9%), HIV-1 (5.8%) and P.falciparum (4.1%). Thirteen of the 364 blood donors (3.6%) and antibodies to T. pallidum. There were no donors with HIV-2 or filarial infection. Infection of donors by hepatitis B virus (HBV), T. pallidum and HIV-1 was not significant dependent on promiscuity, polygamy, previous blood transfusion or local surgery. However, there was a significant difference between donors with no risk factors and those with risk factors with regard to seroprevalence to HBV, T. pallidum and HIV-1 (p = 0.0053). The results confirm that transfusion of unscreened blood carries severe risks of transmitting serious infectious agents and that is a need to enforce laws for transfusing blood in Nigeria. Meanwhile, in the absence of screening facilities, proper counselling of blood donors in order to ascertain their risk behaviour should be used to select donors and reduce this risk. PMID:9299819
Chikwem, J O; Mohammed, I; Okara, G C; Ukwandu, N C; Ola, T O
Background Electroconvulsive therapy (ECT) is shown to be effective in many psychiatric illnesses, but its distorted projection by the Pakistani media and its unregulated use by many physicians across the country have adversely affected its acceptability. Given this situation we aimed to assess the awareness and perceptions regarding ECT as a treatment modality among the psychiatric patients. Methods This was a questionnaire based cross-sectional study carried out at 2 tertiary care hospitals in Karachi, Pakistan. Results We interviewed 190 patients of which 140 were aware of ECT. The study showed that the level of education had a significant impact on the awareness of ECT (p = 0.009). The most common source of awareness was electronic and print media (38%), followed by relatives (24%) and doctors (23%). Physical injuries (42%) and neurological (12%) and cognitive disturbances (11%) were the commonly feared side effects. The most popular belief about ECT was that it was a treatment of last resort (56%). Thirty-nine percent thought that ECT could lead to severe mental and physical illness and 37% considered it inhumane. Patients' willingness to receive ECT was dependant on whether or not they were convinced of its safety (p = 0.001) and efficacy (p = 0.0001). Conclusion We identified a serious lack of dissemination of information regarding ECT by the psychiatrists and the mental health care providers. This may be the result of an inadequate postgraduate training in Pakistan or just a lack of concern about the mentally ill patients. The media seemed to be the major source of information for our patients. We also saw the prevalence of a variety of myths regarding ECT in our society, which we feel may be responsible for the patients' adverse attitudes. Given the widespread applicability of ECT there is a dire need to dispel these misconceptions and improve its acceptability.
Arshad, Mehreen; Arham, Ahmad Zafir; Arif, Mansoor; Bano, Maria; Bashir, Ayisha; Bokutz, Munira; Choudhary, Maria Maqbool; Naqvi, Haider; Khan, Murad Moosa
The use of complementary and alternative medicine (CAM) is now on the increase. Evidence from studies carried out globally has established that CAM use is very common and varies among populations. This study investigated patterns of CAM use, perceived benefits, and associated harm with CAM use among adults. A cross-sectional study was conducted in three local government areas of Enugu urban, Southeast Nigeria. An interviewer-administered questionnaire was used to collect data from all consenting adult participants aged between 18 and 65 years. Of the 732 participants interviewed, 62.8% were females while 37.2% were males. Majority (84.7%) of the participants had used CAM at one time or another. The most commonly used CAM product was the biological products, followed by spiritual therapy. The major route of administration for CAM products was oral and about 40% of the participants combined CAM with conventional medicine. Majority (78.6%) of CAM users benefited from CAM products after using them while a few complained of adverse reactions. As CAM is gaining widespread acceptance and use, there is need for clinical trial on the benefits and adverse effects associated with the use of CAM to facilitate proof of efficacy and safety of the products.
Okoronkwo, Ijeoma; Onyia-pat, Jane-lovena; Okpala, Pat; Agbo, Mary-Ann; Ndu, Afam
This guide, which was developed as part of Texas' home economics education program, is intended to assist teachers of a hospitality services course focusing on the food and lodging segments of the hospitality and tourism industry. The first 40% of the approximately 600-page guide consists of strategies for teaching each of 29 essential…
Texas Tech Univ., Lubbock. Home Economics Curriculum Center.
Hypertension and Chronic kidney disease (CKD) are common in Nepal. Control of blood pressure (BP) in general hypertensive patients is poor. Evaluation of adequacy of BP control in CKD patients with hypertension is rare. All consecutive indoor patients (52) with CKD and hypertension, attending echo-lab of Nepal Medical College Teaching Hospital during prospective study of 3 years period from 16th April 2008 to 15th April 2011, were evaluted. Mean age was 45.3 +/- 16.7 years. Male female ratio was 8:5. Brahman and Chhetri (22, 42.3%) were the usual sufferers. There were two peaks in the age group wise distribution; one in age group 20-29 years and the next in 50-59 years. One hypertensive patient's BP was normalized after starting hemodialysis without antihypertensive therapy and was excluded from this study. Others' BP (n = 51) were followed up during admission for the evaluation of the adequacy of their BP control and their antihypertensive medications were reviewed. The control of hypertension in CKD patients was difficult. More than two third of the patients (68.6%) had BP > 140/90 mm Hg. Intensive BP control was present in less than one tenth (7.9%) of the patients. In comparison to intensive group, uncontrolled group received more antihypertensive agents (3.0 +/- 1.3 vs. 2.0 +/- 0.8, p < 0.05). Amlodipine (39, 76.5%) and frusemide (39, 76.5%) were very popular antihypertensives used followed by Prazocin (20, 39.2%) and Metoprolol (11, 21.6%). Despite good efforts, BP control of Nepalese CKD patients with hypertension, were poor. PMID:23671961
Shrestha, B; Dhungel, S
Echocardiographic reporting system is very poor in Nepal. No long-term feasibility and efficacy data about the echocardiography database with video clips has been studied. Snazzi Movie Studio S4 was used to convert analog video signals into MPEG2 and color photographs were converted into JPEG format for storage and use for the database. All together 2272 patients' echocardiography were performed by one individual prospectively at the Nepal Medical College Teaching Hospital from 10th January 2007 to 9th January 2012. Echocardiographic findings of these patients were evaluated. Mean age +/- SD were 44.4 +/- 28.7 years. Male female ratio was 0.8:1. Brahman/Chhetri were the usual ethnic group to undergo echocardiography (943, 41.5%), followed byjanajati (631, 27.8%) and newar (496, 21.8%). Age group of 60-69 years was the most common echo users (519, 22.8%). Total time for echocardiography/report writing with database compared to non database was 13.9 +/- 2.4 minutes vs. 12.3 +/- 0.8 minutes, p = 0.51. Out of all lesions, valvular lesions were the most common lesions detected (4885, 215%). Mild tricuspid regurgitation (1213, 53.4%) was the most common valvular lesion followed by mild mitral regurgitation (742, 32.7%). Patent foramen ovale was the most common congenital heart disease (32, 45.7%) followed by atrial septal defect (12, 17.1%). About one seventh of the total patients (318, 13.9%) had systolic dysfunction. Out of total chronic cor pulmonale (383, 16.9%), severe Pulmonary arterial dysfulction (PAH) was noted in more than one third of the patients (169, 44.1%). PMID:24047011
Background Peripheral arterial disease (PAD) is a marker of advanced atherosclerosis with an elevated risk of cardiovascular mortality and morbidity. Although intensive risk reduction therapy is critical in reducing the adverse cardiovascular outcomes in patients with PAD, the awareness of this information among all physicians is felt to be low. Given the role of family physicians (FP), general internists (GI), cardiologists (C), and vascular surgeons (VS) in treating patients with PAD, we sought to determine their perceptions and knowledge of risk reduction therapy in these patients. Methods and results We conducted a cross-sectional self-administered survey of 84 physicians who work at a major teaching hospital. FP, GI, C, and VS represent 39%, 33%, 16%, and 12% of the surveyed physicians, respectively. The recommended targets of LDL-cholesterol, blood glucose and blood pressure in PAD patients were known to 37.3%, 94.1% and 35.3% of physicians, respectively. The majority of physicians reported to screen for risk factors in PAD. Although 86.3% of physicians would recommend antiplatelets therapy in PAD, only 17.6% would recommend angiotensin converting enzyme (ACE) inhibitors; 25.5% would recommend nicotine replacement therapy for smokers and 62.7% would recommend statins. Compared to other specialties, cardiologists had the lowest threshold, whereas GI had the highest threshold for initiating antiplatelets and statins for patients with PAD. Conclusion The perceptions towards risk reduction in PAD identify glaring knowledge and action gaps. Effective strategies to encourage health professionals to use risk reduction therapy are needed.
Background Human papillomavirus (HPV) is the cause of 90%–95% of squamous cell cancers. Persistent infection with high-risk HPV can lead to development of precancerous lesions of the cervix in 5%–10% of infected women, and can progress to invasive cervical cancer 15–20 years later. This study was conducted to determine the seroprevalence of HPV immunoglobulin G (IgG) antibodies among women of reproductive age attending a reproductive health clinic at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Methods The study was descriptive, cross-sectional, and experimental, combining the use of a structured questionnaire and analysis of serum samples obtained from 350 consecutive consenting women. The serum samples were analyzed for IgG antibodies to HPV by enzyme-linked immunosorbent assay. Results We found a seroprevalence of 42.9% (150/350) for IgG antibodies to HPV in these women. Women aged 45–49 years and those who had their sexual debut aged 20–23 years had the highest HPV seroprevalence, ie, 50% (57/114) and 51.1% (46/90), respectively. Presence of antibodies varied according to sociodemographic factors, but was significantly associated with educational status, tribe, and religion (P<0.05). Human papillomavirus infection was not significantly associated with the reproductive characteristics and sexual behavior of the women. Antibodies to HPV were detected in 50.0% (9/18) of women with a family history of cervical cancer and in 30.8% (4/13) of those with a history or signs of WHIM (warts, hypogammaglobulinemia, immunodeficiency, myelokathexis) syndrome as a genetic disorder (P>0.05). Conclusion Further studies are needed to determine the HPV serotypes and evaluate the risk of natural development of HPV-related malignancies among women in the study area.
Aminu, M; Gwafan, JZ; Inabo, HI; Oguntayo, AO; Ella, EE; Koledade, AK
Introduction: Diabetes mellitus is on alarming rise in India. Drug utilization studies help to identify the adherence to standard treatment guidelines and to evaluate the rational drug usage. Objective: To study prescription pattern, calculate the cost of antidiabetic drugs and to evaluate the adherence to treatment guidelines in diabetic patients attending the medicine outpatient department in a tertiary care teaching hospital. Materials and Methods: A prospective observational study was carried out for a period of 5 months. The diabetic patients who visited the medicine outdoor department were included. Demographic data and complete prescription details were recorded in the structured case record form. Cost of the drug therapy was calculated from the patient's bills. Indian Council for Medical research guidelines-2005 for diabetes management was used to evaluate the adherence. Results: A total of 250 patients were enrolled in the study with mean age 57.91 ± 9.37. Out of 250 patients 126 (50.4%) were male and rest were female. A total of 1,391 drugs were prescribed, with mean of 5.56 ± 2.52 drugs and out of which 539 drugs were antidiabetics with mean of 2.18 ± 0.96. In monotherapy, metformin was frequently 218 (40.45%) prescribed. Glimepiride and metformin was the most frequently prescribed in 119 (76.28%) out of 156 antidiabetic drug combinations. Most commonly used drugs other than antidiabetics were aspirin 146 (18.9%) and atorvastatin 119 (15.41%). Mean cost of therapy for a month for a diabetic patient was 354.60 ± 305.72 INR. Majority 209 (83.6%) of prescriptions was in accordance to guidelines. Conclusion: Metformin was the most frequently prescribed drug in the diabetes patient. Metformin and glimeperide being the most frequent combination used. Majority of the prescriptions followed standard guidelines.
Acharya, Khushali G.; Shah, Kartik N.; Solanki, Nilay D.; Rana, Devang A.
Background Transfusion-transmissible infectious agents such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis are among the greatest threats to blood safety for the recipient. This study aimed to determine the seroprevalence, risk factors and trends of HIV, HBV, HCV and syphilis infections among blood donors over a period of five years at Gondar University Teaching Hospital, Northwest Ethiopia. Methods A retrospective analysis of consecutive blood donors' records covering the period between January 2003 and December 2007 was conducted. Logistic regression analysis was used to determine risk factors associated with HIV, HBV, HCV and syphilis infections. Results From the total of 6361 consecutive blood donors, 607 (9.5%) had serological evidence of infection with at least one pathogen and 50 (0.8%) had multiple infections. The overall seroprevalence of HIV, HBV, HCV and syphilis was 3.8%, 4.7%, 0.7%, and 1.3% respectively. Among those with multiple infections, the most common combinations were HIV - syphilis 19 (38%) and HIV - HBV 17 (34%). The seropositivity of HIV was significantly increased among female blood donors, first time donors, housewives, merchants, soldiers, drivers and construction workers. Significantly increased HBV seropositivity was observed among farmers, first time donors and age groups of 26 - 35 and 36 - 45 years. Similarly, the seroprevalence of syphilis was significantly increased among daily labourers and construction workers. Statistically significant association was observed between syphilis and HIV infections, and HCV and HIV infections. Moreover, significantly declining trends of HIV, HCV and syphilis seropositivity were observed over the study period. Conclusions A substantial percentage of the blood donors harbour HIV, HBV, HCV and syphilis infections. Strict selection of blood donors and comprehensive screening of donors' blood using standard methods are highly recommended to ensure the safety of blood for recipient.
Background: Health insurance is a social security system that aims to facilitate fair financing of health costs through pooling and judicious utilization of financial resources, in order to provide financial risk protections and cost burden sharing for people against high cost of healthcare through various prepayment methods prior to falling ill. It is still unclear how the Federal Social Health insurance program for federal civil servants has affected the insured and uninsured civil servants in terms of health services cost and utilization in Enugu metropolis. Objectives: The aim of the study was to compare the health services utilization and cost of insured with that of the non-insured federal civil servants with a view to generate information for policymaking on improving services of the National Health Insurance Scheme. Materials and Methods: A comparative, descriptive, cross-sectional survey of both the insured and uninsured federal civil servants was conducted in Enugu metropolis. Respondents were purposively enrolled and were grouped according to their insurance status after signing the informed consent form. Comparative analysis of health services utilization, satisfaction, and health services cost which include total cost, average cost, and catastrophic expenditures were done using SPSS version 17.0. Results: There were 809 respondents; this comprised 451 insured and 358 uninsured respondents. There were 420 males (51.9%) and 389 females (48.1%). It was found that 657 respondents had at least easy access to health; this comprised 369 (56.7%) insured and 288 (43.3%) non-insured respondents while 70 (46%) of the non-insured and 82 (54%) of the insured civil servant had difficult access to health care ( P = 0.620). Conclusion: There are still federal civil servants yet to enroll into the formal sector social insurance program. The NHIS-insured civil servants have no appreciable advantage in terms of access to and cost of health services in Enugu metropolis. PMID:24714012
Ujunwa, F A; Onwujekwe, O; Chinawa, J M
The Talk Time program, which focuses on discussion and encourages children to share their fears and fantasies of the hospital experience, was started at the University of Illinois hospital. It has proved effective as well in teaching hospital personnel about pediatric patients. (Author)
Sheridan, Mary S.
BACKGROUND: This study was designed to determine the correlation between heamatological parameters by Sysmex KX-21N automated hematology analyzer with the manual methods. METHOD: Sixty (60) subjects were randomly selected from both apparently healthy subjects and those who have different blood disorders from the University of Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Enugu State, Nigeria. Three (3)mls of venous blood sample was
Samuel O Ike; Thomas Nubila; Ernest O Ukaejiofo; Imelda N Nubila; Elvis N Shu; Ifeyinwa Ezema
Provided and maintained by the University of Iowa Health Care, the Virtual Hospital is designed as a "medical reference and health promotion tool for health care providers and patients." To that end, the site offers current and authoritative medical information for patients and professional and pedagogical information for health care providers. The former includes patient educational briefs browseable by organ system or by a topical list, a collection of peer-reviewed and annotated Web resources, an internal search engine, and archives of a column offering medical advice to middle-aged users. Resources in the health care provider section include several digital libraries aimed at certain specialties (Pediatrics, Pediatric Radiology, Family Medicine, and Medical Student); multimedia textbooks and teaching files grouped by organ system; lectures and publications; and clinical practice guidelines. Additional resources at the site include links to the Virtual Children's and Virtual Naval Hospitals, an internal search engine, and online continuing education courses.
Background In many countries midwives act as the main providers of care for women throughout pregnancy, labour and birth. In our large public teaching hospital in Australia we restructured the way midwifery care is offered and introduced caseload midwifery for one third of women booked at the hospital. We then compared the costs and birth outcomes associated with caseload midwifery compared to the two existing models of care, standard hospital care and private obstetric care. Methods We undertook a cross sectional study examining the risk profile, birth outcomes and cost of care for women booked into one of the three available models of care in a tertiary teaching hospital in Australia between July 1st 2009 December 31st 2010. To control for differences in population or case mix we described the outcomes for a cohort of low risk first time mothers known as the 'standard primipara'. Results Amongst the 1,379 women defined as 'standard primipara' there were significant differences in birth outcome. These first time ‘low risk’ mothers who received caseload care were more likely to have a spontaneous onset of labour and an unassisted vaginal birth 58.5% in MGP compared to 48.2% for Standard hospital care and 30.8% with Private obstetric care (p < 0.001). They were also significantly less likely to have an elective caesarean section 1.6% with MGP versus 5.3% with Standard care and 17.2% with private obstetric care (p < 0.001). From the public hospital perspective, over one financial year the average cost of care for the standard primipara in MGP was $3903.78 per woman. This was $1375.45 less per woman than those receiving Private obstetric care and $1590.91 less than Standard hospital care per woman (p < 0.001). Similar differences in cost were found in favour of MGP for all women in the study who received caseload care. Conclusions Cost reduction appears to be achieved through reorganising the way care is delivered in the public hospital system with the introduction of Midwifery Group Practice or caseload care. The study also highlights the unexplained clinical variation that exists between the three models of care in Australia.
The research was designed to assess the stigma and discrimination faced by People living with HIV and AIDS (PLWHA) that are receiving treatment in UITH, Ilorin. The study was a descriptive cross-sectional survey conducted on three hundred (300) people living with HIV and AIDS receiving care at the antiretroviral therapy (ART) clinics within University of Ilorin Teaching Hospital (which was the only ART site in Kwara State as at then). A quantitative method through the use of interviewer administered questionnaire was used for data collection. This study was a cross-sectional descriptive study design. All the patients who came to the clinic and met the selection criteria were recruited until the desired sample size was reached. Data were analyzed by EPI-INFO 2005 software package. The mean age of the respondents was 39 years (SD = 9.32), and their age ranged between 19 and 65 years. About two thirds (64.7%) of the respondents were females, 62.7% were married, and 62.9% were from monogamous family settings. Slightly less than half (47.3%) of the respondents were not informed before they were tested for HIV, majority (63.3%) were not counseled before the test, but only 11% did not receive posttest counseling. One quarter of the respondents had experienced stigmatization/discrimination. Various forms of stigmatization/discrimination experienced by the respondents include blame for being responsible for their HIV status, various name callings, telling them that they are no more useful to anybody, violation of confidentiality, social isolation, restriction of their participation in family/religious activities, rejection by their spouses/families, dismissal from place of work, isolating them from other patients, and denying them care at health centers. It is therefore recommended that government at all levels should develop and implement programs to educate health care providers about HIV and AIDS, ethics, and treatment and care; educate the general population on HIV and AIDS, put in place policies that will reduce/stop HIV-related stigma and discrimination at all levels of the society, educate PLWHA on their right to live and work without discrimination, and also ensure full community participation in HIV control programs. PMID:21521807
Owolabi, Rotimi S; Araoye, Margaret O; Osagbemi, Gordon K; Odeigah, Louis; Ogundiran, Adeniyi; Hussain, Nurudeen A
Background: The incidence of ovarian cancer is thought to be increasing in developing countries and little is known about the pattern and incidence of this disease in South-East Nigeria. Aims: The objectives of the study were to determine the incidence, describe the pattern and management of ovarian cancer at a tertiary medical center in Enugu South East Nigeria. Materials and Methods: This was a retrospective review of cases of histologically diagnosed primary ovarian cancer at the study center over 11 years. Cases of histologically diagnosed primary ovarian cancer were identified through the records of the study center cancer registry and confirmed from the records of the histopathology department. Case notes, admission and theatre records were used to obtain data relating to clinical management, mortality and incidence of primary ovarian cancer. Statistical analysis was dose using SPSS statistical software version 17.0 for windows. Descriptive and inferential statistics were applied to obtain rates, proportions and 95% confidence intervals for these estimates. Results: There were 20,227 gynecological admissions during the study period (from January 2000 to December 2010) and 206 gynecological cancers. There were 54 cases of primary ovarian cancer giving an incidence rate of 1/405 gynecological admissions per year or 0.3% (95% confidential interval [CI] 0.23%, 0.38%) or 2.4% (54/206) per gynecological cancer per year. Epithelial ovarian cancer constituted 68% of cases of ovarian cancer (95% CI 54%, 82%): Sex cord and germ cell tumors constituted 16% each (95% CI 6%, 26%). Approximately 60% of women who had epithelial ovarian cancer were aged 50 years or below (95% CI 47%, 74%) and 72% of epithelial ovarian cancer occurred in multiparous women (95% CI 72.1%, 91.9%). Over 84% of ovarian cancer presented in stages 3 and 4 of the disease (95% CI 94%, 72%). The mainstay of management was surgery: Compliance with cis-platinum based adjuvant chemotherapy was poor. Case-specific mortality rate within 1 year of diagnosis was, at least, 70% (95% CI 64%, 84%). Conclusions: Primary ovarian cancer was uncommon and consisted mainly of epithelial cancer. Epithelial ovarian cancer occurred more in multiparous women and in women under 50 years in our center contrary to the known pattern of the disease.
Iyoke, CA; Ugwu, GO; Ezugwu, EC; Onah, N; Ugwu, O; Okafor, O
This paper describes the Internet-accessible radiology teaching file at the department of radiology at a major teaching hospital.\\u000a Instructions for connecting to and using the teaching file, as well as the methods used to assemble the teaching file, are\\u000a discussed. This teaching file can be used by anyone in the world with an Internet connection and free World Wide Web
J. Keith Smith; Mauricio Castillo
This collection of papers examines what it means to teach culture as an integrated part of language from both the language learner's and the language teacher's perspectives. The 11 papers include the following: "Teaching Cultures as an Integrated Part of Language: Implications for the Aims, Approaches and Pedagogies of Language Teaching" (Chantal…
Liddicoat, Anthony J., Ed.; Crozet, Chantal, Ed.
OBJECTIVE: To determine the prevalence, topics, methods, and intensity of ongoing faculty development (FD) in teaching skills.\\u000a \\u000a \\u000a DESIGN: Mailed survey.\\u000a \\u000a \\u000a \\u000a \\u000a PARTICIPANTS: Two hundred and seventy-seven of the 386 (72%) U.S. teaching hospitals with internal medicine residency programs.\\u000a \\u000a \\u000a \\u000a \\u000a MEASUREMENTS: Prevalence and characteristics of ongoing FD.\\u000a \\u000a \\u000a \\u000a \\u000a RESULTS: One hundred and eight teaching hospitals (39%) reported ongoing FD. Hospitals with a primary medical
Jeanne M. Clark; Thomas K. Houston; Ken Kolodner; William T. Branch; Rachel B. Levine; David E. Kern
The cost of the inpatient stay for a typical aortic valve replacement and for an oesophagectomy were determined by recording and costing every aspect of the patients' care from admission until discharge. This method of cost calculation was found to be satisfactory and could be used by other centres to allow comparisons between hospitals or countries. At St Thomas's Hospital in 1977 the cost of a cardiac operation was 2755 pounds, an oesophagectomy 1870 pounds, and a general surgical operation 564 pounds.
Morgan, K D; Disbury, F C; Braimbridge, M V
Community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) is increasingly common in the USA, but rare in the UK. We compared CA-MRSA from the UK and USA to examine differences\\u000a in the molecular epidemiology. We investigated patients presenting with MRSA in the first 72 h of hospital admission or in\\u000a out-patient settings in a UK and a US hospital from January 2004 to March
J. A. Otter; N. L. Havill; J. M. Boyce; G. L. French
The study assessed the dietary intake of lead and cadmium and health risk from consumption of various parts of cow meat by the urban population of Enugu State, Nigeria. Meat samples (n=150) comprising of muscle, liver, kidney, intestine and tripe were purchased from abattoirs in Nsukka and Enugu. The samples were dried, ground and two gram was digested with 3:2 HNO3:HClO4 v/v. The Cd and Pb concentrations were read with an atomic absorption spectrophotometer. The dietary intakes were estimated using a one week food frequency questionnaire administered to 755 subjects. The dietary intake of lead (µg/kg body weight/week) were in the following ranges; men [0.15 (kidney)-0.55(intestine)], non pregnant/non lactating women [0.16 (kidney)-0.62 (liver)], pregnant/lactating women [0.13 (kidney)-0.53 (intestine)], undergraduate students [0.12 (kidney)-0.62 (intestine)] and school children [0.29 (kidney)-1.16 (liver)]; cadmium: men [0.42 (liver)-1.21 (tripe)], non-pregnant/non-lactating women [0.53 (kidney)-1.20 (tripe)], pregnant/lactating women [0.43 (kidney)-0.90 (intestine)], undergraduate students [0.40 (kidney)-1.18 (tripe)] and school children [0.97 (kidney)-1.93 (tripe)]. The total dietary intakes of lead from the various cow meat parts by the groups were much lower than the provisional tolerable weekly intake (PTWI) guide line, but for cadmium, the intakes were quite appreciable when compared to the PTWI guideline while the intake for school children was very high, 113% of PTWI for the metal. The target hazard quotients were in the range of 0.05-0.10 for lead and 0.42-0.90 for cadmium. These values are less than one, indicating that the subjects are not exposed to any significant health risk via cow meat consumption. PMID:23664087
Ihedioha, J N; Okoye, C O B
This article explores pedagogical approaches to teaching students how to practice hospitality toward the other. Using case examples from the college classroom, the authors discuss the roots of Christian hospitality and educational theory on transformative learning to explore how students experience engaging with others after they have…
Burwell, Rebecca; Huyser, Mackenzi
Keeping track of thousands of pieces of equipment in a busy hospital environment is a considerable challenge, but, according to RFID tagging and asset tracking specialist, Harland Simon, RFID technology can make the task considerably simpler. Here Andrew James, the company's RFID sales manager, describes the positive benefits the technology has brought the Medical Equipment Library (MEL) at Addenbrooke's Hospital, one of the world's most famous teaching hospitals. PMID:24341115
This paper describes the experience of a hospital which has introduced a system of computerized management of letters of authorization for healthcare workers to access sensitive health data, through the use of open source software. A new corporate intranet portal was created with access given only to the privacy contacts of each operational unit of the hospital. Once the privacy contact has entered the relevant user authorization, these must be approved first by the Directors of the respective operational units and finally by the privacy officer. The introduction of this system has allowed a systematic approach to the management of authorization for access to health data by hospital staff, regular updating and monitoring of the authorization and the start of a process of digitalization of documents. PMID:22507990
Bodina, Annalisa; Brizzolara, Antonella; Vadruccio, Gianluca; Castaldi, Silvana
As associate director and then director of the Wabash Center for Teaching and Learning in Theology and Religion, Lucinda Huffaker has been a key factor in the Center's reputation for hospitality. The Center's work presupposes that reflection on teaching improves teaching and learning, and good reflection on one's teaching requires taking risks and…
Placher, William C.
Presence, Distribution, and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in a Small Animal Teaching Hospital: A Year-Long Active Surveillance Targeting Dogs and Their Environment
Abstract Methicillin-resistant Staphylococcus aureus (MRSA) is known to be present in small animal veterinary clinical environments. However, a better understanding of the ecology and dynamics of MRSA in these environments is necessary for the development of effective infectious disease prevention and control programs. To achieve this goal, a yearlong active MRSA surveillance program was established at The Ohio State University (OSU) Veterinary Medical Center to describe the spatial and molecular epidemiology of this bacterium in the small animal hospital. Antimicrobial susceptibility testing, staphylococcal chromosomal cassette mec (SCCmec) typing, pulsed-field gel electrophoresis (PFGE) typing, and dendrogram analysis were used to characterize and analyze the 81 environmental and 37 canine-origin MRSA isolates obtained during monthly sampling events. Overall, 13.5% of surfaces were contaminated with MRSA at 1 or more sampling times throughout the year. The majority of the environmental and canine isolates were SCCmec type II (93.8% and 86.5%, respectively) and USA100 (90.1% and 86.5%, respectively). By PFGE analysis, these isolates were found to be closely related, which reflects a low diversity of MRSA strains circulating in the hospital. For 5 consecutive months, 1 unique pulsotype was the most prevalent across the medical services and was recovered from a variety of surfaces and hospital locations. Carts/gurneys, doors, and examination tables/floors were the most frequently contaminated surfaces. Some surfaces maintained the same pulsotypes for 3 consecutive months. Molecular analysis found that incoming MRSA-positive dogs were capable of introducing a new pulsotype into the hospital environment during the surveillance period. Our results suggest that once a MRSA strain is introduced into the hospital environment, it can be maintained and spread for extended periods of time. These findings can aid in the development of biosecurity and biocontainment protocols aimed at reducing environmental contamination and potential exposures to MRSA in veterinary hospital staff, clients, and patients.
van Balen, Joany; Kelley, Christina; Nava-Hoet, Rocio C.; Bateman, Shane; Hillier, Andrew; Dyce, Jonathan; Wittum, Thomas E.
The Introduction of a Diagnostic Decision Support System (DXplain™) into the workflow of a teaching hospital service can decrease the cost of service for diagnostically challenging Diagnostic Related Groups (DRG)s
Background In an era of short inpatient stays, residents may overlook relevant elements of the differential diagnosis as they try to evaluate and treat patients. However, if a resident’s first principal diagnosis is wrong, the patient’s appropriate evaluation and treatment may take longer, cost more, and lead to worse outcomes. A diagnostic decision support system may lead to the generation of a broader differential diagnosis that more often includes the correct diagnosis, permitting a shorter, more effective, and less costly hospital stay. Methods We provided residents on General Medicine services access to DXplain, an established computer-based diagnostic decision support system, for 6 months. We compared charges and cost of service for diagnostically challenging cases seen during the fourth through sixth month of access to DXplain (intervention period) to control cases seen in the six months before the system was made available. Results 564 cases were identified as diagnostically challenging by our criteria during the intervention period along with 1173 cases during the control period. Total charges were $1281 lower (P=.006), Medicare Part A charges $1032 lower (p=.006) and cost of service $990 lower (P=.001) per admission in the intervention cases than in control cases. Conclusions Using DXplain on all diagnostically challenging cases might save our medical center over $2,000,000 a year on the General Medicine Services alone. Using clinical diagnostic decision support systems may improve quality and decrease cost substantially at teaching hospitals.
Elkin, Peter L.; Liebow, Mark; Bauer, Brent A.; Chaliki, Swarna; Wahner-Roedler, Dietlind; Bundrick, John; Lee, Mark; Brown, Steven H.; Froehling, David; Bailey, Kent; Famiglietti, Kathleen; Kim, Richard; Hoffer, Ed; Feldman, Mitchell; Barnett, G. Octo
BACKGROUND AND OBJECTIVES: Use of hair dye is extremely common worldwide. However, our literature search failed to find studies concerning the knowledge and attitudes of the public with regard to hair dyes. We sought to explore the knowledge and practices of, and attitudes towards, the use of hair dye among females. DESIGN AND SETTING: A cross-sectional survey conducted on females who attended various outpatient clinics at King Khalid University Hospital in Riyadh, Saudi Arabia, a tertiary referral hospital open to the general public. PATIENTS AND METHODS: A self-administered questionnaire about the use of hair dyes was distributed randomly among females attending the outpatient clinics at a university hospital in 2008. RESULTS: The response rate was 87.2%, with completion of 567 of the 650 distributed questionnaires. The mean (SD) age of respondents was 32.0 (10.2) years. Among respondents, 82.6% (464/562) had at some point dyed their hair. Furthermore, 69.3% (334/482) had dyed their hair in the past 12 months. The mean (SD) age of the participants when they first dyed their hair was 22.2 (7.1) years (range, 7-50). Of the participants, 76.8% (354/461) used permanent dyes, and about the same percentage of participants believed such dyes were the safest hair dye type. However, 52.4% (278/531) of the participants believed that hair dyes are harmful, and 36% (191/531) believed that hair dyes could cause cancer. Younger females tend to dye their hair less frequently (P<.001), whereas those with less education tend to dye their hair more frequently (P=.013). CONCLUSION: Use of hair dye is very common among females. Because the practice starts at a very young age, we conclude that hair dyes are overused and misused. The public should be informed about the risks associated with excessive hair dye use.
AlGhamdi, Khalid M.; Moussa, Noura A.
In response to a request by hospital management to evaluate employee exposures to aerosolized ribavirin (36791045) (AR), an investigation was made at Florida Hospital (SIC-8062), Orlando, Florida. The hospital was an 801 bed medical center and teaching ho...
J. Decker R. A. Shults
In Japan, healthcare professionals are required by Article 21 of the Medical Practitioner's Law to report "unnatural deaths" to the police in cases of healthcare-associated patient death. The attitudes of medical personnel at the forefront of clinical medicine regarding reporting have not been described. We investigate the attitudes of physicians and risk managers (RMs) regarding reporting to the police under different circumstances. We sent standardized questionnaires to all hospitals in Japan that participate in the National General Residency Program. We asked physicians and RMs to indicate if they would report to the police or not under scenarios including cases where medical error is present, uncertain, or absent. We also asked if they would report when medical error had occurred and the cause-of-death was directly related, possibly related, or unrelated. We found most physicians believe they would report to the police if medical error clearly caused patient death. We found most RMs believe they would advise physicians to report given the same situation. Less but still a large number of participants favor reporting even when cause-of-death is not clearly related to medical care provided. This tendency persisted even when given a scenario where the hospital director opposed the decision to report. PMID:20817591
Maeda, Shoichi; Kamishiraki, Etsuko; Starkey, Jay; Ikeda, Noriaki
Objective: To analyze clinical pharmacist interventions in the intensive care units (ICUs) setting of a tertiary care Indian hospital and to assess the pharmacoeconomic impact on drug-related problems (DRPs). Materials and Methods: A postgraduate clinical pharmacist reviewed drug prescriptions over a period of 7 months. Whenever a DRP is identified, it was discussed with a physician and appropriate suggestions were provided, later it was documented on a preprepared form. Clinical significance of each intervention was graded based on the predicted clinical outcome. Acceptance of the interventions is entirely at the discretion of the medical staff. Each intervention was analyzed with respect to potential cost saving and/or additional cost incurred to existing drug therapy. An independent clinical panel was convened, and all the interventions made by the intervening pharmacist were critically reviewed for potential cost savings. Results: The intervening pharmacist made 117 recommendations, of which 94% was accepted by the medical professionals. The most frequent DRP identified was overdose (24%). The total net cost savings made was Rs. 77260.13 (USD 1796.73). This corresponds with Rs. 965.75 per patient and an annualized savings of Rs. 135205.22. Conclusion: Clinical pharmacist interventions had a significant impact on the cost of drug therapy and the patient outcome in intensive care settings of our hospital.
Lucca, Jisha M.; Ramesh, M.; Narahari, Gopalakrishna M.; Minaz, N.
This research work was carried out under the assumption that wastes generated from hospitals in Irbid, Jordan were hazardous. The hazardous and non-hazardous wastes generated from the different divisions in the three hospitals under consideration were not separated during collection process. Three hospitals, Princess Basma hospital (public), Princess Bade’ah hospital (teaching), and Ibn Al-Nafis hospital (private) in Irbid were selected
A. R. Awad; M. Obeidat; M. Al-Shareef
Guidelines for teaching patients about diabetes mellitus are provided for use by hospital staff. The guidelines were developed by the Center for Health Promotion of the American Hospital Association in cooperation with numerous organizations and individua...
J. E. Espenshade
Characterisation of acute respiratory infections at a United Kingdom paediatric teaching hospital: observational study assessing the impact of influenza A (2009 pdmH1N1) on predominant viral pathogens
Background According to the World Health Organisation, influenza A (2009 pdmH1N1) has moved into the post-pandemic phase, but there were still high numbers of infections occurring in the United Kingdom in 2010-11. It is therefore important to examine the burden of acute respiratory infections at a large children’s hospital to determine pathogen prevalence, occurrence of co-infection, prevalence of co-morbidities and diagnostic yield of sampling methods. Methods This was a retrospective study of respiratory virus aetiology in acute admissions to a paediatric teaching hospital in the North West of England between 1st April 2010 and 31st March 2011. Respiratory samples were analysed either with a rapid RSV test if the patient had symptoms suggestive of bronchiolitis, followed by multiplex PCR testing for ten respiratory viruses, or with multiplex PCR testing alone if the patient had suspected other ARI. Patient demographics and data regarding severity of illness, presence of co-morbidities and respiratory virus sampling method were retrieved from case notes. Results 645 patients were admitted during the study period. 82/645 (12.7%) patients were positive for 2009 pdmH1N1, of whom 24 (29.2%) required PICU admission, with 7.3% mortality rate. Viral co-infection occurred in 48/645 (7.4%) patients and was not associated with more severe disease. Co-morbidities were present more frequently in older children, but there was no significant difference in prevalence of co-morbidity between 2009 pdmH1N1 patients and those with other ARI. NPA samples had the highest diagnostic yield with 192/210 (91.4%) samples yielding an organism. Conclusions Influenza A (2009 pdmH1N1) is an ongoing cause of occasionally severe disease affecting both healthy children and those with co-morbidities. Surveillance of viral pathogens provides valuable information on patterns of disease.
In Brazil, carbapenem-resistant Pseudomonas aeruginosa isolates are closely related to the São Paulo metallo-?-lactamase (SPM) Brazilian clone. In this study, imipenem-resistant isolates were divided in two sets, 2002/2003 and 2008/2009, analysed by pulsed field gel electrophoresis and tested for the Ambler class B metallo-?-lactamase (MBL) genes blaSPM-1, blaIMP and blaVIM. The results show a prevalence of one clone related to the SPM Brazilian clone in 2002/2003. In 2008/2009, P. aeruginosa isolates were mostly MBL negative, genetically diverse and unrelated to those that had been detected earlier. These findings suggest that the resistance to carbapenems by these recent P. aeruginosa isolates was not due to the spread of MBL-positive SPM-related clones, as often observed in Brazilian hospitals. PMID:22510840
Cavalcanti, Felipe Lira de Sá; Almeida, Anna Carolina Soares; Vilela, Marinalda Anselmo; Morais, Marcia Maria Camargo de; Morais Junior, Marcos Antonio de