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  1. Causes of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu, Nigeria.

    PubMed

    Nwankwo, Okechukwu Emmanuel

    2008-04-01

    Gas gangrene (clostridial myonecrosis) is rarely seen and this rarity, coupled with its dramatic presentation and often devastating outcome, makes each case of gas gangrene a spectacular and memorable experience. This study analyses the cases managed, the causes and outcome. Gunshot wounds, compounded by late presentation with its accompanying florid infections, were seen as the causes in 14 cases of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu during the four-year study period from July 2000 to June 2004. PMID:18453489

  2. Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital, Enugu, Nigeria

    PubMed Central

    Ezeome, Emmanuel R; Anarado, Agnes N

    2007-01-01

    Background The use of Complementary and Alternative Medicine (CAM) by cancer patients is very common and varies between populations. The referenced English literature has no local study from Africa on this subject. This study was conducted to define the prevalence, pattern of use, and factors influencing the use of CAM by cancer patients at the University of Nigeria Teaching Hospital Enugu (UNTH-E), Nigeria Method Face-to-face interviews using semi-structured questionnaire were used to determine the use of CAM by cancer patients. All consenting cancer patients were interviewed as they presented at the core surgical units of the UNTH- E, from June 2003 to September 2005. Results 160 patients were interviewed; 68 (42.5%) were males and 94 (57.5%) were females. Ages ranged from 13–86 years. Breast, urogenital system, gastrointestinal system, and soft tissue cancers predominated. One hundred and four patients (65.0%) have used CAM at some time during their current cancer illness; 56 (35.0%) patients have not used any form of CAM. There were more females than males among the non-CAM users. The use of CAM was not affected by age, marital status, level of education, religious affiliation, or socioeconomic status. The most frequently used CAMs were herbs (51.9%), faith/prayer healing (49.4%), aloe vera (23.1%), Forever Living Products (16.3%), medicinal tea (14.4%), and Blackstone (12.5%). Over 23% of those who used CAM were satisfied, but 68.3% were disappointed. Most users (67.3%) did not see any benefit from the CAM, but 25% could describe some specific benefits. More than 21% of users reported various unwanted effects. While 86.5% of CAM users will use orthodox medicine instead of CAM in the future, 9.6% will use the two together to help each other. Most users (79.8%) will not repeat CAM or recommend its use for cancer. The majority of patients (55.8%) did not mention their use of CAM to their doctors – mostly because the doctor did not ask. Conclusion CAM use is

  3. Pattern of respiratory diseases in children presenting to the paediatric emergency unit of the University of Nigeria Teaching Hospital, Enugu: a case series report

    PubMed Central

    2014-01-01

    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

  4. Intracranial meningiomas managed at Memfys hospital for neurosurgery in Enugu, Nigeria

    PubMed Central

    Mezue, Wilfred C; Ohaegbulam, Samuel C; Ndubuisi, Chika C; Chikani, Mark C; Achebe, David S

    2012-01-01

    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. PMID:23188985

  5. Accidental Childhood Poisoning in Enugu, South-East, Nigeria

    PubMed Central

    Edelu, BO; Odetunde, OI; Eke, CB; Uwaezuoke, NA; Oguonu, T

    2016-01-01

    Background: Accidental childhood poisoning is one of the recognized causes of morbidity and mortality in children under the age of 5 years worldwide. The prevalence and type of substance ingested vary from place to place and over time. Aim: This study was conducted with the aim of ascertaining the frequency and pattern of accidental childhood poisoning in Enugu. Subjects and Methods: This retrospective study was conducted at the Emergency Paediatric Unit of the University of Nigeria Teaching Hospital, Enugu, South-East, Nigeria from January 2003 to December 2012 (10 years). All the cases of childhood accidental poisoning that presented within the period were reviewed and important information extracted. Results: Sixty-five cases of childhood poisoning were recorded during the 10-year period, giving an incidence rate of 442 per 100,000 children. The mean age was 22.15 ± 11.7 months. Male:female ratio was 1.5:1. The prevalence was higher among those with low socioeconomic background. Kerosene poisoning was the most common agent. The overall mortality rate was 3.1% (2/65). Conclusion: Accidental childhood poisoning is common in Enugu, with appreciable mortality, with kerosene being the most common agent. We advocate regulatory policy on proper ways of storing kerosene and other harmful household chemicals and medications. PMID:27398248

  6. Developing Marketing Strategies for University Teaching Hospitals.

    ERIC Educational Resources Information Center

    Fink, Daniel J.

    1980-01-01

    University teaching hospitals face increasing competition from community hospitals, expanding regulation of health care, consumerism, and a declining urban population base. New marketing strategies are seen as ways in which teaching hospitals can achieve better relationships with institutions, practitioners, and surrounding communities and…

  7. General Practice Teaching--Within the Hospital

    ERIC Educational Resources Information Center

    Drury, M.

    1976-01-01

    A program of integrated teaching by consultants and general practitioners is described. The teaching took place in the hospitals used for the purpose by the Medical Faculty of the University of Birmingham. (Author)

  8. Semen analysis of infertile Igbo males in Enugu, Eastern Nigeria.

    PubMed

    Nwafia, W C; Igweh, J C; Udebuani, I N

    2006-01-01

    The semen samples of 1,110 (one thousand, one hundred and ten) Igbo males attending infertility clinic, aged between 30-50 years were collected and analyzed. The specimens were collected and analysed in the microbiology laboratory of the University of Nigeria Teaching Hospital (UNTH) Enugu, Eastern Nigeria. The standard method of masturbation after 3-5 days of prior abstinence from sex before sample collection was applied. The samples were examined for semen volume and microscopically as a wet preparation for sperm motility, morphology and count. The semen volume result showed that 91.07 % were normal. 6.3% sperm samples were motile. In the sperm count, only 7.3% had normal cells, 62.0% showed abnormal morphology. The aetiology of male infertility in the population studied seems to be related to the sperm count, motility and morphology but not volume. Racial factor seems to play no role and it is important to abstain from sexual intercourse some days before collection of semen for analysis. PMID:17242721

  9. Multiple antenatal bookings among pregnant women in Enugu, Nigeria.

    PubMed

    Nwogu-Ikojo, E E; Okafor, I I; Ezegwui, H U

    2010-04-01

    Some pregnant women do book concurrently with multiple antenatal care providers. Structured questionnaires were administered to women attending antenatal clinics in 12 facilities in Enugu, Nigeria. A total of 535 women responded: 372 (69.5%) were booked into more than one facility and 163 (30.5%) were booked into a single facility; 280 (52.3%) booked into the two Teaching Hospitals and 91 (12.5%) booked with a traditional birth attendant. Reasons for multiple bookings included selecting a facility with affordable prices (43.9%); selecting a facility promising vaginal delivery (35.3%); avoiding HIV testing (17.9%); avoiding caesarean section (10.8%); avoiding being regarded as unbooked (10.1%) and booking into a facility where they were not known. Possible disadvantages were confusion in deciding where to deliver (53.1%); default on expert advice (27.5%); mismanagement (18.7%); delays, complications and death (12.5%). Multiple bookings were common in this study. Disadvantages of this practice, including risk of death, were identified by the women. PMID:20373923

  10. Pulmonary function indices in children with sickle cell anemia in Enugu, south-east Nigeria

    PubMed Central

    Achigbu, Kingsley I.; Odetunde, Odutola I.; Chinawa, Josephat M.; Achigbu, Eberechukwu O.; Ikefuna, Anthony N.; Emodi, Ifeoma J.; Ibe, Bede C.

    2015-01-01

    Objectives: To determine the pulmonary function indices of children with sickle cell anemia (SCA) attending the pediatric sickle cell clinic at the University of Nigeria Teaching Hospital, Enugu, south-east Nigeria and to compare these indices with the results obtained from other regions. Methods: A case control study of lung function in children with SCA aged 6-20 years. The study was carried out in the University of Nigeria/University of Nigeria Teaching Hospital, Enugu State, Nigeria between October 2014 and January 2015. Measurements of the peak expiratory flow rate, forced vital capacity (FVC), and forced expiratory volume in one second (FEV1) were evaluated. Results: A total of 80 subjects were recruited into the study, comprising 40 homozygous HbSS (hemoglobin SS) patients and an equal number of controls. Children with SCA had statistically lower values of FEV1 (1.6±0.52), FVC (1.76±0.95), and peak expiratory flow rate (PEFR) (309.00±82.64) when compared with normal hemoglobin genotype FEV1 (12.01±0.53), FVC (2.12±0.54), and PEFR (364.10±87.85). The mean FVC, FEV1/FVC, and PEFR were also higher in the male control group compared with the HbSS male group, but these differences were not statistically significant. Female controls had significantly larger FEV1, FVC, and PEFR values compared with the HbSS females. Conclusion: The lung function indices were significantly lower in children and adolescents with SCA compared with the matched controls with a hemoglobin genotype AA. PMID:26219442

  11. Replacing the academic medical center's teaching hospital.

    PubMed

    Reves, J G; Smith, Stuart; Greenberg, Ray; Johnson, Donald

    2005-11-01

    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

  12. Paracetamol use (and/or misuse) in children in Enugu, South-East, Nigeria

    PubMed Central

    2012-01-01

    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

  13. Success factors in merging teaching hospitals.

    PubMed

    Thier, Samuel O; Kelley, William N; Pardes, Herbert; Knight, Amy Wimpey; Wietecha, Mark

    2014-02-01

    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

  14. Jordanian nurses' job satisfaction and intent to stay: comparing teaching and non-teaching hospitals.

    PubMed

    Mrayyan, Majd T

    2007-01-01

    The aims of this study were to identify variables of Jordanian nurses' job satisfaction and intent to stay, compare the phenomena of interest in teaching and non-teaching hospitals, and correlate the two concepts of nurses' job satisfaction and intent to stay. A convenience sample of 433 nurses was obtained from three teaching hospitals and two non-teaching hospitals. Nurses were "neither satisfied nor dissatisfied" and were "neutral" in reporting their intent to stay at their current jobs. Nurses who were working in non-teaching hospitals reported higher job satisfaction and intent to stay rates than those working in teaching hospitals. Nurses' job satisfaction and intent to stay were at the borderlines, which require the immediate attention of nursing and hospital administrators. Nurses' job satisfaction and intent to stay, particularly in teaching hospitals, have to be promoted; thus, interventions have to be effectively initiated and maintained at the unit and organizational levels. PMID:17540315

  15. Health Care Practices for Medical Textiles in Government Hospitals

    ERIC Educational Resources Information Center

    Akubue, B. N.; Anikweze, G. U.

    2015-01-01

    The purpose of this study was to investigate the health care practices for medical textiles in government hospitals Enugu State, Nigeria. Specifically, the study determined the availability and maintenance of medical textiles in government hospitals in Enugu State, Nigeria. A sample of 1200 hospital personnel were studied. One thousand two hundred…

  16. Determinants of Noncompliance to Clinic Appointments and Medications among Nigerian Children with Epilepsy: Experience in a Tertiary Health Facility in Enugu, Nigeria

    PubMed Central

    Ibekwe, Roland Chidi; Ndukuba, Appolos Chidi; Aronu, Ann Ebele; Eke, Christopher Bismarck; Ibekwe, MaryAnn Ugochi; Ojinnaka, Ngozi Chinyelu

    2016-01-01

    Purpose. To determine the frequency and determinants of noncompliance to clinic appointment and medication among Nigerian children with epilepsy. Method. This is a cross-sectional survey of noncompliance to clinic appointments and medication among 113 consecutive children with epilepsy attending the Paediatric Neurology Clinic of University of Nigeria Teaching Hospital, Enugu, southeastern Nigeria. Results. Noncompliance to clinic appointment and medication was 23% and 15.3%, respectively. The major reasons given were lack of finance, clashing with school time, and forgetting to take the drugs. Children whose mothers were less educated and unemployed were more likely to miss clinic appointments. Noncompliance to medication was associated with poor seizure control. Children that were on phenobarbitone were more likely to be noncompliant with medication than those on sodium valproate and/or carbamazepine. Conclusion. Missed clinic appointment and medication noncompliance are common among Nigerian children with epilepsy and financial constraint is the most common reason. PMID:26997756

  17. Wiring a medical school and teaching hospital for telemedicine.

    PubMed

    Hjelm, N M; Lee, J C K; Cheng, D; Chui, C

    2002-06-01

    The planning and installation of a telemedicine system for communication within a teaching hospital and its academic and hospital units with a capacity for accommodation of up to 400 video-stations is described. The system is intended for improving the communication between patients and health professionals, and between the health professionals themselves. It also provides the basis for improving pre-graduate teaching, especially problem-based learning, and all aspects of postgraduate teaching. PMID:12052428

  18. Wiring a medical school and teaching hospital for telemedicine.

    PubMed

    Hjelm, N M; Lee, J C; Cheng, D; Chui, C

    2001-05-01

    The planning and installation of a telemedicine system for communication within a teaching hospital and its academic and hospital units with a capacity for accommodation of up to 400 video-stations is described. The system is intended for improving the communication between patients and health professionals, and between the health professionals themselves. It also provides the basis for improving pre-graduate teaching, especially problem-based learning, and all aspects of postgraduate teaching. PMID:11311677

  19. Hospital management principles applicable to the veterinary teaching hospital.

    PubMed

    Harris, Donna L; Lloyd, James W; Marrinan, Mike

    2004-01-01

    The Skills, Knowledge, Aptitude, and Attitude (SKA) Subcommittee of the National Commission on Veterinary Economic Issues (NCVEI) has identified the need for veterinary teaching hospitals (VTH) to be at the forefront of progressive business management to serve as a model for both students and practitioners to emulate. To provide a foundation for developing a model, this study reviewed pertinent literature applicable to the management of a VTH. Much of the literature relevant to VTH management relates to work completed for the human side of medicine (academic health centers, or AHCs) or to the private sector. This review explores management practices in strategic planning, financial management, human resource management, marketing, pricing, operations, and legal issues. It is concluded that strategic management is important to provide the foundation for success in the VTH. In addition, periodic financial reports are recommended, as are the development and use of benchmarks for financial management. Establishing positive, motivating human resource practices is also suggested, along with development of a marketing plan based on a clear understanding of VTH core competencies and the market's specific needs. PMID:15510343

  20. Income Analysis of University-Owned Teaching Hospitals.

    ERIC Educational Resources Information Center

    Isaacs, Joseph C.

    1979-01-01

    The annual survey, undertaken by the Association of American Medical Colleges, of income, expense and general operating information for university-owned teaching hospitals is discussed. Focus is on sources of income, including state funds, Medicare, and insurance companies. (JMD)

  1. The process of VNA affiliation with a major teaching hospital.

    PubMed

    Harris, M D

    1992-01-01

    Affiliation among agencies with differing staff, resources, organizational structure, policies, and programs is never easy. The author discusses major components of an affiliation between a visiting nurse association and its former competitor--a major teaching hospital. PMID:1506912

  2. Availability of Instructional Materials at the Basic Education Level in Enugu Educational Zone of Enugu State, Nigeria

    ERIC Educational Resources Information Center

    Chukwu, Leo C.; Eze, Thecla A. Y.; Agada, Fidelia Chinyelugo

    2016-01-01

    The study examined the availability of instructional materials at the basic education level in Enugu Education Zone of Enugu State, Nigeria. One research question and one hypothesis guided the study. The research question was answered using mean and grand mean ratings, while the hypothesis was tested using t-test statistics at 0.05 level of…

  3. Out-of-pocket cost of managing sick newborns in Enugu, southeast Nigeria

    PubMed Central

    Ekwochi, Uchenna; Osuorah, D Chidiebere; Ndu, Ikenna K; Ezenwosu, Osita U; Amadi, Ogechukwu F; Nwokoye, Ikenna C; Odetunde, O Israel

    2014-01-01

    Background Neonatal illnesses usually require long hospital stays and specialized care and/or facilities, which usually results in huge medical bills. With more than 70% of people in Nigeria living on less than US$2 per day, these bills are not affordable to many families’ livelihoods. Aim This study aims to determine the average cost of managing neonatal illnesses in Enugu in southeast Nigeria and the proportion of family income spent on these illnesses. It further seeks to ascertain the cost of various components in the management of neonatal diseases. Methods This is a longitudinal and descriptive study involving 106 newborns admitted to the sick baby unit of the Enugu State University Teaching Hospital and the out-of-pocket medical expenditure in the management of their illnesses. Results A hundred and six newborns participated in the study. All (100%) medical bills were out-of-pocket payments, and 103 (97.2%) of these were catastrophic health expenditure (more than 10% of total family monthly income). The average duration of hospital stay and cost of managing a neonatal illness was 12.86±8.81 days and ₦36,382±19,389.72 (US$223±119), respectively. This expenditure amounted to 157%, 71%, and 25% of total monthly family income for the low, middle, and upper socioeconomic class families, respectively, with a mean percentage of 85%. Families with a total monthly income of less than ₦10,000 (US$61), ₦10,000–49,999 (US$61–306), and ₦50,000–100,000 (US$306–612) and more than ₦100,000 (US$612) on average spent 683%, 108%, 54%, and 20% of their monthly income on their newborn’s illness. Hospital and utility bills compared with bills accruing from drug and laboratory investigations account for a significantly larger proportion of total cost incurred in neonatal sepsis (₦23,499±14,987 [US$144±92], P=0.001), low birth weight (₦39,863±24,003 [US$224±147], P=0.001), severe anemia (₦40,504±13,923 [US$248±85], P=0.001), transient tachypnea

  4. Poisonings at Nepal Medical College Teaching Hospital.

    PubMed

    Shrestha, B; Singh, P M; Bharati, U; Dhungel, S

    2011-09-01

    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

  5. 'Blueprint' for creating classroom facilities in teaching hospitals.

    PubMed

    Hayes, O W

    1993-06-01

    Classroom facilities in teaching hospitals have evolved from simple rooms with blackboards to sophisticated amphitheaters with high-tech audiovisual equipment. This article presents a "blueprint," which was used in an osteopathic hospital, to renovate existing space into classrooms that are conducive to learning. PMID:8349484

  6. Well waters fluoride in Enugu, Nigeria.

    PubMed

    Ogbu, I Si; Okoro, O Io; Ugwuja, E I

    2012-04-01

    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

  7. Effect of Low CD4 Cell Count on Cervical Squamous Intraepithelial Lesions among HIV-Positive Women in Enugu, Southeastern Nigeria

    PubMed Central

    Enebe, Joseph Tochukwu; Nnakenyi, Emeka Francis; Ezegwui, Hyginus Uzochukwu; Ozumba, Benjamin Chukwuma

    2015-01-01

    Introduction HIV-positive women are more likely to develop cervical neoplasm. HIV-positive women with low CD4 T-lymphocyte cell count may be more predisposed to cervical squamous intraepithelial lesions (SILs). This study aimed to determine the association between low cellular immunity of HIV positive women, and the prevalence and grade of cervical squamous intraepithelial lesions. Materials and Methods Pap smear was carried out on two cohorts of Highly Active Anti Retroviral Therapy (HAART) experienced HIV-positive women (178 per group) at the AIDS Prevention Initiative in Nigeria-Centre for Disease Control Adult Anti-Retroviral clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria from June to November, 2012. The study group had CD4 cell count of < 200 cells/μl while the control group had CD4 cell count of ≥200 cells/μl. Results The mean CD4 cell counts of participants in the study (low CD4) group was 127.9 ± 47.49 cells/ml while that of the control (high CD4) group was 489.2 ± 186.36 cells/ml (p < 0.001). The prevalence of SIL was 10.2% (18/176) for the low CD4 group, and 5.7% (10/176) for the high CD4 group [OR = 1.9 (95% CI: 0.85, 4.22)]. The commonest category of SILs identified was Low-grade Squamous Intraepithelial Lesion (LSIL), thus 11 (6.3%) in the study versus 7 (4.0%) in the control group (p = 0.703). Conclusion Prevalence of cervical SILs among HIV positive women on HAART in Enugu, Nigeria is low and has no significant relationship with their CD4 cell count. PMID:26674006

  8. Hurricane Katrina's Impact on Tulane's Teaching Hospitals

    PubMed Central

    Taylor, Ian L.

    2007-01-01

    On Monday, August 29, 2005 Hurricane Katrina passed east of New Orleans causing minimal damage to Tulane's Medical Center. Later that day, levees that protected the city failed and several feet of water entered the hospitals and school buildings. Emergency generators provided power for 36 hours before running out of fuel. Temperatures in the hospitals soared into the upper 90's and conditions were made intolerable by 100% humidity and backed-up sewage. For several days, faculty, residents, nurses and hospital personnel performed heroically, caring for patients in appalling conditions, hand-ventilating critically ill patients in shifts. Approximately 200 patients, and 1500 additional personnel would be evacuated on Wednesday and Thursday from a makeshift heliport on Tulane's parking garage. Current disaster plans may be inadequate should facilities be inaccessible for months because of damage or contamination. Contingency plans also need to be made should outside disaster relief be markedly delayed as was the case with Katrina. PMID:18528490

  9. Erratum: maternal mortality in Cameroon: a university teaching hospital report.

    PubMed

    2015-01-01

    This erratum corrects article: "Maternal mortality in Cameroon: a university teaching hospital report." The Pan African Medical Journal. 2015;21:16. doi:10.11604/pamj.2015.21.16.3912[This corrects the article on p. 16 in vol. 21, PMID: 26401210.]. PMID:26816561

  10. Maximizing Financial Resources in Veterinary Medical Teaching Hospitals.

    ERIC Educational Resources Information Center

    Walker, Terry S.

    1979-01-01

    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…

  11. Dealing with the complex dynamics of teaching hospitals.

    PubMed

    van Rossum, Tiuri R; Scheele, Fedde; Scherpbier, Albert J J A; Sluiter, Henk E; Heyligers, Ide C

    2016-01-01

    Innovation and change in postgraduate medical education programs affects teaching hospital organizations, since medical education and clinical service are interrelated.Recent trends towards flexible, time-independent and individualized educational programs put pressure on this relationship. This pressure may lead to organizational uncertainty, unbalance and friction making it an important issue to analyze.The last decade was marked by a transition towards outcome-based postgraduate medical education. During this transition competency-based programs made their appearance. Although competency-based medical education has the potential to make medical education more efficient, the effects are still under debate. And while this debate continues, the field of medical education is already introducing next level innovations: flexible and individualized training programs. Major organizational change, like the transition to flexible education programs, can easily lead to friction and conflict in teaching hospital organizations.This article analyses the organizational impact of postgraduate medical education innovations, with a particular focus on flexible training and competency based medical education. The characteristics of teaching hospital organizations are compared with elements of innovation and complexity theory.With this comparison the article argues that teaching hospital organizations have complex characteristics and behave in a non-linear way. This perspective forms the basis for further discussion and analysis of this unexplored aspect of flexible and competency based education. PMID:27048264

  12. Innovative Model for Information Assurance Curriculum: A Teaching Hospital

    ERIC Educational Resources Information Center

    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

    2006-01-01

    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…

  13. Possible adverse drug events leading to hospital admission in a Brazilian teaching hospital

    PubMed Central

    Varallo, Fabiana Rossi; Capucho, Helaine Carneiro; da Silva Planeta, Cleópatra; de Carvalho Mastroianni, Patrícia

    2014-01-01

    OBJECTIVES: Drug safety problems can lead to hospital admission. In Brazil, the prevalence of hospitalization due to adverse drug events is unknown. This study aims to estimate the prevalence of hospitalization due to adverse drug events and to identify the drugs, the adverse drug events, and the risk factors associated with hospital admissions. METHOD: A cross-sectional study was performed in the internal medicine ward of a teaching hospital in São Paulo State, Brazil, from August to December 2008. All patients aged ≥18 years with a length of stay ≥24 hours were interviewed about the drugs used prior to hospital admission and their symptoms/complaints/causes of hospitalization. RESULTS: In total, 248 patients were considered eligible. The prevalence of hospitalization due to potential adverse drug events in the ward was 46.4%. Overprescribed drugs and those indicated for prophylactic treatments were frequently associated with possible adverse drug events. Frequently reported symptoms were breathlessness (15.2%), fatigue (12.3%), and chest pain (9.0%). Polypharmacy was a risk factor for the occurrence of possible adverse drug events. CONCLUSION: Possible adverse drug events led to hospitalization in a high-complexity hospital, mainly in polymedicated patients. The clinical outcomes of adverse drug events are nonspecific, which delays treatment, hinders causality analysis, and contributes to the underreporting of cases. PMID:24626940

  14. Epidemiology of systemic inflammatory response syndrome and sepsis in cats hospitalized in a veterinary teaching hospital.

    PubMed

    Babyak, Jonathan M; Sharp, Claire R

    2016-07-01

    OBJECTIVE To describe the epidemiology of the systemic inflammatory response syndrome (SIRS) and sepsis in cats hospitalized in a veterinary teaching hospital. DESIGN Observational study. ANIMALS 246 client-owned cats. PROCEDURES During a 3-month period, daily treatment records were evaluated for all hospitalized cats. Information extracted included signalment, temperature, heart rate, respiratory rate, diagnostic test results, diagnosis, duration of hospitalization, and outcome (survival or death). Cats were classified into 1 of 4 disease categories (sepsis [confirmed infection and SIRS], infection [confirmed infection without SIRS], noninfectious SIRS [SIRS without a confirmed infection], and no SIRS [no SIRS or infection]). RESULTS Of the 246 cats, 26 and 3 were hospitalized 2 and 3 times, respectively; thus, 275 hospitalizations were evaluated. When SIRS was defined as the presence of ≥ 2 of 4 SIRS criteria, 17 cats had sepsis, 16 had infections, 81 had noninfectious SIRS, and 161 were classified in the no SIRS category at hospital admission. The prevalence of sepsis at hospital admission was 6.2 cases/100 admissions. Four cats developed sepsis while hospitalized, resulting in a sepsis incidence rate of 1.5 cases/100 hospital admissions. Four of 17 cats with sepsis at hospital admission and 3 of 4 cats that developed sepsis while hospitalized died or were euthanized, resulting in a mortality rate of 33.3% for septic cats; 239 hospitalizations resulted in survival, 28 resulted in euthanasia, and 8 resulted in death. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that many hospitalized cats have evidence of SIRS and some have sepsis. In cats, sepsis is an important clinical entity with a high mortality rate. PMID:27308883

  15. Point prevalence of hospital-acquired infections in two teaching hospitals of Amhara region in Ethiopia

    PubMed Central

    Yallew, Walelegn Worku; Kumie, Abera; Yehuala, Feleke Moges

    2016-01-01

    Purpose Hospital-acquired infection (HAI) is a major safety issue affecting the quality of care of hundreds of millions of patients every year, in both developed and developing countries, including Ethiopia. In Ethiopia, there is no comprehensive research that presents the whole picture of HAIs in hospitals. The objective of this study was to examine the nature and extent of HAIs in Ethiopia. Methods A repeated cross-sectional study was conducted in two teaching hospitals. All eligible inpatients admitted for at least 48 hours on the day of the survey were included. The survey was conducted in dry and wet seasons of Ethiopia, that is, in March to April and July 2015. Physicians and nurses collected the data according to the Centers for Disease Control and Prevention definition of HAIs. Coded and cleaned data were transferred to SPSS 21 and STATA 13 for analysis. Univariate and multivariable logistic regression analyses were used to examine the prevalence of HAIs and relationship between explanatory and outcome variables. Results A total of 908 patients were included in this survey, the median age of the patients was 27 years (interquartile range: 16–40 years). A total of 650 (71.6%) patients received antimicrobials during the survey. There were 135 patients with HAI, with a mean prevalence of 14.9% (95% confidence interval 12.7–17.1). Culture results showed that Klebsiella spp. (22.44%) and Staphylococcus aureus (20.4%) were the most commonly isolated HAI-causing pathogens in these hospitals. The association of patient age and hospital type with the occurrence of HAI was statistically significant. Conclusion It was observed that the prevalence of HAI was high in the teaching hospitals. Surgical site infections and pneumonia were the most common types of HAIs. Hospital management should give more attention to promoting infection prevention practice for better control of HAIs in teaching hospitals. PMID:27601932

  16. Six years' experience of symphysiotomy in a teaching hospital.

    PubMed

    Norman, R J

    1978-12-30

    One hundred and sixty-one symphysiotomies were performed at Harari Maternity Hospital, Rhodesia, over a 6-year period. Indications for the operation are discussed and fetal and maternal results reviewed. Seventy-two patients suffered from postoperative complications but the majority of these were minor and of short duration. Multiparous patients did not have a higher morbidity than did primiparous ones. It is concluded that symphysiotomy has a useful role to play in a teaching hospital, provided it is performed by an experienced surgeon on carefully selected patients. PMID:746479

  17. Reimbursing for the costs of teaching and research in Finnish hospitals: a stochastic frontier analysis.

    PubMed

    Linna, Miika; Häkkinen, Unto

    2006-03-01

    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

  18. Implementing electronic medication management at an Australian teaching hospital.

    PubMed

    Day, Richard O; Roffe, David J; Richardson, Katrina L; Baysari, Melissa T; Brennan, Nicholas J; Beveridge, Sandy; Melocco, Teresa; Ainge, John; Westbrook, Johanna I

    2011-11-01

    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

  19. Teaching hospital performance: towards a community of shared values?

    PubMed

    Mauro, Marianna; Cardamone, Emma; Cavallaro, Giusy; Minvielle, Etienne; Rania, Francesco; Sicotte, Claude; Trotta, Annarita

    2014-01-01

    This paper explores the performance dimensions of Italian teaching hospitals (THs) by considering the multiple constituent model approach, using measures that are subjective and based on individual ideals and preferences. Our research replicates a study of a French TH and deepens it by adjusting it to the context of an Italian TH. The purposes of this research were as follows: to identify emerging views on the performance of teaching hospitals and to analyze how these views vary among hospital stakeholders. We conducted an in-depth case study of a TH using a quantitative survey method. The survey uses a questionnaire based on Parsons' social system action theory, which embraces the major models of organizational performance and covers three groups of internal stakeholders: physicians, caregivers and administrative staff. The questionnaires were distributed between April and September 2011. The results confirm that hospital performance is multifaceted and includes the dimensions of efficiency, effectiveness and quality of care, as well as organizational and human features. There is a high degree of consensus among all observed stakeholder groups about these values, and a shared view of performance is emerging. Our research provides useful information for defining management priorities to improve the performance of THs. PMID:24560230

  20. Transfusion monitoring: care practice analysis in a public teaching hospital

    PubMed Central

    dos Reis, Valesca Nunes; Paixão, Isabella Bertolin; Perrone, Ana Carolina Amaral de São José; Monteiro, Maria Inês; dos Santos, Kelli Borges

    2016-01-01

    ABSTRACT Objective To analyze the process of recording transfusion monitoring at a public teaching hospital. Methods A descriptive and retrospective study with a quantitative approach, analyzing the instruments to record transfusion monitoring at a public hospital in a city in the State of Minas Gerais (MG). Data were collected on the correct completion of the instrument, time elapsed from transfusions, records of vital signs, type of blood component more frequently transfused, and hospital unit where transfusion was performed. Results A total of 1,012 records were analyzed, and 53.4% of them had errors in filling in the instruments, 6% of transfusions started after the recommended time, and 9.3% of patients had no vital signs registered. Conclusion Failures were identified in the process of recording transfusion monitoring, and they could result in more adverse events related to the administration of blood components. Planning and implementing strategies to enhance recording and to improve care delivered are challenging. PMID:27074233

  1. 42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions of payment: Assistants at surgery in... in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching hospitals. (a... schedule basis for the services of an assistant at surgery in a teaching hospital. This section is based...

  2. 42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Conditions of payment: Assistants at surgery in... in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching hospitals. (a... schedule basis for the services of an assistant at surgery in a teaching hospital. This section is based...

  3. Tuberculosis treatment outcomes among hospital workers at a public teaching and national referral hospital in Kenya

    PubMed Central

    Makori, L.; Gikera, M.; Wafula, J.; Chakaya, J.; Edginton, M. E.; Kumar, A. M. V.

    2013-01-01

    Setting: Kenyatta National Hospital (KNH), Nairobi, Ken-ya, a large referral and teaching hospital. Objective: 1) To document tuberculosis (TB) case notification rates and trends; 2) to describe demographic, clinical and workplace characteristics and treatment outcomes; and 3) to examine associations between demographic and clinical characteristics, HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome) treatment and anti-tuberculosis treatment outcomes among hospital workers with TB at KNH during the period 2006–2011. Design: A retrospective cohort study involving a review of medical records. Results: The TB case notification rate among hospital staff ranged between 413 and 901 per 100 000 staff members per year; 51% of all cases were extra-pulmonary TB; 74% of all cases were among medical, paramedical and support staff. The TB-HIV coinfection rate was 60%. Only 75% had a successful treatment outcome. Patients in the retreatment category, those with unknown HIV status and those who were support staff had a higher risk of poor treatment outcomes. Conclusion: The TB case rate among hospital workers was unacceptably high compared to that of the general population, and treatment outcomes were poor. Infection control in the hospital and management of staff with TB requires urgent attention. PMID:26393055

  4. A comparative analysis of the CVP structure of nonprofit teaching and for-profit non-teaching hospitals.

    PubMed

    Liu, Li-Lin; Forgione, Dana A; Younis, Mustafa Z

    2012-01-01

    Due to the market turbulence facing the hospital industry, the financial viability of teaching hospitals has been severely threatened. Their missions of education, research, and patient care even strengthen this crisis. Therefore, the objective of this study is to conduct a comparative analysis of the cost, volume, and profit (CVP) structure between large nonprofit urban teaching hospitals and small for-profit rural/suburban non-teaching hospitals. The following two hypotheses were developed: (1) large nonprofit urban teaching hospitals tend to have higher fixed cost, lower variable cost, lower total revenue adjusted by case mix index (CMI), and lower return on total assets (ROA); and (2) small for-profit rural/suburban non-teaching hospitals tend to have lower fixed cost, higher variable cost, higher total revenue adjusted by CMI, and higher ROA. Using 117 teaching hospitals and 102 non-teaching hospitals selected from the Medicare Cost Report database in 2005, the results from multiple regression indicated that large nonprofit teaching hospitals located in urban areas are more likely to have higher fixed cost and lower variable cost. While such cost structure doesn't necessarily affect their total revenue adjusted by CMI, it does lead to a lower return on hospitals' total assets. The results support our hypotheses in terms of fixed cost percentage, variable cost percentage, and ROA, but not total revenue adjusted by CMI. The results suggest that cost structure is significantly associated with hospitals' performance. Also, as teaching hospitals' portfolios of services and programs increase (e.g., provision of uncompensated care to Medicare and Medicaid patients and doing research), it becomes strategically necessary and critical to manage the allocation of resources or investments into the fixed capital that supports the business. PMID:23155742

  5. The Balanced Budget Act of 1997: its impact on U.S. teaching hospitals.

    PubMed

    Dickler, R; Shaw, G

    2000-05-16

    The Balanced Budget Act of 1997 had a profound impact on the financing and organization of many health care services. The Act disproportionately affected U.S. teaching hospitals, leading to substantial budget reductions in many institutions and the threat of cuts in major programs and services that teaching hospitals provide to communities. This paper examines the overall financial and organizational impact of the Balanced Budget Act on teaching hospitals and considers its effect on residency education. It also discusses to what degree the Balanced Budget Refinement Act of 1999 will mitigate these effects and posits other solutions to the serious financial issues facing teaching hospitals in the United States. PMID:10819706

  6. Council of Teaching Hospitals: Survey of Housestaff Stipends, Benefits and Funding, 1992.

    ERIC Educational Resources Information Center

    Evans, Alison

    This report presents the results of an annual survey of housestaff stipends, benefits, and funding for physicians at teaching hospitals in 1992. The data, presented in 48 tables and 4 figures, are based on responses from 325 members of the Council of Teaching Hospitals (COTH), an 83 percent response rate to the survey. Chapter I contains stipend…

  7. Family Physicians and Teaching Hospitals: A Litany of Woes

    PubMed Central

    Hansen, Niels H.

    1984-01-01

    Retreat of family physicians from caring for their patients in teaching hospitals has been partly imposed and partly passively accepted. Confusion of patient, family doctor and consultant relationships has resulted. Town/gown and family physician/specialist communication problems disrupt a proper model of care. Family physicians need to take individual and group action to initiate change, but little action has been evident. Everyone is the loser. We should reinstitute a model in which family physicians are the closest professionals to their patients, wherever they are in the health care system. Demonstrating the value of family physician coordination of care and continuity of care will positively affect the current financial `loss leader' status of this work. PMID:21279057

  8. Teaching hospital planning: a case study and the need for reform.

    PubMed

    Davis, Christopher K; Smith, Harry

    2010-08-16

    Academic teaching hospitals and their networks can best serve patients and other stakeholders by achieving critical mass and scope of clinical services, teaching and research. Successful hospital reconfigurations are associated with a convincing case and majority clinician buy-in. The inscrutable political decision to relocate services away from a major teaching hospital campus and into a merged Queensland Children's Hospital was determined without broad stakeholder consultation or a transparent and accountable business case. This compromised process poses a significant and enduring risk to patient care and Queensland's paediatric, perinatal, adolescent and obstetric academic teaching hospital services. As the proposed major stakeholder in Australia's public hospitals and medical workforce training, the federal government should review this decision using an effective methodology incorporating relevant criteria. National guidelines are needed to ensure best practice in the future planning and auditing of major health care projects. The medical profession is responsible for ensuring that health care policy complies with reliable evidence and good practice. PMID:20712545

  9. Complementary and alternative medicine use among adults in Enugu, Nigeria

    PubMed Central

    2011-01-01

    Background Attention and interest in the use of Complementary and Alternative Medicine (CAM) has been reawakened globally. Evidence from studies carried out in different parts of the world has established that CAM use is very common and varies among populations. This study investigated the use of CAM among adults in Enugu urban, irrespective of their health status. It provided information on the prevalence of CAM use, forms of CAM remedies used and reasons for utilizing them Methods The study areas were three local government areas in Enugu urban of Enugu State. Cross-sectional survey using questionnaires were administered to randomly selected households. All consenting participants were used for the study Results 732 participants (37.2% males and 62.8% females) were used for the study. Ages ranged from 18 - 65 years. 620 (84.7%) of the adult population have used CAM ranging from one single type to twenty different types while 112 (15.3%) have not used any form of CAM. The most commonly used CAM product was the biological products, followed by prayer/faith healing. Major reasons for using CAM include their natural state and also for health promotion and maintenance. Conclusion There is need for adequate policy formulation and regulation to ensure safety and efficacy of CAM products. Measures to ensure rational use of CAM should be instituted. PMID:21375759

  10. 42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Conditions of payment: Assistants at surgery in... Physician Services in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching... a fee schedule basis for the services of an assistant at surgery in a teaching hospital....

  11. 42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Conditions of payment: Assistants at surgery in... Physician Services in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching... a fee schedule basis for the services of an assistant at surgery in a teaching hospital....

  12. 42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Conditions of payment: Assistants at surgery in... Physician Services in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching... a fee schedule basis for the services of an assistant at surgery in a teaching hospital....

  13. Effect of Auditory Training on Reading Comprehension of Children with Hearing Impairment in Enugu State

    ERIC Educational Resources Information Center

    Ugwuanyi, L. T.; Adaka, T. A.

    2015-01-01

    The paper focused on the effect of auditory training on reading comprehension of children with hearing impairment in Enugu State. A total of 33 children with conductive, sensory neural and mixed hearing loss were sampled for the study in the two schools for the Deaf in Enugu State. The design employed for the study was a quasi experiment (pre-test…

  14. Evolution of Hospital-based Pharmacy Teaching Programs from 1989-1998.

    ERIC Educational Resources Information Center

    Raehl, Cynthia; Bond, C. A.

    2000-01-01

    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…

  15. Audit of Childbirth Emergency Referrals by Trained Traditional Birth Attendants in Enugu, Southeast, Nigeria

    PubMed Central

    Okafor, II; Arinze-Onyia, SU; Ohayi, SAR; Onyekpa, JI; Ugwu, EO

    2015-01-01

    Background: The essence of training traditional birth attendants (TBAs) is to attend to women in uncomplicated labor and to refer them immediately to hospitals when complications develop. Aim: The aim was to audit childbirth emergency referrals by trained TBAs to a specialist hospital in Enugu, Nigeria. Subjects and Methods: A retrospective study of 205 childbirth emergencies referred to Semino Hospital and Maternity (SHM), Enugu by trained TBAs from August 1, 2011 to January 31, 2014. Data analysis was descriptive and inferential at 95% confidence level. Results: Most of the patients (185/205, 90.2%) were married and (100/205, 48.8%) had earlier booked for antenatal care in formal health facilities. There were obstetric danger signs or previous bad obstetric histories (pregnancies with unfavorable outcome) in 110 (110/205, 53.7%) women on admission at SHM. One hundred and fifteen (115/205, 56.1%) women walked into the hospital by themselves while 50 (50/205, 24.39%) could not walk. The fetal heart sounds were normal in 94 (94/205, 45.6%), abnormal in 65 (65/205, 31.8%) and absent in 42 (42/205, 20.4%) of the women on admission. Five healthy babies were delivered by the TBAs before referring their mothers. Delays of more than 12 h had occurred in 155 (155/205, 76.6%) of the women before referrals. Prolonged labor (100/205, 48.8%), obstructed labor (40/205, 19.5%), attempted vaginal birth after previous cesarean delivery (40/205, 19.5%) and malpresentation (30/205, 14.6%) were the common indications for referrals. The maternal mortality and perinatal mortality ratios were 610/100,000 live births and 228/1000 total births respectively. Conclusion: Delays at TBA centers are common before referral and most patients are referred in poor clinical state. Further training and re-training of the TBAs with more emphasis on recognition of obstetric danger signs and bad obstetric histories may help in screening high-risk patients for prompt referral to hospitals before

  16. Improvement of hospital processes through business process management in Qaem Teaching Hospital: A work in progress

    PubMed Central

    Yarmohammadian, Mohammad H.; Ebrahimipour, Hossein; Doosty, Farzaneh

    2014-01-01

    In a world of continuously changing business environments, organizations have no option; however, to deal with such a big level of transformation in order to adjust the consequential demands. Therefore, many companies need to continually improve and review their processes to maintain their competitive advantages in an uncertain environment. Meeting these challenges requires implementing the most efficient possible business processes, geared to the needs of the industry and market segments that the organization serves globally. In the last 10 years, total quality management, business process reengineering, and business process management (BPM) have been some of the management tools applied by organizations to increase business competiveness. This paper is an original article that presents implementation of “BPM” approach in the healthcare domain that allows an organization to improve and review its critical business processes. This project was performed in “Qaem Teaching Hospital” in Mashhad city, Iran and consists of four distinct steps; (1) identify business processes, (2) document the process, (3) analyze and measure the process, and (4) improve the process. Implementing BPM in Qaem Teaching Hospital changed the nature of management by allowing the organization to avoid the complexity of disparate, soloed systems. BPM instead enabled the organization to focus on business processes at a higher level. PMID:25540784

  17. Evaluation of ureteroscopy outcome in a teaching hospital

    PubMed Central

    Al-Naimi, Abdulla; Alobaidy, Abdulqadir; Majzoub, Ahmad; Ibrahim, Tarek Ahmed Amin

    2016-01-01

    Objective To evaluate factors affecting semi-rigid ureteroscopy (URS) results highlighting the influence of teaching on its outcomes. Material and methods We reviewed the files of 891 adult patients who had undergone 1182 ureteroscopies at our institute during the period from July 2008 to June 2011. The outcomes of all URSs were evaluated. Outcomes were measured by stone- free rate and presence of complications, which were assessed using the Clavien-Dindo system. Patients were divided into 2 groups; Group 1 (favorable outcome) became stone- free after the first URS and had no documented complications, while Group 2 (unfavorable outcome) had residual stones and/or complications. Group 2 was subdivided according to the skill level of the operating surgeon into two subgroups. Patients belonging to subgroup A had their procedures performed by urology trainees under direct supervision of expert urologists, while those in subgroup B had their procedures performed by the expert urologists themselves. All groups were compared using univariate (chi-square and t tests) and multivariate (logistic regression) statistical tests to identify significant risk factors. All data was analyzed using SPSS. Results A total of 1182 URSs were evaluated. 958 patients had a favorable outcome (Group 1) while 224 patients had an unfavorable outcome (Group 2). Factors associated with an unfavorable outcome include location of the presenting stone (p<0.001) and presence of stone impaction (p<0.001). No statistically significant differences were detected in the overall complication rate between trainees and expert urologists. Trainees stone- free rate was comparable to that of experts; 90.3% vs. 91.1%, respectively, p=0.6. Conclusion Factors such as stone impaction and proximal location are associated with an unfavorable surgical outcome. In a high- volume teaching hospital, semi-rigid URS done by trainees under direct supervision is safe and their outcome is comparable to literature findings.

  18. Analysis of uterine rupture at university teaching hospital Pakistan

    PubMed Central

    Aziz, Nousheen; Yousfani, Sajida

    2015-01-01

    Objective: To determine the risk factors, management modalities, fetomaternal outcome of uterine rupture cases at University teaching hospital in Pakistan. Methods: This retrospective descriptive study was conducted at the Department of Gynaecology and Obstetrics Liaquat University of Medical and Health Sciences (LUMHS) for a period of one year from January 1st to December 31st 2012. Main outcome measures were frequency, age, parity, booking status, risk factors, management modalities, fetal and maternal mortality associated with uterine rupture. The data was collected on pre-designed proforma analysed using SPSS Version 16 statistical package. Results: The frequency of ruptured uteri was calculated to be 0.67%, giving a ratio of 1:148 deliveries. Highest incidence was found in age group 25-30 (44.26%) with mean age of 30.36 years. and parity group 2-3 (57.37%) with mean parity 4.08. The risk factors for ruptured uterus include Caesarean section 43(70.49%), injudicious use of oxytocin 33(54.09%), obstructed labour 15 (24.59%) and multiparty 18 (29.50%). Repair of uterus was performed in 47(77.04%) cases. Maternal case fatality was 5(8.19%), while foetal wastage was 51 (83.60%). Conclusion: This study confirms the existence of a serious preventable obstetric problem, with significant maternal mortality and foetal wastage. Integrated efforts include Health education, focused antenatal care, skilled attendance, avoidance of injudicious use of oxytocin, and need of hospital based deliveries in patients with caesarean section which should be intensified to reduce this drastic obstetrical complication. PMID:26430430

  19. Acute leukaemias in adult Ethiopians in a teaching hospital.

    PubMed

    Shamebo, M

    1994-01-01

    Eighty-two consecutive cases of acute leukaemias in adult Ethiopians were admitted to the Tikur Anbessa (Black Lion) Hospital, a teaching and referral hospital in Addis Abeba, Ethiopia, from January 1982 to December 1992. These cases were studied to describe the clinical and haematological findings, response to therapy and prognosis. The age range was 13-78 (mean 29.6) years. The male to female ratio was 1.6:1. Acute myeloblastic (AML) and acute lymphoblastic (ALL) leukaemias occurred in 53.7% and 46.3%, respectively. The commonest symptoms were anaemia, fever and bleeding tendencies. The commonest signs were pallor, fever, sternal tenderness and purpura. Splenomegaly was more commonly seen in ALL patients. The haematological findings were anaemia (mean Hgb 6.35 g%), leucocytosis (mean WBC count 88,507/mm3) and thrombocytopenia (mean platelet count 31,700/mm3). Of the patients eligible for evaluation treated with chemotherapeutic agents, only 38.4% of ALL and 6.2% of AML achieved complete remission. Twenty-seven patients with ALL died from one day to 84 (median 1.0) months after diagnosis. Ten are lost to follow-up from two weeks to 36 (median 2.5) months, one is still alive 40 months after diagnosis. Thirty-nine of the AML patients died from one day to nine (median 0.3) months after diagnosis. Five are lost to follow-up from two weeks to two and a half (median 2.0) months. The causes of death were sepsis and bleeding, separately or in combination. Increasing numbers of acute leukaemia patients are being referred to this centre. Therefore, attempts should be made to equip it for the treatment of such cases. PMID:8187778

  20. Antifungal agent utilization evaluation in hospitalized neutropenic cancer patients at a large teaching hospital

    PubMed Central

    Vazin, Afsaneh; Davarpanah, Mohammad Ali; Ghalesoltani, Setareh

    2015-01-01

    To evaluate pattern of using of three antifungal drugs: fluconazole, amphotericin B and voriconazole, at the hematology–oncology and bone marrow transplant wards of one large teaching hospital. In a prospective cross-sectional study, we evaluated the appropriateness of using antifungal drugs in patients, using Infectious Disease Society of America (IDSA) and National Comprehensive Cancer Network (NCCN) guidelines. All the data were recorded daily by a pharmacist in a form designed by a clinical pharmacist and infectious diseases specialist, for antifungals usage, administration, and monitoring. During the study, 116 patients were enrolled. Indications of prescribing amphotericin B, fluconazole, and voriconazole were appropriate according to guidelines in 83.4%, 80.6%, and 76.9% respectively. The duration of treatments were appropriate according to guidelines in 75%, 64.5%, and 71.1% respectively. The dose of voriconazole was appropriate according to guidelines in 46.2% of patients. None of the patients received salt loading before administration of amphotericin B. The most considerable problems with the mentioned antifungals were about the indications and duration of treatment. In addition, prehydration for amphotericin B and dosage of voriconazole were not completely compatible with the mentioned guidelines. A suitable combination of controlling the use of antifungals and educational programs could be essential for improving the general process of using antifungal drugs at our hospital. PMID:26064070

  1. Vulvovaginal Candidiasis in Aminu Kano Teaching Hospital, North-West Nigeria: Hospital-Based Epidemiological Study

    PubMed Central

    Ugwa, EA

    2015-01-01

    Background: Vulvovaginal candidiasis (VVC) remains a common problem worldwide and the role of douching as a predisposing factor is unclear. Aim: This study was undertaken to highlight the prevalence and predisposing factors of VVC in North-west Nigeria. Subjects and Methods: This was a prospective study done at Aminu Kano Teaching Hospital (AKTH), North-west. AKTH is a 500-bed tertiary hospital located in Kano, the most populous state in Nigeria. Ethical clearance was obtained. Three hundred patients with VVC were recruited from the gynecologic and general outpatients’ clinics of AKTH. Research structured questionnaires were used to obtain sociodemographic and clinical information. The data obtained were analyzed using SPSS version 16.0 statistical software (SPSS Inc., Chicago IL, USA). Frequency, mean and simple percentages were used to analyze data. Result: Candida albicans was the most frequent cause of the positive high vaginal swabs constituting 84.5% (316/374) while Proteus vulgaris was the least frequent cause constituting 0.53% (2/374). Fifty-three percent (143/270) of those with VVC were aged 26–35 years; the married were 80% (216/270) and those who were unmarried were 20% (54/270). Douching was the commonest predisposing factor occurring in 42.5% (115/270) of cases. Conclusion: VVC was the most prevalent cause of vaginosis in North-west Nigeria, and douching was the commonest predisposing factor. PMID:26229716

  2. Cost of nursing turnover in a Teaching Hospital.

    PubMed

    Ruiz, Paula Buck de Oliveira; Perroca, Marcia Galan; Jericó, Marli de Carvalho

    2016-02-01

    OBJECTIVE To map the sub processes related to turnover of nursing staff and to investigate and measure the nursing turnover cost. METHOD This is a descriptive-exploratory study, classified as case study, conducted in a teaching hospital in the southeastern, Brazil, in the period from May to November 2013. The population was composed by the nursing staff, using Nursing Turnover Cost Calculation Methodology. RESULTS The total cost of turnover was R$314.605,62, and ranged from R$2.221,42 to R$3.073,23 per employee. The costs of pre-hire totaled R$101.004,60 (32,1%), and the hiring process consumed R$92.743,60 (91.8%) The costs of post-hire totaled R$213.601,02 (67,9%), for the sub process decreased productivity, R$199.982,40 (93.6%). CONCLUSION The study identified the importance of managing the cost of staff turnover and the financial impact of the cost of the employee termination, which represented three times the average salary of the nursing staff. PMID:27007427

  3. Burn injuries in a young nigerian teaching hospital.

    PubMed

    Olaitan, P B; Fadiora, S O; Agodirin, O S

    2007-06-30

    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. PMID:21991070

  4. Clinical experience with adolescent diabetes in a Nigerian teaching hospital.

    PubMed Central

    Akanji, A. O.

    1996-01-01

    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. PMID:8776066

  5. Consultation and referral patterns from a teaching hospital emergency department.

    PubMed

    Cortazzo, J M; Guertler, A T; Rice, M M

    1993-09-01

    The objective of this study was to describe consultation and referral patterns from a military emergency department (ED). The design of the study consisted of a prospective analysis of consultations and referrals from Madigan Army Medical Center ED during April 1990, an Army Medical Center with multiple residencies, including emergency medicine (EM). Patient population included active and retired military personnel, their families, and civilian emergency medical system-transported patients. ED visits averaged 60,000 per year. The overall rate of consultation and referral was 39.9%; 10.7% were consultations, whereas 29.2% were referrals. PGY-2 and -3 EM residents consultation rates were higher than average. Of all ED visits, 19.7% resulted in consultations or referrals to surgical services, 13.6% to medical services, and 2.8% to pediatrics. ED patients frequently are referred to or result in consultations with non-EM physicians. Differences in consultation by level of training and the impact of consultation on consulting services both deserve further investigation. Review of EM resident use of consultation and referral may focus evaluation of ED care in teaching hospitals. PMID:8395848

  6. Clinical experience with adolescent diabetes in a Nigerian teaching hospital.

    PubMed

    Akanji, A O

    1996-02-01

    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. PMID:8776066

  7. Labial adhesion in children at the Jos University Teaching Hospital

    PubMed Central

    Samuels, Ephraim; Ocheke, Amaka Ngozi; Samuels, Nathaniel E. O.

    2016-01-01

    Background: Labial adhesion is one of the most common reasons for gynaecologic consultations in children. We sought to determine the prevalence of labial adhesions, mode of presentation and treatment in children at the Jos University Teaching Hospital. Materials and Methods: A retrospective study of labial adhesions in children from January 2004 to December 2013. Data on paediatric gynaecological consultations, and labial adhesions were retrieved from the gynaecological clinic and the theatre records. The case notes of those with labial adhesions were retrieved and the relevant data extracted. Results: The total number of paediatric patients seen at the gynaecology clinic over the study period was 379 and 25 had labial adhesion (6.6%). The majority (88%) presented in the first 2 years of life, all the patients were asymptomatic, and 2 (8%) had surgical separation of the adhesions while the rest were managed conservatively. A total of 5 (20%) came for follow-up. While 2 (8%) came a week later following surgical management, 3 (12%) came back more than 6 months later due to recurrence following conservative management. Conclusion: Labial adhesions account for significant proportion of paediatric gynaecologic consultations. They are usually asymptomatic, occur in the first 2 years of life and frequently managed conservatively. PMID:27251516

  8. Diffusion of innovation I: Formulary acceptance rates of new drugs in teaching and non-teaching British Columbia hospitals--a hospital pharmacy perspective.

    PubMed

    D'Sa, M M; Hill, D S; Stratton, T P

    1994-12-01

    Lag times in the diffusion of new drugs in the hospital setting have both patient care and pharmaceutical industry implications. This two-part series uses diffusion theory to examine differences in the adoption rates of new drugs in British Columbia teaching and non-teaching hospitals. Formulary addition of a new drug by a hospital's Pharmacy and Therapeutics Committee was considered the adoption indicator. Time for adoption was defined as the difference between a drug's Canadian market approval date and the date of formulary addition. Surveys were mailed in September 1990 to 41 hospital pharmacies (response rate = 88%), asking respondents to provide formulary inclusion dates of 29 drugs marketed between July 1987 and March 1990. A significant difference (Mann-Whitney U Test, p < 0.0358) in median adoption time was observed between the six teaching and 25 non-teaching study hospitals, with the former adopting a new drug in 7.5 months versus the latter adopting a new drug in 12.1 months. PMID:10139270

  9. Competitive strategy in turbulent healthcare markets: an analysis of financially effective teaching hospitals.

    PubMed

    Langabeer, J

    1998-01-01

    As the healthcare marketplace, characterized by declining revenues and heavy price competition, continues to evolve toward managed care, teaching hospitals are being forced to act more like traditional industrial organizations. Profit-oriented behavior, including emphases on market strategies and competitive advantage, is now a necessity if these hospitals are going to survive the transition to managed care. To help teaching hospitals evaluate strategic options that maximize financial effectiveness, this study examined the financial and operating data for 100 major U.S. teaching hospitals to determine relationships among competitive strategy, market environment, and financial return on invested capital. Results should help major hospitals formulate more effective strategies to combat environmental turbulence. PMID:10338929

  10. 42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... exceed $30,000. Example No: 2. Dr. Smith received $25,000 from Hospital X for services as a department head in a teaching hospital. Dr. Smith also voluntarily furnished direct medical services to... compensated services ($25,000) exceeds the $30,000 maximum amount allowable for all of Dr. Smith's...

  11. Association between Hospital Birth Volume and Maternal Morbidity among Low-Risk Pregnancies in Rural, Urban, and Teaching Hospitals in the United States.

    PubMed

    Kozhimannil, Katy B; Thao, Viengneesee; Hung, Peiyin; Tilden, Ellen; Caughey, Aaron B; Snowden, Jonathan M

    2016-05-01

    Objectives This study aims to examine the relationship between hospital birth volume and multiple maternal morbidities among low-risk pregnancies in rural hospitals, urban non-teaching hospitals, and urban teaching hospitals, using a representative sample of U.S. hospitals. Study Design Using the 2011 Nationwide Inpatient Sample from 607 hospitals, we identified 508,146 obstetric deliveries meeting low-risk criteria and compared outcomes across hospital volume categories. Outcomes include postpartum hemorrhage (PPH), chorioamnionitis, endometritis, blood transfusion, severe perineal laceration, and wound infection. Results Hospital birth volume was more consistently related to PPH than to other maternal outcomes. Lowest-volume rural (< 200 births) and non-teaching (< 650 births) hospitals had 80% higher odds (adjusted odds ratio [AOR] = 1.80; 95% CI = 1.56-2.08) and 39% higher odds (AOR = 1.39; 95% CI = 1.26-1.53) of PPH respectively, than those in corresponding high-volume hospitals. However, in urban teaching hospitals, delivering in a lower-volume hospital was associated with 14% lower odds of PPH (AOR = 0.86; 95% CI = 0.80-0.93). Deliveries in rural hospitals had 31% higher odds of PPH than urban teaching hospitals (AOR = 1.31; 95% CI = 1.13-1.53). Conclusions Low birth volume was a risk factor for PPH in both rural and urban non-teaching hospitals, but not in urban teaching hospitals, where higher volume was associated with greater odds of PPH. PMID:26731180

  12. Sources of Construction Funds in Teaching Hospitals, 1979.

    ERIC Educational Resources Information Center

    Eng, Mary

    1981-01-01

    Data compiled from the American Hospital Association's annual surveys on the sources of funding for hospital construction are provided. The pattern of financing hospital construction in institutions shifted dramatically during the last decade with the most striking change in the use of debt financing. (MLW)

  13. Traditional eye medicine use by newly presenting ophthalmic patients to a teaching hospital in south-eastern Nigeria: socio-demographic and clinical correlates

    PubMed Central

    Eze, Boniface Ikenna; Chuka-Okosa, Chimdi Memnofu; Uche, Judith Nkechi

    2009-01-01

    Background This study set out to determine the incidence, socio-demographic, and clinical correlates of Traditional Eye Medicine (TEM) use in a population of newly presenting ophthalmic outpatients attending a tertiary eye care centre in south-eastern Nigeria. Methods In a comparative cross-sectional survey at the eye clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu, between August 2004 - July 2006, all newly presenting ophthalmic outpatients were recruited. Participants' socio-demographic and clinical data and profile of TEM use were obtained from history and examination of each participant and entered into a pretested questionnaire and proforma. Participants were subsequently categorized into TEM- users and non-users; intra-group analysis yielded proportions, frequencies, and percentages while chi-square test was used for inter-group comparisons at P = 0.01, df = 1. Results Of the 2,542 (males, 48.1%; females, 51.9%) participants, 149 (5.9%) (males, 45%; females, 55%) used TEM for their current eye disease. The TEMs used were chemical substances (57.7%), plant products (37.7%), and animal products (4.7%). They were more often prescribed by non-traditional (66.4%) than traditional (36.9%) medicine practitioners. TEMs were used on account of vision loss (58.5%), ocular itching (25.4%) and eye discharge (3.8%). Reported efficacy from previous users (67.1%) and belief in potency (28.2%) were the main reasons for using TEM. Civil servants (20.1%), farmers (17.7%), and traders (14.1%) were the leading users of TEM. TEM use was significantly associated with younger age (p < 0.01), being married (p < 0.01), rural residence (p < 0.01), ocular anterior segment disease (p < 0.01), delayed presentation (p < 0.01), low presenting visual acuity (p < 0.01), and co-morbid chronic medical disease (p < 0.01), but not with gender (p = 0.157), and educational status (p = 0.115). Conclusion The incidence of TEM use among new ophthalmic outpatients at UNTH is low

  14. Evaluation of standardized teaching plans for hospitalized pediatric patients: a performance improvement project.

    PubMed

    Blagojevic, Joanne; Stephens, Sigrid

    2008-01-01

    Discharge teaching in a pediatric hospital setting is difficult because the situation involves multiple learners, time constraints, and differing skill levels of nurse teachers. Shortened length of stay forces nurses to complete patient education efficiently. Unstructured education can lead to failed learning, as evidenced by readmissions and postdischarge feedback. A performance improvement project was conducted to evaluate the effectiveness of standardized teaching plans for diabetes mellitus and infant cardiopulmonary resuscitation. Preliminary data indicated a passing score of at least 90% on posttests by all learners, suggesting that standardized teaching plans may help nurses complete prescribed discharge teaching. PMID:18507236

  15. A Statewide Strategy for Expanding Graduate Medical Education by Establishing New Teaching Hospitals and Residency Programs.

    PubMed

    Nuss, Michelle A; Robinson, Ben; Buckley, Peter F

    2015-09-01

    The graduate medical education (GME) system in the United States is in need of reform to ensure that the physician workforce being trained is able to meet the current and future health care needs of the population. However, GME funding to existing teaching hospitals and programs relies heavily on support from Medicare, which was capped in 1997. Thus, new, innovative models to expand GME are needed. To address physician shortages, especially in primary care and general surgery and in rural areas, the state of Georgia implemented a statewide initiative. They increased medical school enrollment by 600 students from 2000 to 2010 and committed to establishing new GME programs at new teaching hospitals to train 400 additional residents by 2018. As increasing the capacity of GME programs likely increases the number of physicians practicing in the state, these efforts aim to encourage trainees to practice in Georgia. Although new teaching hospitals, like these, are eligible for new Medicare funding, this approach to expanding GME also incorporates state funding to cover the start-up costs associated with establishing a new teaching hospital and GME program.In this article, the authors provide background on the current state of GME funding in the United States and on the physician workforce and medical education system in Georgia. They then outline the steps taken to expand GME by establishing new teaching hospitals and programs. They conclude by sharing outcomes to date as well as challenges faced and lessons learned so that others can follow this novel model. PMID:26312605

  16. Quality of bedside teaching in internal wards of Qaem and Imam Reza hospitals in Mashhad

    PubMed Central

    Jamaazghandi, Alireza; Emadzadeh, Ali; Vakili, Vida; Bazaz, Seyed Mojtaba Mousavi

    2015-01-01

    Background: Bedside teaching is a patient-based teaching method in medical education. The present study has been conducted with the aim of investigating the quality of bedside teaching in the internal wards of Qaem and Imam Reza Educational Hospitals. Methods: This study follows a mixed qualitative-quantitative approach using checklists on educational clinical rounds in Imam Reza and Qaem Hospitals in Mashhad. In the first stage consisting of qualitative study, the parts related to the quality of bedside teaching were recognized and a checklist was designed in three domains of patient comfort (8 questions), targeted teaching (14 questions) and group dynamics (8 questions), and its reliability and validity were verified. In the next step, data were collected and then analyzed using SPSS 16 software through statistical techniques of independent t-test, one-way ANOVA and variance analysis. Results: In total, 113 educational rounds were investigated in this study. Among them, 59 (52.2%) and 54 (47.8%) educational rounds have been investigated in Imam Reza and Qaem Hospitals, respectively. The average total score of bedside teaching was 180.8 out of 300 in the internal wards of both Imam Reza and Qaem Hospitals. Conclusion: The results of this study showed that generally the quality of bedside teaching in Imam Reza and Qaem Hospitals of Mashhad is low according to the qualitative standards considered in this study. Holding educational workshops along with more familiarity of the professors with effective bedside teaching strategies could be effective in improving the quality of educational rounds. PMID:26396735

  17. Effects of ownership, subsidization and teaching activities on hospital costs in Switzerland.

    PubMed

    Farsi, Mehdi; Filippini, Massimo

    2008-03-01

    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

  18. Exclusive breast-feeding practice and associated factors in Enugu, Nigeria.

    PubMed

    Aghaji, Margaret N

    2002-01-01

    A cross-sectional questionnaire survey was conducted among 235 infant-mother pairs in five Baby Friendly pairs in five Baby Friendly Hospitals in Enugu-Nigeria in 1998. The aims were to study their breast-feeding practices and associated factors. The exclusive breast-feeding rate was 33.3% while the predominant breast-feeding rate was 50.2%. Factors associated with exclusive breast-feeding included infants' birth order (P = 0.015), fathers' education (P =0.0244), mothers' education (P = 0.000001), occupation (P = 0.0069) and parity (P = 0.004). However, the infants' age (P = 0.054) and sex (P = 0.403), mothers' age (P = 0.2005), number of breast-feeding counseling attendances (P = 0.0883) and the breast-feeding initiator (P = 0.473) were comparable irrespective of breast-feeding practice. In the mothers' perspectives, the commonest reasons for not breastfeeding exclusively included; insufficient breast milk (58,37.0%) and the sociocultural practice of giving water to babies because of the hot climate (52,33.1%). For an improvement in the exclusive breast-feeding rate of this population, health workers should highlight to mothers the dangers of water supplementation and the dynamics of breastmilk supply through health education, home visits and the formation of community based lactation support groups. PMID:12081350

  19. Migration of patients between five urban teaching hospitals in Chicago.

    PubMed

    Galanter, William L; Applebaum, Andrew; Boddipalli, Viveka; Kho, Abel; Lin, Michael; Meltzer, David; Roberts, Anna; Trick, Bill; Walton, Surrey M; Lambert, Bruce L

    2013-04-01

    To quantify the extent of patient sharing and inpatient care fragmentation among patients discharged from a cohort of Chicago hospitals. Admission and discharge dates and patient ZIP codes from 5 hospitals over 2 years were matched with an encryption algorithm. Admission to more than one hospital was considered fragmented care. The association between fragmentation and socio-economic variables using ZIP-code data from the 2000 US Census was measured. Using validation from one hospital, patient matching using encrypted identifiers had a sensitivity of 99.3 % and specificity of 100 %. The cohort contained 228,151 unique patients and 334,828 admissions. Roughly 2 % of the patients received fragmented care, accounting for 5.8 % of admissions and 6.4 % of hospital days. In 3 of 5 hospitals, and overall, the length of stay of patients with fragmented care was longer than those without. Fragmentation varied by hospital and was associated with the proportion of non-Caucasian persons, the proportion of residents whose income fell in the lowest quartile, and the proportion of residents with more children being raised by mothers alone in the zip code of the patient. Patients receiving fragmented care accounted for 6.4 % of hospital days. This percentage is a low estimate for our region, since not all regional hospitals participated, but high enough to suggest value in creating Health Information Exchange. Fragmentation varied by hospital, per capita income, race and proportion of single mother homes. This secure methodology and fragmentation analysis may prove useful for future analyses. PMID:23381645

  20. Marital Stress and Extraversion Personality as Predicators of Job Satisfaction among Married Women Teachers in Enugu, Nigeria

    ERIC Educational Resources Information Center

    Elom, Sampson Omena; Egba, Nwamaka A.

    2015-01-01

    The study investigated marital stress and extraversion personality as predictors of job satisfaction among married women teachers in Enugu, Nigeria. One hundred and eighty eight married women teachers in Enugu, Nigeria participated in the study. Three instruments were used to gather information in this study. They included marital stress inventory…

  1. The Balanced Budget Act of 1997 and the Financial Health of Teaching Hospitals

    PubMed Central

    Phillips, Robert L.; Fryer, George E.; Chen, Frederick M.; Morgan, Sarah E.; Green, Larry A.; Valente, Ernest; Miyoshi, Thomas J.

    2004-01-01

    BACKGROUND We wanted to evaluate the most recent, complete data related to the specific effects of the Balanced Budget Act of 1997 relative to the overall financial health of teaching hospitals. We also define cost report variables and calculations necessary for continued impact monitoring. METHODS We undertook a descriptive analysis of hospital cost report variables for 1996, 1998, and 1999, using simple calculations of total, Medicare, prospective payment system, graduate medical education (GME), and bad debt margins, as well as the proportion with negative total operating margins. RESULTS Nearly 35% of teaching hospitals had negative operating margins in 1999. Teaching hospital total margins fell by nearly 50% between 1996 and 1999, while Medicare margins remained relatively stable. GME margins have fallen by nearly 24%, however, even as reported education costs have risen by nearly 12%. Medicare+Choice GME payments were less than 10% of those projected. CONCLUSIONS Teaching hospitals realized deep cuts in profitability between 1996 and 1999; however, these cuts were not entirely attributable to the Balanced Budget Act of 1997. Medicare payments remain an important financial cushion for teaching hospitals, more than one third of which operated in the red. The role of Medicare in supporting GME has been substantially reduced and needs special attention in the overall debate. Medicare+Choice support of the medical education enterprise is 90% less than baseline projections and should be thoroughly investigated. The Medicare Payment Advisory Commission, which has a critical role in evaluating the effects of Medicare policy changes, should be more transparent in its methods. PMID:15053286

  2. Accounting for teaching hospitals' higher costs and what to do about them.

    PubMed

    Newhouse, Joseph P

    2003-01-01

    Academic health centers (AHCs) have higher costs per case and also lower margins than either other teaching hospitals or community hospitals. The differences in margins stem mostly from differences in the intensity with which similar patients are treated, as well as hospitals' ability to generate revenue to cover the costs of that greater intensity, rather than graduate medical education per se. How much patient care capacity should be supported in AHCs and who should be treated with the greater intensity they offer are open questions. If there is to be a public trust fund to subsidize AHCs, it should be financed from general revenues. PMID:14649439

  3. Estimates of costs by DRG in Sydney teaching hospitals: an application of the Yale cost model.

    PubMed

    Palmer, G; Aisbett, C; Fetter, R; Winchester, L; Reid, B; Rigby, E

    1991-01-01

    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

  4. Adapting teaching styles to accommodate learning preferences for effective hospital development.

    PubMed

    Eshleman, Kelly Y

    2008-12-01

    Hospital development professionals in organ procurement organizations engage in many roles in the hospital. The important role of educator requires making the most of each teaching opportunity by understanding the characteristics of the learning audience and applying proven principles of adult educational design, with a focus on collaborative learning and variety in presentation techniques. The goal is to provide effective education, enabling hospital staff to transfer this learning to the job setting, with the outcome of facilitating a supportive process that saves lives through organ donation. PMID:19186583

  5. Malaria in Birmingham and a London teaching hospital.

    PubMed Central

    Ellis, C J; Eykyn, S J; Watkins, P; Bell, M; Geddes, A M

    1979-01-01

    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. PMID:367507

  6. Workload Impact of Medical Subspecialties in the Teaching Hospital

    ERIC Educational Resources Information Center

    Van Peenen, Hubert J.

    1973-01-01

    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)

  7. Epidemiology of Pseudomonas aeruginosa in a tertiary referral teaching hospital.

    PubMed

    Bradbury, R S; Champion, A C; Reid, D W

    2009-10-01

    A genotypically indistinguishable strain of Pseudomonas aeruginosa (Australian epidemic strain III: AES III) has previously been found in a proportion of adults with cystic fibrosis (CF) in Tasmania, Australia. The aim of this study was to identify a source of these infections within the major tertiary referral hospital for the State of Tasmania, and to determine if this strain could be isolated from settings other than the CF lung. A total of 120 isolates of P. aeruginosa were collected from clinical and environmental sources within the hospital and from environmental locations in the hospital vicinity. These isolates were genotyped by random amplification of polymorphic DNA (RAPD)-polymerase chain reaction (PCR) and antimicrobial susceptibility testing was performed using the Clinical and Laboratory Standards Institute method. Confirmation of similar genotypes identified by RAPD-PCR was performed using pulsed-field gel electrophoresis with restriction enzyme SpeI. AES III was not recovered from any source other than the respiratory secretions of CF patients. P. aeruginosa in the non-CF settings was found to be panmictic, and no cross-infection or acquisition of hospital environment strains by patients was observed. PMID:19699556

  8. Factors Associated with Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana

    ERIC Educational Resources Information Center

    Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A.; Akingbola, Titilola S.; Hewlett, Sandra A.; Tayo, Bamidele O.; Cole, Helen V.; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

    2016-01-01

    Background: Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study…

  9. A Method to Estimate the Number of House Officers Required in Teaching Hospitals.

    ERIC Educational Resources Information Center

    Chan, Linda S.; Bernstein, Sol

    1980-01-01

    A method of estimating the number of house officers needed for direct patient care in teaching hospitals is discussed. An application of the proposed method is illustrated for 11 clinical services at the Los Angeles County-University of Southern California Medical Center. (Author/MLW)

  10. 42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Determining payment for physician services furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS,...

  11. Persistence and transmission of Salmonella Infantis in a veterinary teaching hospital

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The purpose of this study was to compare Salmonella enterica serotype Infantis isolates obtained from patients or the environment of a veterinary teaching hospital over a period of nine years following a nosocomial outbreak to determine whether isolates were epidemiologically related or represented ...

  12. Approaching Hospital-Bound/Home-Bound Special Education as an Opportunity for Innovation in Teaching

    ERIC Educational Resources Information Center

    Trentin, Guglielmo

    2014-01-01

    Paradoxically some "extreme" didactic needs, such as those of students who are unable to attend normal education regularly (e.g., hospitalized and/or homebound students), have shown themselves to be ideal for the development of a teaching style aimed at stimulating the active role of the student, at fostering a learning process based…

  13. A "Prepaid Package" for Obstetrics: Effect on Teaching and Patient Care in a University Hospital

    ERIC Educational Resources Information Center

    Young, Philip E.

    1976-01-01

    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)

  14. THE EFFECT OF OUTPATIENT SERVICE QUALITY ON PATIENT SATISFACTION IN TEACHING HOSPITALS IN IRAN

    PubMed Central

    Pouragha, Behrouz; Zarei, Ehsan

    2016-01-01

    Aim: The quality of services plays a primary role in achieving patient satisfaction. The main purpose of this study was to explore the effect of outpatient service quality on patient satisfaction in teaching hospitals in Iran. Methods: this cross-sectional study was conducted in 2014. The study sample included 500 patients were selected with systematic random method from the outpatient departments (clinics) of four teaching hospitals in Tehran. The survey instrument was a questionnaire consisted of 44 items, which were confirmed its reliability and validity. The data were analyzed by using descriptive statistics, Pearson’s correlation, and multivariate regression methods with the SPSS.18 software. Results: According to the findings of this study, the majority of patients had a positive experience in the outpatient departments of the teaching hospitals and thus evaluated the services as good. Perceived service costs, physician consultation, physical environment, and information to patient were found to be the most important determinants of outpatient satisfaction. Conclusion: The results suggest that improving the quality of consultation, providing information to the patients during examination and consultation, creating value for patients by reducing costs or improving service quality, and enhancing the physical environment quality of the clinic can be regarded as effective strategies for the management of teaching hospitals toward increasing outpatient satisfaction. PMID:27047262

  15. Critical Incident Reporting System in Teaching Hospitals in Turkey: A Survey Study

    PubMed Central

    Şalvız, Emine Aysu; Edipoğlu, Saadet İpek; Sungur, Mukadder Orhan; Altun, Demet; Büget, Mehmet İlke; Seyhan, Tülay Özkan

    2016-01-01

    Objective Critical incident reporting systems (CIRS) and morbidity–mortality meetings (MMMs) offer the advantages of identifying potential risks in patients. They are key tools in improving patient safety in healthcare systems by modifying the attitudes of clinicians, nurses and staff (human error) and also the system (human and/or technical error) according to the analysis and the results of incidents. Methods One anaesthetist assigned to an administrative and/or teaching position from all university hospitals (UHs) and training and research hospitals (TRHs) of Turkey (n=114) was contacted. In this survey study, we analysed the facilities of anaesthetists in Turkish UHs and TRHs with respect to CIRS and MMMs and also the anaesthetists’ knowledge, experience and attitudes regarding CIs. Results Anaesthetists from 81 of 114 teaching hospitals replied to our survey. Although 96.3% of anaesthetists indicated CI reporting as a necessity, only 37% of departments/hospitals were reported to have CIRS. True definition of CI as “an unexpected /accidental event” was achieved by 23.3% of anaesthetists with CIRS. MMMs were reported in 60.5% of hospitals. Nevertheless, 96% of anaesthetists believe that CIRS and MMMs decrease the incidence of CI occurring. CI occurrence was attributed to human error as 4 [1–5]/10 and 3 [1–5]/10 in UHs and TRHs, respectively (p=0.005). In both hospital types, technical errors were evaluated as 3 [1–5]/10 (p=0.498). Conclusion This first study regarding CIRS in the Turkish anaesthesia departments/hospitals highlights the lack of CI knowledge and CIRS awareness and use in anaesthesia departments/teaching hospitals in Turkey despite a safety reporting system set up by the Turkish Ministry of Health. PMID:27366560

  16. Pharmacy Information Systems in Teaching Hospitals: A Multi-dimensional Evaluation Study

    PubMed Central

    Kazemi, Alireza; Moghaddasi, Hamid; Deimazar, Ghasem

    2016-01-01

    Objectives In hospitals, the pharmacy information system (PIS) is usually a sub-system of the hospital information system (HIS). The PIS supports the distribution and management of drugs, shows drug and medical device inventory, and facilitates preparing needed reports. In this study, pharmacy information systems implemented in general teaching hospitals affiliated to medical universities in Tehran (Iran) were evaluated using a multi-dimensional tool. Methods This was an evaluation study conducted in 2015. To collect data, a checklist was developed by reviewing the relevant literature; this checklist included both general and specific criteria to evaluate pharmacy information systems. The checklist was then validated by medical informatics experts and pharmacists. The sample of the study included five PIS in general-teaching hospitals affiliated to three medical universities in Tehran (Iran). Data were collected using the checklist and through observing the systems. The findings were presented as tables. Results Five PIS were evaluated in the five general-teaching hospitals that had the highest bed numbers. The findings showed that the evaluated pharmacy information systems lacked some important general and specific criteria. Among the general evaluation criteria, it was found that only two of the PIS studied were capable of restricting repeated attempts made for unauthorized access to the systems. With respect to the specific evaluation criteria, no attention was paid to the patient safety aspect. Conclusions The PIS studied were mainly designed to support financial tasks; little attention was paid to clinical and patient safety features. PMID:27525164

  17. [Study of tasks performed by nurses in a teaching hospital].

    PubMed

    Costa, Rita de Almeida; Shimizu, Helena Eri

    2006-09-01

    The purpose of this study was to analyze tasks performed by nurses at hospitalization units (maternity, general medicine, surgical and pediatric) in a training hospital in order to better know which factors make it difficult to outline their role as well as the meaning of their actions. It's a descriptive-type qualitative research. Twenty nurses were interviewed following a half-structured script. Nurses perceive that they perform help-providing tasks more frequently, followed by administrative tasks, dealing with the information system and educational tasks. The lack of skilled human resources, essentially nurses, infrastructure, valorization of nursing care and its workers, work organization and integration among members of the multi-disciplinary staff were identified as work-hampering factors. PMID:17094327

  18. Horizontal strabismus surgical outcomes in a teaching hospital.

    PubMed

    Idrees, Z; Dooley, I; Fahy, G

    2014-06-01

    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

  19. Factors affecting the informal payments in public and teaching hospitals

    PubMed Central

    Aboutorabi, Ali; Ghiasipour, Maryam; Rezapour, Aziz; Pourreza, Abolghasem; Sarabi Asiabar, Ali; Tanoomand, Asghar

    2016-01-01

    Background: Informal payments in the health sector of many developing countries are considered as a major impediment to health care reforms. Informal payments are a form of systemic fraud and have adverse effects on the performance of the health system. In this study, the frequency and extent of informal payments as well as the determinants of these payments were investigated in general hospitals affiliated to Tehran University of Medical Sciences. Methods: In this cross-sectional study, 300 discharged patients were selected using multi-stage random sampling method. First, three hospitals were selected randomly; then, through a simple random sampling, we recruited 300 discharged patients from internal, surgery, emergency, ICU & CCU wards. All data were collected by structured telephone interviews and questionnaire. We analyzed data using Chi- square, Kruskal-Wallis and Mann-Whitney tests. Results: The results indicated that 21% (n=63) of individuals paid informally to the staff. About 4% (n=12) of the participants were faced with informal payment requests from hospital staff. There was a significant relationship between frequency of informal payments with marital status of participants and type of hospitals. According to our findings, none of the respondents had informal payments to physicians. The most frequent informal payments were in cash and were made to the hospitals’ housekeeping staff to ensure more and better services. There was no significant relationship between the informal payments with socio-demographic characteristics, residential area and insurance status. Conclusion: Our findings revealed that many strategies can be used for both controlling and reducing informal payments. These include training patients and hospitals’ staff, increasing income levels of employees, improving the quantity and quality of health services and changing the entrenched beliefs that necessitate informal payments. PMID:27390685

  20. Nasalseptal hematoma/abscess: management and outcome in a tertiary hospital of a developing country

    PubMed Central

    Nwosu, Jones N; Nnadede, Peter C

    2015-01-01

    Background Nasal hematoma/abscess is an uncommon entity, but capable of leading to serious consequences if not handled meticulously, and with urgency. Objective To present the management, and outcome of nasal septal hematoma/abscess in a Nigerian tertiary institution. Method Consecutive patients diagnosed with nasal septal hematoma/abscess over a 10-year period, treated at the University of Nigeria Teaching Hospital, Enugu, Nigeria, were prospectively studied. The processes leading to diagnosis, treatment, and outcome were sequentially evaluated. Results Fifty-three patients (37 males and 16 females), age 5–65 years (with mean age of 23.10 years), were included. Surgical drainage of the hematoma/abscess, intranasal packing with insertion of drain was performed with total resolution of problem in all the cases. Conclusion Incision and drainage, and intranasal packing with insertion of drain was effective in treating nasal septal hematoma/abscess. PMID:26251577

  1. Desire for prenatal gender disclosure among primigravidae in Enugu, Nigeria

    PubMed Central

    Okeke, Tochukwu C; Enwereji, Jamike O; Okoro, Onyemaechi S; Iferikigwe, Eric S; Ikeako, Lawrence C; Ezenyeaku, Cyril C; Adiri, Charles O

    2015-01-01

    Background Prenatal gender disclosure is a nonmedical fetal ultrasonography view, which is considered ethically unjustified but has continued to grow in demand due to pregnant women’s requests. Objective The aim of this study was to determine the proportion of primigravidae who want prenatal gender disclosure and the reasons for it. Methods This was a descriptive cross-sectional study of randomly selected primigravidae seen at Enugu Scan Centre. The women were randomly selected using a table of random numbers. Results Ninety percent (225/250) of 250 primigravidae who fulfilled the criteria for inclusion in this study wanted to know the gender of their unborn baby, while 10% (25/250) declined gender disclosure. Furthermore, 62% (155/250) of primigravidae had preference for male children. There was statistically significant desire for male gender (P=0.0001). Statistically significant number of primigravidae who wanted gender disclosure did so to plan for the new baby (P=0.0001), and those that declined gender disclosure “leave it to the will of GOD” (P=0.014). Conclusion Ninety percent of primigravidae wanted gender disclosure because of plans for the new baby, personal curiosity, partner and in-laws’ curiosity; moreover, some women wanted to test the accuracy of the findings at delivery and 62% of primigravidae had preference for male children. In view of these results, gender disclosure could be beneficial in this environment. PMID:25792816

  2. Applying the Balanced Scorecard approach in teaching hospitals: a literature review and conceptual framework.

    PubMed

    Trotta, Annarita; Cardamone, Emma; Cavallaro, Giusy; Mauro, Marianna

    2013-01-01

    Teaching hospitals (THs) simultaneously serve three different roles: offering medical treatment, teaching future doctors and promoting research. The international literature recognises such organisations as 'peaks of excellence' and highlights their economic function in the health system. In addition, the literature describes the urgent need to manage the complex dynamics and inefficiency issues that threaten the survival of teaching hospitals worldwide. In this context, traditional performance measurement systems that focus only on accounting and financial measures appear to be inadequate. Given that THs are highly specific and complex, a multidimensional system of performance measurement, such as the Balanced Scorecard (BSC), may be more appropriate because of the multitude of stakeholders, each of whom seek a specific type of accountability. The aim of the paper was twofold: (i) to review the literature on the BSC and its applications in teaching hospitals and (ii) to propose a scorecard framework that is suitable for assessing the performance of THs and serving as a guide for scholars and practitioners. In addition, this research will contribute to the ongoing debate on performance evaluation systems by suggesting a revised BSC framework and proposing specific performance indicators for THs. PMID:23081849

  3. Prevalence of auditory changes in newborns in a teaching hospital

    PubMed Central

    Guimarães, Valeriana de Castro; Barbosa, Maria Alves

    2012-01-01

    Summary Introduction: The precocious diagnosis and the intervention in the deafness are of basic importance in the infantile development. The loss auditory and more prevalent than other joined riots to the birth. Objective: Esteem the prevalence of auditory alterations in just-born in a hospital school. Method: Prospective transversal study that evaluated 226 just-been born, been born in a public hospital, between May of 2008 the May of 2009. Results: Of the 226 screened, 46 (20.4%) had presented absence of emissions, having been directed for the second emission. Of the 26 (56.5%) children who had appeared in the retest, 8 (30.8%) had remained with absence and had been directed to the Otolaryngologist. Five (55.5%) had appeared and had been examined by the doctor. Of these, 3 (75.0%) had presented normal otoscopy, being directed for evaluation of the Evoked Potential Auditory of Brainstem (PEATE). Of the total of studied children, 198 (87.6%) had had presence of emissions in one of the tests and, 2 (0.9%) with deafness diagnosis. Conclusion: The prevalence of auditory alterations in the studied population was of 0,9%. The study it offers given excellent epidemiologists and it presents the first report on the subject, supplying resulted preliminary future implantation and development of a program of neonatal auditory selection. PMID:25991933

  4. Some Correlates of Electronic Health Information Management System Success in Nigerian Teaching Hospitals

    PubMed Central

    Ojo, Adebowale I; Popoola, Sunday O

    2015-01-01

    Nowadays, an electronic health information management system (EHIMS) is crucial for patient care in hospitals. This paper explores the aspects and elements that contribute to the success of EHIMS in Nigerian teaching hospitals. The study adopted a survey research design. The population of study comprised 442 health information management personnel in five teaching hospitals that had implemented EHIMS in Nigeria. A self-developed questionnaire was used as an instrument for data collection. The findings revealed that there is a positive, close relationship between all the identified factors and EHIMS’s success: technical factors (r = 0.564, P < 0.05); social factors (r = 0.616, P < 0.05); organizational factors (r = 0.621, P < 0.05); financial factors (r = 0.705, P < 0.05); and political factors (r = 0.589, P < 0.05). We conclude that consideration of all the identified factors was highly significant for the success of EHIMS in Nigerian teaching hospitals. PMID:25983557

  5. Defining teaching hospitals' GME strategy in response to new financial and market challenges.

    PubMed

    Wray, J L; Sadowski, S M

    1998-04-01

    The authors present an overview of current graduate medical education (GME) issues, particularly the financial challenges to teaching hospitals resulting from the Balanced Budget and Tax Payer Relief Acts of 1997 and other recent market-driven factors. They describe in detail the nature of Medicare GME payments before and after the 1997 legislation, with specific examples, and explain the negative financial impact of the legislation and aspects of the legislation that are designed to alleviate that impact. Other factors influencing GME program size and composition are also discussed, including oversupplies or shortages of physicians, the concern that teaching hospitals are using public funds to train international medical graduates, changing training requirements, etc. The authors also describe a recent consulting assignment during which they assisted a major teaching hospital to develop a GME strategy that was responsive to the organization's mission and patients and that took into account future GME financing challenges. Detailed explanations are given of how the consultants analyzed the hospital's GME programs and finances, developed and ranked key institution-specific program criteria (strategic, organizational and operational, and financial), and, in consultation with all key stakeholders, formulated a GME strategy specific to the institution's needs. The authors conclude by cautioning that each institution's GME strategy will be different, but that it is important for institutions to develop such strategies to better face future challenges. PMID:9580713

  6. Serum osmolality in alcohol ingestions: differences in availability among laboratories of teaching hospital, nonteaching hospital, and commercial facilities.

    PubMed

    Eisen, T F; Lacouture, P G; Woolf, A

    1989-05-01

    Freezing point depression osmometry is preferred over vapor pressure with ingestions of volatile substances. Sixty-six laboratories nationwide (23 teaching hospital, 22 nonteaching hospital, and 21 commercial facilities) were surveyed to determine the availability and use of these techniques. Overall, 80% conducted serum osmometry (teaching, 100%; nonteaching, 82%; commercial, 57%). Freezing point depression was the most common method used by all laboratories; however, 33% of commercial laboratories and 11% of nonteaching laboratories used vapor pressure exclusively. One half of all laboratory supervisors did not identify why one method was preferred. Only 3% identified vapor pressure as a possible source of error in ingestions of volatile substances. Most laboratories estimated that they were aware of the patient diagnosis less than 50% of the time. Because vapor pressure osmometry is a potential source of false negative results when estimating serum concentrations of volatile substances, clinicians treating patients who have ingested ethanol, ethylene glycol, isopropanol, or methanol need to be aware of the methodology used in their reference laboratories. PMID:2712885

  7. Cranial computed tomography scan findings in head trauma patients in Enugu, Nigeria

    PubMed Central

    Ohaegbulam, Samuel C.; Mezue, Wilfred C.; Ndubuisi, Chika A.; Erechukwu, Uwadiegwu A.; Ani, Chinenye O.

    2011-01-01

    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. PMID:22276236

  8. The Intricate Relationship Between a Medical School and a Teaching Hospital: A Case Study in Uganda

    PubMed Central

    Mubuuke, Aloysius Gonzaga; Businge, Francis; Mukule, Emmanuel

    2015-01-01

    Background The relationship between medical schools and teaching hospitals is full of opportunities but also challenges even though they have complementary goals that could enhance each other. Although medical schools and teaching hospitals may face some similar challenges around the world, there could be context-specific observations that differ in resource-rich versus resource-limited settings. The purpose of this study was to investigate factors that are perceived to have influenced the relationship between a medical school and a teaching hospital in Uganda, a resource-limited setting. Methods This was a cross-sectional, descriptive study in which key informant individual interviews were conducted with senior administrators and senior staff members of the Mulago Hospital and Makerere University Medical School. The interviews explored factors perceived to have favoured the working relationship between the two institutions, challenges faced and likely future opportunities. Both quantitative and qualitative data were generated. Thematic analysis was used with the qualitative data. Results Respondents reported a strained relationship between the two institutions, with unfavourable factors far outweighing the favourable factors influencing the relationship. Key negative reported factors included having different administrative set-ups, limited opportunities to share funds and to forge research collaborations, unexploited potential of sharing human resources to address staff shortages, as well as a lack of a memorandum of understanding between the two institutions. Discussion This study identifies barriers in the existing relationship between a teaching hospital and medical college in a resource-poor country. It proposes a collaborative model, rather than competitive model, for the two institutions that may work in both resource-limited and resource-rich settings. PMID:25758388

  9. Methicillin-resistant staphylococcal contamination of cellular phones of personnel in a veterinary teaching hospital

    PubMed Central

    2012-01-01

    Background Hospital-associated infections are an increasing cause of morbidity and mortality in veterinary patients. With the emergence of multi-drug resistant bacteria, these infections can be particularly difficult to eradicate. Sources of hospital-associated infections can include the patients own flora, medical staff and inanimate hospital objects. Cellular phones are becoming an invaluable feature of communication within hospitals, and since they are frequently handled by healthcare personnel, there may be a potential for contamination with various pathogens. The objective of this study was to determine the prevalence of contamination of cellular phones (hospital issued and personal) carried by personnel at the Ontario Veterinary College Health Sciences Centre with methicillin-resistant Staphylococcus pseudintermedius (MRSP) and methicillin-resistant Staphylococcus aureus (MRSA). Results MRSP was isolated from 1.6% (2/123) and MRSA was isolated from 0.8% (1/123) of cellular phones. Only 21.9% (27/123) of participants in the study indicated that they routinely cleaned their cellular phone. Conclusions Cellular phones in a veterinary teaching hospital can harbour MRSP and MRSA, two opportunistic pathogens of significant concern. While the contamination rate was low, cellular phones could represent a potential source for infection of patients as well as infection of veterinary personnel and other people that might have contact with them. Regardless of the low incidence of contamination of cellular phones found in this study, a disinfection protocol for hospital-issued and personal cellular phones used in veterinary teaching hospitals should be in place to reduce the potential of cross-contamination. PMID:22533923

  10. Organ donation after circulatory death in a university teaching hospital.

    PubMed

    Sidiropoulos, S; Treasure, E; Silvester, W; Opdam, H; Warrillow, S J; Jones, D

    2016-07-01

    Although organ transplantation is well established for end-stage organ failure, many patients die on waiting lists due to insufficient donor numbers. Recently, there has been renewed interest in donation after circulatory death (DCD). In a retrospective observational study we reviewed the screening of patients considered for DCD between March 2007 and December 2012 in our hospital. Overall, 148 patients were screened, 17 of whom were transferred from other hospitals. Ninety-three patients were excluded (53 immediately and 40 after review by donation staff). The 55 DCD patients were younger than those excluded (P=0.007) and they died from hypoxic brain injury (43.6%), intraparenchymal haemorrhage (21.8%) and subarachnoid haemorrhage (14.5%). Antemortem heparin administration and bronchoscopy occurred in 50/53 (94.3%) and 22/55 (40%) of cases, respectively. Forty-eight patients died within 90 minutes and proceeded to donation surgery. Associations with not dying in 90 minutes included spontaneous ventilation mode (P=0.022), absence of noradrenaline infusion (P=0.051) and higher PaO2:FiO2 ratio (P=0.052). The number of brain dead donors did not decrease over the study period. The time interval between admission and death was longer for DCD than for the 45 brain dead donors (5 [3-11] versus 2 [2-3] days; P<0.001), and 95 additional patients received organ transplants due to DCD. Introducing a DCD program can increase potential organ donors without reducing brain dead donors. Antemortem investigations appear to be acceptable to relatives when included in the consent process. PMID:27456178

  11. A profile and educational framework for physician managers in a teaching hospital.

    PubMed

    Barrable, W

    1988-01-01

    The role of the physician executive is explored in this article using a case study approach to outline administrative performance. Based on a survey of clinician executives at University Hospital in London, Ontario, a profile of background characteristics, activities and responsibilities, and reports on physician attitudes on the merit of administrative training, qualities that make good physician leaders, ethics in health care, and the nature of physician participation in management is presented. Recommendations from this research for developing an administrative training program designed for clinician executives in a teaching hospital follow. PMID:10316246

  12. Teaching evidence-based practice in the hospital and the library: two different groups, one course.

    PubMed

    Blake, Lindsay; Ballance, Darra

    2013-01-01

    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

  13. Use of potentially inappropriate medications in hospitalized elderly at a teaching hospital: A comparison between Beers 2003 and 2012 criteria

    PubMed Central

    Momin, Taufik G.; Pandya, Rushi N.; Rana, Devang A.; Patel, Varsha J.

    2013-01-01

    Objectives: To detect the prevalence and pattern of use of Potentially inappropriate medications (PIMs) in hospitalized elderly patients of a tertiary care teaching hospital using Beers 2012 criteria and to compare the same with Beers 2003 criteria. Materials and Methods: Prescriptions of the elderly patients aged 65 years and above were collected from the medicine ward and analyzed. PIMs were identified with help of Beers 2003 and Beers 2012 criteria and comparison was made between the two criteria. Predictors associated with use of PIM were identified using bivariate and multivariate logistic regression analysis. Results: A total of 210 patients received 2,267 drugs. According to Beers 2003 criteria, 60 (28.57%) elderly patients received at least one PIM and 2.9% drugs were prescribed inappropriately. According to Beers 2012 criteria, 84 (40%) elderly received at least one PIM while 22 (10.47%) received multiple PIMs and about 5% drugs were prescribed inappropriately. The most commonly prescribed PIM was mineral oil-liquid paraffin (30, 14.3%) followed by spironolactone (25, 11.9%), digoxin (19, 9%), and benzodiazepines (14, 6.7%). There was a significant association between the number of patients receiving more than six drugs and the use of PIMs (P < 0.01). Use of more than 10 drugs was a significant predictor for use of PIMs in the elderly. Conclusion: The study shows high prevalence of prescribing PIMs in hospitalized elderly patients. Beers 2012 criteria are more effective in identifying PIMs than Beers 2003 criteria. PMID:24347769

  14. Telemedicine activity at a Canadian university medical school and its teaching hospitals.

    PubMed

    Aires, L M; Finley, J P

    2000-01-01

    Dalhousie University Medical School and its teaching hospitals have been providing clinical telemedicine services since 1987. The object of the present study was to assess the extent and growth of telemedicine at the medical school and teaching hospitals, as well as to evaluate the obstacles to its deployment. This was achieved by conducting structured personal interviews with telemedicine providers. Twenty telemedicine programmes were identified, of which 15 were operational and five were being planned. The number of established telemedicine projects had doubled in the six months preceding the study. A wide variety of telemedicine services were provided, ranging from clinical consultations in a number of medical specialties to patient education, grand rounds and continuing medical education. These services were provided to sites in a wide area in the Maritime region and internationally. The three most important obstacles to the implementation of telemedicine were a lack of knowledge about telemedicine (80% of respondents), time constraints (75%) and funding (70%). PMID:10824388

  15. Noncompliance pattern due to medication errors at a Teaching Hospital in Srikot, India

    PubMed Central

    Thakur, Heenopama; Thawani, Vijay; Raina, Rangeel Singh; Kothiyal, Gitanjali; Chakarabarty, Mrinmoy

    2013-01-01

    Objective: To study the medication errors leading to noncompliance in a tertiary care teaching hospital. Materials and Methods: This study was conducted in a tertiary care hospital of a teaching institution from Srikot, Garhwal, Uttarakhand to analyze the medication errors in 500 indoor prescriptions from medicine, surgery, obstetrics and gynecology, pediatrics and ENT departments over five months and 100 outdoor patients of medicine department. Results: Medication error rate for indoor patients was found to be 22.4 % and 11.4% for outdoor patients as against the standard acceptable error rate 3%. Maximum errors were observed in the indoor prescriptions of the surgery department accounting for 44 errors followed by medicine 32 and gynecology 25 in the 500 cases studied leading to faulty administration of medicines. Conclusion: Many medication errors were noted which go against the practice of rational therapeutics. Such studies can be directed to usher in the rational use of medicines for increasing compliance and therapeutic benefits. PMID:23833376

  16. Twenty-four-Hour Intensivist Staffing in Teaching Hospitals

    PubMed Central

    Halpern, Scott D.

    2012-01-01

    There is an inherent tension between the training needs of inexperienced clinicians and the safety of the patients for whom they are responsible. Our society has accepted this tension as a necessary trade-off to maintain a competent workforce of physicians year after year. However, recent trends in medical education have diminished resident autonomy in favor of the safety of current patients. One dramatic example is the rapid increase in the number of academic ICUs that provide coverage by attending physicians at all hours. The potential benefits of this staffing model have strong face validity: improved quality and efficiency from the constant involvement of experienced intensivists, increased family and staff satisfaction from the immediate availability of attending physicians, and reduced burn-out among intensivists from reduced on-call responsibilities. Thus, many hospitals have moved toward 24-h coverage by attending intensivist physicians without evidence that these benefits actually accrue and perhaps without full consideration of possible unintended consequences. In this article, we discuss the potential benefits and risks of nocturnal intensivist staffing, considering the needs of current and future patients. Furthermore, we suggest that there remains sufficient uncertainty about these benefits and risks that it is both necessary and ethical to study the effects in earnest. PMID:22553264

  17. Needlestick injuries at a tertiary teaching hospital in Singapore.

    PubMed

    Seng, M; Sng, G K J; Zhao, X; Venkatachalam, I; Salmon, S; Fisher, D

    2016-09-01

    This study investigated the incidence and risk to staff groups for sustaining needlestick injuries (NSIs) in the National University Hospital (NUH), Singapore. A retrospective cohort review of incident NSI cases was undertaken to determine the injury rate, causation, and epidemiological profile of such injuries. Analysis of the risk of sustaining recurrent NSI by occupation and location was done using the Cox proportional hazards model. There were 244 NSI cases in 5957 employees in NUH in 2014, giving an incidence rate of 4·1/100 healthcare workers (HCWs) per year. The incidence rate was highest for doctors at 21·3, and 2·7 for nurses; 40·6% of injuries occurred in wards, and 32·8% in operating theatres. There were 27 cases of repeated NSI cases. The estimated cost due to NSIs in NUH ranged from US$ 109 800 to US$ 563 152 in 2014. We conclude that creating a workplace environment where top priority is given to prevention of NSIs in HCWs, is essential to address the high incidence of reported NSIs. The data collected will be of value to inform the design of prevention programmes to reduce further the risk of NSIs in HCWs. PMID:27151164

  18. Cancer Mortality Pattern in Lagos University Teaching Hospital, Lagos, Nigeria

    PubMed Central

    Akinde, Olakanmi Ralph; Phillips, Adekoyejo Abiodun; Oguntunde, Olubanji Ajibola; Afolayan, Olatunji Michael

    2015-01-01

    Background. Cancer is a leading cause of death worldwide and about 70% of all cancer deaths occurred in low- and middle-income countries. The cancer mortality pattern is quite different in Africa compared to other parts of the world. Extensive literature research showed little or no information about the overall deaths attributable to cancer in Nigeria. Aims and Objectives. This study aims at providing data on the patterns of cancer deaths in our center using the hospital and autopsy death registers. Methodology. Demographic, clinical data of patients who died of cancer were extracted from death registers in the wards and mortuary over a period of 14 years (2000–2013). Results. A total of 1436 (4.74%) cancer deaths out of 30287 deaths recorded during the period. The male to female ratio was 1 : 2.2 and the peak age of death was between 51 and 60 years. Overall, breast cancer was responsible for most of the deaths. Conclusion. The study shows that the cancers that accounted for majority of death occurred in organs that were accessible to screening procedures and not necessary for survival. We advise regular screening for precancerous lesions in these organs so as to reduce the mortality rate and burden of cancer. PMID:25628656

  19. Academic health center teaching hospitals in transition: a perspective from the field.

    PubMed

    Cyphert, S T; Colloton, J W; Levey, S

    1997-01-01

    A study of 11 Academic Health Center Teaching Hospitals (ATHs) in 11 states found that cost reduction programs, internal reorganizations, reengineering, benchmarking, and broadened entrepreneurial activity were prominent among the strategic initiatives reported in dealing with an increasingly turbulent environment. Although none of the ATHs had experienced negative net margins, we conclude that today's competitive healthcare system requires ATHs be reimbursed separately for their educational and other societally related costs to assist them in competing on a level playing fields. PMID:9543922

  20. Positioning academic medical centers and teaching hospitals to thrive in the next decade.

    PubMed

    Morris, D E

    1985-06-01

    Market share for academic medical centers and teaching hospitals will decline over the next five years necessitating new strategies to ensure growth and profitability. These types of institutions are, however, in a strong position to compete and gain market share locally by building a defensible competitive advantage. This article offers three avenues for increasing market share: networking, brand name product differentiation, and business diversification. PMID:10271804

  1. Nutritional risk, malnutrition and nutritional support among hospitalized patients in orthopedics/spinal surgery of a Hohhot teaching hospital.

    PubMed

    Wang, Nannan; Dong, Yalin; Huo, Ting; Shao, Yanqing; Xing, Wenhua; Li, Shuwen

    2016-01-01

    The evolution of nutritional status (the prevalence of nutritional risk, malnutrition, overweight and obesity) and the nutritional support of the hospitalized patients from admission to discharge or over a two-week period in orthopedics/ spinal surgery of a teaching hospital in Hohhot were investigated. 432 patients from two wards of the orthopedics/spinal surgery from Jan to Dec 2013, the traditional spinal surgery and the minimally invasive spinal surgery, were selected and detected in this study. The Nutritional Risk Score 2002 (NRS 2002) was used to determine the patients' nutritional status within 48 h after admission and during their hospitalization. The overall prevalence of nutritional risk, malnutrition, overweight and obesity at admission was 11.6%, 12.7%, 35.9% and 7.41%, respectively. Overall, there were 88.0% of the patients who were at nutritional risk received nutritional support, while 14.1% of non-risk patients received a redundant nutritional support. The overall prevalence of nutritional risk changed from 11.6% at admission to 19.4% upon discharge (p<0.05), and the prevalence of malnutrition changed from 12.7% to 20.6% (p<0.05). The prevalence of overweight and obesity, which changed from 35.9% to 31.0% and from 7.41% to 5.79% respectively, didn't experience statistically significant evolution. NRS 2002 was a feasible nutritional risk screening tool for patients in spinal surgery of orthopedics department. Patients' prevalence of nutritional risk and malnutrition increased significantly in spinal surgery of this hospital. Some inappropriate uses of nutritional support were observed in orthopedics/spinal surgery, and nutritional support guidelines or protocols should be promoted by a professional committee. PMID:27222410

  2. Incidence of Potential Drug-Drug Interaction and Related Factors in Hospitalized Neurological Patients in two Iranian Teaching Hospitals

    PubMed Central

    Namazi, Soha; Pourhatami, Shiva; Borhani-Haghighi, Afshin; Roosta, Sareh

    2014-01-01

    Background: Reciprocal drug interactions are among the most common causes of adverse drug reactions. We investigated the incidence and related risk factors associated with mutual drug interactions in relation to prescriptions written in the neurology wards of two major teaching hospitals in Shiraz, southern Iran. Methods: Data was collected from hand-written prescriptions on a daily basis. Mutual drug interactions were identified using Lexi-Comp 2012 version 1.9.1. Type D and X drug interactions were considered as potential drug-drug interactions. The potential risk factors associated with drug-drug interactions included the patient’s age and gender, number of medications and orders, length of hospitalization and the type of neurological disorder. To determine potential drug-drug interactions, relevant interventions were suggested to the physicians or nurses and the outcome of the interventions were documented. Results: The study comprised 589 patients, of which 53% were males and 47% females, with a mean age of 56.65±18.19 SD years. A total of 4942 drug orders and 3784 medications were prescribed among which 4539 drug-drug interactions were detected, including 4118 type C, 403 type D, and 18 type X. Using a logistic regression model, the number of medications, length of hospitalization and non-vascular type of the neurological disorder were found to be significantly associated with potential drug-drug interactions. From the total interventions, 74.24% were accepted by physicians and nurses. Conclusion: Potentially hazardous reciprocal drug interactions are common among patients in neurology wards. Clinical pharmacists can play a critical role in the prevention of drug-drug interactions in hospitalized patients. PMID:25429173

  3. Parents' and Teachers' Preferred Medium of Instruction in Primary Schools in Enugu, Nigeria

    ERIC Educational Resources Information Center

    Amadi, Eugenia Ada

    2012-01-01

    This study which investigated parents' and teachers' preferred medium of instruction in primary schools was conducted in Enugu, South East, Nigeria. It employed the descriptive survey research method. 500 respondents were used for the study. 250 teachers were selected through simple random sampling technique. Two researcher-designed questionnaires…

  4. Ethnobotanical Potentials of Common Herbs in Nigeria: A Case Study of Enugu State

    ERIC Educational Resources Information Center

    Aiyeloja, A. A.; Bello, O. A.

    2006-01-01

    Research was carried out on the ethnobotanical potentials of common herbs in Nigeria using Enugu State as a case study. A total of 200 questionnaires were administered on herb sellers in major herb markets in the state. In all, 96 different plant species were encountered in the markets. Attempts were made to write the names of the species both in…

  5. Professionalism of physicians at a major teaching hospital during the Fukushima nuclear disaster.

    PubMed

    Narita, M; Tokuda, Y; Barnett, P

    2016-07-01

    It poses a serious problem if physicians leave a hospital without having a replacement or without permission. A huge earthquake followed by a devastating tsunami seriously damaged the Fukushima-Daiichi nuclear power plant. This disaster overwhelmed a major teaching hospital in the local area and many hospital employees, including some resident physicians, left the premises. Since the threat of severe radiation exposure poses a potentially greater lifetime risk to younger individuals, letting the young resident physicians leave the hospital was not only allowed, it was actually recommended by many attending physicians and hospital administrators. The hospital administrator was required to make the difficult decision of whether to make all efforts to provide the highest level of medical care, including keeping all of the physicians on the premises, or to evacuate the resident physicians in order to preserve their health and their potential future contributions to healthcare. Consideration and compassion needed to be provided to all people, regardless of the reason they wanted to leave. From an ethical perspective, the roles of performance under these complex circumstances should be understood and embraced by us as individuals, professionals, supervisors and society as a whole. PMID:27121040

  6. War injuries during the Gulf War: experience of a teaching hospital in Kuwait.

    PubMed Central

    Behbehani, A.; Abu-Zidan, F.; Hasaniya, N.; Merei, J.

    1994-01-01

    The war injuries of 361 patients admitted to Mubarak Al-Kabeer Teaching Hospital, during the Gulf War are reported. More abdominal and chest injuries were seen in this series in comparison with other conflicts owing to the short evacuation time. Of the injuries, 54% were caused by gunshots, 34% were fragment injuries and 5.5% were glass and stab injuries. Civilians accounted for 50% of the injured. Wound infection rate was 7%, average hospital stay was 8.8 days and hospital mortality was 5.5%. We advocate radical wound excision, exploration of penetrating wounds of neck and abdomen, and mainly conservative management of chest injuries that do not involve the mediastinum. PMID:7702326

  7. Gender inequality in acute coronary syndrome patients at Omdurman Teaching Hospital, Sudan

    PubMed Central

    Mirghani, Hyder O.; Elnour, Mohammed A.; Taha, Akasha M.; Elbadawi, Abdulateef S.

    2016-01-01

    Background: Gender differences among patients with the acute coronary syndrome is still being debated, no research has been done on gender inequality among coronary syndrome patients in Sudan. Objectives: To study gender differences in presentation, management, and outcomes of acute coronary syndrome in Sudan. Subjects and Methods: This cross-sectional descriptive longitudinal study was conducted in Omdurman Teaching Hospital between July 2014 and August 2015. Patients were invited to sign a written informed consent form, were interviewed and examined by a physician, and then followed during their hospital stay. Information collected includes coronary risk factors, vital signs, echocardiography findings, arrhythmias, heart failure, cardiogenic shock, and death. The Ethical Committee of Omdurman Teaching Hospital approved the research. Results: A total of 197 consecutive acute coronary syndrome patients were included, 43.1% were females. A significant statistical difference was evident between males and females regarding the type of acute coronary syndrome, its presentation, and time of presentation to the hospital, smoking, and receipt of thrombolysis (P < 0.05). No differences were found with regard to age, hypertension, diabetes, family history of myocardial infarction, percutaneous coronary intervention, and in-hospital acute coronary complications (P > 0.05). Conclusion: Women were less likely to receive thrombolytic therapy, present with chest pain, and diagnosed with ST-segment elevation myocardial infarction. No gender differences were found in acute coronary syndrome risk factors apart from smoking, which was more common in males, and there were no differences between males and females as regards in-hospital complications. PMID:27186156

  8. Patient Safety in Obstetrics and Gynecology Departments of two Teaching Hospitals in Delhi

    PubMed Central

    Gupta, Bindiya; Guleria, Kiran; Arora, Renu

    2016-01-01

    Background: A healthy safety culture is integral to positive health care. A sound safety climate is required in Obstetrics and Gynecology to prevent adverse outcomes. Objective: The objective of this study was to assess and compare patient safety culture in two departments of Obstetrics and Gynecology. Materials and Methods: Using a closed-ended standard version of Hospital Survey on Patient Safety Culture (HSOPS), respondents were asked to answer 42 survey items, grouped into 10 dimensions and two outcome variables in two tertiary care teaching hospitals in Delhi. Qualitative data were compared using Fisher's exact test and chi-square test wherever applicable. Mean values were calculated and compared using unpaired t-test. Results: The overall survey response rate was 55%. A positive response rate of 57% was seen in the overall perception of patient safety that ranged from very good to acceptable. Sixty-four percent showed positive teamwork across hospital departments and units, while 36% gave an affirmative opinion with respect to interdepartmental handoffs. However, few adverse events (0-10) were reported in the last 12 months and only 38% of mistakes by doctors were reported. Half of the respondents agreed that their mistakes were held against them. There was no statistical difference in the safety culture between the two hospitals. Conclusions: Although the perception of patient safety and standards of patient safety were high in both the hospitals' departments, there is plenty of scope for improvement with respect to event reporting, positive feedback, and nonpunitive error. PMID:27385879

  9. Patient education process in teaching hospitals of Tehran University of Medical Sciences

    PubMed Central

    Seyedin, Hesam; Goharinezhad, Salime; Vatankhah, Soodabeh; Azmal, Mohammad

    2015-01-01

    Background: Patient education is widely recognized as a core component of nursing. Patient education can lead to quality outcomes including adherence, quality of life, patients' knowledge of their illness and self-management. This study aimed to clarify patient education process in teaching hospitals affiliated to Tehran University of Medical Sciences (TUMS) in Iran. Methods: This cross-sectional study was conducted in 2013. In this descriptive quantitative study, the sample covered 187 head nurses selected from ten teaching hospitals through convenience sampling. Data were collected with a questionnaire developed specifically for this study. The questionnaire measured patient education process in four dimensions: need assessment, planning, implementing and evaluating. Results: The overall mean score of patient education was 3.326±0.0524. Among the four dimensions of the patient education process, planning was in the highest level (3.570±0.0591) and the lowest score belonged to the evaluation of patient education (2.840 ±0.0628). Conclusion: Clarifying patient education steps, developing standardized framework and providing easily understandable tool-kit of the patient education program will improve the ability of nurses in delivering effective patient education in general and specialized hospitals. PMID:26478878

  10. Quality assessment of clinical education services in teaching hospitals located in Kerman, Iran

    PubMed Central

    Yazdi-Feyzabadi, Vahid; Gozashti, Mohammad Hossein; Komsari, Samane; Mohammadtaghizadeh, Sedigheh; Amiresmaili, Mohammadreza

    2015-01-01

    Introduction Clinical education is one of the most important components of the resource generation function of health systems, and it has a very important role in graduates’ competency with respect to effective, practical education. This study aimed to assess the quality of clinical services in Kerman’s teaching hospitals located in southeastern Iran. Methods This cross-sectional study was conducted in 2011 on 303 medical students at different levels of medical education at Kerman’s teaching hospitals. A modified SERVQUAL instrument was used to collect the data after its validity and reliability were checked. The data were analyzed by SPSS 18.0 using the paired t-test, Kruskal-Wallis, and post hoc tests, when appropriate. Results In all five dimensions of quality, gaps were observed between students’ perceptions and expectations as follows: Assurance (mean = −1.18), Responsiveness (−1.56), Empathy (−1.4), Reliability (−1.27), and Tangibles (−1.21). There was a significant difference between the quality perceptions and expectations of the medical students (p < 0.001). A significant difference was observed between three educational levels, including externships, internships, and assistantships regarding the dimensions of the quality gaps (p < 0.001). Conclusion The clinical services provided by teaching hospitals in the study did not meet the students’ expectations at any of the three educational levels. As we precisely assessed the dimensions and items that had the higher quality gaps, it was apparent that, for most part, clinical education officials could improve the quality by designing interventions, which would not be very difficult to do. PMID:26767094

  11. Study of type 2 diabetes mellitus cases at Nepal Medical College Teaching Hospital.

    PubMed

    Dhungel, Sanjib; Devkota, Krishna Chandra; Chhetri, Pramod; Bhattarai, Praveen; Shrestha, Ananta

    2004-12-01

    A total of 110 cases attending diabetic clinic at Nepal Medical College Teaching Hospital were studied. Associated risk factors and co-morbid conditions were analyzed. Among them 63.6% have systolic BP more than 130 mm of Hg and 24.5% have diastolic BP more than 85 mm of Hg reflecting hypertension as most common co-morbid condition. Various complications of diabetes in studied subjects are highlighted. Eighty percent of patients have fasting blood sugar more than 110 mg% and 93.0% have post-prandial blood sugar more than 140 mg% reflecting poor overall glycemic control despite the use of medication. PMID:16295737

  12. Study of cases of hypertension admitted at Nepal Medical College Teaching Hospital.

    PubMed

    Dhungel, Sanjib; Shrestha, Ananta; Bhattarai, Prabeen; Paudel, Badri

    2004-06-01

    Hundred cases of hypertension admitted to medical ward at Nepal Medical College and Teaching Hospital were studied and analysed. They constituted 9.4% of the total admitted patients in the medical ward. Association of hypertension with other diseases is highlighted. Thirty two percent of these hypertensives were diabetic and 22.0% of hypertensives also had Chronic obstructive airway disease (COAD). Different types of complications of hypertension seen in the studied subjects are mentioned. Only 19.0% of hypertensives had their blood pressure controlled and the rest were uncontrolled hypertensives. PMID:15449651

  13. [Description of workloads and fatigue experienced among health workers in a teaching hospital].

    PubMed

    Santana, Leni de Lima; Miranda, Fernanda Moura D'Almeida; Karino, Márcia Eiko; Baptista, Patrícia Campos Pavan; Felli, Vanda Elisa Andres; Sarquis, Leila Maria Mansano

    2013-03-01

    This is an exploratory, descriptive and quantitative study, based on the following categories: work process, workloads and fatigue in a teaching hospital in Curitiba in the southern region of Brazil. The article characterizes the load and stress experienced in a university hospital, based on a previous study entitled "System for monitoring the health of nursing workers" (SIMOSTE). The results show that females were the most affected (85.9%) and the most affected professionals were nursing assistants (53.1%). The highest number of sick leaves was due to diseases of the osteoarticular system (25.2%) and the most significant loads were mechanical and physiological with 33.06% each. These results may support intervention strategies in the policies directed toward the workers' health to ensure a better quality of life and consequently improve the quality of care provided to the user. PMID:23781725

  14. Women's perceptions of caesarean section: reflections from a Turkish teaching hospital.

    PubMed

    Tatar, M; Günalp, S; Somunoğlu, S; Demirol, A

    2000-05-01

    Caesarean section as a contentious topic has attracted attention world-wide and different dimensions of the issue has been investigated. The primary reason behind these initiatives have been the upsurge of caesarean sections both in the developed and developing world and the realisation that the operation may not always contribute positively to the mother's and baby's health. By contrast, several studies have demonstrated both the short and long term negative effects. Research has also revealed that factors other than medical necessity play an important role in the decision to perform a caesarean section. Turkey, although reliable data does not exist, can be classified among the countries experiencing the caesarean epidemic, at least among highly educated and wealthy mothers. This research, exploring the perceptions of mothers in a teaching hospital with a high caesarean rate, is a rare example of its kind in Turkey. The main finding is the dissatisfaction of the mothers undergoing caesareans during their stay in the hospital. PMID:10728843

  15. Rate and predictors of low serum ferritin levels among healthy parturient women in Enugu, Nigeria

    PubMed Central

    Emegoakor, Fausta Chioma J; Iyoke, Chukwuemeka Anthony; Ezegwui, Hyginus Uzo; Ezugwu, Frank Okechukwu; Umeora, Odidika Ugochukwu; Ibeagha, Izuchukwu Obumneme

    2015-01-01

    Background Low serum ferritin levels signify low iron stores and this could predispose to iron deficiency anemia. Objective To determine the rate and predictors of low serum ferritin levels during the puerperium in Enugu, Southeast Nigeria. Study design A hospital-based prospective longitudinal study involving parturient women who delivered singleton fetuses at term. Venous blood samples were collected to determine the serum ferritin concentration at 48 hours and 6 weeks postpartum. Data analysis involved descriptive and inferential statistics at 95% confidence interval (CI) using Statistical Package for Social Sciences (SPSS) computer software version 20.0. Results Two-hundred and two women who carried singleton pregnancies to term were studied. The mean serum ferritin levels at 48 hours and 6 weeks were 27.82±18.41 µg/L and 36.12±21.53 µg/L, respectively. Forty-eight hours postdelivery, 29.2% had low ferritin levels and this decreased to 12.4% at 6 weeks postpartum. There was a significant positive correlation between the serum ferritin level at 48 hours postdelivery and the serum ferritin level at 6 weeks postpartum (r=0.89, P<0.001). Predictors of the low ferritin level at 6 weeks included age <20 years (odds ratio [OR] =0.70, 95% CI =0.53, 0.93), multiparity (OR =63.7, 95% CI =3.18, 127.5), anemia at 48 hours postpartum (OR =61.7, 95% CI =13.27, 116.6), a low ferritin level at 48 hours (OR =78.1, 95% CI =8.8, 108.3), and intake of antenatal hematinics for <3 months (OR =0.04, 95% CI =0.01, 0.20). Conclusion There was a significant occurrence of low ferritin levels during the puerperium in the study centers, and this was associated mainly with pregnancy and delivery factors. Efforts to improve the iron stores in parturient women could benefit from early booking and compliance with antenatal hematinics and optimizing hemoglobin and iron levels before delivery. PMID:26425110

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

    PubMed Central

    Menezes, Vishma Hydie; Nair, Shoba N; Soumya, MS; Tarey, SD

    2016-01-01

    Background: Drugs used in the palliative care unit for managing symptoms are major contributors toward the expenditure occurring in palliative care. This study was conducted to understand the prescription pattern of analgesic drugs in the patients who are receiving palliative care in a teaching hospital in India by a retrospective study of case records. Methods: Case record based, retrospective, descriptive study was conducted at the Pain and Palliative Care Department of St. John's Medical College Hospital, Bengaluru. Case record files of all patients referred to Pain and Palliative Care Department for the treatment of pain in the year of 2012 were studied. Patients’ age, gender, diagnoses, numerical pain rating scale (0–10), drugs prescribed, dosage, frequency, route of administration were recorded. The difference in drug utilization between the genders was done using Chi-square test. Data were collected from 502 patients of which 280 (56%) were males and 222 (44%) were females. Twelve percent of patients had mild pain (1–3), 34% had moderate pain (4–6), and 54% had severe pain (7–10). The most commonly used analgesic drugs were opioids (47%), followed by nonsteroidal anti-inflammatory drugs (36%). The opioids used were tramadol (56%), and morphine (38%). Ninety percent of patients with numerical pain scale more than 6 received morphine. There was no difference in analgesic drug utilization with regards to gender. Prescription pattern differed depending on the severity of pain. Opioids were the most commonly used drugs for pain management. Conclusion: The study shows that prescription pattern in palliative care unit of this hospital was in accordance with WHO pain management guidelines. The study showed the current trend in prescription of analgesic drugs in the teaching hospital where the study was conducted. PMID:26962282

  17. How one teaching hospital system and one medical school are jointly affirming their academic mission.

    PubMed

    Rosenblatt, M; Rabkin, M T; Tosteson, D C

    1997-06-01

    The economic forces that are reshaping the practice of medicine and the funding of medical research will have great impact on clinical education and research in teaching hospitals and their associated medical schools. Changes in the setting of and approach to medical education will need to be made in order to continue to train physicians at the same high level as in the past and to maintain the productivity of our national biomedical research enterprise and its contributions to health. Academic leaders, such as department chiefs who have clinical service responsibilities, are finding it more and more difficult to manage simultaneously the demands of the clinical business, education, and research. In an effort to organize a teaching hospital and a medical school in a manner that would position them to maintain more effectively their common academic mission front and center with the clinical business, Harvard Medical School and the Beth Israel Hospital created a joint venture in 1996. The new nonprofit Institute for Education and Research has education and research as its top (and only) mission. It is designed to provide additional and specific academic leadership and to enable the joint venture to undertake strategic planning for the academic mission. In addition to the challenges it faces from changes in the external environment, the Institute for Education and Research will need to establish a new pattern of interactions internally within the parent institutions. Collaborations with department chairs and faculty are an essential ingredient for its success. It is hoped that this structure will prove to be a useful template for organizing other medical school-hospital collaborations on behalf of the academic mission. PMID:9200578

  18. Medication error detection in two major teaching hospitals: What are the types of errors?

    PubMed Central

    Saghafi, Fatemeh; Zargarzadeh, Amir H

    2014-01-01

    Background: Increasing number of reports on medication errors and relevant subsequent damages, especially in medical centers has become a growing concern for patient safety in recent decades. Patient safety and in particular, medication safety is a major concern and challenge for health care professionals around the world. Our prospective study was designed to detect prescribing, transcribing, dispensing, and administering medication errors in two major university hospitals. Materials and Methods: After choosing 20 similar hospital wards in two large teaching hospitals in the city of Isfahan, Iran, the sequence was randomly selected. Diagrams for drug distribution were drawn by the help of pharmacy directors. Direct observation technique was chosen as the method for detecting the errors. A total of 50 doses were studied in each ward to detect prescribing, transcribing and administering errors in each ward. The dispensing error was studied on 1000 doses dispensed in each hospital pharmacy. Results: A total of 8162 number of doses of medications were studied during the four stages, of which 8000 were complete data to be analyzed. 73% of prescribing orders were incomplete and did not have all six parameters (name, dosage form, dose and measuring unit, administration route, and intervals of administration). We found 15% transcribing errors. One-third of administration of medications on average was erroneous in both hospitals. Dispensing errors ranged between 1.4% and 2.2%. Conclusion: Although prescribing and administrating compromise most of the medication errors, improvements are needed in all four stages with regard to medication errors. Clear guidelines must be written and executed in both hospitals to reduce the incidence of medication errors. PMID:25364360

  19. Evaluation of pharmacy information system in teaching, private and social services Hospitals in 2011

    PubMed Central

    Saghaeiannejad-Isfahani, Sakineh; Mirzaeian, Razieh; Jannesari, Hasan; Ehteshami, Asghar; Feizi, Awat; Raeisi, Ahmadreza

    2014-01-01

    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. PMID:25013832

  20. Diversity of Bacterial Communities on Four Frequently Used Surfaces in a Large Brazilian Teaching Hospital

    PubMed Central

    Pereira da Fonseca, Tairacan Augusto; Pessôa, Rodrigo; Felix, Alvina Clara; Sanabani, Sabri Saeed

    2016-01-01

    Frequently used hand-touch surfaces in hospital settings have been implicated as a vehicle of microbial transmission. In this study, we aimed to investigate the overall bacterial population on four frequently used surfaces using a culture-independent Illumina massively parallel sequencing approach of the 16S rRNA genes. Surface samples were collected from four sites, namely elevator buttons (EB), bank machine keyboard buttons (BMKB), restroom surfaces, and the employee biometric time clock system (EBTCS), in a large public and teaching hospital in São Paulo. Taxonomical composition revealed the abundance of Firmicutes phyla, followed by Actinobacteria and Proteobacteria, with a total of 926 bacterial families and 2832 bacterial genera. Moreover, our analysis revealed the presence of some potential pathogenic bacterial genera, including Salmonella enterica, Klebsiella pneumoniae, and Staphylococcus aureus. The presence of these pathogens in frequently used surfaces enhances the risk of exposure to any susceptible individuals. Some of the factors that may contribute to the richness of bacterial diversity on these surfaces are poor personal hygiene and ineffective routine schedules of cleaning, sanitizing, and disinfecting. Strict standards of infection control in hospitals and increased public education about hand hygiene are recommended to decrease the risk of transmission in hospitals among patients. PMID:26805866

  1. Simulation-Based Dysphagia Training: Teaching Interprofessional Clinical Reasoning in a Hospital Environment.

    PubMed

    Miles, Anna; Friary, Philippa; Jackson, Bianca; Sekula, Julia; Braakhuis, Andrea

    2016-06-01

    This study evaluated hospital readiness and interprofessional clinical reasoning in speech-language pathology and dietetics students following a simulation-based teaching package. Thirty-one students participated in two half-day simulation workshops. The training included orientation to the hospital setting, part-task skill learning and immersive simulated cases. Students completed workshop evaluation forms. They filled in a 10-question survey regarding confidence, knowledge and preparedness for working in a hospital environment before and immediately after the workshops. Students completed written 15-min clinical vignettes at 1 month prior to training, immediately prior to training and immediately after training. A marking rubric was devised to evaluate the responses to the clinical vignettes within a framework of interprofessional education. The simulation workshops were well received by all students. There was a significant increase in students' self-ratings of confidence, preparedness and knowledge following the study day (p < .001). There was a significant increase in student overall scores in clinical vignettes after training with the greatest increase in clinical reasoning (p < .001). Interprofessional simulation-based training has benefits in developing hospital readiness and clinical reasoning in allied health students. PMID:26803776

  2. Questionnaire survey of working relationships between nurses and doctors in University Teaching Hospitals in Southern Nigeria

    PubMed Central

    Ogbimi, Roseline I; Adebamowo, Clement A

    2006-01-01

    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 managerial and training needs that might be used to improve it. Method Questionnaire survey of doctors and nurses working in four UTH in Southern Nigeria was done in 2002. The setting and subjects were selected by random sampling procedures. Information on factors in domains of work, union activities, personnel and hospital management were studied using closed and open-ended questionnaires. Results Nurse-doctor working relationships were statistically significantly affected by poor after-work social interaction, staff shortages, activist unionism, disregard for one's profession, and hospital management and government policies. In general, nurses had better opinion of doctors' work than doctors had about nurses' work. Conclusion Working relationships between doctors and nurses need to be improved through improved training and better working conditions, creation of better working environment, use of alternative methods of conflict resolution and balanced hospital management and government policies. This will improve the retention of staff, job satisfaction and efficiency of health care delivery in Nigeria. PMID:16504039

  3. Resistance and integron characterization of Acinetobacter baumannii in a teaching hospital in Chongqing, China

    PubMed Central

    Huang, C.; Long, Q.; Qian, K.; Fu, T.; Zhang, Z.; Liao, P.; Xie, J.

    2015-01-01

    A total of 189 Acinetobacter baumannii isolates were collected in 2011 from a teaching hospital in Chongqing, China. Susceptibility data showed strains carrying integrons were significantly more resistant to all tested antibiotics that strains lacking integrons. Five types of gene cassettes belonging to class I integrons were identified in this study, and for the first time two types of gene cassettes belonging to class II integrons are reported. Most of the cassettes belong to a class I integron (136/144) encoding arr3, aacA4, dfrA17, aadA5, aadB, cat, blaOXA10, aadA1, aadA2, dfrA and aacC1. Isolates contained a class I gene cassette; AadA2-HP-dfrA was the prevalent strain in this hospital. A class II integron was detected in eight strains, which contained the type IV fimbriae expression regulatory gene pilR and sulfate adenylyltransferase, suggesting a possible role in multidrug resistance. The major epidemic strains from intensive care unit patients belong to international clone 2. In conclusion, the presence of integrons was significantly associated with multiple drug resistance of A. baumannii in this hospital, and class I integron isolates bearing AadA2-HP-dfrA were the prevalent strain in this hospital. PMID:26649184

  4. Large Epidemiological Influenza A Outbreak in a Teaching Hospital from Guatemala City

    PubMed Central

    Mejía, Carlos; Silvestre, Monica; Cazali, Iris; García, Judith; Sánchez, Ruth; García, Leticia; Castillo, Leticia; Escobar, Ingrid; Terraza, Sandra

    2012-01-01

    Objective. To describe the characteristics and interventions to control a large epidemiological Influenza A Outbreak. Methods. During the months of February to April 2006, a large outbreak of Influenza A was detected, which affected Health Care Workers and hospitalized patients in a large teaching Hospital in Guatemala City. Interventions to interrupt transmission were implemented and included barrier methods (N95 masks, respiratory isolation measures, etc.) and enhanced hand hygiene, vaccination of healthy Health Care Workers (HCW), restrictions for patient visits. Results. From February to April 2006, 59 hospitalized patients diagnosed with Influenza A. 19 AIDS patients (mortality: 71%) and 5/40 (12.5%) in other diseases: cancer (3), severe cardiac failure (1) and severe malnutrition (1). The attack rate at day 20 in doctors and medical students was 21% while in other HCW it was 10.5%. Within 3 weeks of the beginning of the plan, deaths were stopped and no more cases in HCW were detected after 3 additional weeks. Conclusion. A rapid, comprehensive plan for the control of nosocomial epidemic Influenza A outbreaks is essential to limit severe morbidity and mortality in hospitals who attend large immunocompromised populations, including AIDS patients. HCW regular vaccinations programs are mandatory. PMID:24052881

  5. Diversity of Bacterial Communities on Four Frequently Used Surfaces in a Large Brazilian Teaching Hospital.

    PubMed

    Pereira da Fonseca, Tairacan Augusto; Pessôa, Rodrigo; Felix, Alvina Clara; Sanabani, Sabri Saeed

    2016-02-01

    Frequently used hand-touch surfaces in hospital settings have been implicated as a vehicle of microbial transmission. In this study, we aimed to investigate the overall bacterial population on four frequently used surfaces using a culture-independent Illumina massively parallel sequencing approach of the 16S rRNA genes. Surface samples were collected from four sites, namely elevator buttons (EB), bank machine keyboard buttons (BMKB), restroom surfaces, and the employee biometric time clock system (EBTCS), in a large public and teaching hospital in São Paulo. Taxonomical composition revealed the abundance of Firmicutes phyla, followed by Actinobacteria and Proteobacteria, with a total of 926 bacterial families and 2832 bacterial genera. Moreover, our analysis revealed the presence of some potential pathogenic bacterial genera, including Salmonella enterica, Klebsiella pneumoniae, and Staphylococcus aureus. The presence of these pathogens in frequently used surfaces enhances the risk of exposure to any susceptible individuals. Some of the factors that may contribute to the richness of bacterial diversity on these surfaces are poor personal hygiene and ineffective routine schedules of cleaning, sanitizing, and disinfecting. Strict standards of infection control in hospitals and increased public education about hand hygiene are recommended to decrease the risk of transmission in hospitals among patients. PMID:26805866

  6. An ethnographic investigation of junior doctors' capacities to practice interprofessionally in three teaching hospitals.

    PubMed

    Milne, Jacqueline; Greenfield, David; Braithwaite, Jeffrey

    2015-01-01

    Collaborative practice among early career staff is at the bedrock of interprofessional care. This study investigated factors influencing the enactment of interprofessional practice by using the day-to-day role of six junior doctors in three teaching hospitals as a gateway to understand the various professions' interactive behaviours. The contextual framework used for the study was Strauss' theory of negotiated order. Ethnographic techniques were applied to observe the actions and interactions of participants on typical working days in their hospital environments. Field notes were created and thematic analysis was applied to the data. Three themes explored were culture, communication, and collaboration. Issues identified highlight the bounded organisational and professional cultures within which junior doctors work, and systemic problems in interprofessional interaction and communication in the wards of hospitals. There are indications that early career doctors are interprofessional isolates. The constraints of short training terms and pressure from multi-faceted demands on junior doctors can interfere with the establishment of meaningful relationships with nurses and other health professionals. The realisation of sustained interprofessional practice is, therefore, practically and structurally difficult. Enabling factors supporting the sharing of expertise are outweighed by barriers associated with professional and hospital organisational cultures, poor interprofessional communication, and the pressure of competing individual task demands in the course of daily practice. PMID:25646898

  7. Use of non-formulary drugs in children at a Brazilian teaching hospital: a descriptive study

    PubMed Central

    Tramontina, Mariana Y.; Heineck, Isabela; Dos Santos, Luciana

    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. PMID:24155845

  8. Night shift fatigue among anaesthesia trainees at a major metropolitan teaching hospital.

    PubMed

    Lancman, B M

    2016-05-01

    Night shifts expose anaesthesia trainees to the risk of fatigue and, potentially, fatigue-related performance impairment. This study examined the workload, fatigue and coping strategies of anaesthesia trainees during night shifts. A blinded survey-based study was undertaken at a major single centre metropolitan teaching hospital in Australia. All ten anaesthesia trainees who worked night shifts participated. The survey collected data on duration of night shifts, workload, and sleep patterns. Fatigue was assessed using the Karolinska Sleepiness Scale (KSS). There were 93 night shifts generating data out of a potential 165. Trainees tended to sleep an increasing amount before their shift as the nights progressed from 1 to 5. Night 1 was identified as an 'at risk' night due to the amount of time spent awake before arriving at work (32% awake for U+003E8 hours); on all other nights trainees were most likely to have slept 6-8 hours. The KSS demonstrated an increase in sleepiness of 3 to 4 points on the scale from commencement to conclusion of a night shift. The Night 1 conclusion sleepiness was markedly worse than any other night with 42% falling into an 'at-risk' category. The findings demonstrate fatigue and inadequate sleep in anaesthesia trainees during night shifts in a major metropolitan teaching hospital. The data obtained may help administrators prepare safer rosters, and junior staff develop improved strategies to reduce the likelihood of fatigue. PMID:27246936

  9. Surveillance of ESBL producing multidrug resistant Escherichia coli in a teaching hospital in India

    PubMed Central

    Rath, Shakti; Dubey, Debasmita; Sahu, Mahesh C.; Padhy, Rabindra N

    2014-01-01

    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.

  10. Necrotizing Fasciitis: A Review of Management Guidelines in a Large Obstetrics and Gynecology Teaching Hospital

    PubMed Central

    Thompson, C. D.; Brekken, A. L.

    1993-01-01

    Necrotizing fasciitis is a severe, life-threatening soft tissue infection that results in rapid and progressive destruction of the superficial fascia and subcutaneous tissue. Because of its varied clinical presentation and bacteriological make-up, it has been labelled with many other names such as acute streptococcal gangrene, gangrenous erysipelas, necrotizing erysipelas, hospital gangrene, and acute dermal gangrene. Although described by Hippocrates and Galen, it has received increasing attention in obstetrical and gynecological literature only within the last 20 years. This review includes two recent cases successfully managed at Parkland Memorial Hospital, Dallas, Texas. The first patient was a 50 year old, morbidly obese, diabetic woman who presented with a small, painful lesion on the vulva. After failing triple antibiotic therapy with ampicillin, clindamycin, and gentamicin, the diagnosis of necrotizing fasciitis of the vulva was made, and she was taken to the operating room for extensive excision. She was discharged home on hospital day 29. The second patient was a 65 year old, obese, diabetic woman with risk factors for atherosclerosis who had a wound separation after an abdominal hysterectomy. Two days later a loss of resistance to probing was noted in the subcutaneous tissue. Necrotizing fasciitis was suspected, and she was taken to the operating room for resection. The patient was discharged home on hospital day 27. The mortality rate after diagnosis of necrotizing fasciitis has been reported to be 30% to 60%. We review the literature and outline the guidelines used in a large Ob/Gyn teaching hospital to minimize the adverse outcome. Lectures on soft-tissue infections are included on a regular basis. The high-risk factors of age over 50, diabetes, and atherosclerosis are emphasized. The need for early diagnosis and surgical treatment within 48 hours is stressed, and any suspicious lesions or wound complications are reported to experienced senior house

  11. Factors Associated With Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana.

    PubMed

    Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A; Akingbola, Titilola S; Hewlett, Sandra A; Tayo, Bamidele O; Cole, Helen V; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

    2016-08-01

    Background Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study evaluated duration and factors that influenced waiting time from first presentation to start of definitive treatment. Method We conducted a hospital-based retrospective study of 205 breast cancer patients starting definitive treatment at Korle Bu Teaching Hospital between May and December 2013. We used descriptive statistics to summarize patient characteristics. Mann-Whitney U and Kruskal-Wallis tests and Spearman rank correlation were performed to examine the patients, health system, and health worker factors associated with median waiting time. Poisson regression was used to examine the determinants of waiting time. Results The mean age of the patients was 51.1 ± 11.8 years. The median waiting time was 5 weeks. The determinants of waiting time were level of education, age, income, marital status, ethnicity, disease stage, health insurance status, study sites, time interval between when biopsy was requested and when results were received and receipt of adequate information from health workers. Conclusion A prolonged waiting time to treatment occurs for breast cancer patients in Ghana, particularly for older patients, those with minimal or no education, with lower income, single patients, those with late disease, those who are insured, and who did not receive adequate information from the health workers. Time to obtain biopsy reports should be shortened. Patients and providers need education on timely treatment to improve prognosis. PMID:27091222

  12. The role of teaching and research hospitals in improving global health (in a globalized world).

    PubMed

    Leggat, Sandra G; Tse, Nancy

    2003-01-01

    Globalization is impacting on Hong Kong and Australia in different ways, but the experience of the public healthcare systems in both jurisdictions suggests a need for teaching and research hospitals to refocus from the management of international patients to better meet the needs for global health. Traditional globalization suggests a stockpiling of capital--a focus on improving global health suggests dismantling the stockpiles and sharing access to the necessary data, information, knowledge and discoveries to further develop local health expertise. Consistent with its position as a leading healthcare provider, the University Health Network (UHN) has been reflecting on the impact of increasing globalization on hospitals. The goals of the UHN paper on globalization are threefold--to suggest how the external and internal environments of hospitals will change as a result of globalization; to suggest a role for hospitals in a globalized world; and to stimulate discussion and debate. Given our perspective, from the other side of the world, we are pleased to contribute to the discussion and debate but will limit our comments to the future role of teaching and research hospitals based on some of the experiences of Australia and Hong Kong. The citizens of Hong Kong have been acutely aware of the issue of globalization--the excellent deep-water harbour has ensured the position of Hong Kong as a major trading hub. Hong Kong has also had a continually evolving role as a financial centre and gateway to China, and with China's accession to the World Trade Organization the impact of globalization will be even greater. On the other hand, the citizens of Australia have lived with geographic isolation, relatively limited natural resources and a small population, all of which have limited their role in global trade and financial markets. However, both Hong Kong and Australia have seen recent benefits from the increasing speed of communication and information transfer and exchange

  13. Factors associated with the patient safety climate at a teaching hospital1

    PubMed Central

    Luiz, Raíssa Bianca; Simões, Ana Lúcia de Assis; Barichello, Elizabeth; Barbosa, Maria Helena

    2015-01-01

    Objectives: to investigate the association between the scores of the patient safety climate and socio-demographic and professional variables. Methods: an observational, sectional and quantitative study, conducted at a large public teaching hospital. The Safety Attitudes Questionnaire was used, translated and validated for Brazil. Data analysis used the software Statistical Package for Social Sciences. In the bivariate analysis, we used Student's t-test, analysis of variance and Spearman's correlation of (α=0.05). To identify predictors for the safety climate scores, multiple linear regression was used, having the safety climate domain as the main outcome (α=0.01). Results: most participants were women, nursing staff, who worked in direct care to adult patients in critical areas, without a graduate degree and without any other employment. The average and median total score of the instrument corresponded to 61.8 (SD=13.7) and 63.3, respectively. The variable professional performance was found as a factor associated with the safety environment for the domain perception of service management and hospital management (p=0.01). Conclusion: the identification of factors associated with the safety environment permits the construction of strategies for safe practices in the hospitals. PMID:26487138

  14. Role of Organizational Climate in Organizational Commitment: The Case of Teaching Hospitals

    PubMed Central

    Bahrami, Mohammad Amin; Barati, Omid; Ghoroghchian, Malake-sadat; Montazer-alfaraj, Razieh; Ranjbar Ezzatabadi, Mohammad

    2015-01-01

    Objective The commitment of employees is affected by several factors, including factors related to the organizational climate. The aim of this study was to investigate the relationship between organizational commitment of nurses and the organizational climate in hospital settings. Methods A cross-sectional study was conducted in 2014 at two teaching hospitals in Yazd, Iran. A total of 90 nurses in these hospitals participated. We used stratified random sampling of the nursing population. The required data were gathered using two valid questionnaires: Allen and Meyer's organizational commitment standard questionnaire and Halpin and Croft's Organizational Climate Description Questionnaire. Data analysis was done through SPSS 20 statistical software (IBM Corp., Armonk, NY, USA). We used descriptive statistics and Pearson's correlation coefficient for the data analysis. Results The findings indicated a positive and significant correlation between organizational commitment and organizational climate (r = 0.269, p = 0.01). There is also a significant positive relationship between avoidance of organizational climate and affective commitment (r = 0.208, p = 0.049) and between focus on production and normative and continuance commitment (r = 0.308, p = 0.003). Conclusion Improving the organizational climate could be a valuable strategy for improving organizational commitment. PMID:27169007

  15. Assessing the operating efficiencies of teaching hospitals by an enhancement of the AHA/AAMC method. American Hospital Association/Association of American Medical Colleges.

    PubMed

    Morey, R C; Retzlaff-Roberts, D L; Fine, D J; Loree, S W

    2000-01-01

    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

  16. A survey of digital radiography practice in four South African teaching hospitals: an illuminative study

    PubMed Central

    Nyathi, T; Chirwa, TF; van der Merwe, DG

    2010-01-01

    Purpose: The purpose of this study was to assess radiographer familiarity and preferences with digital radiography in four teaching hospitals and thereafter make recommendations in line with the migration from screen film to digital radiography. Materials and methods: A questionnaire was designed to collect data from either qualified or student radiographers from four teaching hospitals. From the four teaching hospitals, there were a total of 205 potential respondents. Among other things, responses regarding experiences and preferences with digital radiography, quality control procedures, patient dose, advantages and disadvantages of digital radiography were sought. The information collected was based on self-reporting by the participants. The study is exploratory in nature and descriptive statistics were generated from the collected data using Microsoft Excel 2007 and StatsDirect software. Results: Sixty-three out of 205 (31%) radiographers from all the four radiology centers responded to the circulated questionnaire. Only 15% (8) of the qualified radiographers had 4 or more years of experience with digital radiography compared to 68% (36) for the same amount of experience with screen-film radiography. Sixty-one percent (38) of the participants had been exposed to digital radiography during their lectures while at university. A small proportion, 16% (10) of the respondents underwent formal training in quality control procedures on the digital X-ray units they were using. Slightly more than half (55%) of the participants felt it was easier for them to retake an image in digital radiography than in screen film radiography. Conclusion: The results of this survey showed that the participants are familiar with digital radiography and have embraced this relatively new technology as shown by the fact that they can identify both its advantages and disadvantages as applied to clinical practice. However, there are minimal quality control procedures specific to digital

  17. Study of patient satisfaction in a surgical unit of a tertiary care teaching hospital

    PubMed Central

    Mishra, P.H.; Gupta, Shakti

    2012-01-01

    Background The hospitals have evolved from being an isolated sanatorium to a place with five star facilities. Patients and their relatives coming to the hospital not only expect world-class treatment, but also other facilities to make their stay comfortable in the hospital. This change in expectation has come due to tremendous growth of media and its exposure, as well as commercialization and improvement in facilities. The aim of this study was to evaluate the level of patient/relatives satisfaction at tertiary care teaching hospital and feedback from them for improvement of the same. Methods The study was conducted by 1. Review of available national and international literature on the subject. 2. Carrying out survey amongst 50 patients and their relatives at one of the surgical unit by using structured questionnaire. 3. By analyzing the data using appropriate statistical methods. Results Eighty two percent people were satisfied with the service at admission counter while 81% were satisfied with room preparation at the time of admission. The nursing services satisfied 80% of people while 92% were satisfied with explanation about disease and treatment by doctor. The behavior of nurses, doctors and orderlies satisfied 92, 92 and 83% of people. The cleanliness of toilets satisfied only 49% while diet services satisfied 78% of people. Conclusion The five major satisfiers were behavior of doctors, explanation about disease and treatment, courtesy of staff at admission counter, behavior and cooperation of nurses. The five major dissatisfiers were cleanliness of toilets, quality of food, explanation about rules and regulation, behavior of orderlies and sanitary attendant and room preparedness. PMID:25983455

  18. Nurses exposure to workplace violence in a large teaching hospital in Iran

    PubMed Central

    Teymourzadeh, Ehsan; Rashidian, Arash; Arab, Mohammad; Akbari-Sari, Ali; Hakimzadeh, Seyyed Mostafa

    2014-01-01

    Background: Workplace violence is one of the factors which can strongly reduce job satisfaction and the quality of working life of nurses. The aim of this study was to measure nurses’ exposure to workplace violence in one of the major teaching hospitals in Tehran in 2010. Methods: We surveyed the nurses in a cross-sectional design in 2010. The questionnaire was adapted from a standardized questionnaire designed collaboratively by the International Labor Office (ILO), the International Health Organization (IHO), the International Council of Nurses (ICN), and the Public Services International (PSI). Finally, in order to analyze the relationships among different variables in the study, T-test and Chi-Square test were used. Results: Three hundred and one nurses responded to the questionnaire (a response rate of 73%). Over 70% of the nurses felt worried about workplace violence. The participants reported exposure to verbal abuse (64% CI: 59-70%), bullying-mobbing (29% CI: 24-34%) and physical violence (12% CI: 9-16%) at least once during the previous year. Relatives of hospital patients were responsible for most of the violence. Nurses working in the emergency department and outpatient clinics were more likely to report having experienced violence. Nurses were unlikely to report violence to hospital managers, and 40% of nurses were unaware of any existing policies within the hospital for reducing violence. Conclusion: We observed a considerable level of nurse exposure to workplace violence. The high rate of reported workplace violence demonstrates that the existing safeguards that aim to protect the staff from abusive patients and relatives are inadequate. PMID:25396205

  19. Antibiotic consumption in non-teaching Lebanese hospitals: A cross-sectional study.

    PubMed

    Iskandar, Katia; Hanna, Pierre A; Salameh, Pascale; Raad, Etwal B

    2016-01-01

    The rising threat of antibiotic resistance is linked to patterns of antibiotic use in hospital settings where global efforts are undertaken to encourage reporting and benchmarking antibiotic consumption in an attempt to improve prescription regimens. In Lebanon, where data concerning the level of antibiotic consumption in hospitals is scarce, the aim of our paper is to track the intensity of antibiotic consumption in order to identify potential evidence of antibiotic misuse or abuse. The study is conducted in 2012 for a period of 12-month using data from pharmacy records in 27 non-teaching Lebanese hospitals according to the Anatomical, Therapeutic and chemical classification system and Defined Daily Dose (ATC/DDD) recommended by the World Health Organization and compiling data on ABC Calc software version 3.1. Results show that the average antibiotic consumption excluding pediatric cases is 72.56 Defined Daily Dose per 100 Bed-Days (DDD/100BD). Total broad spectrum antibiotic consumption is 12.14 DDD/100BD with no significant difference found between public and private hospitals (p>0.05 for all). The most commonly used antibiotics were Amoxycillin/Clavulanic acid, Ceftriaxone, Amoxycillin and Cefuroxime for parenteral use. Consumption of beta-lactams, Cephalosporins, Carbapenems, Monobactams and quinolones did not vary significantly by region, occupancy rate, number of beds including the number of intensive care unit beds. Our data findings provides baseline information on patterns of antibiotic consumption in Lebanon and the issue calls for concerted efforts to encourage data reporting on national basis and to correlate future findings with results of antibiotic susceptibility testing which can provide insights and tools needed to assess the public health consequences of antimicrobial misuse and to evaluate the impact of antibiotic resistance containment interventions. PMID:26806876

  20. A comparative study of collimation in bedside chest radiography for preterm infants in two teaching hospitals

    PubMed Central

    Stollfuss, J.; Schneider, K.; Krüger-Stollfuss, I.

    2015-01-01

    Objective Unnecessary exposure of the abdomen, arms or head may lead to a substantial increase of the radiation dose in portable chest X-rays on the neonatal intensive care unit. The objective was to identify potential factors influencing inappropriate exposure of non-thoracic structures in two teaching hospitals. Methods The study analysed 200 consecutive digital chest radiographs in 20 preterm neonates (mean gestation 25 ± 1 weeks). Demographical data, tube settings and exposure parameters were recorded. To grade the collimation, we used a scoring system with a maximum of 12 exposed non-thoracic structures. Length of gestation, age, the radiographer, years of experience in performing X-rays and the number of in situ catheters or lines, were correlated with collimation quality. Results There was no significant difference between the rates of optimal images obtained in the two hospitals (0.32 vs 0.39, n.s.). Scores showed that most suboptimal images had only mildly reduced image quality (1.40 ± 1.38 vs 1.20 ± 1.43, n.s.). Length of gestation or presence of surgical drains, catheters and tubes had no obvious effects on the exposure of non-thoracic structures. Large intra-individual variation in optimal collimation (14–86%) was noted for the radiographers in both hospitals; this was unrelated to their respective years of experience. Conclusion In our study, the only identifiable factor influencing the collimation of portable chest radiographs in preterm infants was the radiographer’s dedication and awareness. There were no apparent differences between the hospitals investigated. Exposure of non-thoracic structures was relatively frequent and mainly involved the proximal humeri. PMID:26937444

  1. Awareness, Knowledge, Attitude and Skills of Telemedicine among Health Professional Faculty Working in Teaching Hospitals

    PubMed Central

    Kumar, Santosh

    2016-01-01

    Introduction Telemedicine is an emerging technology in health sector in India. The success of any new technology depends on many factors including the knowledge and understanding of the concept, skills acquired, attitude towards technology and working environment by the concerned professionals. Aim The main objective of this study was to assess the awareness, knowledge, attitude and skills of telemedicine among the health professionals working in the teaching hospitals of Puducherry Region of India. Materials and Methods A cross-sectional survey was carried out among various healthcare professionals using a proper sampling frame obtained from a list of teaching hospitals located in Puducherry Union Territory, India. A total of 120 teaching faculties and practitioners from the preclinical, para-clinical and clinical departments were taken up for the study. A pre-validated self-administered questionnaire was used for the survey to assess the awareness, knowledge, attitude and skills of telemedicine. The questionnaires were mailed to the respondents and the completed questionnaires were analysed as per the study objectives using descriptive statistics for the quantitative data and content analysis for the qualitative data. Results The knowledge level of the respondents was found to be good with 41% of the respondents, 35% possess fair knowledge and 24% don’t have adequate knowledge of telemedicine. With regard to the attitude towards telemedicine 39% of the respondents possess high attitude, 31% possess moderate attitude and 30% possess low level of attitude. Investigations on the skills of the respondents on telemedicine showed that 19% respondents are highly skilled or experts, 25% are moderately skilled which includes learners or beginners, and 56% are unskilled in handling telemedicine and its related equipments. Conclusion The findings of the study suggest that although the respondents experience and knowledge are limited in telemedicine technology a fair

  2. Predictors of preoperative anxiety among surgical patients in Jimma University Specialized Teaching Hospital, South Western Ethiopia

    PubMed Central

    2014-01-01

    Background Hospitalization and surgery are critical negative life events that lead to the experience of considerable anxiety in patients. Patients may perceive the day of surgery as the biggest and the most threatening day in their lives. There is paucity of information on predictors of anxiety in the current study area. The main objective of this study is to assess predictors of preoperative anxiety among patients scheduled for surgery in Jimma University Specialized Teaching Hospital. Methods A facility based cross-sectional study was conducted using quantitative data collection technique in Jimma University Specialized Teaching Hospital from February 13 to April 13, 2012 on 239 patients scheduled for surgery. The data were collected by five trained diploma nurses using structured interviewer administered questionnaires that were prepared based on state trait anxiety inventory measurement scale. The quantitative data were entered into SPSS for windows version 16. 0 and descriptive, simple and multiple linear regression analyses were performed. Results A total of 239 patients were enrolled in the study with a response rate of 93.0%. Their mean age was 42.7 ± 1.8 years (range 16 to 85 years). Nearly over half 53.6% were females, while 48.1% illiterate, 72.4% Oromo and 56.5% were Muslim followers. Significant preoperative anxiety was seen in 70.3% patients. The most common factors that lead to anxiety were fear of death 38.1% and fear of unknown origin 24.3% and the most common strategy mentioned by patient in reducing anxiety were talking to other patient 79.8% and religious belief. Conclusions In the present study, two third 70.3% of preoperative patients had anxiety. Factors which were positively correlated with anxiety were trait anxiety, single and divorced, time of operation and income. Factors which were shown to reduce anxiety were preoperative anxiety related information provision and afternoon operation. Health professionals working in the hospital

  3. Development of an effective risk management system in a teaching hospital

    PubMed Central

    2012-01-01

    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

  4. Eye Injuries Among Primary School Children in Enugu, Nigeria: Rural vs Urban

    PubMed Central

    Okpala, Nonso Ejikeme; Umeh, Rich Enujioke; Onwasigwe, Ernest Nnemeka

    2015-01-01

    .04%), siblings (2.04%), and others (1.02%). The primary agents that caused an eye injury were sticks/wood, 29 (29.60%); stone, 21 (21.43%); pieces of metal, 19 (19.39%); fall, 10 (10.20%); fight/fist blow, 9 (9.918%); plastic, 2 (2.04%); fingernails, 2 (2.04%); farm tools/fruits, 2 (2.04%); and RTA, glass, and headbutt, each 1.02%. Farm implements/fruits as well as fingernails appear to be fairly common primary agents that cause an eye injury in the rural Enugu, Nigeria. In terms of prevalence, there was no significant difference between the urban and rural areas. The findings from this study showed a high prevalence of eye injury among primary school children. In terms of treatment, 58.16% of the children with an eye injury had no form of treatment for it. The children from this study with monocular blindness did not receive adequate medical treatment. Treatment of an eye injury, according to this study, was sought from chemists (19.39%), at hospital/health centers (16.33%), at home (3.06%), and from traditional healers (3.06%). The persons who treated an eye injury, as observed from this study, were doctors (14.29%), nurses (4.08%), chemists (17.35%), and traditional healers and fathers (3.06% each). The frequency of noninjury-related diagnosis made in this study was refractive error, 4.85%; allergic conjunctivitis, 1.94%; oculocutaneous albinism, 0.24%; prepapillary vascular loops, 0.40%; and then ptosis, exotropia, stye, corneal opacity, and retinitis pigmentosa, 0.08% each. The annual incidence of an eye injury according to this study was 3.48%. The majority of the causes of an eye injury, as per this study, were preventable. Appropriate promotion of preventive eye care among children may go a long way in reducing the burden of blindness from eye injuries. PMID:26124686

  5. Eye Injuries Among Primary School Children in Enugu, Nigeria: Rural vs Urban.

    PubMed

    Okpala, Nonso Ejikeme; Umeh, Rich Enujioke; Onwasigwe, Ernest Nnemeka

    2015-01-01

    .04%), siblings (2.04%), and others (1.02%). The primary agents that caused an eye injury were sticks/wood, 29 (29.60%); stone, 21 (21.43%); pieces of metal, 19 (19.39%); fall, 10 (10.20%); fight/fist blow, 9 (9.918%); plastic, 2 (2.04%); fingernails, 2 (2.04%); farm tools/fruits, 2 (2.04%); and RTA, glass, and headbutt, each 1.02%. Farm implements/fruits as well as fingernails appear to be fairly common primary agents that cause an eye injury in the rural Enugu, Nigeria. In terms of prevalence, there was no significant difference between the urban and rural areas. The findings from this study showed a high prevalence of eye injury among primary school children. In terms of treatment, 58.16% of the children with an eye injury had no form of treatment for it. The children from this study with monocular blindness did not receive adequate medical treatment. Treatment of an eye injury, according to this study, was sought from chemists (19.39%), at hospital/health centers (16.33%), at home (3.06%), and from traditional healers (3.06%). The persons who treated an eye injury, as observed from this study, were doctors (14.29%), nurses (4.08%), chemists (17.35%), and traditional healers and fathers (3.06% each). The frequency of noninjury-related diagnosis made in this study was refractive error, 4.85%; allergic conjunctivitis, 1.94%; oculocutaneous albinism, 0.24%; prepapillary vascular loops, 0.40%; and then ptosis, exotropia, stye, corneal opacity, and retinitis pigmentosa, 0.08% each. The annual incidence of an eye injury according to this study was 3.48%. The majority of the causes of an eye injury, as per this study, were preventable. Appropriate promotion of preventive eye care among children may go a long way in reducing the burden of blindness from eye injuries. PMID:26124686

  6. Analysis of the quality of hospital information systems in Isfahan teaching hospitals based on the DeLone and McLean model

    PubMed Central

    Saghaeiannejad-Isfahani, Sakineh; Saeedbakhsh, Saeed; Jahanbakhsh, Maryam; Habibi, Mahboobeh

    2015-01-01

    Background: Quality is one of the most important criteria for the success of an information system, which refers to its desirable features of the processing system itself. The aim of this study was the analysis of system quality of hospital information systems (HIS) in teaching hospitals of Isfahan based on the DeLone and McLean model. Materials and Methods: This research was an applied and analytical-descriptive study. It was performed in teaching hospitals of Isfahan in 2010. The research population consisted of the HIS's users, system designers and hospital information technology (IT) authorities who were selected by random sampling method from users’ group (n = 228), and system designers and IT authorities (n = 52) using census method. The data collection tool was two researcher-designed questionnaires. Questionnaires’ reliability was estimated by using Cronbach's alpha was calculated. It was 97.1% for the system designers and IT authorities’ questionnaire and 92.3% for system users’ questionnaire. Results: Findings showed that the mean of system quality score in a variety of HIS and among different hospitals was significantly different and not the same (P value ≥ 0.05). In general, Kosar (new version) system and Rahavard Rayaneh system have dedicated the highest and the lowest mean scores to themselves. The system quality criterion overall mean was 59.6% for different HIS and 57.5% among different hospitals respectively. Conclusion: According to the results of the research, it can be stated that based on the applied model, the investigated systems were relatively desirable in terms of quality. Thus, in order to achieve a good optimal condition, it is necessary to pay particular attention to the improving factors of system quality, type of activity, type of specialty and hospital ownership type. PMID:25767816

  7. Teaching neuraxial anesthesia techniques for obstetric care in a Ghanaian referral hospital: achievements and obstacles.

    PubMed

    Olufolabi, Adeyemi J; Atito-Narh, Evans; Eshun, Millicent; Ross, Vernon H; Muir, Holly A; Owen, Medge D

    2015-06-01

    Anesthesia providers in low-income countries may infrequently provide regional anesthesia techniques for obstetrics due to insufficient training and supplies, limited manpower, and a lack of perceived need. In 2007, Kybele, Inc. began a 5-year collaboration in Ghana to improve obstetric anesthesia services. A program was designed to teach spinal anesthesia for cesarean delivery and spinal labor analgesia at Ridge Regional Hospital, Accra, the second largest obstetric unit in Ghana. The use of spinal anesthesia for cesarean delivery increased significantly from 6% in 2006 to 89% in 2009. By 2012, >90% of cesarean deliveries were conducted with spinal anesthesia, despite a doubling of the number performed. A trial of spinal labor analgesia was assessed in a small cohort of parturients with minimal complications; however, protocol deviations were observed. Although subsequent efforts to provide spinal analgesia in the labor ward were hampered by anesthesia provider shortages, spinal anesthesia for cesarean delivery proved to be practical and sustainable. PMID:25988637

  8. Maternal mortality in a teaching hospital in southern India. A 13-year study.

    PubMed

    Rao, K B

    1975-10-01

    During the 13 years 1960-1972, in a teaching hospital that serves a predominantly rural and semiurban population in southern India, there were 74,384 deliveries and 1245 maternal deaths, a maternal mortality rate of 16.7 per 1000 births. Direct obstetric factors caused 854 (65.5%) of these deaths. The leading indirect or associated causes of maternal deaths were anemia, cerebrovascular accidents, and infectious hepatitis. During the past 13 years, monthly maternal mortality meetings have helped to reduce the incidence of avoidable factors in maternal deaths among patients from the city but not among those brought from the surrounding countryside. The important causes of maternal deaths in this developing country, and their prevention, are individually discussed. PMID:1080844

  9. Methicillin-resistant staphylococcal colonization in dogs entering a veterinary teaching hospital.

    PubMed

    Hanselman, Beth A; Kruth, Stephen; Weese, J Scott

    2008-01-01

    Nasal, axillary and rectal swabs were collected from 193 dogs admitted to the Ontario Veterinary College Veterinary Teaching Hospital. Enrichment culture was performed and coagulase positive staphylococci were identified via standard methods. Methicillin-resistant Staphylococcus pseudintermedius was isolated from 4/193 (2.1%) dogs, and methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus schleiferi subsp. coagulans were each isolated from 1/193 (0.5%) dogs. Methicillin-resistant Staphylococcus intermedius was not identified. All S. pseudintermedius isolates were unrelated on pulsed-field gel electrophoresis. Evaluation of the epidemiology of methicillin-resistant staphylococcal colonization is necessary to understand the apparent emergence of these strains and to develop appropriate control strategies. PMID:17643874

  10. Teaching physicians-in-training to address racial disparities in health: a hospital-community partnership.

    PubMed Central

    Jacobs, Elizabeth A.; Kohrman, Claire; Lemon, Maurice; Vickers, Dennis L.

    2003-01-01

    Racial and ethnic disparities in health care continue to be a major impediment to improving the health of many communities in the United States. Efforts must be directed at the multiple social, economic, and historic determinants of health disparities. In addition, health care providers must be aware of these determinants and must have the tools to address them in their individual relationships with patients. This article describes a partnership that arose out of the mutual recognition by a community organization and public hospital of the need to (a) teach physicians how to recognize the root causes of health disparities, (b) improve their cross-cultural understanding and communication, and (c) enhance their awareness of the capacity of community resources to positively impact their patients' lives. PMID:12815083

  11. Exposure to blood among mortuary workers in teaching hospitals in south-west Nigeria

    PubMed Central

    Ogunnowo, Babatunde; Anunobi, Charles; Onajole, Adebayo; Odeyemi, Kofoworola

    2012-01-01

    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. PMID:22593797

  12. Spatial distribution and accessibility to public sector tertiary care teaching hospitals in Karachi: A Geographic Information Systems application.

    PubMed

    Shaikh, Masood Ali; Ali, Mir Shabbar

    2016-07-01

    Optimal utilization of specialized curative healthcare services is contingent on spatial access to tertiary-care hospitals by the targeted population. The objectives of this study were to determine the spatial distribution of public sector tertiary-care teaching hospitals in Karachi, and to use GIS and network analysis for modeling the accessibility to these hospitals for Karachi residents. Maps of three, six, and nine kilometer buffers were created around the five selected hospitals to determine which towns of Karachi are either entirely or partially covered/accessible. Most of the towns in Karachi were covered either partially or completely by the three buffers and service areas of 3,6, and 9 kilometers around the five selected hospitals. This study highlights the limitations of using publicly available data for road network, and the need for creating and making available in public domain, comprehensive road network vector dataset in conjunction with population breakdowns by administrative subdivisions. PMID:27427142

  13. Distribution of bacterial contamination in a teaching hospital in Tehran - a special focus on Staphylococcus aureus.

    PubMed

    Mirzaii, Mehdi; Emaneini, Mohammad; Maleknejad, Parviz; Jonaidi, Nematollah; Fooladi, Abbas Ali Imani; Aligholi, Marzieh; Jabalameli, Fereshteh; Halimi, Shahnaz; Taherikalani, Morovat; Kasaeian, Amir

    2012-03-01

    There are documents that confirm the cycle of bacterial transmission between patients, staff, and the inanimate environment. The environment may have more effect on intensive care units (ICUs), because the patients who require intensive care have unstable clinical conditions and are more sensitive to infections. The aim of this study was to determine the prevalence of bacteria in air and inanimate surface in the ICUs and to compare the microbial levels to standard levels.Air and inanimate surface in the four ICUs of a teaching hospital underwent weekly surveillance by means of air sampler and swabs for a period of six-month. Total bacterial counts were evaluated onto trypticase soy agar and mannitol salt agar (MSA).A total of 725 samples [air (168) and inanimate surfaces (557)] were collected. The total mean ± SD CFU/m3 of airborne bacteria in all of the ICUs were 115.93 ± 48.04. The most common bacteria in air of the ICUs were Gram-positive cocci (84.2%). The total mean ± SD airborne of Staphylococcus aureus was 12.10±8.11 CFU/m3. The highest levels of S. aureus contamination were found in ventilators and bed ledges. More suitable disinfection of hospital environments and monthly rotation in utilization of the various disinfectant agents are needed for the prevention of airborne and inanimate transmission of S. aureus. PMID:22510282

  14. T cell subset profile in healthy Zambian adults at the University Teaching Hospital

    PubMed Central

    Chisenga, Caroline Cleopatra; Kelly, Paul

    2016-01-01

    Introduction Symptom-free human immunodeficiency virus antibody-negative Zambian adults (51 subjects, aged 20 to 62 years, 33.3% women and 66.7% men) were studied to establish T cell subset reference ranges. Methods We carried out across sectional study at the University Teaching Hospital, Lusaka. Blood samples were collected from healthy donor volunteers from hospital health care staff, between February and March 2015. Immunopheno typing was undertaken to characterize Tcell subsets using the markers CD3, CD4, CD8, α4β7, Ki67, CD25, CCR7, CD54RA, CD57, CD28, CD27 and HLA-DR. Results Among 51 volunteers, Women had significantly higher absolute CD4 count (median 1042; IQR 864, 1270) than in men (671; 545, 899) (p=0.003). Women also had more CD4 cells expressing homing, naïve, effector and effector memory T cell subsets compared to men. However, in the CD8 population, only the effector cells were significantly different with women expressing more than the males. Conclusion We provide early reference range for T cell subsets in Zambian adults and conclude that among the African women some T cell subsets are higher than men. PMID:27231509

  15. Quality of nursing care and satisfaction of patients attended at a teaching hospital1

    PubMed Central

    de Freitas, Juliana Santana; Silva, Ana Elisa Bauer de Camargo; Minamisava, Ruth; Bezerra, Ana Lúcia Queiroz; de Sousa, Maiana Regina Gomes

    2014-01-01

    Objectives assess the quality of nursing care, the patients' satisfaction and the correlation between both. Method cross-sectional study, involving 275 patients hospitalized at a teaching hospital in the Central-West of Brazil. The data were collected through the simultaneous application of three instruments. Next, they were included in an electronic database and analyzed in function of the positivity, median value and Spearman's correlation coefficients. Results among the nursing care assessed, only two were considered safe - hygiene and physical comfort; nutrition and hydration - while the remainder were classified as poor. Nevertheless, the patients were satisfied with the care received in the domains assessed: technical-professional, confidence and educational. This can be justified by the weak to moderate correlation that was observed among these variables. Conclusion Despite the quality deficit, the patients' satisfaction level with the nursing care received was high. These results indicate that the institution needs to center its objectives on a continuing evaluation system of the care quality, aiming to attend to the patients' expectations. PMID:25029057

  16. Patient Experience of Nursing Quality in a Teaching Hospital in Saudi Arabia

    PubMed Central

    Al Momani, M; Al Korashy, H

    2012-01-01

    Background: Examining the quality of nursing care from the patient's perspective is an important element in quality evaluation. The extent to which patients’ expectations are met will influence their perceptions and their satisfaction with the quality of care received. Methods: A cross-sectional survey was conducted among admitted patients at King Khalid Teaching Hospital, Riyadh, Saudi Arabia. Data were collected (from January 2011 to March 2011) from a convenience sample of 448 patients using a 42-items questionnaire assessing six dimensions of the nursing care provided to, during hospitalization. Results: On a four–point scale (4-higly agree,3-agree, 2-disagree, and 1-higly disagree). The individual items of nursing care showing the lowest means were the information received from the nurses about self-help (2.81), the information about the laboratory results (2.76) and the way the nurse shared the patient's feeling (2.72). A strong correlation existed between the overall perception level and the variables of gender (P=0.01), and the types of department (0.004). Conclusion: The findings of this study demonstrate negative experiences of patients with nursing care in dimensions of information, caring behavior, and nurse competency and technical care. Awareness of the importance of these dimensions of nursing care and ongoing support to investigate patients’ perception periodically toward quality of nursing care are critical to success the philosophy of patient centered health care. PMID:23113223

  17. Evaluation of an intensive care unit in a teaching hospital in Saudi Arabia.

    PubMed

    Adu-Gyamfi, Y; al-Ghassab, G; al-Suleiman, S A; al-Sibai, M H; Wosornu, L

    1992-01-01

    Intensive Care Units (ICU) in general hospitals have become a standard requirement in tertiary care centres. However, the appropriateness of their use is not widely known. We have used the Therapeutic Intervention Scoring System (TISS) to evaluate a multidisciplinary ICU in a teaching hospital in Saudi Arabia. The average occupancy rate was 79%, the nurse: patient ratio was 1:1.4, duration of stay 4.1 +/- 3.5 days, and mortality was 1.4%. The distribution of severity of illness was as follows: Classes I & II, 82%, and Classes III & IV, 18%. The average TISS points were: daily per patient 15.1 +/- 2.7 (range 11.5-21.7), total per day 125.6 +/- 38.2 (range 35-211), and patient points per nurse was 21.1. We conclude that, although less than 20% of patients required unique ICU services, the use of our ICU was appropriate to the current medical and manpower training needs of the community it was designed to serve, but the basis of nurses' complaints of overwork remains to be determined. PMID:1399373

  18. Empathy from the Nurses' Viewpoint in Teaching Hospitals of Tabriz University of Medical Sciences, Iran

    PubMed Central

    Parvan, Kobra; Ebrahimi, Hossein; Zamanzadeh, Vahid; Seyedrasooly, Alehe; Dadkhah, Delavar; Jabarzadeh, Faranak

    2014-01-01

    Introduction: Empathy is the ability to put one in the place of others and to better understand their feelings and experiences. According to researchers, there is a type of challenge in using this concept in nursing field. In most cases, the term empathy substitutes other concepts. Regarding this point, it seems quite necessary to research and discuss different dimensions of this concept in different studies. This study aimed to determine empathy regarding the nurses' point of view. Methods: In this descriptive study sample size was selected according to study population or in the other hand all the nurses in 3 general hospital was selected because they are the most important teaching hospital in Tabriz. LEP (La Monica Empathy Profile) was used as empathy tool. Data were analyzed by SPSS Ver. 13.0. Results: In nonverbal behavior dimension, touching the patient was considered as the most effective methods. On the other hand, nurses could not always be able to control stress and they could not always being with patients to show their empathy. Many people believe that nurses showed very little feelings while raggedly the reflective enclosure and they occasionally had to change their schedules to talk to patients. Conclusion: In most cases the nurses support nonverbal behavior, such as reflective, close and touching encountering in establishing relationship with the patient. However, to improve this situation, planning for nurses to become familiar with the ways through which they can express their interest to show empathy would be effective PMID:25276746

  19. Needlestick injury among medical personnel in Accident and Emergency Department of two teaching hospitals.

    PubMed

    Ng, Y W; Hassim, I Noor

    2007-03-01

    Needlestick injury has been recognized as one of the occupational hazards which results in transmission of bloodborne pathogens. A cross-sectional study was carried out among 136 health care workers in the Accident and Emergency Department of two teaching hospitals from August to November 2003 to determine the prevalence of cases and episodes of needlestick injury. In addition, this study also assessed the level of knowledge of blood-borne diseases and Universal Precautions, risk perception on the practice of Universal Precautions and to find out factors contributing to needlestick injury. Prevalence of needlestick injury among the health care workers in the two hospitals were found to be 31.6% (N = 43) and 52.9% (N = 87) respectively. Among different job categories, medical assistants appeared to face the highest risk of needlestick injury. Factors associated with needlestick injury included shorter tenure in one's job (p < 0.05). Findings of this study support the hypothesis that health care workers are at risk of needlestick injury while performing procedures on patients. Therefore, comprehensive infection control strategies should be applied to effectively reduce the risk of needlestick injury. PMID:17682562

  20. Auditing Analgesic Use in Post-operative Setting in a Teaching Hospital

    PubMed Central

    Bathini, Prapthi

    2015-01-01

    Introduction: Managing postoperative pain efficiently is one important therapeutic challenge in the hospitals. Combination use of analgesics is in vogue, where in drugs from the opioid and non-opioid group are given synergistically. The aim of this study is to audit the use of different analgesics on the first postoperative day. Effort has been made to look into the drug or drug combinations used and other factors associated with their use. Materials and Methods: Retrospective, cross sectional observational study was conducted over a period of 11 months in a tertiary care teaching hospital at Hyderabad with approval from institutional ethics committee. Medical records of 649 patients on the first postoperative day were analysed for analgesics by various indicators. Results: Average number of drugs per encounter was 4.23. Percentage of patients prescribed drugs from national essential drug list/WHO was 81.94%. Most common analgesic (monotherapy) prescribed was tramadol followed by diclofenac and the most common combination drugs prescribed were tramadol+Paracetamol. The most common route of administration was intravenous. All the drugs except piroxicam, were in the lower limit of the recommended daily dose. Conclusion: The present study gives an idea of the overall pattern of analgesic drug use in postoperative patients. The drug combinations used, the most common single use drug can be made out. The health professionals can be encouraged to prescribe by generic name and from the National List of Essential Medicines NLEMs. PMID:26023565

  1. A review of cleft lip and palate management: Experience of a Nigerian Teaching Hospital

    PubMed Central

    Efunkoya, Akinwale Adeyemi; Omeje, Kelvin Uchenna; Amole, Ibiyinka Olushola; Osunde, Otasowie Daniel; Akpasa, Izegboya Olohitae

    2015-01-01

    Background: Cleft lip (CL) and palate (CLP) management is multidisciplinary. A cleft team was formed in a Nigerian Tertiary Hospital to address the health needs of cleft patients in the centre. Aim: This paper aims at documenting the Aminu Kano Teaching Hospital (AKTH) management protocol for orofacial clefts and also to review our experience with CLP surgeries performed at AKTH since our partnering with Smile Train. Materials and Methods: A retrospective review of all the cleft patients surgically treated from January 2006 to December 2014 under Smile Train sponsorship was undertaken. A descriptive narrative of the cleft team protocol was also given. Results: One hundred and fifty-five patients (80 males, 75 females) had surgical repairs of either the lip or palate. CL patients were 83 (53.55%), while CLP patients were 45 (29.03%) and isolated cleft palate patients were 27 (17.42%). Conclusion: The inclusion of various specialities in the cleft team is highly desirable. Poverty level amongst our patients frequently limits our management to surgical treatment sponsored by the Smile Train, despite the presence of other residual problems. PMID:26712291

  2. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India

    PubMed Central

    Jhaveri, Binit N.; Patel, Tejas K.; Barvaliya, Manish J; Tripathi, Chandrabhanu

    2014-01-01

    Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer's criteria (2012) and PRISCUS list (2010). Results: A total of 676 geriatric patients (52.12% females) were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer's criteria, at least one inappropriate medicine was prescribed in 590 (87.3%) patients. Metoclopramide (54.3%), alprazolam (9%), diazepam (8%), digoxin > 0.125 mg/day (5%), and diclofenac (3.7%) were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) in heart and renal failure patients was the commonly identified drug–disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06%) patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients. PMID:25276629

  3. Antibiotic prescribing in two private sector hospitals; one teaching and one non-teaching: A cross-sectional study in Ujjain, India

    PubMed Central

    2012-01-01

    Background The worldwide increase in antibiotic resistant bacteria is of great concern. One of the main causes is antibiotic use which is likely to be high but is poorly described in India. The aim was to analyze and compare antibiotic prescribing for inpatients, in two private sector tertiary care hospitals; one Teaching and one Non-teaching, in Ujjain, India. Methods A cross-sectional study with manual data collection was carried out in 2008. Antibiotic prescribing was recorded for all inpatients throughout their hospital stay. Demographic profile of inpatients and prescribed antibiotics were compared. WHO Anatomical Therapeutic Chemical (ATC) classifications for antibiotics was used and Defined Daily Doses (DDD) were calculated per patient day. Results A total of 8385 inpatients were admitted during the study period. In the Teaching hospital (TH) 82% of 3004 and in the Non-teaching hospital (NTH) 79% of 5381 patients were prescribed antibiotics. The most commonly prescribed antibiotic groups were; fluoroquinolones and aminoglycosides in the TH and, 3rd generation cephalosporins and combination of antibiotics in the NTH. Of the prescriptions, 51% in the TH and 87% in the NTH (p<0.001) were for parenteral route administration. Prescribing by trade name was higher in the NTH (96%) compared with the TH (63%, p<0.001). Conclusions The results from both hospitals show extensive antibiotic prescribing. High use of combinations of antibiotics in the NTH might indicate pressure from pharmaceutical companies. There is a need to formulate and implement; based on local prescribing and resistance data; contextually appropriate antibiotic prescribing guidelines and a local antibiotic stewardship program. PMID:22788873

  4. Trauma Registry Development for Jos University Teaching Hospital: Report of the First Year Experience.

    PubMed

    Ozoilo, Kenneth N; Ali, Mariam; Peter, Solomon; Chirdan, Lohfa; Mock, Charles

    2015-08-01

    Adequate intervention in trauma management and prevention requires a well-documented database for objective study of the disease characteristics, hence the need for a trauma registry. The aim and objective of this study is to document in a database all patients admitted in our hospital following trauma. This study was conducted at the Jos University Teaching Hospital, Jos, Plateau State, Nigeria. Beginning 1 January 2012, data was collected on a trauma data sheet and transferred to a 3-page, 80-point questionnaire on Epi info3.5.2 software and stored in a standalone desktop computer. Four hundred fifty-nine patients were registered. Road traffic collisions were the most common causes of trauma, 312 (70.0 %), followed by gunshots, 58 (12.6 %). Mechanism of injury was blunt in 307 patients (66.9 %) and penetrating in 152 patients (33.1 %). Only 9 patients (2.0 %) were brought in by ambulance; majority came by public transportation, 401 (87.4 %). Eighty four patients (18.3 %) suffered various complications; 342 (74.5 %) were discharged home in satisfactory condition, and there were 32 hospital mortalities (7.0 %). Challenges encountered include difficulty in data collection, lack of computer software and internet access, no dedicated registry staff and no funding to engage, train and retain data gathering and management personnel. Our results provide data in support of the known epidemiology of trauma in our environment. Challenges encountered can be overcome using local assets and resources. PMID:26702237

  5. Metabolic syndrome and associated factors among outpatients of Jimma University Teaching Hospital

    PubMed Central

    Abda, Edris; Hamza, Leja; Tessema, Fasil; Cheneke, Waqtola

    2016-01-01

    Background Developing countries are now experiencing the epidemiologic transition, whereby the burden of chronic diseases, like metabolic syndrome, is increasing. However, no study had previously been conducted to show the status of metabolic syndrome among outpatients of Jimma University Teaching Hospital. Therefore, this study was designed to determine the prevalence of metabolic syndrome and associated factors among adult (≥20 years) patients. Methods A cross-sectional hospital-based study was conducted in July 2014 among adult (≥20 years) patients attending Jimma University Teaching Hospital, outpatient department. All patients attending the outpatient department and were willing to participate in the study were included. Anthropometric and biochemical measurements were undertaken for all the study subjects to know the status of metabolic syndrome. Metabolic syndrome was identified using the National Cholesterol Education Program’s Adult Treatment Panel III criteria. Results A total of 225 participants were included in the study, of whom 106 (47.1%) were males and 119 (52.9%) were females. A total of 59 (26%) adults were found to have metabolic syndrome, which was seen more than twice as much in females, 42 (35%), as compared with males, 17 (16%), (P<0.01). The most frequent metabolic syndrome parameters were hypertension (45%), hyperglycemia (39%), decreased high-density lipoprotein (HDL) (31%), central obesity (26%), and elevated triglycerides (18%). Elevated blood pressure is more common in females (44.5%) than in males (34.9%). Decreased HDL-cholesterol was observed among 37% of females versus 24% males (P<0.001) and 6% of males versus 45% females had central obesity (P<0.001). Hypertension and body mass index were significantly lower among males (35% and 14%) than females (45% and 41%) (P<0.01 and P<0.001), respectively. Conclusion It is demonstrated that metabolic syndrome is prevalent in adult outpatients in Jimma and increases as age increases; it

  6. Physicians and the teaching of breast self-examination: implications from a survey at a university teaching hospital.

    PubMed Central

    O'Malley, M S; Fletcher, S W; Bunce, L A

    1985-01-01

    We surveyed 80 physicians from four specialties (Family Medicine, General Medicine, General Surgery, Ob-Gyn) to investigate how they taught breast self-examination (BSE). Only half reported personally teaching BSE. Few MDs reported routinely using techniques to assess BSE competency. Most (72 per cent) claimed no formal training in teaching BSE; 10 per cent claimed no training at all. Techniques used to teach BSE may vary, and physicians may lack the training to teach BSE. PMID:4003638

  7. Seroprevalence and Correlates of Hepatitis C Virus Infection in Secondary School Children in Enugu, Nigeria

    PubMed Central

    Eke, CB; Ogbodo, SO; Ukoha, OM; Muoneke, VU; Ibekwe, RC; Ikefuna, AN

    2016-01-01

    Background: Although children comprise a small fraction of the burden of hepatitis C virus (HCV) infections, which is a major global health challenge, a significant number of them develop chronic HCV infection and are at risk of its complications. Aim: The aim of the current study was to determine the prevalence and associated factors of HCV infection in school children in Enugu urban. Subjects and Methods: This was a cross-sectional seroepidemiological study involving children aged 10–18 years selected using multistage systematic sampling in Enugu metropolis, Southeast Nigeria. The anti-HCV was tested using a 3rd generation enzyme-linked immunosorbent assay. Data were analyzed using SPSS Version 16.0 with the level of significance set at P < 0.05. Results: Four hundred and twenty children were selected and screened comprising 210 (50.0%) males and females. The seroprevalence of anti-HCV was 4 (1.0%). Three (75%) out of the four positive cases for the anti-HCV were females while one was a male giving a male to female ratio of 0.3–1. Traditional scarifications/tattoos were the putative risk factors observed to be significantly associated with anti-HCV seropositivity. Conclusion: This study has demonstrated an anti-HCV seroprevalence of 1.0% among children aged 10–18 years in Enugu with traditional scarification as the predominant associated risk factor. Proper health education including school health education and promotion of behavioral change among the public on the practice of safe scarifications/tattoos should be encouraged in our setting. PMID:27398246

  8. Waiting time to conception among the Igbo women of Enugu, Nigeria.

    PubMed

    Onah, H E; Obi, S N; Akogu, S P O

    2009-07-01

    The objective of this study was to determine the waiting time to conception among a sample of pregnant Igbo women resident in an urban area of South-east Nigeria. This was a cross-sectional questionnaire study of antenatal clinic attendees at four major health institutions within Enugu, South-eastern Nigeria. The time to conception showed a pattern closer to that of the USA than that of the UK and is consistent with high fertility previously recorded in the Igbo population. We conclude that the data will be useful in counselling women who present with difficulty in conception. PMID:19603320

  9. Assault and abuse of health care workers in a large teaching hospital.

    PubMed Central

    Yassi, A

    1994-01-01

    OBJECTIVES: To determine the nature, extent and costs of injuries to health care workers caused by physical abuse. DESIGN: Retrospective study. SETTING: Large acute and tertiary care teaching hospital in Winnipeg. PARTICIPANTS: All health care workers at the hospital who filed reports of abuse-related injuries and of verbal abuse and threatening behaviour from Apr. 1, 1991, to Mar. 31, 1993. OUTCOME MEASURES: Frequency of physical and verbal abuse of hospital personnel according to job category, type of injury, hours of staff time lost and estimates of costs compensated for abuse-related injuries. RESULTS: Of the 242 reported abuse-related injuries 194 (80.2%) occurred among the nursing personnel. The nurses in the medical units filed most (33.1%) of the reports. Although the psychiatric nurses filed fewer reports (35 [14.5%]) they had the highest rate of injuries per 100,000 paid hours among the nursing staff. Not surprisingly, the security officers were at highest risk, 53.5% having reported an abuse-related injury for a rate of 16.8 such injuries per 100,000 paid hours. Male staff members had a higher injury rate than their female counterparts in all occupational groups. Bruising or crushing was the most frequent type of injury (in 126 cases); the next most frequent were cuts and lacerations (in 47) and human bites and exposures to blood or body fluids (in 23). However, the 36 sprains and strains resulted in the largest amount of time lost. In all, over 8000 hours were lost due to abuse-related injuries, and over $76,000 was paid in workers' compensation benefits. Concurrently, 646 incidents of verbal abuse and threatening behaviour were reported. Only three abuse-related injuries and two incidents of verbal abuse were reported by physicians. CONCLUSIONS: Abuse-related injuries to health care workers in an urban hospital are prevalent, serious and can be costly in terms of time off work and compensation. Underreporting is likely, especially among physicians

  10. Impact of Hospital Teaching Status on Mortality, Length of Stay and Cost Among Patients With Cardiac Arrest in the United States.

    PubMed

    Dolmatova, Elena V; Moazzami, Kasra; Klapholz, Marc; Kothari, Neil; Feurdean, Mirela; Waller, Alfonso H

    2016-09-01

    Limited data exist regarding the in-hospital outcomes in patients with cardiac arrest (CA) in teaching versus nonteaching hospital settings. Using the Nationwide (National) Inpatient Sample (2008 to 2012), 731,107 cases of CA were identified using International Classification of Diseases, Ninth Edition codes. Among these patients, 348,368 (47.6%) were managed in teaching hospitals and 376,035 (51.4%) in nonteaching hospitals. Patients in teaching hospitals with CA were younger (62.42 vs 68.08 years old), had less co-morbidities (p <0.001), were less likely to be white (54.6% vs 65.5%) and more likely to be uninsured (9.1% vs 7.6%). Mortality in patients with CA was significantly lower in teaching hospitals than in nonteaching hospitals (55.3% vs 58.8%; all p <0.001). The mortality remained significantly lower after adjusting for baseline patient and hospital characteristics (odds ratio 0.917, CI 0.899 to 0.937, p <0.001). However, the survival benefit was no longer present after adjusting for in-hospital procedures (OR 0.997, CI 0.974 to 1.02, p = 0.779). In conclusion, teaching status of the hospital was associated with decreased in-hospital mortality in patients with CA. The differences in mortality disappeared after adjusting for in-hospital procedures, indicating that routine application of novel therapeutic methods in patients with CA in teaching hospitals could translate into improved survival outcomes. PMID:27378144

  11. Increasing access to legal termination of pregnancy and postabortion contraception at the University Teaching Hospital, Lusaka, Zambia.

    PubMed

    Macha, Swebby; Muyuni, Mutinta; Nkonde, Scholastica; Faúndes, Anibal

    2014-07-01

    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

  12. Bacterial bloodstream infections in HIV-infected adults attending a Lagos teaching hospital.

    PubMed

    Adeyemi, Adeleye I; Sulaiman, Akanmu A; Solomon, Bamiro B; Chinedu, Obosi A; Victor, Inem A

    2010-08-01

    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

  13. Personality Traits and Socio-Demographic Variables as Correlates of Counselling Effectiveness of Counsellors in Enugu State, Nigeria

    ERIC Educational Resources Information Center

    Onyekuru, Bruno U.; Ibegbunam, Josephat

    2015-01-01

    Quality personality traits and socio-demographic variables are essential elements of effective counselling. This correlational study investigated personality traits and socio-demographic variables as predictors of counselling effectiveness of counsellors in Enugu State. The instruments for data collection were Personality Traits Assessment Scale…

  14. Medicine utilization review at a university teaching hospital in New Delhi

    PubMed Central

    Aqil, M.; Bhadana, V.; Alam, M.S.; Pillai, K. K.; Kapur, P.

    2012-01-01

    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

  15. Compliance With Guideline Statements for Urethral Catheterization in an Iranian Teaching Hospital

    PubMed Central

    Taleschian-Tabrizi, Negar; Farhadi, Fereshteh; Madani, Neda; Mokhtarkhani, Mohaddeseh; Kolahdouzan, Kasra; Hajebrahimi, Sakineh

    2015-01-01

    Background: It is believed that healthcare staff play an important role in minimizing complications related to urethral catheterization. The purpose of this study was to determine whether or not healthcare staff complied with the standards for urethral catheterization. Methods: This study was conducted in Imam Reza teaching hospital, Tabriz, Iran, from July to September 2013. A total of 109 catheterized patients were selected randomly from surgical and medical wards and intensive care units (ICUs). A questionnaire was completed by healthcare staff for each patient to assess quality of care provided for catheter insertion, while catheter in situ, draining and changing catheter bags. Items of the questionnaire were obtained from guidelines for the prevention of infection. Data analysis was performed with SPSS 16. Results: The mean age of the patients was 50.54 ± 22.13. Of the 109 patients, 56.88% were admitted to ICUs. The mean duration of catheter use was 15.86 days. Among the 25 patients who had a urinalysis test documented in their hospital records, 11 were positive for urinary tract infection (UTI). The lowest rate of hand-washing was reported before bag drainage (49.52%). The closed drainage catheter system was not available at all. Among the cases who had a daily genital area cleansing, in 27.63% cases, the patients or their family members performed the washing. In 66.35% of cases, multiple-use lubricant gel was applied; single-use gel was not available. The rate of documentation for bag change was 79%. Conclusion: The majority of the guideline statements was adhered to; however, some essential issues, such as hand hygiene were neglected. And some patients were catheterized routinely without proper indication. Limiting catheter use to mandatory situations and encouraging compliance with guidelines are recommended. PMID:26673464

  16. Clinical Setting Influences Off-Label and Unlicensed Prescribing in a Paediatric Teaching Hospital

    PubMed Central

    Czarniak, Petra; Bint, Lewis; Favié, Laurent; Parsons, Richard; Hughes, Jeff; Sunderland, Bruce

    2015-01-01

    Purpose To estimate the prevalence of off-label and unlicensed prescribing during 2008 at a major paediatric teaching hospital in Western Australia. Methods A 12-month retrospective study was conducted at Princess Margaret Hospital using medication chart records randomly selected from 145,550 patient encounters from the Emergency Department, Inpatient Wards and Outpatient Clinics. Patient and prescribing data were collected. Drugs were classified as off-label or unlicensed based on Australian registration data. A hierarchical system of age, indication, route of administration and dosage was used. Drugs were classified according to the Anatomical Therapeutic Chemical Code. Results A total of 1,037 paediatric patients were selected where 2,654 prescriptions for 330 different drugs were prescribed to 699 patients (67.4%). Most off-label drugs (n = 295; 43.3%) were from the nervous system; a majority of unlicensed drugs were systemic hormonal preparations excluding sex hormones (n = 22, 32.4%). Inpatients were prescribed more off-label drugs than outpatients or Emergency Department patients (p < 0.0001). Most off-label prescribing occurred in infants and children (31.7% and 35.9% respectively) and the highest percentage of unlicensed prescribing (7.2%) occurred in infants (p < 0.0001). There were 25.7% of off-label and 2.6% of unlicensed medications prescribed across all three settings. Common reasons for off-label prescribing were dosage (47.4%) and age (43.2%). Conclusion This study confirmed off-label and unlicensed use of drugs remains common. Further, that prevalence of both is influenced by the clinical setting, which has implications in regards to medication misadventure, and the need to have systems in place to minimise medication errors. Further, there remains a need for changes in the regulatory system in Australia to ensure that manufacturers incorporate, as it becomes available, evidence regarding efficacy and safety of their drugs in children in the

  17. Adherence to Venous Thromboprophylaxis Guidelines for Medical and Surgical Inpatients of Teaching Hospitals, Shiraz-Iran

    PubMed Central

    Manoucheri, Reza

    2015-01-01

    Background: Venous thromboembolism (VTE) exerts a considerable burden on the health care systems. Although many practice guidelines have been developed regarding prophylaxis and treatment of venous thromboembolism, there is a large gap between the recommendations and the medical practice in health care centers. In this study, we tried to assess adherence of the medical team to guidelines for venous thromboprophylaxis in medical and surgical wards of teaching hospitals affiliated to Shiraz University of Medical Sciences. Materials and Methods: In this cross-sectional descriptive study, a total number of 500 patients were recruited among hospitalized patients in neurosurgery, orthopedics, general surgery, internal medicine, and obstetrics & gynecology departments and surgical and medical intensive care units. Afterwards, adherence to thromboprophylaxis guidelines was assessed by comparing the medical records of patients with proper indications extracted from the American College of Chest Physicians Guidelines for VTE prophylaxis (ACCP, 9th edition). In other words, for each patient a comparison between proper indications of receiving thromboprophylaxis and the regimen used in practice was made. Results: Out of 472 patients assessed with respect to the appropriateness of the administered prophylaxis, 212 (45.1%) had received proper type of thromboprophylaxis with regard to ACCP guidelines. Orthopedic surgical wards showed the highest rate of appropriateness while neurosurgical wards showed the lowest rate of adherence (76% vs. 1.8%). The overall rate of inappropriateness was 54.9% (260 patients). Inappropriateness was divided into 3 categories: 1) patients had absolute indications to receive thromboprophylaxis but were not provided with any type of prophylaxis in practice (171 patients, 36.2% of total), 2) in presence of absolute indications, incorrect type of prophylaxis was administered (52 patients, 11% of total), 3) in absence of indications for thromboprophylaxis

  18. Hypertension and prehypertension among adolescents in secondary schools in Enugu, South East Nigeria

    PubMed Central

    2013-01-01

    Background Hypertension is a prevalent cardiovascular disease risk factor among blacks and adolescent hypertension can progress into adulthood. Objective To determine the prevalence of hypertension and prehypertension among secondary school adolescents in Enugu South East Nigeria. Methodology A study of 2694 adolescents aged 10-18 years in Enugu metropolis was carried out. Socio-demographic profile anthropometric and blood pressure readings were obtained. Derived measurements such as Prehypertension, hypertension and BMI were obtained. Results The results showed that the mean systolic blood pressure and diastolic blood pressure for males were 106.66+ 11.80 mmHg and 70.25 + 7.34 mmHg respectively. The mean SBP and DBP for females were 109.83+ 11.66 mmHg and 72.23 + 8.26 mmHg respectively (p < 0.01). Blood pressure was found to increase with age. Prevalence of hypertension and prehypertension was 5.4% and 17.3% respectively with a higher rate in females (6.9%) than males (3.8%). Prevalence of prehypertension among males and females were 14.3% and 20.1% respectively. The prevalence of obesity was 1.9%. Conclusion Modifiable risk factors exist among adolescents. Early lifestyle modification and a strengthened school health are recommended. PMID:24180427

  19. Poor Availability of Skilled Birth Attendants in Nigeria: A Case Study of Enugu State Primary Health Care System

    PubMed Central

    Nkwo, Peter O; Lawani, Lucky O; Ubesie, Agozie C; Onodugo, Vincent A; Obu, Herbert A; Chinawa, Josephat M

    2015-01-01

    Background: The Government of Enugu State plans to offer free perinatal services at the primary health care (PHC) centers in order to improve perinatal outcomes in the state, but it was not clear whether there are skilled birth attendants (SBAs) at the PHC level to implement the program. Aims: To determine whether there are sufficient numbers of SBAs in the public PHC system in Enugu State of Nigeria. Subjects and Methods: This cross-sectional survey involved enumeration of health workers who worked at each public PHC facility in Enugu State and included verification of the qualifications and trainings of each health worker. Data analysis was performed with the help of Stata statistical package version 13 and results were presented in tables and as simple proportions. Results: There were 55 nurses and no midwife or doctor in the 152 PHC clinics studied. This number represents 0.36 nurses per health facility or about 9% (i.e., 55/608) of a minimum of 608 SBAs required for 24-h perinatal services at the 152 PHC clinics. There were 1233 junior community health extension worker/community health extension workers (JCHEW/CHEWs), averaging 8.1 JCHEW/CHEWs per PHC clinic. Conclusions: Enugu State has an acute shortage of SBAs. We recommend employment of qualified SBAs and in-service training of the JCHEW/CHEW and nurses to upgrade their midwifery skills. Incorporation of competency-based midwifery training into the pre-service training curricula of nurses and JCHEW/CHEW would provide a more sustainable supply of SBAs in Enugu state. PMID:25745571

  20. Pharmaceutical interventions in medications prescribed for administration via enteral tubes in a teaching hospital

    PubMed Central

    Ferreira, Carolina Justus Buhrer; Plodek, Caroline Koga; Soares, Franciny Kossemba; de Andrade, Rayza Assis; Teleginski, Fernanda; da Rocha, Maria Dagmar

    2016-01-01

    Abstract Objective: to analyze the impact of guidelines regarding errors in medications prescribed for administration through enteral tubes. Method: quantitative study, in three phases, undertaken in internal medicine, neurology and an intensive care unit in a general teaching hospital. In Phase 1, the following was undertaken: a protocol for dilution and unit-dose repackaging and administration for 294 medications via enteral tubes; a decision flowchart; operational-standard procedures for dilution and unit-dose repackaging of oral pharmaceutical forms and for administration of medications through enteral tubes. In phase 2, errors in 872 medications prescribed through enteral tubes, in 293 prescriptions for patients receiving inpatient treatment between March and June, were investigated. This was followed by training of the teams in relation to the guidelines established. In Phase 3, pharmaceutical errors and interventions in 945 medications prescribed through enteral tubes, in 292 prescriptions of patients receiving inpatient treatment between August and September, were investigated prospectively. The data collected, in a structured questionnaire, were compiled in the Microsoft Office Excel(r) program, and frequencies were calculated. Results: 786 errors were observed, 63.9% (502) in Phase 2, and 36.1% (284) in Phase 3. In Phase 3, a reduction was ascertained in the frequency of prescription of medications delivered via enteral tubes, medications which were contraindicated, and those for which information was not available. Conclusion: guidelines and pharmaceutical interventions were determined in the prevention of errors involving medications delivered through enteral tubes. PMID:27276019

  1. The management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust

    PubMed Central

    Peacock, M

    2013-01-01

    Management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust is described. The organisation and input of various stakeholders and their involvement with ultrasound equipment management and scientific ultrasound is discussed. Two important stakeholders are the Medical Equipment Management Group and the Radiation Safety Steering Committee. The Medical Equipment Management Group has a specific sub-group, the Ultrasound sub-group, and its role is to coordinate the purchase, replacement and quality assurance of ultrasound equipment in the Trust. The Radiation Safety Steering Committee has a non-ionising radiation representative and the role of this committee is to provide corporate assurance that any health and safety issues arising from the use of radiation to either patients, members of the public or staff within the Trust are being effectively managed. The Ultrasound sub-group of the Medical Equipment Management Group has successfully brought together management of all ultrasound equipment within the Trust and is in the process of fulfilling the quality assurance and training milestones set out by the Medical Equipment Management Group. Advice from the Radiation Safety Steering Committee has helped to increase awareness of ultrasound safety and good scanning practice, especially in the case of neonatal ultrasound imaging, within the Trust. In addition, the RSSC has given advice on clinical pathways for patients undergoing ionising radiation imaging while being treated by extra-corporeal shockwave lithotripsy. PMID:27433195

  2. Pharmacovigilance Knowledge among Patients at a Teaching Hospital in Lalitpur District, Nepal

    PubMed Central

    Jha, Nisha; Rathore, Devendra S; Shankar, P Ravi; Gyawali, Sudesh

    2014-01-01

    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. PMID:24783073

  3. Screening for Imported Diseases in an Immigrant Population: Experience from a Teaching Hospital in Barcelona, Spain

    PubMed Central

    Bocanegra, Cristina; Salvador, Fernando; Sulleiro, Elena; Sánchez-Montalvá, Adrián; Pahissa, Albert; Molina, Israel

    2014-01-01

    The objective of this study was to describe the screening for imported diseases among an immigrant population. This retrospective observational study was of all adult immigrants attended at the Tropical Medicine Unit of the Vall d'Hebron Teaching Hospital from September of 2007 to March of 2010. The screening strategy was adjusted by symptoms, country of origin, and length of residence in Europe. Overall, 927 patients were included. The median age was 34.5 years, and 42.1% of patients were male. A diagnosis was made in 419 (45.2%) patients. The most frequent diagnoses were Chagas disease, anemia, latent tuberculosis infection, intestinal parasitosis, hepatitis B virus (HBV) infection, and human immunodeficiency virus (HIV) infection. After screening, more diseases were identified in immigrants from sub-Saharan Africa (new diagnoses in 56.6% of patients) than patients from other geographic areas. The geographic origin and length of residence in a developed country determine the prevalence of diseases; hence, screening protocols must be based on this information. PMID:25331805

  4. Population Structure of Candida albicans from Three Teaching Hospitals in Ghana.

    PubMed

    Adjapong, Gloria; Hale, Marie; Garrill, Ashley

    2016-02-01

    Previous studies on Candida species in a clinical setting in Ghana have shown a prevalence of Candida albicans. Despite this, very little is known about the various strain types and their population genetic structure. In this study three microsatellite loci, CAI, CAIII and CAVI, were used to investigate the population genetic structure of C. albicans from clinical isolates in Ghana. In all, 240 clinically unrelated C. albicans isolates were recovered from patients reporting at three teaching hospitals. All the isolates were heterozygous for at least one of the three loci, except for one isolate, which was homozygous for all three loci. Sixty-seven unique alleles and 240 different genotypes were generated by the three polymorphic microsatellite loci, resulting in a very high discriminatory potential of approximately 0.98. There was no significant difference in allele frequencies from the small number of anatomical sites sampled, regardless of the host conditions although high genotypic diversities were observed among the isolates. There was evidence for clonal reproduction, including over-expression of observed heterozygotes across the populations. The populations deviated significantly from Hardy-Weinberg equilibrium and pair-wise genotypic linkage disequilibria comparisons across the three loci were significant, also suggesting a clonal population. The overall Wright FIS for the three loci was negative, and the overall FST value was not significantly different from zero for the three loci analyzed, indicating a clonal and homogeneous population across the three sampling locations from Ghana. PMID:26483431

  5. Role-Reversal Exercise with Deaf Strong Hospital to Teach Communication Competency and Cultural Awareness

    PubMed Central

    Parkhill, Amy L.; Schlehofer, Deirdre A.; Starr, Matthew J.; Barnett, Steven

    2011-01-01

    Objective To implement a role-reversal exercise to increase first-year pharmacy students' awareness of communication barriers in the health care setting, especially for deaf and hard-of-hearing patients. Design Volunteers from the local deaf community conducted Deaf Strong Hospital, a role-reversal exercise in which students were the “patients.” Students navigated through a reception area, encounter with a physician, and having a prescription filled at a pharmacy without receiving or using any spoken language. Assessment A debriefing session was held in which small groups of students had the opportunity to ask questions of a panel of deaf and hard-of-hearing volunteers. On a survey administered to assess students' learning, 97% agreed or strongly agreed that the experience would likely impact their attitudes and behavior in future interactions with patients who did not speak English. Conclusions The role-reversal exercise was an effective method of teaching students that the delivery of health care is dependent on adequate communication between health care providers and the patient. PMID:21655407

  6. Kerosene poisoning in childhood: a 6-year prospective study at the University of Ilorin Teaching Hospital.

    PubMed

    Fagbule, D O; Joiner, K T

    1992-01-01

    In a 6-year prospective study of kerosene poisoning in children admitted to the Department of Paediatrics, University of Ilorin Teaching Hospital (UITH), between January 1982 and December 1987, 109 cases were seen. They were aged 6 months to 9 years, with a male: female ratio of 1.8:1. Majority (79.8%) were below 2 years. Many households (52.3%) stored the agent in familiar beverage or household containers placed on kitchen or bedroom floors, within easy reach of infants and toddlers. Seventy-six (69.7%) cases had home remedies, palm oil being the most common accounting for 55.3%. More than half of the cases (56.9%) presented within 12 hours of the accident due to persistent cough and dyspnoea. Respiratory complications viz pneumonia, pleural effusion and pulmonary oedema were the most common, evident in 67.3% of those who had chest radiographs. Approximately, three quarters (74.3%) of patients with radiologic abnormalities had palm oil alone or in combination with milk as home remedies. Severity of poisoning was influenced by the type of home remedy and the interval between accident and admission (P less than 0.05; P less than 0.01 respectively). Presence of radiological or CNS abnormality or both was associated with a higher morbidity. The only death in the study had complications referable to both systems. Ways of minimizing the risk of kerosene poisoning and its attendant morbidity are discussed. PMID:1390371

  7. Drug utilization study in ophthalmology outpatients at a tertiary care teaching hospital.

    PubMed

    Jadhav, Pradeep R; Moghe, Vijay V; Deshmukh, Yeshwant A

    2013-12-22

    In view of the advancement in drug development and availability of new ocular therapeutics in the discipline of ophthalmology, we attempted to study the drug utilization and describe the prescribing practices of ophthalmologists in a tertiary care teaching hospital. Method. A prospective, cross-sectional, observational study was conducted on patients attending Outpatient Department of Ophthalmology for curative complaints. Prescriptions of 600 patients treated were analyzed by the WHO prescribing indicators and additional indices. Results. Analysis showed that the average number of drugs per prescription was 1.49. Percentage of drugs prescribed by generic name was 2.35%. Percentage of encounters with antibiotics was 44.83%. Percentage of drugs prescribed from National Essential drug list (NEDL)/National Formulary of India (NFI) was 19.48%. Patient's knowledge of correct dosage was 93.83%. Antimicrobial agents were the most commonly prescribed drugs followed by antiallergy drugs and ocular lubricants. Fluoroquinolones accounted for 60% of the total antimicrobial drugs, of which gatifloxacin was the most frequently prescribed fluoroquinolone. Conclusion. The study indicated an awareness of polypharmacy, but showed ample scope for improvement in encouraging the ophthalmologists to prescribe by generic name and selection of essential drugs from NEDL/NFI. PMID:24455298

  8. Prevalence of ESBLs-producing Pseudomonas aeruginosa isolates from different wards in a Chinese teaching hospital

    PubMed Central

    Chen, Zhilong; Niu, Hui; Chen, Guangyu; Li, Mingcheng; Li, Ming; Zhou, Yuqing

    2015-01-01

    This study was to explore the molecular dissemination of P. aeruginosa producing extended spectrum β-lactamase (ESBLs) recovered from the different wards in a teaching hospital, Jilin. Among 240 isolates, 91 strains were isolated from burn wards and 149 strains from surgical wards. A total of 210 strains (87.5%) produced ESBLs, 30 strains (12.5%) didn’t produce ESBLs. All ESBLs isolates showed identical antimicrobial susceptibility profiles. The genotypic prevalence of ESBLs for bla SHV-12, bla TEM-24, bla CTX-M-1, bla CTX-M-2, bla CTX-M-3, bla PER and bla VEB genes was 17.6%, 20.5%, 14.3%, 9.6%, 12.9%, 13.8% and 11.4% respectively. All P. aeruginosa strains producing ESBLs had three to six plasmids and contained class 1 integrons, which transferred resistance to E. coli C 600 by conjuation. The data indicated a high prevalence of ESBL among P. aeruginosa isolates in this region and their enzyme types were diverse. PMID:26770582

  9. Potential Drug-drug Interactions in Post-CCU of a Teaching Hospital.

    PubMed

    Haji Aghajani, Mohammad; Sistanizad, Mohammad; Abbasinazari, Mohammad; Abiar Ghamsari, Mahdieh; Ayazkhoo, Ladan; Safi, Olia; Kazemi, Katayoon; Kouchek, Mehran

    2013-01-01

    Drug-drug interactions (DDIs) can lead to increased toxicity or reduction in therapeutic efficacy. This study was designed to assess the incidence of potential drug interactions (PDI) and rank their clinical value in post coronary care unit (Post-CCU) of a teaching hospital in Tehran, Iran. In this prospective study, three pharmacists with supervision of a clinical pharmacist actively gathered necessary information for detection of DDIs. Data were tabulated according to the combinations of drugs in treatment chart. Verification of potential drug interactions was carried out using the online Lexi-Interact™ 2011. A total of 203 patients (113 males and 90 females) were enrolled in the study. The mean age of patients was 61 ± 12.55 years (range = 26-93). A total of 90 drugs were prescribed to 203 patients and most prescribed drugs were atorvastatin, clopidogrel and metoprolol. Mean of drugs was 11.22 per patient. A total of 3166 potential drug interactions have been identified by Lexi- Interact™, 149 (4.71%) and 55 (1.73%) of which were categorized as D and X, respectively. The most serious interactions were clopidogrel+omeprazole and metoprolol+salbutamol. Drug interactions leading to serious adverse effects are to be cautiously watched for when multiple drugs are used simultaneously. In settings with multiple drug use attendance of a pharmacist or clinical pharmacist, taking the responsibility for monitoring drug interactions and notifying the physician about potential problems could decrease the harm in patient and increase the patient safety. PMID:24250596

  10. Factors associated with knowledge of the nursing staff at a teaching hospital on blood transfusion 1

    PubMed Central

    Tavares, Jordânia Lumênia; Barichello, Elizabeth; Mattia, Ana Lúcia De; Barbosa, Maria Helena

    2015-01-01

    Abstract Objective: to determine whether there is an association between knowledge of the nursing professionals about blood transfusion and the variables related to the professional aspects. Method: this is an observational, cross-sectional and quantitative study, carried out at a large general teaching hospital. The sample consisted of 209 nursing professionals, obtained by simple random sampling. For data collection, a checklist was used. In the univariate analysis, descriptive statistics and central trend and dispersion measures were used. In the bivariate analysis, Student's t-Test, analysis of variance and Pearson's correlation were used. To determine the predictors, multiple linear regression was applied. The Institutional Review Board (Opinion number 2434) approved the study. Results: the overall average knowledge score was 52.66%; in the Pre-transfusion Step, it corresponded to 53.38%; in the Transfusion Step 51.25% and, in the Post-transfusion Step, 62.68%. The factors related to knowledge were professional category and received training and/or guidance to accomplish the transfusion process (p<0.01). Conclusion: this study showed the influence of training and guidance on the knowledge and provided a diagnosis to identify the professionals' difficulties regarding the transfusion process. PMID:26444160

  11. Impact of waste management training intervention on knowledge, attitude and practices of teaching hospital workers in Pakistan

    PubMed Central

    Kumar, Ramesh; Somrongthong, Ratana; Ahmed, Jamil

    2016-01-01

    Objective: To evaluate the sustainability and effectiveness of training as an intervention to improve the knowledge, attitude and practices of hospital workers on health care waste management. Method: We conducted this quasi-experimental study in two tertiary care teaching hospitals in Rawalpindi in October 2013. Training, practical demonstrations and reminders on standard waste management were given to 138 hospital workers in one hospital and compared with 137 workers from the control hospital. We collected data 18 months after intervention through a structured questionnaire to assess the impact of the intervention. We used paired t-test to compare the scores on knowledge, attitude and practices at baseline and first follow up and final impact assessment. Chi square test was used to compare group variables between intervention and control groups. Results: After 18 months since intervention the mean scores on knowledge attitude and practices differed statistically significantly since baseline and intervention group had statistically significantly better knowledge positive attitudes and good health care waste management practices (p < 0.001). Health care and sanitary workers in intervention group scored statistically significantly higher (p < 0.001). Conclusion: Trainings of health and sanitary workers on health care waste management guidelines were sustainable among the intervention group after 18 months which shows the positive impact of our intervention. It is recommended that the trainings as intervention be included in the overall policies of the public and private sector hospitals in Pakistan and other similar settings. PMID:27375718

  12. What has happened to programmes in quality assurance by physicians in large teaching hospitals in Australia and New Zealand?

    PubMed

    Richmond, D E

    1990-06-01

    Hospital Quality Assurance (QA) programmes by divisions and departments of medicine have developed since the late 1970s. The Continuing Education Unit of the Royal Australasian College of Physicians played a facilitatory role in this development, especially in the first five to six years. A survey of 38 major teaching hospitals in Australia and New Zealand early in 1989 revealed that of the 35 responding all had introduced a formal QA programme in internal medicine between 1976 and 1988. The 'Austin Hospital Method' of review seminars was the most popular format when QA programmes were introduced and 26 hospitals still maintain such a format - at least as a component of their programmes. Most programmes have been subject to modification to suit local needs. There have been no serious problems in maintaining confidentiality of information derived from QA exercises. Despite a formidable array of constraining forces, the majority of continuing QA programmes appeared to be stable. Seventeen hospitals reported that the organising group was recognised as an official committee of their hospital's administration. Although eight programmes have been discontinued in the last four years, nearly as many new ones have been introduced. PMID:2372280

  13. The experience of implementing the board of trustees’ policy in teaching hospitals in Iran: an example of health system decentralization

    PubMed Central

    Doshmangir, Leila; Rashidian, Arash; Ravaghi, Hamid; Takian, Amirhossein; Jafari, Mehdi

    2015-01-01

    Background: In 2004, the health system in Iran initiated an organizational reform aiming to increase the autonomy of teaching hospitals and make them more decentralized. The policy led to the formation of a board of trustees in each hospital and significant modifications in hospitals’ financing. Since the reform aimed to improve its predecessor policy (implementation of hospital autonomy began in 1995), it expected to increase user satisfaction, as well as enhance effectiveness and efficiency of healthcare services in targeted hospitals. However, such expectations were never realized. In this research, we explored the perceptions and views of expert stakeholders as to why the board of trustees’ policy did not achieve its perceived objectives. Methods: We conducted 47 semi-structured face-to-face interviews and two focus group discussions (involving 8 and 10 participants, respectively) with experts at high, middle, and low levels of Iran’s health system, using purposive and snowball sampling. We also collected a comprehensive set of relevant documents. Interviews were transcribed verbatim and analyzed thematically, following a mixed inductive-deductive approach. Results: Three main themes emerged from the analysis. The implementation approach (including the processes, views about the policy and the links between the policy components), using research evidence about the policy (local and global), and policy context (health system structure, health insurers capacity, hospitals’ organization and capacity and actors’ interrelationships) affected the policy outcomes. Overall, the implementation of hospital decentralization policies in Iran did not seem to achieve their intended targets as a result of assumed failure to take full consideration of the above factors in policy implementation into account. Conclusion: The implementation of the board of trustees’ policy did not achieve its desired goals in teaching hospitals in Iran. Similar decentralization

  14. Medicare. Concerns with Physicians at Teaching Hospitals (PATH) Audits. Report to the Chairman, Subcommittee on Health, Committee on Ways and Means, House of Representatives.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

    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…

  15. Surveillance of infection status of drug resistant Staphylococcus aureus in an Indian teaching hospital

    PubMed Central

    Dubey, Debasmita; Rath, Shakti; Sahu, Mahesh C.; Pattnaik, Lolly; Debata, Nagen K.; Padhy, Rabindra N.

    2013-01-01

    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 χ2-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

  16. Triple-Negative Breast Cancer in Ghanaian Women: The Korle Bu Teaching Hospital Experience.

    PubMed

    Der, Edmund M; Gyasi, Richard K; Tettey, Yao; Edusei, Lawrence; Bayor, Marcel T; Jiagge, Evelyn; Gyakobo, Mawuli; Merajver, Sofia D; Newman, Lisa A

    2015-01-01

    Breast cancers that have negative or extremely low expression of estrogen receptor and progesterone receptor and non-amplification of human epidermal growth factor receptor-2 (HER2)/neu are termed triple-negative breast cancer (TNBC). The majority of TNBC tumors belong to the biologically aggressive basal subtype, and they cannot be managed with targeted endocrine or anti-HER2/neu agents. In western, high resource environments, risk factors for TNBC include younger age at diagnosis and hereditary susceptibility. Women of African ancestry in the United States and in continental Africa have higher frequencies of TNBC, prompting speculation that this risk may have an inherited basis and may at least partially explain breast cancer survival disparities related to racial/ethnic identity. Efforts to document and confirm the breast cancer burden of continental Africa have been hampered by the limited availability of registry and immunohistochemistry resources. Our goal was to evaluate the breast cancers diagnosed in one of the largest health care facilities in western Africa, and to compare the frequencies as well as risk factors for TNBC versus non-TNBC in this large referral tertiary hospital. The Korle Bu Teaching Hospital is affiliated with the University of Ghana and is located in Accra, the capital of Ghana. We conducted an institutional, Department of Pathology-based review of the breast cancer cases seen at this facility for the 2010 calendar year, and for which histopathologic specimens were available. The overall study population of 223 breast cancer cases had a median age of 52.4 years, and most had palpable tumors larger than 5 cm in diameter. More than half were TNBC (130; 58.3%). We observed similar age-specific frequencies, distribution of stage at diagnosis and tumor grade among cases of TNBC compared to cases of non-TNBC. Ghanaian breast cancer patients tend to have an advanced stage distribution and relatively younger age at diagnosis compared to

  17. [Evolution of neonatal mortality at the Blida University Teaching Hospital (Algeria) between 1999 and 2006].

    PubMed

    Bezzaoucha, A; El Kebboub, A; Aliche, A

    2010-02-01

    Within the framework of the active information system set up by the department of epidemiology on hospital mortality at the Blida (Algeria) University Teaching Hospital (CHU), a study was carried out to assess the importance and evolution of neonatal mortality recorded at the CHU in the last eight years (1999-2006) as well as the causes of neonatal death. The International Classification of Diseases (ICD-9) was used to encode the nature of the causal disease. Using the software EpiInfo™ in its sixth version performed data entry, monitoring and analysis. On the whole, 2,167 neonatal deaths were recorded at the CHU during the study period, representing a proportional mortality of 25.4%. Early neonatal mortality (0-6 days) accounted for 83.4% of all neonatal mortality. Nearly two thirds of early neonatal deaths occurred in the first three days of life. The monthly evolution of the number of early neonatal deaths revealed a significant rising trend during the study period (P < 0.05) without identification of seasonal effect. The sex ratio was practically the same for early and late neonatal mortality, respectively 1.4 and 1.5. Prematurity accounted for 42.1% of the deaths in early neonatal deaths, followed by respiratory distress syndrome and infection, respectively 17.0 and 14.4%. Infections, with a relative frequency of 36.2%, represented the most common cause for the late neonatal mortality. The rate of early neonatal mortality during the study period, when this one took for denominator the number of newborns admitted in neonatology to express the mortality of service, was 15.6%. Throughout the study period, the rate of early neonatal mortality, without counting the deaths among transferred newborms, could be estimated at 19.2 per 1,000 live births, while the overall neonatal mortality rate could be estimated at 22.3 per 1,000 live births. No significant temporal tendency was pointed out. The CHU of Blida is not characterized by a lower risk of neonatal mortality

  18. Indications and Risk Factors for Complications of Lower Third Molar Surgery in a Nigerian Teaching Hospital

    PubMed Central

    Osunde, OD; Saheeb, BD; Bassey, GO

    2014-01-01

    Background: The surgical extraction of impacted third molars is a common oral surgical procedure, and it is often associated with complications such as sensory nerve damage, dry socket, pain, swelling, trismus, infection and hemorrhage. Aim: The aim of this study was to determine the surgical indications and risk factors for complications of third molar surgery at a Nigerian teaching hospital. Materials and Methods: Medical records of patients referred to the Oral Surgery Clinic of our institution for surgical extraction of their impacted mandibular third molars from January 2008 to December 2010 were retrospectively examined. Information on patients’ demography, types of impaction, operative parameters and complications were obtained and analyzed using Statistical Package for Social Sciences (SPSS Version 13), Chicago, IL, USA. A P < 0.0.5 was considered significant. Results: A total of 330 impacted teeth were extracted from 250 patients. Male comprises (104/250 [41.6%]) and female (146/250 [58.4%]). The mesioangular (176/330 [53.4%]) and distoangular (73/330 [22.1%]) impactions were the commonest types. Recurrent pericoronitis (154/330 [46.7%]) was the most common indication for extraction. The complications were delayed healing (19/330 [5.8%]), alveolar, osteitis (9/330 [2.7%]) and injury to alveolar nerve (2/330 [0.6%]). Cigarette smoking (P < 0.001), Oral contraceptives use (P = 0.01), age of the patient (P = 0.03) and the surgeon's experience (P = 0.04) were found to be significantly associated with the development of alveolar osteitis; nerves injuries were significantly associated with the raising of a lingual flap (P < 0.001) and the technique of surgery (P ≤ 0.001). Conclusion: The age of the patient, cigarette smoking and oral contraceptive use at the time of surgery are some of the factors affecting outcome in third molar surgery. PMID:25506490

  19. Proton Beam Radiotherapy for Uveal Melanomas at Nice Teaching Hospital: 16 Years' Experience

    SciTech Connect

    Caujolle, Jean-Pierre; Mammar, Hamid; Chamorey, Emmanuel Phar; Pinon, Fabien; Herault, Joel; Gastaud, Pierre

    2010-09-01

    Purpose: To present the results of uveal melanomas treated at Nice Teaching Hospital. Methods and Materials: This retrospective study included 886 consecutive patients referred to our clinic for the treatment of uveal melanomas by proton beam radiotherapy from June 1991 to December 2007. Survival rates were determined by using Kaplan-Meier estimates, and prognostic factors were evaluated using the log-rank test or Cox model. Results: The number (percent total) of subjects staged according to the TNM classification system (6th edition) of malignant tumors included 39 stage T1 (4.4%), 420 stage T2 (47.40%), 409 stage T3 (46.16%), and 18 stage T4 (2.03%) patients. The median follow-up was 63.7 months. The Kaplan-Meier overall survival rate at 5 years according to the sixth edition TNM classification was 92% for T1, 89% for T2, 67% for T3, and 62% for T4; and at 10 years, 86% for T1, 78% for T2, 43% for T3, and 41% for T4. Five factors were found to be associated with an increased death rate: advanced age, tumor thickness, largest tumor basal diameter, tumor volume, and tumor volume-to-eyeball volume ratio. The metastasis-free survival rates were 88.3 % at 5 years and 76.4 % at 10 years. The local control rates were 93.9% at 5 years and 92.1% at 10 years. The ocular conservation rates were 91.1% at 5 years and 87.3% at 10 years. Conclusions: We report the results of a large series of patients treated for uveal melanomas with a very long follow-up. Despite the large tumor volume treated, our results were similar to previously published findings relating to proton beam therapy.

  20. Impacts of Computerized Physician Documentation in a Teaching Hospital: Perceptions of Faculty and Resident Physicians

    PubMed Central

    Embi, Peter J.; Yackel, Thomas R.; Logan, Judith R.; Bowen, Judith L.; Cooney, Thomas G.; Gorman, Paul N.

    2004-01-01

    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. PMID:15064287

  1. Factors influencing heartworm, flea, and tick preventative use in patients presenting to a veterinary teaching hospital

    PubMed Central

    Gates, Maureen C.; Nolan, Thomas J.

    2009-01-01

    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

  2. Adherence to preventive medications in asthmatic children at a tertiary care teaching hospital in Malaysia

    PubMed Central

    Md Redzuan, Adyani; Lee, Meng Soon; Mohamed Shah, Noraida

    2014-01-01

    Purpose Asthma affects an estimated 300 million people worldwide. Poor adherence to prescribed preventive medications, especially among children with asthma, leads to increased mortality and morbidity. The purpose of this study was to assess the adherence and persistence levels of asthmatic children at the Universiti Kebangsaan Malaysia Medical Center (UKMMC), a tertiary care teaching hospital, and to determine the factors that influence adherence to prescribed preventive medications. Patients and methods Participants were asthmatic patients aged 18 years and younger with at least one prescription for a preventive medication refilled between January and December 2011. Refill records from the pharmacy dispensing database were used to determine the medication possession ratio (MPR) and continuous measure of gaps (CMG), measures of adherence and persistence levels, respectively. Results The sample consisted of 218 children with asthma from the General and Respiratory pediatric clinics at UKMMC. The overall adherence level was 38% (n=83; MPR ≥80%), and the persistence level was 27.5% (n=60; CMG ≤20%). We found a significant association between the adherence and persistence levels (r=0.483, P<0.01). The presence of comorbidities significantly predicted the adherence (odds ratio [OR] =16.21, 95% confidence interval [CI]: 7.76–33.84, P<0.01) and persistence level (OR =2.63, 95% CI: 0.13–52.79, P<0.01). Other factors, including age, sex, ethnicity, duration of asthma diagnosis, and number of prescribed preventive medications did not significantly affect adherence or persistence (P>0.05). Conclusion In conclusion, the adherence level among children with asthma at UKMMC was low. The presence of comorbidities was found to influence adherence towards preventive medications in asthmatic children. PMID:24600208

  3. Drug utilization in pediatric neurology outpatient department: A prospective study at a tertiary care teaching hospital

    PubMed Central

    Bhatt, Krutika M.; Malhotra, Supriya D.; Patel, Kamlesh P.; Patel, Varsha J.

    2014-01-01

    Background: Neurological disorders are a significant cause of morbidity, mortality and adversely affect quality of life among pediatric patients. In India, more than 30% population is under 20 years of age, many of whom present late during the course of illness. Several drugs prescribed to pediatric population suffering from neurological disorders may be off label or unlicensed. Aims and Objectives: To study drug use pattern, identify off-label/unlicensed drug use and to check potential for drug-drug interactions in patients attending outpatient department of pediatric neurology at a tertiary care teaching hospital. Methodology: Prescriptions of patients attending pediatric neurology outpatient department were collected prospectively for 8 weeks. They were analyzed for prescribing pattern, WHO core prescribing indicators, off-label/unlicensed drug use and potential for drug-drug interactions. Result: A total of 140 prescriptions were collected, male female ratio being 2:1. Epilepsy was the most common diagnosis (73.57%) followed by breath holding spells, migraine and developmental disorders. Partial seizure was the most common type of epilepsy (52.42%). Average number of drugs prescribed per patient was 1.56. Most commonly prescribed drug was sodium valproate (25.11%) followed by phenytoin (11.41%). About 16% of the prescriptions contained newer antiepileptic drugs. More than 60% of the drugs were prescribed from WHO essential drug list. In 8.57% of cases drugs were prescribed in off-label/unlicensed manner. Twenty-six percent prescriptions showed potential for drug interactions. Conclusion: Epilepsy is the most common neurological disease among children and adolescents. Sodium valproate is the most commonly prescribed drug. A few prescriptions contained off-label/unlicensed drugs. PMID:25278669

  4. Worldwide Lineages of Clinical Pneumococci in a Japanese Teaching Hospital Identified by DiversiLab System.

    PubMed

    Kashiwaya, Kiyoshi; Saga, Tomoo; Ishii, Yoshikazu; Sakata, Ryuji; Iwata, Morihiro; Yoshizawa, Sadako; Chang, Bin; Ohnishi, Makoto; Tateda, Kazuhiro

    2016-06-01

    Pneumococcal Molecular Epidemiology Network (PMEN) clones are representatives of worldwide-spreading pathogens. DiversiLab system, a repetitive PCR system, has been proposed as a less labor-and time-intensive genotyping platform alternative to conventional methods. However, the utility and analysis parameters of DiversiLab for identifying worldwide lineages was not established. To evaluate and optimize the performance of DiversiLab for identifying worldwide pneumococcal lineages, we examined 245 consecutive isolates of clinical Streptococcus pneumoniae from all age-group patients at a teaching hospital in Japan. The capsular swelling reaction of all isolates yielded 24 different serotypes. Intensive visual observation (VO) of DiversiLab band pattern difference divided all isolates into 73 clusters. Multilocus sequence typing (MLST) of representative 73 isolates from each VO cluster yielded 51 different STs. Among them, PMEN-related lineages accounted for 63% (46/73). Although the serotype of PMEN-related isolates was identical to that of the original PMEN clone in 70% (32/46), CC156-related PMEN lineages, namely Greece(6B)-22 and Colombia(23F)-26, harbored various capsular types discordant to the original PMEN clones. Regarding automated analysis, genotyping by extended Jaccard (XJ) with a 75% similarity index cutoff (SIC) showed the highest correlation with serotyping (adjusted Rand's coefficient, 0.528). Elevating the SIC for XJ to 85% increased the discriminatory power sufficient for distinguishing two major PMEN-related isolates of Taiwan(19F)-14 and Netherlands(3)-31. These results demonstrated a potential utility of DiversiLab for identifying worldwide lineage of pneumococcus. An optimized parameters of automated analysis should be useful especially for comparison for reference strains by "identification" function of DiversiLab. PMID:27107736

  5. Is an urban legend true in the teaching hospital that "you will get hurt if you go to hospital at the beginning of the fiscal year"?

    PubMed

    Inoue, Satoki; Abe, Ryuichi; Tanaka, Yu; Kawaguchi, Masahiko

    2015-02-01

    An urban legend that "you will get hurt if you go to hospital at the beginning of the fiscal year" is in circulation, because people in general suppose that inexperienced newcomers start to work at clinical practice during that time period. We tried to determine whether this urban legend was true or not by using data from our operation management system. We retrospectively conducted a study to investigate whether the number of cannulation failures, which was used as an index of patient disadvantages at clinical practice, could be affected by the volume of residents in clinical participation. The number of insertion trials per case was not prominent in the first month of the fiscal year. However, the number of insertion trials per case increased in proportion to the average number of residents per day. It seems that there was no evidence to support the urban legend that "you will get hurt if you go to hospital at the beginning of the fiscal year." However, our results suggest that rather than an urban legend, we are now confronting the fact that patients may suffer from medical disadvantages in the teaching hospitals. PMID:24981561

  6. Prescribing practice and evaluation of appropriateness of enteral nutrition in a university teaching hospital

    PubMed Central

    Zhu, Xiu-Ping; Zhu, Ling-Ling; Zhou, Quan

    2013-01-01

    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

  7. Vulnerability and Knowledge of Sexually Transmitted Infections Among Female Traders of Reproductive Age in Enugu, Nigeria

    PubMed Central

    Ikeako, LC; Ekwueme, OC; Ezegwui, HU; Okeke, TOC

    2014-01-01

    Background: Sexually transmitted infections (STIs) constitute major public health concern and enigma. A comprehensive knowledge of the modes of transmission is necessary to evolve an effective preventive strategy. Aim: The aim of the study is to assess the vulnerability, knowledge and prevention of STIs among female traders of reproductive age in Enugu, Southeast Nigeria. Subjects and Methods: This was a cross-sectional descriptive study carried out on female traders aged 15-49 years at Ogbete Main Market, Enugu, Southeast Nigeria. Data was analyzed using Epi-Info 2000 version 3.3.1 Centers for Disease Control and Prevention Atlanta USA) was used to analyze the data and results were presented in tabular form. Results: A total of 200 female traders of reproductive age participated in the study. The mean (standard deviation) age was 26 (7.4) years. 16% (32/200) were adolescents. Knowledge of specific STIs was highest for human immunodeficiency virus/acquired immune deficiency syndrome 90% (130/200). Parents were poor sources of information as only 28.5% (57/200) respondents heard about STIs from their parents compared with 46% (92/200) from friends and peers. Risk factors identified were multiple sexual partners 75.5% (151/200), non-use of condoms 62% (124/200) and early debut 58% (116/200). Majority 67.5% (135/200) were aware that STIs could be treated by a visit to the doctor while 21.5% (43/200) preferred traditional/herbal healers. Conclusion: The inclusion of health education in schools’ curricula to ensure that adolescents are adequately aware of STIs, their modes of transmission, prevention and treatment before embarking on any vocation out-of-school is advocated. PMID:24669343

  8. Changing Pattern of Bacteriuria among Asymptomatic Secondary School Adolescents within Enugu South East Nigeria

    PubMed Central

    Nwokocha, ARC; Ujunwa, FA; Onukwuli, VO; Okafor, HU; Onyemelukwe, N

    2014-01-01

    Background: Urinary tract infection is one of the infections that could lead to chronic kidney disease. Most of the offending isolates are usually Gram-negative bacteria such as Escherichia coli. Adolescent age groups are a special group of individuals who indulge in some risk behavior that could predispose them to urinary tract infections with possible mixed flora. Aim: The aim was to determine the burden of Gram-positive significant bacteriuria among adolescents in Enugu. Subjects and Methods: A survey of 628 adolescents attending secondary schools in Enugu was studied. Information on sociodemographic profile was obtained using a self-administered questionnaire. Clean-catch urine sample was collected using a sterile boric acid bottle, and this was cultured in both anaerobic and aerobic media. Significant isolates were Gram-stained in order to determine their characteristics. Data were analyzed using SPSS version 15.0.(Chicago Illinois USA). Results: There were 324 females and 304 males. Significant bacteria growth was identified in 61 samples giving a prevalence rate of 9.7% (61/628). Gram-positive bacteria were isolated in 77.1% (47/61) of samples, while Gram-negative bacteria were isolated in 22.9% (14/61) of samples. Staphylococcus saprophyticus was the most common Gram-positive organism isolated this consists 38.3% (18/47) while E. coli was the most common Gram-negative bacteria isolated comprising 64.2% (9/14). Other Gram-positive bacteria isolated were Staphylococcus auerus, Staphylococcus epididimis. All isolated bacteria were more common in females 44/61 (72.1%) than males 17/61 (27.9%). Conclusion: Gram-positive bacteriuria is prevalent among secondary school adolescents, and S. saprophyticus is the most common Gram-positive organism implicated. Further studies should be undertaken to determine the risk factors and possible sensitivity pattern among the age group. PMID:25328783

  9. Quality of care in African-American patients admitted for congestive heart failure at a university teaching hospital.

    PubMed

    Ilksoy, Nurcan; Moore, Renee H; Easley, Kirk; Jacobson, Terry A

    2006-03-01

    Previous studies have shown that the quality of congestive heart failure (CHF) treatment for hospitalized patients varies. The goal of this study was to evaluate the compliance of physicians at a large, inner-city teaching hospital with current evidence-based guidelines. A retrospective review of the medical records of 104 patients admitted with CHF was conducted. Quality-of-care indicators were assessed, including the use of echocardiograms, the administration of angiotensin-converting enzyme (ACE) inhibitors and beta blockers to appropriate patients, and lifestyle and medication counseling at discharge. The assessment of left ventricular (LV) function was documented in 96.1% of patients (n = 100). A total of 65 patients (92.8%) with systolic dysfunction were considered to be ideal candidates for ACE inhibitor therapy. Of these 65 patients, 58 (89.2%) were discharged on ACE inhibitors. Of 41 patients with LV systolic dysfunction who were considered to be ideal candidates for beta-blocker therapy, only 10 (24.4%) were discharged on beta-blocker therapy. Of all patients with CHF, 50% received discharge counseling on medication compliance, 48% received counseling on a low-salt diet, and only 9% were told to monitor daily weight. This study shows that in a major academic teaching hospital, there is a need for improvement in the use of beta-blocker therapy as well as greater emphasis on patient education strategies regarding diet, medication adherence, and monitoring daily weight. PMID:16490439

  10. The effect of new emergency program on patient length of stay in a teaching hospital emergency department of Tehran

    PubMed Central

    Talleshi, Z.; Hosseininejad, S. M.; Khatir, Goli; Bozorghi, F.; Gorji, A. M. Heidari; Gorji, M. A. Heidari

    2014-01-01

    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. PMID:24791047

  11. Perceived versus Observed Patient Safety Measures in a Critical Care Unit from a Teaching Hospital in Southern Colombia

    PubMed Central

    Montenegro, Jorge Hernan; Romero, Adriana Fernanda; Tejada, Paola Andrea; Olaya, Sandra Ximena; Rubiano, Andres Mariano

    2016-01-01

    Introduction. Patient safety is an important topic. The purpose of this study is to evaluate the perceived versus observed patient safety measures (PSM) in critically ill patients in a teaching hospital in Latin America. Materials and Methods. The level of perceived patient safety was evaluated with the patient safety hospital survey. Three months later, a qualitative study was conducted, including video recording of procedures, graded according to adherence to PSM. Levels of adherence were scored during patient mobilization (PM), placement of central catheters (PCC), other invasive procedures (OIP), infection control (IC), and endotracheal intubation (ETI). Results. The perceived adherence of PSM in the prestudy survey was considered fair by 89.1% of the ICU staff. After the survey, 829 ICU procedures were video-recorded. Mean observed adherence for fair patient safety measures was 20.8%. Perceived adherence was higher than the real patient safety protocol measures observed in the videos. Conclusion. Perception of PSM was higher than observed in the management of critically ill patients in a teaching hospital in southern Colombia. PMID:26989508

  12. Teaching Cost-Conscious Medicine: Impact of a Simple Educational Intervention on Appropriate Abdominal Imaging at a Community-Based Teaching Hospital

    PubMed Central

    Covington, Matthew F.; Agan, Donna L.; Liu, Yang; Johnson, John O.; Shaw, David J.

    2013-01-01

    Background Rising costs pose a major threat to US health care. Residency programs are being asked to teach residents how to provide cost-conscious medical care. Methods An educational intervention incorporating the American College of Radiology appropriateness criteria with lectures on cost-consciousness and on the actual hospital charges for abdominal imaging was implemented for residents at Scripps Mercy Hospital in San Diego, CA. We hypothesized that residents would order fewer abdominal imaging examinations for patients with complaints of abdominal pain after the intervention. We analyzed the type and number of abdominal imaging studies completed for patients admitted to the inpatient teaching service with primary abdominal complaints for 18 months before (738 patients) and 12 months following the intervention (632 patients). Results There was a significant reduction in mean abdominal computed tomography (CT) scans per patient (1.7–1.4 studies per patient, P < .001) and total abdominal radiology studies per patient (3.1–2.7 studies per patient, P  =  .02) following the intervention. The avoidance of charges solely due to the reduction in abdominal CT scans following the intervention was $129 per patient or $81,528 in total. Conclusions A simple educational intervention appeared to change the radiologic test-ordering behavior of internal medicine residents. Widespread adoption of similar interventions by residency programs could result in significant savings for the health care system. PMID:24404274

  13. Burns functional disabilities among burn survivors: a study in Komfo Anokye Teaching Hospital, Ghana

    PubMed Central

    Agbenorku, Pius

    2013-01-01

    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. PMID

  14. Knowledge, Attitude and Practice of Contraception among Postpartum Women Attending Kathmandu Medical College Teaching Hospital.

    PubMed

    Bajracharya, A

    2015-01-01

    Background Failure to plan a pregnancy can adversely affect the health of the family as a whole. High parity is related to increased maternal, perinatal and infant deaths and is associated with nutritional problems of both mother and child. Hence, good knowledge, attitude and practice of family planning among women are important. This study is aimed to determine the knowledge, attitude and practice of contraception among the postpartum women attending Kathmandu Medical College Teaching Hospital. Objective To determine the knowledge, attitude and the practice of various contraceptive methods among the postpartum women. Method A cross-sectional observational study was conducted in the department of Obstetrics and Gynecology on 400 postpartum women (within 42 days of delivery) who delivered and came for follow-up in this institution. All the postnatal women were interviewed with pre-designed questionnaire and information on sociodemographic variable, awareness and knowledge of various contraceptive methods, previous and current use of family planning methods, source of information, utilization and reasons for use/non-use of family planning methods were obtained. Data collected were entered and analyzed using SPSS 20. The results were presented as percentages, means, tables and charts. Result Majority of the participants 363 (90.8%) were aware of contraceptive usage. Amongst 60.5% of women who had previously used contraception, OCPs were the commonest one. Maximum number of participants (60.35%) had used modern contraceptives in the past. The most common source of information on contraception was media (55.7%). The reason of using contraception was spacing between the subsequent pregnancies, while the most common reason of discontinuation or not willing to use family planning methods was husband being abroad, fear of side effects and not knowing which contraceptives to use. Conclusion The contraceptive awareness and knowledge among the postpartum women was high but

  15. Delivery of pharmaceutical services at ward level in a teaching hospital.

    PubMed

    Schellack, N; Martins, V; Botha, N; Meyer, J C

    2009-03-01

    Poor management of pharmaceuticals could lead to wastage of financial resources and poor services in the public sector. The main aim of the study was to investigate the quality of pharmaceutical services at ward level in a teaching hospital. The design of the study was descriptive. Three data collection instruments were designed and pilot-tested prior to the actual data collection. Two structured questionnaires were used to interview the sister-in-charge of each ward and the stock and drug controller at the pharmacy. A checklist for the management of pharmaceuticals was completed for each ward. Descriptive statistics were used to describe and summarise the data. Sisters-in-charge of 30 wards and the stock and drug controller at the pharmacy participated in the study. The relationship with the pharmacy was perceived to be average by 54% (n = 30) of the sisters-in-charge of the wards. Communication with the pharmacy was mainly by telephone and 57% of the sisters-in-charge mentioned that they experienced difficulties in conveying messages to the pharmacy. Ten of the wards received regular ward visits by a pharmacist. Expiry dates were checked by all wards but at different intervals. The majority of the wards (90%) used patient cards, which refer to prescription charts, for stock control and ordering from the pharmacy. Fridge temperatures were checked and charted on a daily basis by 30% of the wards. Written standard operating procedures (SOPs) were used by the pharmacy for issuing ward stock. Although 83% of the wards indicated that they used SOPs, evidence of written SOPs was not available. The results indicated that the management of pharmaceutical services at ward level could be improved. Implementation of appropriate communication systems will enhance cooperation between the pharmacy and the wards. A uniform ward stock control system, either by computer or stock cards, should be introduced. Regular ward visits by a pharmacist to oversee ward stock management are

  16. Van der Woude syndrome: A review of 11 cases seen at the Lagos University Teaching Hospital

    PubMed Central

    James, Olutayo; Adeyemo, Wasiu L.; Emeka, Christian I.; Ogunlewe, Mobolanle O.; Ladeinde, Akinola L.; Butali, Azeez

    2014-01-01

    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. PMID:24647295

  17. Nurses' Knowledge, Practices, and Barriers in Care of Patients with Pressure Ulcers in a Ugandan Teaching Hospital

    PubMed Central

    Mwebaza, Ivan; Katende, Godfrey; Groves, Sara; Nankumbi, Joyce

    2014-01-01

    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. PMID:24707398

  18. Clinical utility and impact of autopsies on clinical practice among doctors in a large teaching hospital in Ghana

    PubMed Central

    Tette, Edem; Yawson, Alfred E.; Tettey, Yao

    2014-01-01

    Background Autopsies can provide a good indication of the quality of patient care, in terms of the accuracy of clinical diagnosis and the quality of treatment given. Designs This was a cross-sectional study among clinicians at the Korle-Bu Teaching Hospital (KBTH) in 2012. Data were collected with a 69-item, self-administered, structured questionnaire. A total of 215 questionnaires were sent out and 119 clinicians responded. Data were collected on the benefits and utility of autopsies for medical practice, care of patients, and management of clinical wards. Survey data were analyzed by simple descriptive statistics (i.e. proportions, ratios, and percentages). Data were analyzed using SPSS version 21. Objective This study examined the views of clinicians regarding the utility of autopsies and their influence on clinical practice in a large teaching hospital in Ghana. Results Overall, clinicians in KBTH agreed that autopsy reports are useful in answering clinical questions (55/119; 46.2%), confirming or verifying clinical diagnoses (54/119; 45.4%), providing information on unsuspected diagnoses (40/119; 33.6%), and for medical education (90/119; 75.6%). Overall, 70/119 (58.8%) of clinicians agreed that autopsy findings improve completeness and reliability of death certification and provide information on clinical effectiveness of treatment and patient management. However, only 23/119 (19.3%) of sampled clinicians had personal interactions with a pathologist during autopsy processes and 93/119 (78.2%) had not attended any autopsy demonstrations in the past 6 months. Attendance of pathologists at clinicopathological meetings of clinical departments of KBTH was minimal. Unfortunately, the use of autopsy reports for auditing clinical diagnostic performance was not seen as essential. Conclusion Strengthening the interaction between doctors and pathologists is essential in improving the autopsy process and utilization in the hospital. KBTH should create opportunities for

  19. Comatose and noncomatose adult diabetic ketoacidosis patients at the University Teaching Hospital, Zambia: Clinical profiles, risk factors, and mortality outcomes

    PubMed Central

    Kakusa, Mwanja; Kamanga, Brown; Ngalamika, Owen; Nyirenda, Soka

    2016-01-01

    Background: Diabetic ketoacidosis (DKA) is one of the commonly encountered diabetes mellitus emergencies. Aim: This study aimed at describing the clinical profiles and hospitalization outcomes of DKA patients at the University Teaching Hospital (UTH) in Lusaka, Zambia and to investigate the role of coma on mortality outcome. Materials and Methods: This was a cross-sectional analytical study of hospitalized DKA patients at UTH. The data collected included clinical presentation, precipitating factors, laboratory profiles, complications, and hospitalization outcomes. Primary outcome measured was all-cause in-hospital mortality. Results: The median age was 40 years. Treatment noncompliance was the single highest identified risk factor for development of DKA, followed by new detection of diabetes, then infections. Comatose patients were significantly younger, had lower baseline blood pressure readings, and higher baseline respiratory rates compared to noncomatose patients. In addition, comatose patients had higher baseline admission random blood glucose readings. Their baseline sodium and chloride levels were also higher. The prevalences of hypokalemia, hypernatremia, and hyperchloremia were also higher among comatose patients compared to noncomatose patients. Development of aspiration during admission with DKA, pneumonia at baseline, development of renal failure, and altered mental status were associated with an increased risk of mortality. Development of renal failure was independently predictive of mortality. Conclusion: The mortality rate from DKA hospitalizations is high at UTH. Treatment noncompliance is the single highest identifiable precipitant of DKA. Aspiration, development of renal failure, altered sensorium, and pneumonia at baseline are associated with an increased risk of mortality. Development of renal failure during admission is predictive of mortality. PMID:27042416

  20. Spectrum of Microbial Diseases and Resistance Patterns at a Private Teaching Hospital in Kenya: Implications for Clinical Practice

    PubMed Central

    Maina, Daniel; Omuse, Geoffrey; Revathi, Gunturu; Adam, Rodney D.

    2016-01-01

    Background Accurate local prevalence of microbial diseases and microbial resistance data are vital for optimal treatment of patients. However, there are few reports of these data from developing countries, especially from sub-Saharan Africa. The status of Aga Khan University Hospital Nairobi as an internationally accredited hospital and a laboratory with an electronic medical record system has made it possible to analyze local prevalence and antimicrobial susceptibility data and compare it with other published data. Methods We have analyzed the spectrum of microbial agents and resistance patterns seen at a 300 bed tertiary private teaching hospital in Kenya using microbial identity and susceptibility data captured in hospital and laboratory electronic records between 2010 and 2014. Results For blood isolates, we used culture collection within the first three days of hospitalization as a surrogate for community onset, and within that group, Escherichia coli was the most common, followed by Staphylococcus aureus. In contrast, Candida spp. and Klebsiella pneumoniae were the most common hospital onset causes of bloodstream infection. Antimicrobial resistance rates for the most commonly isolated Gram negative organisms was higher than many recent reports from Europe and North America. In contrast, Gram positive resistance rates were quite low, with 94% of S. aureus being susceptible to oxacillin and only rare isolates of vancomycin-resistant enterococci. Conclusions The current report demonstrates high rates of antimicrobial resistance in Gram negative organisms, even in outpatients with urinary tract infections. On the other hand, rates of resistance in Gram positive organisms, notably S. aureus, are remarkably low. A better understanding of the reasons for these trends may contribute to ongoing efforts to combat antimicrobial resistance globally. PMID:26807811

  1. 42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... to the medical school) and the hospital are related by common ownership or control as described in... the medical school for the costs of those services furnished to all patients, payment is made by... surgical services furnished to hospital patients must be apportioned to beneficiaries as provided for...

  2. 42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... to the medical school) and the hospital are related by common ownership or control as described in... the medical school for the costs of those services furnished to all patients, payment is made by... surgical services furnished to hospital patients must be apportioned to beneficiaries as provided for...

  3. 42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) and the hospital are related by common ownership or control as described in § 413.17 of this chapter... school for the costs of those services furnished to all patients, payment is made by Medicare to the... services furnished to hospital patients must be apportioned to beneficiaries as provided for...

  4. Outcomes of a Postexposure Prophylaxis Program at the Korle-Bu Teaching Hospital in Ghana: A Retrospective Cohort Study.

    PubMed

    Tetteh, Raymond A; Nartey, Edmund T; Lartey, Margaret; Mantel-Teeuwisse, Aukje K; Leufkens, Hubert G M; Nortey, Priscilla A; Dodoo, Alexander N O

    2015-01-01

    The risk for occupational exposure to HIV is a serious public health problem that is well characterized in the developed world, but less so in the developing countries such as Ghana. This study was undertaken to examine the characteristics of occupational exposure to HIV and the utilization of a risk assessment system (RAS)-based postexposure prophylaxis (PEP) among health care workers (HCWs) and health care students (HCSs) in the Korle-Bu Teaching Hospital (KBTH). During the study period (January 2005-December 2010), a total of 260 and 35 exposures were reported by HCWs and HCSs, respectively. Ward attendants reported the highest incidence rate of 6.46 of 100 person-years (P-Y). The incidence of high-risk exposures was 0.33 of 100 P-Y (n = 65); 60.0% occurred during a procedure of disposing of a needle and 24.6% during a cannula insertion. A total of 289 of the 295 individuals were administered PEP, of which 181 (62.6%) completed the 6-month follow-up testing schedule and none sero-converted. This shows that with a good RAS in place, it is possible to deploy an effective PEP program in a typical African teaching hospital like the KBTH in Accra, Ghana. PMID:24162616

  5. Adult surgical emergencies in a developing country: the experience of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.

    PubMed

    Chianakwana, Gabriel U; Ihegihu, Chima C; Okafor, Pius I S; Anyanwu, Stanley N C; Mbonu, Okechukwu O

    2005-06-01

    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 of adult patients treated as emergencies over a 5-year period, from 7 September 1998 to 6 September 2003, were obtained. The hospital folders were then retrieved from the Records Department. From each folder, the following details about each patient were extracted: age, sex, diagnosis at presentation, causative factors, treatment given, and outcome. A total of 902 adult patients were treated during the period. The commonest emergency operation was appendectomy for acute appendicitis in 139 patients (97 women and 42 men), followed closely by road traffic accidents (RTAs) involving 137 patients (103 men and 34 women). Gunshot injuries, which resulted mainly from armed robbery attacks, accounted for 127 cases. More men (113) sustained gunshot injuries than women (14). Of the 92 cases of acute intestinal obstruction seen, 62 occurred in women and 30 in men. Some 126 men presented with acute urinary retention, and two others presented with priapism. Governments at various levels should provide modern diagnostic tools for the accurate preoperative diagnosis of surgical emergencies in hospitals. Governments should also inculcate strict discipline into drivers using the highways, particularly in relation to abuse of alcohol and drugs. Good roads and adequate security should be provided for the people. The need for Pre-Hospital Care for the efficient evacuation of accident victims is emphasized. These measures will help to improve the management and outcome of surgical emergencies, and decrease the number of surgical emergencies resulting from RTAs and gunshot wounds. PMID:15880283

  6. An evaluation of knowledge, attitude, and practice of adverse drug reaction reporting in a tertiary care teaching hospital of Sikkim

    PubMed Central

    Datta, Supratim; Sengupta, Shramana

    2015-01-01

    Aim: Spontaneous voluntary adverse drug reaction (ADR) reporting is paramount to the success of the Pharmacovigilance Programme of India. There has however been minimal and sporadic voluntary reporting of ADR's at the ADR Monitoring Centre (AMC) Gangtok, Sikkim. Knowledge, perception, attitude, and awareness of health professionals are determinants of reporting practices. This questionnaire study aims at evaluating these indicators in the teaching hospital attached to the Medical Institute and find out methods to improve existing reporting practices. Materials and Methods: This is a cross-sectional questionnaire-based observational study carried out in the Medical, Surgical and Pathology Departments of the Teaching Hospital, Gangtok, Sikkim over a period of 2 months. The questionnaires were filled by the respondents and returned back to us within the next 24 h. Data obtained from filled questionnaires were thereby analyzed. Results: The overall correct response rate to the knowledge-based questions was 56.3%. While 97% of respondents were of the view that ADR reporting was necessary, 35% of the respondents felt that the difficulty in deciding the causality of an ADR discouraged them from reporting. 79% of the respondents were not aware of the presence of an AMC affiliated to the hospital, and 87% of the respondents admitted that they were not sending filled ADR forms to the AMC. Conclusions: The study indicates that the respondents have an average knowledge and positive attitude toward ADR reporting and pharmacovigilance. There is however a lack of awareness and poor ADR reporting practices. Efforts are required to enhance awareness and attitude toward pharmacovigilance and ADR reporting. PMID:26623391

  7. Oral Health Status of a Sample of Prisoners in Enugu: A Disadvantaged Population

    PubMed Central

    Akaji, EA; Ashiwaju, MO

    2014-01-01

    Background: The aim of this study is to determine the oral health status of a sample of prisoners at the Federal Prison in Enugu. The health status of inmates in the prison system needs to be incorporated into data and reports that summarize the state of the nation's health; this will encourage the provision of health care to prisoners and foster development of the nation's health. Subjects and Methods: The study involved 230 inmates of the Federal Prison in Enugu. An interviewer-administered questionnaire was used to gather data on the demographic characteristics of the participants, social habits, methods and frequency of cleaning the mouth. Intraoral examination was carried out to determine caries and periodontal statuses employing decayed missing and filled teeth (DMFT) index and community periodontal index of treatment needs respectively. The proportions of participants with other soft and hard tissue conditions were also recorded. Frequency distribution tables with mean values were generated for categorical variables and non-parametric test was used to relate DMFT values with frequency of cleaning the mouth. Results: Among the participants, 67.0% (154/230) had decayed teeth or tooth missing due to caries. None of the decayed teeth was restored yielding a 0.0% (0/230) index of restorative provision. Spearman correlation (rho) between ranks of DMFT and frequency of cleaning the mouth was -0.32 (95%CI=-0.43 to -0.19). 5.2% (12/230) participants had community periodontal index (CPI) score of 0 and 94.8% (218/230) had CPI of 1, 2, 3 or 4. Also, 56.1% (129/230) had extrinsic stains on their teeth and 17.3% (40/230) presented with fractured teeth. Conclusion: More than half of the participants were affected by dental caries and periodontal health was compromised in the majority of them. Measures to improve their oral health and the establishment of dental health-care facility in the institution are strongly encouraged. PMID:25221723

  8. Water quality assessment of the Asata River catchment area in Enugu Metropolis, Southeast Nigeria

    NASA Astrophysics Data System (ADS)

    Osinowo, Olawale Olakunle

    2016-09-01

    Hydrogeochemical mapping of the Asata River Catchment area in the Enugu metropolis, southeast Nigeria was carried out in order to assess the quality of the surface and groundwater and based on the analyses of the hydrogeochemical data, establish the level of chemical contaminations which inhibit the availability of potable water in the area. Forty (40) water samples comprising five (5) springs, nineteen (19) surface (streams/rivers) and sixteen (16) groundwater (well/borehole) samples were collected and analysed for the presence and degree of contamination of nine (9) major chemical contaminants. Hydrochemical analyses indicate that Electrical Conductivity (EC) which has a linear relationship with Total Dissolved Solid (TDS) ranges between 015 and 887 μS/cm, pH between 4.4 and 8.3, nitrate (NO3-) ranges between 40 and 130 mg/l and chloride (Cl-) between 7 and 130 mg/l. The concentrations of the dissolved chemical constituents defined the pollution trend and the rate of dispersion of contaminants. The degree of contaminants followed a simple trend, where the level of contamination of the dissolved chemical constituents is least in sampled spring water, with measured chemical constituents of EC, pH, NO3- and Cl- range from 15 to 354 μS/cm; 6.4-6.5; 4.0-70 mg/l and 8-36 mg/l, respectively. However, the value of the measured chemical constituent of EC, pH, NO3- and Cl- gradually increases down the stream in both the surface (63-354 μS/cm; 4.5-7.7; 7.1-110 mg/l; 8-41 mg/l) and groundwater (56-531 μS/cm; 4.5-7.5; 40-130 mg/l; 7-130 mg/l), respectively. Noticeable peaks in contamination levels characterised sections of the study area where human population or their activities is highest. The result of the hydrogeochemical mapping indicate that Enugu coal mine operation, the industrial activities, fertilizer applied to plants cultivated on river banks and domestic human wastes which are indiscriminately dumped along river channels are the major sources of chemical

  9. Molecular Diagnostics for Lassa Fever at Irrua Specialist Teaching Hospital, Nigeria: Lessons Learnt from Two Years of Laboratory Operation

    PubMed Central

    Hass, Meike; Gabriel, Martin; Ölschläger, 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.; Günther, Stephan

    2012-01-01

    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. PMID:23029594

  10. A review of opioid prescription in a teaching hospital in Colombia

    PubMed Central

    Moyano, Jairo; Figueras, Albert

    2012-01-01

    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. PMID:23049273

  11. Epidemiology of Enterococcus faecalis urinary tract infection in a teaching hospital in London, United Kingdom.

    PubMed Central

    Hall, L M; Duke, B; Urwin, G; Guiney, M

    1992-01-01

    Enterococcus faecalis is a frequent cause of urinary tract infection in hospitalized patients. Recent reports have suggested that the organism may frequently be acquired by cross-infection from other patients. In this study, we used total DNA restriction patterns to type 135 urine isolates of E. faecalis from four sets of patients. Isolates were placed into types (all bands identical) and into groups (most bands identical). Most isolates were discriminated by the typing method, and the results suggested that direct cross-infection occurred rarely if at all. However, two groups of clonally related isolates occurred frequently in the urine specimens and also in feces from hospital-associated patients and were often associated with antibiotic resistance. Isolates from these two groups were found less frequently in feces from people not associated with the hospital. Images PMID:1500498

  12. 78 FR 32663 - Medicare Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-31

    ... November 24, 2010 Calendar Year (CY) 2011 Outpatient Prospective Payment System (OPPS) final rule (75 FR... Care Hospital Prospective Payment System final rule (FY 2013 IPPS/LTCH PPS final rule (77 FR 53434... comment period, a copy of the FY 2013 IPPS/LTCH PPS final rule (77 FR 53434 through 53447), and a list...

  13. Medical Device-Associated Candida Infections in a Rural Tertiary Care Teaching Hospital of India

    PubMed Central

    Deorukhkar, Sachin C.; Saini, Santosh

    2016-01-01

    Health care associated infections (HCAIs) add incrementally to the morbidity, mortality, and cost expected of the patient's underlying diseases alone. Approximately, about half all cases of HCAIs are associated with medical devices. As Candida medical device-associated infection is highly drug resistant and can lead to serious life-threatening complications, there is a need of continuous surveillance of these infections to initiate preventive and corrective measures. The present study was conducted at a rural tertiary care hospital of India with an aim to evaluate the rate of medical device-associated Candida infections. Three commonly encountered medical device-associated infections (MDAI), catheter-associated urinary tract infection (CA-UTI), intravascular catheter-related blood stream infections (CR-BSI), and ventilator-associated pneumonia (VAP), were targeted. The overall rate of MDAI in our hospital was 2.1 per 1000 device days. The rate of Candida related CA-UTI and CR-BSI was noted as 1.0 and 0.3, respectively. Untiring efforts taken by team members of Hospital Acquired Infection Control Committee along with maintenance of meticulous hygiene of the hospital and wards may explain the low MDAI rates in our institute. The present surveillance helped us for systematic generation of institutional data regarding MDAI with special reference to role of Candida spp. PMID:26904115

  14. Hippi Care Hospital: Towards Proactive Business Processes in Emergency Room Services. Teaching Case

    ERIC Educational Resources Information Center

    Tan, Kar Way; Shankararaman, Venky

    2014-01-01

    It was 2:35 am on a Saturday morning. Wiki Lim, process specialist from the Process Innovation Centre (PIC) of Hippi Care Hospital (HCH), desperately doodling on her notepad for ideas to improve service delivery at HCH's Emergency Department (ED). HCH has committed to the public that its ED would meet the service quality criterion of serving 90%…

  15. Coproduction of KPC-2 and IMP-10 in Carbapenem-Resistant Serratia marcescens Isolates from an Outbreak in a Brazilian Teaching Hospital.

    PubMed

    Silva, Kesia Esther; Cayô, Rodrigo; Carvalhaes, Cecilia Godoy; Patussi Correia Sacchi, Flávia; Rodrigues-Costa, Fernanda; Ramos da Silva, Ana Carolina; Croda, Julio; Gales, Ana Cristina; Simionatto, Simone

    2015-07-01

    We describe an outbreak caused by KPC-2- and IMP-10-producing Serratia marcescens isolates in a Brazilian teaching hospital. Tigecycline was the only active antimicrobial agent tested. The blaIMP-10 gene was located in a new class 1 integron, named In990, carried by a nonconjugative plasmid, in contrast to blaKPC-2. PMID:25878341

  16. Coproduction of KPC-2 and IMP-10 in Carbapenem-Resistant Serratia marcescens Isolates from an Outbreak in a Brazilian Teaching Hospital

    PubMed Central

    Silva, Kesia Esther; Cayô, Rodrigo; Carvalhaes, Cecilia Godoy; Patussi Correia Sacchi, Flávia; Rodrigues-Costa, Fernanda; Ramos da Silva, Ana Carolina; Croda, Julio; Gales, Ana Cristina

    2015-01-01

    We describe an outbreak caused by KPC-2- and IMP-10-producing Serratia marcescens isolates in a Brazilian teaching hospital. Tigecycline was the only active antimicrobial agent tested. The blaIMP-10 gene was located in a new class 1 integron, named In990, carried by a nonconjugative plasmid, in contrast to blaKPC-2. PMID:25878341

  17. Molecular epidemiology of environmental MRSA at an equine teaching hospital: introduction, circulation and maintenance

    PubMed Central

    2014-01-01

    The role that environmental contamination might play as a reservoir and a possible source of Methicillin-resistant Staphylococcus aureus (MRSA) for patients and personnel at equine veterinary hospitals remains undefined, as the environment has only been monitored during outbreaks or for short periods. Therefore, the objectives of this study were to determine the monthly presence, distribution, and characteristics of environmental MRSA at an equine hospital, and to establish patterns of contamination over time using molecular epidemiological analyses. For this purpose, a yearlong active MRSA surveillance was performed targeting the environment and incoming patients. Antimicrobial susceptibility testing, SCCmec typing, PFGE typing, and dendrographic analysis were used to characterize and analyze these isolates. Overall, 8.6% of the surfaces and 5.8% of the horses sampled were positive for MRSA. The most common contaminated surfaces were: computers, feed-water buckets, and surgery tables-mats. Ninety percent of the isolates carried SCCmec type IV, and 62.0% were classified as USA500. Molecular analysis showed that new pulsotypes were constantly introduced into the hospital throughout the year. However, maintenance of strains in the environment was also observed when unique clones were detected for 2 consecutive months on the same surfaces. Additionally, pulsotypes were circulating throughout several areas and different contact surfaces of the hospital. Based on these results, it is evident that MRSA is constantly introduced and frequently found in the equine hospital environment, and that some contact surfaces could act as “hot-spots”. These contaminated surfaces should be actively targeted for strict cleaning and disinfection as well as regular monitoring. PMID:24641543

  18. Molecular epidemiology of environmental MRSA at an equine teaching hospital: introduction, circulation and maintenance.

    PubMed

    van Balen, Joany; Mowery, Jade; Piraino-Sandoval, Micha; Nava-Hoet, Rocio C; Kohn, Catherine; Hoet, Armando E

    2014-01-01

    The role that environmental contamination might play as a reservoir and a possible source of Methicillin-resistant Staphylococcus aureus (MRSA) for patients and personnel at equine veterinary hospitals remains undefined, as the environment has only been monitored during outbreaks or for short periods. Therefore, the objectives of this study were to determine the monthly presence, distribution, and characteristics of environmental MRSA at an equine hospital, and to establish patterns of contamination over time using molecular epidemiological analyses. For this purpose, a yearlong active MRSA surveillance was performed targeting the environment and incoming patients. Antimicrobial susceptibility testing, SCCmec typing, PFGE typing, and dendrographic analysis were used to characterize and analyze these isolates. Overall, 8.6% of the surfaces and 5.8% of the horses sampled were positive for MRSA. The most common contaminated surfaces were: computers, feed-water buckets, and surgery tables-mats. Ninety percent of the isolates carried SCCmec type IV, and 62.0% were classified as USA500. Molecular analysis showed that new pulsotypes were constantly introduced into the hospital throughout the year. However, maintenance of strains in the environment was also observed when unique clones were detected for 2 consecutive months on the same surfaces. Additionally, pulsotypes were circulating throughout several areas and different contact surfaces of the hospital. Based on these results, it is evident that MRSA is constantly introduced and frequently found in the equine hospital environment, and that some contact surfaces could act as "hot-spots". These contaminated surfaces should be actively targeted for strict cleaning and disinfection as well as regular monitoring. PMID:24641543

  19. Adverse events caused by potential drug-drug interactions in an intensive care unit of a teaching hospital

    PubMed Central

    Alvim, Mariana Macedo; da Silva, Lidiane Ayres; Leite, Isabel Cristina Gonçalves; Silvério, Marcelo Silva

    2015-01-01

    Objective To evaluate the incidence of potential drug-drug interactions in an intensive care unit of a hospital, focusing on antimicrobial drugs. Methods This cross-sectional study analyzed electronic prescriptions of patients admitted to the intensive care unit of a teaching hospital between January 1 and March 31, 2014 and assessed potential drug-drug interactions associated with antimicrobial drugs. Antimicrobial drug consumption levels were expressed in daily doses per 100 patient-days. The search and classification of the interactions were based on the Micromedex® system. Results The daily prescriptions of 82 patients were analyzed, totaling 656 prescriptions. Antimicrobial drugs represented 25% of all prescription drugs, with meropenem, vancomycin and ceftriaxone being the most prescribed medications. According to the approach of daily dose per 100 patient-days, the most commonly used antimicrobial drugs were cefepime, meropenem, sulfamethoxazole + trimethoprim and ciprofloxacin. The mean number of interactions per patient was 2.6. Among the interactions, 51% were classified as contraindicated or significantly severe. Highly significant interactions (clinical value 1 and 2) were observed with a prevalence of 98%. Conclusion The current study demonstrated that antimicrobial drugs are frequently prescribed in intensive care units and present a very high number of potential drug-drug interactions, with most of them being considered highly significant. PMID:26761473

  20. Designing and evaluating a balanced scorecard for a health information management department in a Canadian urban non-teaching hospital.

    PubMed

    Nippak, Pria Md; Veracion, Julius Isidro; Muia, Maria; Ikeda-Douglas, Candace J; Isaac, Winston W

    2016-06-01

    This report is a description of a balanced scorecard design and evaluation process conducted for the health information management department at an urban non-teaching hospital in Canada. The creation of the health information management balanced scorecard involved planning, development, implementation, and evaluation of the indicators within the balanced scorecard by the health information management department and required 6 months to complete. Following the evaluation, the majority of members of the health information management department agreed that the balanced scorecard is a useful tool in reporting key performance indicators. These findings support the success of the balanced scorecard development within this setting and will help the department to better align with the hospital's corporate strategy that is linked to the provision of efficient management through the evaluation of key performance indicators. Thus, it appears that the planning and selection process used to determine the key indicators within the study can aid in the development of a balanced scorecard for a health information management department. In addition, it is important to include the health information management department staff in all stages of the balanced scorecard development, implementation, and evaluation phases. PMID:24948412

  1. Kaposi Sarcoma among HIV Infected Patients in Lagos University Teaching Hospital, Nigeria: A 14-Year Retrospective Clinicopathological Study

    PubMed Central

    Akinde, Olakanmi; Adeyemo, Titilope; Omoseebi, Oladipo; Ikeri, Nzechukwu; Okonkwo, Ikechukwu; Afolayan, Olatunji

    2016-01-01

    Background. Despite the increased incidence of Kaposi sarcoma (KS) resulting from the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) pandemic, there is still significant underreporting of KS in this environment. Objectives. This study was aimed at determining the incidence and clinicopathologic patterns of KS among HIV infected patients in Lagos University Teaching Hospital (LUTH), Nigeria, over a 14-year period: January 2000 to December 2013. Methodology. The materials for this study included patients' hospital clinical files, duplicate copies of histopathologic reports, and tissue blocks and corresponding archival slides in the Anatomic and Molecular Pathology Department and the HIV/AIDS unit of the Department of Haematology. Results. Within the study period, 182 cases of KS were diagnosed, accounting for 1.2% of all patients managed for HIV/AIDS and 2.99% of solid malignant tumours. The male-to-female ratio and modal age group were 1 : 1.3 and 5th decade, respectively. Most cases (90%) had purely mucocutaneous involvement with the lower limb being the commonest site (65.8%). The majority of lesions were plaques (65.8%). Vascular formation was the predominant histologic type seen (43.5%). Conclusion. KS in Lagos followed the same epidemiologic trend as other centers in Nigeria, with an increasing incidence in this era of HIV/AIDS. PMID:27034839

  2. Surgical site infection prevention: a survey to identify the gap between evidence and practice in University of Toronto teaching hospitals

    PubMed Central

    Eskicioglu, Cagla; Gagliardi, Anna R.; Fenech, Darlene S.; Forbes, Shawn S.; McKenzie, Marg; McLeod, Robin S.; Nathens, Avery B.

    2012-01-01

    Background A gap exists between the best evidence and practice with regards to surgical site infection (SSI) prevention. Awareness of evidence is the first step in knowledge translation. Methods A web-based survey was distributed to 59 general surgeons and 68 residents at University of Toronto teaching hospitals. Five domains pertaining to SSI prevention with questions addressing knowledge of prevention strategies, efficacy of antibiotics, strategies for changing practice and barriers to implementation of SSI prevention strategies were investigated. Results Seventy-six individuals (60%) responded. More than 90% of respondents stated there was evidence for antibiotic prophylaxis and perioperative normothermia and reported use of these strategies. There was a discrepancy in the perceived evidence for and the self-reported use of perioperative hyperoxia, omission of hair removal and bowel preparation. Eighty-three percent of respondents felt that consulting published guidelines is important in making decisions regarding antibiotics. There was also a discrepancy between what respondents felt were important strategies to ensure timely administration of antibiotics and what strategies were in place. Checklists, standardized orders, protocols and formal surveillance programs were rated most highly by 75%–90% of respondents, but less than 50% stated that these strategies were in place at their institutions. Conclusion Broad-reaching initiatives that increase surgeon and trainee awareness and implementation of multifaceted hospital strategies that engage residents and attending surgeons are needed to change practice. PMID:22617541

  3. A study of occupational health and safety measures in the Laundry Department of a private tertiary care teaching hospital, Bengaluru

    PubMed Central

    Kumar, M. Shashi; Goud, B. Ramakrishna; Joseph, Bobby

    2014-01-01

    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. PMID:25006311

  4. Evaluation of the contribution of isolation precautions in prevention and control of multi-resistant bacteria in a teaching hospital.

    PubMed

    Eveillard, M; Eb, F; Tramier, B; Schmit, J L; Lescure, F X; Biendo, M; Canarelli, B; Daoudi, F; Laurans, G; Rousseau, F; Thomas, D

    2001-02-01

    From February 1999 to January 2000, a control programme to prevent the spread multi-resistant bacteria (MRB) was implemented in a French teaching hospital. This programme focused on methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBL), and was based on the application of barrier precautions (washing hands with antiseptic soaps, wearing disposable gloves and gowns, identifying MRB carriers). No changes in antibiotic policy occurred during the year. Our aim was to conduct an evaluation of this programme by measuring incidence rates. Concurrently, the effect of barrier precautions was estimated in an indirect way, by documenting the availability of barrier precautions in MRB carriers' rooms and by analysing the monthly correlation between the supply of such material and the theoretical cumulated length of MRB carriers' isolation in six randomized wards. All MRB isolated in hospitalized patients were recorded, and differentiated between acquisition in our hospital or from elsewhere. For the analysis of trends, the year was divided in three periods of four months. Over the year, the global MRB incidence was 1.26 per 1000 patient-days (PD) [95% confidence interval (95%CI)=1.16-1.36]. The MRSA incidence was 0.89 per 1000 PD (95%CI=0.81- 0.97) and the ESBL incidence was 0.38 per 1000 PD (95% CI=0.33-0.43). The MRB incidence decreased significantly in all types of specialties except for surgical wards. The incidence decreased by 17.9% for MRSA, 54.9% for ESBL and 34.8% for both MRB. Concurrently, the proportion of strains acquired in our hospital decreased for MRSA (P for trend > or = 0.05) and ESBL (P for trend > or = 0.01), whereas the incidence of imported strains increased slightly. The proportion of multiresistant strains in S. aureus (36.8%) and Enterobacter aerogenes (37.0%) remained similar throughout the year. Thus, the decrease of the incidence concerned both resistant and susceptible strains

  5. [Safe surgery checklist: analysis of the safety and communication of teams from a teaching hospital].

    PubMed

    Pancieri, Ana Paula; Santos, Bruna Pegorer; de Avila, Marla Andréia Garcia; Braga, Eliana Mara

    2013-03-01

    This study aimed to apply the WHO surgical safety checklist in the surgical specialties of a university hospital and to evaluate the opinion of the team regarding the influence of its application on the safety of the surgical process and on the interpersonal communication of the team. It is a descriptive, analytical qualitative field study conducted in the surgical center of a university hospital Data were collected by applying the checklist in a total of 30 surgeries. The researcher conducted its application in three phases, and then members of the surgical team were invited to voluntarily participate in the study, signifying their agreement to participate by signing an informed consent form and answering guiding questions. Bardin's Content Analysis Method was used to organize and analyze the data. The subjects did not notice any changes in their interpersonal communication when using the checklist; however, they gave suggestions and reported that its use provided greater safety to the procedure. PMID:23781726

  6. Postoperative complications from primary repair of cleft lip and palate in a semi-urban Nigerian teaching hospital

    PubMed Central

    Adesina, Oluwafemi Adewale; Efunkoya, Akinwale Adeyemi; Omeje, Kelvin Uchenna; Idon, Paul Ikhodaro

    2016-01-01

    Background: This paper seeks to investigate the incidence of short-term postoperative complications in children and adult patients undergoing primary surgery of cleft lip and palate. Patients and Methods: One hundred and fifteen patients consisting of children (below 12 years) and adult (12 years and above) who were operated for both cleft lip and palate within a 2-year period at the University of Maiduguri Teaching Hospital were reviewed postoperatively at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year intervals, respectively. The complications encountered within the periods of the review were recorded. Results: One hundred and twenty surgeries were performed on 115 patients (85 children 30 Adults). A total of 43 complications (31 in children and 12 in adults) were recorded over the study period. Eighteen (41.9%) of these complications were noticed in unilateral cleft lip repair, while 12 (27.9%) and 13 (30.2%) complications were observed in bilateral cleft lip and cleft palate surgeries, respectively. A higher complication rate (72.0%) was recorded in children compared with adults. Major complications (13.9%) were, however, observed more in adults than children. Conclusion: Although every surgeon attempts to prevent complications during surgery, they may still occur. The high complication rate observed in our study may be due to a small sample size. General complications observed among children are due to cross infection during a hospital stay, contributing immensely to the higher rate of complications in children. Moreover, this may be reduced by short hospital stay following surgery. We also advocate early contact with children with cleft, and early surgical intervention in other to prevent some of the major complications encountered in adult patients. PMID:27397954

  7. Bacteriological Profile and Antibiotic Susceptibility Pattern of Neonatal Sepsis at a Teaching Hospital in Bayelsa State, Nigeria

    PubMed Central

    Peterside, Oliemen; Pondei, Kemebradikumo; Akinbami, Felix O

    2015-01-01

    Background: Sepsis is one of the most common causes of neonatal hospital admissions and is estimated to cause 26% of all neonatal deaths worldwide. While waiting for results of blood culture, it is necessary to initiate an empirical choice of antibiotics based on the epidemiology of causative agents and antibiotic sensitivity pattern in a locality. Objective: To determine the major causative organisms of neonatal sepsis at the Niger Delta University Teaching Hospital (NDUTH), as well as their antibiotic sensitivity patterns, with the aim of formulating treatment protocols for neonates. Methods: Within a 27-month period (1st of October 2011 to the 31st of December 2013), results of blood culture for all neonates screened for sepsis at the Special Care Baby Unit of the hospital were retrospectively studied. Results: Two hundred and thirty-three (49.6%) of the 450 neonates admitted were screened for sepsis. Ninety-seven (43.5%) of them were blood culture positive, with 52 (53.6%) of the isolated organisms being Gram positive and 45 (46.4%) Gram negative. The most frequently isolated organism was Staphylococcus aureus (51.5%) followed by Escherichia coli (16.5%) and Klebsiella pneumoniae (14.4%). All isolated organisms demonstrated the highest sensitivity to the quinolones. Conclusion: Neonatal sepsis is a significant cause of morbidity among neonates admitted at the NDUTH. There is a need for regular periodic surveillance of the causative organisms of neonatal sepsis as well as their antibiotic susceptibility pattern to inform the empirical choice of antibiotic prescription while awaiting blood culture results. PMID:26543394

  8. A retrospective cohort study of panipenem/betamipron for adult pneumococcal bacteremia at three teaching hospitals in Japan.

    PubMed

    Suzuki, Hiromichi; Tokuda, Yasuharu; Shichi, Daisuke; Hitomi, Shigemi; Ishikawa, Hiroichi; Maeno, Tetsuhiro; Nakamura, Hidenori

    2013-08-01

    Panipenem/betamipron (PAPM/BP) may be highly effective for life-threatening Streptococcus pneumoniae infection. However, the efficacy of PAPM/BP for S. pneumoniae infections has not been compared with that of other antimicrobial agents. We retrospectively compared PAPM/BP with other carbapenems for treatment of life-threatening infections in newly hospitalized adults with pneumococcal bacteremia. Clinical information for cases of pneumococcal bacteremia was collected from three teaching hospitals in Japan from January 2003 to December 2010. In total, 17 patients who received PAPM/BP therapy and 34 treated with other carbapenems (27 with meropenem, 4 with imipenem/cilastatin, and 3 with biapenem) were identified. The mean age (71 vs. 70 years old), sex distribution (women, 29 vs. 21 %), Charlson comorbidity index (CCI) (1.5 vs. 1.6), and rates of septic shock (29 vs. 38 %), and meningitis (5.9 vs. 8.8 %) did not differ significantly between the two groups. The inpatient mortality rates were lower in the PAPM/BP group (12 vs. 44 %, p = 0.03). Multiple logistic regression analysis adjusted for age, sex, CCI, and severe sepsis/septic shock showed that use of other carbapenems was associated with higher in-hospital mortality, with an odds ratio of 6.922 (95 % CI, 1.171-40.92) compared to PAPM/BP therapy. Initial PAPM/BP therapy might have a therapeutic advantage over other carbapenems in treatment of severe Streptococcus pneumoniae infections. PMID:23203218

  9. Utilization study of antidiabetic agents in a teaching hospital of Sikkim and adherence to current standard treatment guidelines

    PubMed Central

    Satpathy, Sushrut Varun; Datta, Supratim; Upreti, Binu

    2016-01-01

    Objective: Diabetes has gradually emerged as one of the most serious public health problems in our country. This underlines the need for timely disease detection and decisive therapeutic intervention. This prospective cross-sectional observational study aims at analyzing the utilization pattern of antidiabetic agents in a remote North-East Indian tertiary care teaching hospital in the perspective of current standard treatment guidelines. Materials and Methods: Diabetic patients receiving antidiabetic medication, both as outpatients and inpatients in our hospital over a period of 12 months (May 2013–May 2014), were included in this study. The data obtained were sorted and analyzed on the basis of gender, type of therapy, and hospital setting. Results: A total of 310 patients were included in the study. Metformin was the single most frequently prescribed antidiabetic agent (66.8%) followed by the sulfonylureas group (37.4%). Insulin was prescribed in 23.2% of the patients. Combination antidiabetic drug therapy (65.1%) was used more frequently than monotherapy (34.8%). The use of biguanides (P < 0.0001) and sulfonylureas (P = 0.02) in combination was significant as compared to their use as monotherapy. A total of 48% of all antidiabetic combinations used, comprised metformin and sulfonylureas (n = 96). Insulin use was significantly higher as monotherapy and in inpatients (P < 0.0001). The utilization of drugs from the National List of Essential Medicines was 51.2%, while 11% of antidiabetics were prescribed by generic name. Conclusion: The pattern of utilization largely conforms to the current standard treatment guidelines. Increased use of generic drugs is an area with scope for improvement. PMID:27413351

  10. Cost-outcome description of clinical pharmacist interventions in a university teaching hospital

    PubMed Central

    2014-01-01

    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. PMID:24742158

  11. Identification and management of adverse effects of antipsychotics in a tertiary care teaching hospital

    PubMed Central

    Lucca, Jisha Myalil; Madhan, Ramesh; Parthasarathi, Gurumurthy; Ram, Dushad

    2014-01-01

    Objective: Antipsychotics have revolutionized psychiatry by allowing significant numbers of patients in long-term hospital settings to be discharged and successfully maintained in the community. However, these medications are also associated with a range of adverse events ranging from mostly annoying to rarely dangerous. This study is carried out to identify the adverse drug reactions (ADRs) to antipsychotics and its management in psychiatric patients. Methods: Prospective interventional study was conducted in the psychiatric unit of a tertiary care hospital. Patients of any age and either sex prescribed with at least one antipsychotic were included and monitored for ADRs. Findings: Among the 517 patients receiving antipsychotics, a total of 289 ADRs were identified from 217 patients at an overall incidence rate of 41.97%. Sixty-seven different kinds of ADRs were observed in the study patients. Central and peripheral nervous system was the most commonly affected system organ class (n = 59) and weight gain (n = 30) was the most commonly observed ADR. Olanzapine was most commonly implicated in reported ADRs (n = 92) followed by risperidone (n = 59). Of the 289 ADRs, 80% required interventions including cessation of drug and/or specific/symptomatic/nonpharmacological treatment. Conclusion: This post marketing surveillance study provides a representative data of the ADR profile of the antipsychotics likely to be encountered in psychiatric patients in an Indian tertiary care hospital. PMID:25114936

  12. Estimation of subsurface hydrological parameters around Akwuke, Enugu, Nigeria using surface resistivity measurements

    NASA Astrophysics Data System (ADS)

    Utom, Ahamefula U.; Odoh, Benard I.; Egboka, Boniface C. E.; Egboka, Nkechi E.; Okeke, Harold C.

    2013-04-01

    As few boreholes may be available and carrying out pumping tests can be expensive and time consuming, relationships between aquifer characteristics and the electrical parameters of different geoelectric layers exist. Data from 19 vertical electrical soundings (VESs; 13 of these selected for evaluation) was recorded with a Schlumberger electrode configuration in the area around Akwuke, Enugu, Nigeria. The data was interpreted by computer iterative modelling with curve matching for calibration purposes. Geoelectric cross-sections along a number of lines were prepared to ascertain the overall distribution of the resistivity responses of the subsurface lithology. Identified probable shallow aquifer resistivity, thickness and depth values are in the range of 28-527 Ωm, 2.1-22.5 m and 3.1-28.3 m respectively. As our aquifer system consists of fine-grained, clay-silty sand materials, a modification of the Archie equations (Waxman-Smits model) was adopted to determine the true formation factor using the relationship between the apparent formation factor and the pore water resistivity. This representation of the effects of a separate conducting path due to the presence of clay particles in the aquifer materials was used in making reliable estimations of aquifer properties. The average hydraulic conductivity of 8.96 × 10-4 m s-1 transmissivity ranging between 1.88 × 10-3 and 2.02 × 10-3 m2 s-1 estimated from surface resistivity measurements correlated well with the available field data. Results of the study also showed a direct relationship between aquifer transmissivity and modified transverse resistance (R2 = 0.85).

  13. Impact of a hospital-wide multifaceted programme for reducing carbapenem-resistant Enterobacteriaceae infections in a large teaching hospital in northern Italy.

    PubMed

    Viale, P; Tumietto, F; Giannella, M; Bartoletti, M; Tedeschi, S; Ambretti, S; Cristini, F; Gibertoni, C; Venturi, S; Cavalli, M; De Palma, A; Puggioli, M C; Mosci, D; Callea, E; Masina, R; Moro, M L; Lewis, R E

    2015-03-01

    We performed a quasi-experimental study of a multifaceted infection control programme for reducing carbapenem-resistant Enterobacteriaceae (CRE) transmission and bloodstream infections (BSIs) in a 1420-bed university-affiliated teaching hospital during 2010-2014, with 30 months of follow-up. The programme consisted of the following: (a) rectal swab cultures were performed in all patients admitted to high-risk units (intensive-care units, transplantation, and haematology) to screen for CRE carriage, or for any room-mates of CRE-positive patients in other units; (b) cohorting of carriers, managed with strict contact precautions; (c) intensification of education, cleaning and hand-washing programmes; and (d) promotion of an antibiotic stewardship programme carbapenem-sparing regimen. The 30-month incidence rates of CRE-positive rectal cultures and BSIs were analysed with Poisson regression. Following the intervention, the incidence rate of CRE BSI (risk reduction 0.96, 95% CI 0.92-0.99, p 0.03) and CRE colonization (risk reduction 0.96, 95% CI 0.95-0.97, p <0.0001) significantly decreased over a period of 30 months. After accounting for changes in monthly census and percentage of externally acquired cases (positive at ≤72 h), the average institutional monthly rate of compliance with CRE screening procedures was the only independent variable associated with a declining monthly incidence of CRE colonization (p 0.002). The monthly incidence of CRE carriage was predictive of BSI (p 0.01). Targeted screening and cohorting of CRE carriers and infections, combined with cleaning, education, and antimicrobial stewardship measures, significantly decreased the institutional incidence of CRE BSI and colonization, despite endemically high CRE carriage rates in the region. PMID:25658534

  14. Strategies for Dealing with Low Adoption of Agricultural Innovations: A Case Study of Farmers in Udenu L.G.A. of Enugu State, Nigeria

    ERIC Educational Resources Information Center

    Uguru, Chike; Ajayi, S. L.; Ogbu, Oliver C.

    2015-01-01

    A study to access the level of acceptance/adoption of agricultural innovations by farmers in Udenu Local Government Area of Enugu State was carried out. The aim was to find out the reasons behind the low acceptance/adoption of agricultural innovations by farmers in the area and to suggest possible strategies to address this ugly situation; as a…

  15. Traditions and Customs in Community Development: The Case of Nkanu West and Nkanu East Local Government Areas of Enugu State, Nigeria

    ERIC Educational Resources Information Center

    Adekola, G.; Egbo, Nwoye Charles

    2016-01-01

    This study examined the influence of traditions and customs on community development in Nkanu West and Nkanu East Local Government Areas of Enugu State. The study was carried out with three objectives and three null hypotheses. The research adopted descriptive survey design with a population of 2,125 members of community Based Organizations in the…

  16. Implementation of a radiology electronic imaging network: the community teaching hospital experience.

    PubMed

    Arreola, M; Neiman, H L; Sugarman, A; Laurenti, L; Forys, R

    1997-08-01

    Because of their typically small in-house computer and network staff, non-university hospitals often hesitate to consider picture archiving and communication system (PACS) as a solution to the very demanding financial, clinical, and technological needs of today's Radiology Department. This article presents the experiences of the 3-year process for the design and implementation of the Radiology Electronic Imaging Network (REIN) in the Department of Radiology at The Western Pennsylvania Hospital (WPH). WPH embarked on this project in late 1994 to find a solution to the very pressing demands to reduce operating costs and improve service to primary care clinicians, both on-site and at WPH-affiliated clinics. A five-member committee consisting of in-house medical, administrative, information services, and medical physics staff was formed to design a network that would satisfy specific needs of WPH by using a phased mini-PACS approach and to select the various vendors to implement it. Suppliers for individual mini-PACS were selected to provide modality-specific solutions. For the backbone network, vendors were evaluated based on their technological progress, competence and resources, the commitment of the company to the imaging network business, and their willingness to embark on a mid-sized PACS project such as this. Based on patient volume, workflow patterns, and image quality requirements, the committee produced proposals detailing number and location of workstations, short- and long-term memory requirements, and so on. Computed tomography/magnetic resonance imaging, computer radiography, ultrasound, nuclear medicine, digital fluoroscopy, and angiography mini-PACS have been implemented over the past 2 years, and most of these are already integrated into the main REIN. This article presents detailed information concerning the design, selection and implementation processes, including storage requirement calculations. This indicates that PACS implementation is achievable

  17. Pharmacovigilance study of Ayurvedic medicine in Ayurvedic Teaching Hospital: A prospective survey study

    PubMed Central

    Ajanal, Manjunath N.; Nayak, Shradda U.; Kadam, Avinash P.; Prasad, B. S.

    2015-01-01

    Introduction: Though Ayurveda is practiced in the Indian subcontinent since centuries, there is a paucity of systematic documentation related to the occurrence of adverse drug reactions (ADR) and other issues regarding the safety of Ayurveda medicines. Aim: To monitor and analyze the pattern and frequency of ADR to Ayurvedic medicines in an Ayurvedic hospital setup. Materials and Methods: In this prospective study, ADR monitoring was done in KLE Ayurveda Secondary Care Hospital, Belgaum, Karnataka, India by spontaneous and intensive monitoring technique for a span of 1-year (June 2010 to May 2011). Data pertaining to patient demography, drug and reaction characteristics, organ system involved and reaction outcomes were collected and evaluated. The reaction severity and predisposing factors were also assessed. Results: In a span of one year, 84 adverse drug events were reported out of which 52 confirmed as ADR. The overall incidence of ADR in the patient population was 1.14%, out of which 23 (44.23%) were related to Panchakarma (detoxification process), 13 (25.00%) related to the herbal formulations and 06 (11.53%) were of Rasa Aushadhi (mineral or herbo-mineral formulations). The commonly affected organ systems were gastrointestinal system 24 (46.15%) and skin 15 (28.84%). The majority of the reactions were moderate 30 (57.69%) to mild 20 (38.46%) in severity. Most patients recovered from the incidence. Conclusion: The present work has documented the incidence and characteristic of ADR to Ayurvedic medicine in a typical Ayurveda hospital setup. This will help in developing various strategies for boosting pharmacovigilance in Ayurveda, thereby ensuring safer use of Ayurveda medicines. PMID:27011712

  18. Feasibility of Energy Medicine in a Community Teaching Hospital: An Exploratory Case Series

    PubMed Central

    Dufresne, Francois; Simmons, Bonnie; Vlachostergios, Panagiotis J.; Fleischner, Zachary; Joudeh, Ramsey; Blakeway, Jill

    2015-01-01

    Abstract Background: Energy medicine (EM) derives from the theory that a subtle biologic energy can be influenced for therapeutic effect. EM practitioners may be trained within a specific tradition or work solo. Few studies have investigated the feasibility of solo-practitioner EM in hospitals. Objective: This study investigated the feasibility of EM as provided by a solo practitioner in inpatient and emergent settings. Design: Feasibility study, including a prospective case series. Settings: Inpatient units and emergency department. Outcome measures: To investigate the feasibility of EM, acceptability, demand, implementation, and practicality were assessed. Short-term clinical changes were documented by treating physicians. Participants: Patients, employees, and family members were enrolled in the study only if study physicians expected no or slow improvement in specific symptoms. Those with secondary gains or who could not communicate perception of symptom change were excluded. Results: EM was found to have acceptability and demand, and implementation was smooth because study procedures dovetailed with conventional clinical practice. Practicality was acceptable within the study but was low upon further application of EM because of cost of program administration. Twenty-four of 32 patients requested relief from pain. Of 50 reports of pain, 5 (10%) showed no improvement; 4 (8%), slight improvement; 3 (6%), moderate improvement; and 38 (76%), marked improvement. Twenty-one patients had issues other than pain. Of 29 non–pain-related problems, 3 (10%) showed no, 2 (7%) showed slight, 1 (4%) showed moderate, and 23 (79%) showed marked improvement. Changes during EM sessions were usually immediate. Conclusions: This study successfully implemented EM provided by a solo practitioner in inpatient and emergent hospital settings and found that acceptability and demand justified its presence. Most patients experienced marked, immediate improvement of symptoms associated

  19. Case series of naturally acquired Plasmodium knowlesi infection in a tertiary teaching hospital.

    PubMed

    Azira, N M S; Zairi, N Z; Amry, A R; Zeehaida, M

    2012-09-01

    Plasmodium knowlesi is a simian malaria parasite and is recently recognized as the fifth malaria parasite infecting humans. Manifestation of the infection may resemble other infection particularly dengue fever leading to inappropriate management and delay in treatment. We reported three cases of naturally acquired P. knowlesi in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Clinical manifestations were quite similar in those cases. Microscopically, the diagnosis might be challenging. These cases were confirmed by polymerase chain reaction method which serves as a gold standard. PMID:23018503

  20. "The City of the Hospital": On Teaching Medical Students to Write.

    PubMed

    Hellerstein, David J

    2015-12-01

    "The City of the Hospital" is a creative nonfiction writing workshop for medical students, which the author has conducted annually since 2002. Part of the required preclinical Narrative Medicine curriculum at the Columbia University College of Physicians and Surgeons, this six-week intensive workshop includes close readings of literary works and in-class assignments that are then edited by fellow class members and rewritten for final submission. Over the years, students have produced a wide range of compelling essays and stories, and they describe the class as having an effect that lasts throughout their further medical training. This special section includes selected works from class members. PMID:26179365

  1. Optimal allocation of public water supply to the urban sectors of Enugu, Nigeria: a linear programming approach

    NASA Astrophysics Data System (ADS)

    Ezenwaji, Emma E.; Anyadike, Raymond N. C.; Igu, Nnaemeka I.

    2014-03-01

    Recent studies in water supply in Enugu urban area have observed that there is a persistent water supply shortage relative to demand. One of the strategies for achieving a good water supply under the circumstance is through efficient water allocation to consumers. The existing allocation system by the Enugu State Water Corporation is not achieving the desired goal, because it is not based on any scientific criteria. In this study, we have employed the linear programming modelling technique to optimise the allocation of 35,000,000 L of water produced daily by the State Water Corporation and supplied to the four sectors of the town. The result shows that the model allocated 27,470,000 L to the residential sector, 3,360,000 L to commercial, 3,120,000 L to industrial and 882,000 L to public institutions sectors leaving a balance of 168,000 L to be utilised in emergency situations. This allocation pattern departs sharply from the present management technique adopted by the corporation. It is then suggested that for urban water supply to be sustainable in the town, the corporation should rely on this technique for water supply.

  2. Intervention to reduce the use of unsafe abbreviations in a teaching hospital

    PubMed Central

    Alshaikh, Mashael; Mayet, Ahmed; Adam, Mansour; Ahmed, Yusuf; Aljadhey, Hisham

    2012-01-01

    Objectives To determine the effectiveness of a two-phase intervention designed to reduce the use of unsafe abbreviations. Methods An observational prospective study was conducted at the King Khalid University Hospital in Riyadh, Saudi Arabia during May–September 2009. A list of unsafe abbreviations was formulated based on the recommendations of the Institute for Safe Medication Practices. The first 7000 medication orders written at the beginning of each period were collected. Phase one of the intervention involved educating health care professionals about the dangers of using unsafe abbreviations. In the second phase of the intervention, a policy was approved that prohibited the use of unsafe abbreviations hospital-wide. Then, another educational campaign targeted toward prescribers was organized. Descriptive statistics are used in this paper to present the results. Results At baseline, we identified 1980 medication abbreviations used in 7000 medication orders (28.3%). Three months after phase one of the intervention, the number of abbreviations found in 7000 medication orders had decreased to 1489 (21.3%). Six months later, after phase two of the intervention, the number of abbreviations used had decreased to 710 (10%). During this phase, the use of all abbreviations had declined relative to the baseline and phase one use levels. The decrease in the use of abbreviations was statistically significant in all three periods (P < 0.001). Conclusion The implementation of a complex intervention program reduced the use of unsafe abbreviations by 65%. PMID:23960844

  3. Nosocomial infections by Klebsiella pneumoniae carbapenemase producing enterobacteria in a teaching hospital

    PubMed Central

    Seibert, Gabriela; Hörner, Rosmari; Meneghetti, Bettina Holzschuh; Righi, Roselene Alves; Forno, Nara Lucia Frasson Dal; Salla, Adenilde

    2014-01-01

    Objective To analyze the profile of patients with microorganisms resistant to carbapenems, and the prevalence of the enzyme Klebsiella pneumoniae carbapenemase in interobacteriaceae. Methods Retrospective descriptive study. From the isolation in bacteriological tests ordered by clinicians, we described the clinical and epidemiological characteristics of patients with enterobacteria resistants to carbapenems at a university hospital, between March and October 2013. Results We included 47 isolated patients in this study, all exhibiting resistance to carbapenems, including 9 patients who were confirmed as infected/colonized with K. pneumoniae carbapenemase. Isolation in tracheal aspirates (12; 25.5%) predominated. The resistance to ertapenem, meropenem, and imipenem was 91.5%, 83.0% and 80.0%, respectively. Aminoglycosides was the class of antimicrobials that showed the highest sensitivity, 91.5% being sensitive to amikacin and 57.4% to gentamicin. Conclusion The K. pneumoniae carbapenemase was an important agent in graun isotaling in hospital intection. The limited therapeutic options emphasize the need for rapid laboratory detection, as well as the implementation of measures to prevent and control the spread of these pathogens. PMID:25295446

  4. Knowledge and Performance about Nursing Ethic Codes from Nurses' and Patients' Perspective in Tabriz Teaching Hospitals, Iran

    PubMed Central

    Mohajjel-Aghdam, Alireza; Hassankhani, Hadi; Zamanzadeh, Vahid; Khameneh, Saied; Moghaddam, Sara

    2013-01-01

    Introduction: Nursing profession requires knowledge of ethics to guide performance. The nature of this profession necessitates ethical care more than routine care. Today, worldwide definition of professional ethic code has been done based on human and ethical issues in the communication between nurse and patient. To improve all dimensions of nursing, we need to respect ethic codes. The aim of this study is to assess knowledge and performance about nursing ethic codes from nurses' and patients' perspective. Methods: A descriptive study Conducted upon 345 nurses and 500 inpatients in six teaching hospitals of Tabriz, 2012. To investigate nurses' knowledge and performance, data were collected by using structured questionnaires. Statistical analysis was done using descriptive and analytic statistics, independent t-test and ANOVA and Pearson correlation coefficient, in SPSS13. Results: Most of the nurses were female, married, educated at BS degree and 86.4% of them were aware of Ethic codes also 91.9% of nurses and 41.8% of patients represented nurses respect ethic codes. Nurses' and patients' perspective about ethic codes differed significantly. Significant relationship was found between nurses' knowledge of ethic codes and job satisfaction and complaint of ethical performance. Conclusion: According to the results, consideration to teaching ethic codes in nursing curriculum for student and continuous education for staff is proposed, on the other hand recognizing failures of the health system, optimizing nursing care, attempt to inform patients about Nursing ethic codes, promote patient rights and achieve patient satisfaction can minimize the differences between the two perspectives. PMID:25276730

  5. Amniotic band syndrom at Bobo Dioulasso university teaching hospital (Burkina-Faso): about two cases

    PubMed Central

    Zaré, Cyprien; Traoré, Ibrahim Alain; Dakouré, Patrick Wendpuoiré Hamed; Gandéma, Salif; Sano, Bakary Gustave; Bénao, Lazard Bouma; Belemlilga, Hermann; Yabré, Nassirou

    2015-01-01

    Amniotic band syndrome is a rare congenital disorder. The authors report the first cases documented at Souro Sanou University Hospital in Bobo-Dioulasso (CHUSS) in 2 male new borns. The malformations found at birth, were worn only on limbs and were in the form of skin furrow necking with a major lymphedema downstream. In both cases, the constriction furrow at member pelvic was associated with a club foot and a pseudosyndactyly in one case. Surgical treatment consisted of a section of the constrictor ring and a Z-plasty. The functional outcome was satisfactory with the acquisition of a plantar support for both children. Through these two observations, epidemiological, diagnostic, and particularities of the management of this condition are discussed in the Burkina-Faso. PMID:26918082

  6. Interest of including trauma photography in the picture archiving and communication system of a teaching hospital.

    PubMed

    Bronsard, N; Chignon Sicard, B; Amoretti, N; Rottier, H; Ertz, P; de Peretti, F

    2015-05-01

    Digital imaging is a daily practice in traumatology. Such photographs should remain confidential. However, there is a need for objectivity concerning the circumstances and clinical follow-up for trauma patients. This paper describes how to conserve these photographs within the picture archiving and communication system (PACS) safely as regards identity and confidentiality. A computer converts the photographs into DICOM files. The DICOM image is associated to a reconciliation layer, validated by the physician in charge, and then included in the hospital PACS. This improves transmission from one medical team to another, both initially and after the accident if an expert medical opinion is required. The literature has demonstrated the value of photographs in modern medicine, but the technical and legal challenges are many. They enhance the computerized medical records. Identification, confidentiality and integration in the PACS are obstacles that we have now overcome. PMID:25817905

  7. A systematic comparison of teaching hospital and remote-site clinical education.

    PubMed

    Friedman, C P; Stritter, F T; Talbert, L M

    1978-07-01

    This paper present a methodology for examining activities of medical students on multisite clinical clerkships to determine whether differences exist in the educational experience offered at various sites. Five criterion variables are explored: distribution of student activities, type or class of clinical conditions encountered by students, degree of "esoterism" of those conditions, type of student role, and flexibility of student role. A format for data collection, employing a specially designed activity recording pad, was developed as part of the study. Application of this method to a clerkship in obstetrics and gynecology documents the existence of systematic differences in the educational experiences offered at different sites, particularly with regard to type of activities undertaken and conditions encountered. Most notably, the results suggest that it is fallacious to dichotomize clerkship sites as "academic" or "community" based. It is found that community hospitals themselves can differ markedly and offer an experience paralleling that of the academic referral center. PMID:671498

  8. Imported Malaria over Fifteen Years in an Inner City Teaching Hospital of Washington DC

    PubMed Central

    Yeruva, Sri Lakshmi Hyndavi; Sinha, Archana; Sarraf-Yazdy, Mariam; Gajjala, Jhansi

    2016-01-01

    As endemic malaria is not commonly seen in the United States, most of the cases diagnosed and reported are associated with travel to and from the endemic places of malaria. As the number of imported cases of malaria has been increasing since 1973, it is important to look into these cases to study the morbidity and mortality associated with this disease in the United States. In this study, we would like to share our experience in diagnosing and treating these patients at our institution. We did a retrospective chart review of 37 cases with a documented history of imported malaria from 1998 to 2012. Among them, 16 patients had complicated malaria during that study period, with a mean length of hospital stay of 3.5 days. Most common place of travel was Africa, and chemoprophylaxis was taken by only 11% of patients. Travel history plays a critical role in suspecting the diagnosis and in initiating prompt treatment. PMID:27417079

  9. Imported Malaria over Fifteen Years in an Inner City Teaching Hospital of Washington DC.

    PubMed

    Yeruva, Sri Lakshmi Hyndavi; Sinha, Archana; Sarraf-Yazdy, Mariam; Gajjala, Jhansi

    2016-06-01

    As endemic malaria is not commonly seen in the United States, most of the cases diagnosed and reported are associated with travel to and from the endemic places of malaria. As the number of imported cases of malaria has been increasing since 1973, it is important to look into these cases to study the morbidity and mortality associated with this disease in the United States. In this study, we would like to share our experience in diagnosing and treating these patients at our institution. We did a retrospective chart review of 37 cases with a documented history of imported malaria from 1998 to 2012. Among them, 16 patients had complicated malaria during that study period, with a mean length of hospital stay of 3.5 days. Most common place of travel was Africa, and chemoprophylaxis was taken by only 11% of patients. Travel history plays a critical role in suspecting the diagnosis and in initiating prompt treatment. PMID:27417079

  10. Cost of providing inpatient burn care in a tertiary, teaching, hospital of North India.

    PubMed

    Ahuja, Rajeev B; Goswami, Prasenjit

    2013-06-01

    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

  11. Outpatient Waiting Time in Health Services and Teaching Hospitals: A Case Study in Iran

    PubMed Central

    Mohebbifar, Rafat; Hasanpoor, Edris; Mohseni, Mohammad; Sokhanvar, Mobin; Khosravizadeh, Omid; Isfahani, Haleh Mousavi

    2014-01-01

    Background: One of the most important indexes of the health care quality is patient’s satisfaction and it takes place only when there is a process based on management. One of these processes in the health care organizations is the appropriate management of the waiting time process. The aim of this study is the systematic analyzing of the outpatient waiting time. Methods: This descriptive cross sectional study conducted in 2011 is an applicable study performed in the educational and health care hospitals of one of the medical universities located in the north west of Iran. Since the distributions of outpatients in all the months were equal, sampling stage was used. 160 outpatients were studied and the data was analyzed by using SPSS software. Results: Results of the study showed that the waiting time for the outpatients of ophthalmology clinic with an average of 245 minutes for each patient allocated the maximum time among the other clinics for itself. Orthopedic clinic had the minimal waiting time including an average of 77 minutes per patient. The total average waiting time for each patient in the educational hospitals under this study was about 161 minutes. Conclusion: by applying some models, we can reduce the waiting time especially in the realm of time and space before the admission to the examination room. Utilizing the models including the one before admission, electronic visit systems via internet, a process model, six sigma model, queuing theory model and FIFO model, are the components of the intervention that reduces the outpatient waiting time. PMID:24373277

  12. Comparing the perspectives of managers and employees of teaching hospitals about job motivation.

    PubMed

    Mohebbifar, Rafat; Zakaria Kiaei, Mohammad; Khosravizadeh, Omid; Mohseni, Mohammad

    2014-11-01

    Recognition of career motivators and understanding of managers and employees in prioritizing them, in order to plan incentives for this understanding, can play an important role in increasing productivity and creating harmony between the goals of the organization and staff. This study was done to survey the importance of career motivating factors from perspective of employees and managers in educational hospitals of Iran. In this study 269 from a total of 1843 employees of educational hospitals in Qazvin province of Iran were selected through Quota-Random sampling and studied along with all 49 Managers. Lawrence Lindale questionnaire with 10 factors where used in order to determine motivational priorities. The results indicated that among the 10 studied motivational factors, from employees' viewpoint; "Good wages", "Good Working Conditions" and "Job Security" have the greatest roles in motivating employees. In the context of perspective agreement amongst employees and managers, the results showed 20 percent agreement. In this study, results of "Independent T" test showed a significant difference in comparison, between prioritizing employees' view and prediction of managers in the factors of "Job Security" (p = 0/031) and "Interesting Work" (p = 0/001). With respect to increase disagreement in the views of managers and employees as compared to previous studies, Managers need to pay more attention to cognition of motivational factors and make their viewpoints closer to actual motivational need of their employees. Attention to this fact can be a great help to the growth and productivity of the organization, making the organizational and individual goals closer and also keeping managers safe from execution of constant and undue motivational patterns. PMID:25363113

  13. Comparing the Perspectives of Managers and Employees of Teaching Hospitals About Job Motivation

    PubMed Central

    Mohebbifar, Rafat; Kiaei, Mohammad Zakaria; Khosravizadeh, Omid; Mohseni, Mohammad

    2014-01-01

    Recognition of career motivators and understanding of managers and employees in prioritizing them, in order to plan incentives for this understanding, can play an important role in increasing productivity and creating harmony between the goals of the organization and staff. This study was done to survey the importance of career motivating factors from perspective of employees and managers in educational hospitals of Iran. In this study 269 from a total of 1843 employees of educational hospitals in Qazvin province of Iran were selected through Quota-Random sampling and studied along with all 49 Managers. Lawrence Lindale questionnaire with 10 factors where used in order to determine motivational priorities. The results indicated that among the 10 studied motivational factors, from employees’ viewpoint; “Good wages”, “Good Working Conditions” and “Job Security” have the greatest roles in motivating employees. In the context of perspective agreement amongst employees and managers, the results showed 20 percent agreement. In this study, results of “Independent T” test showed a significant difference in comparison, between prioritizing employees’ view and prediction of managers in the factors of “Job Security” (p = 0.031) and “Interesting Work” (p = 0.001). With respect to increase disagreement in the views of managers and employees as compared to previous studies, Managers need to pay more attention to cognition of motivational factors and make their viewpoints closer to actual motivational need of their employees. Attention to this fact can be a great help to the growth and productivity of the organization, making the organizational and individual goals closer and also keeping managers safe from execution of constant and undue motivational patterns. PMID:25363113

  14. The barriers to the application of the research findings from the nurses’ perspective: A case study in a teaching hospital

    PubMed Central

    Bahadori, Mohammadkarim; Raadabadi, Mehdi; Ravangard, Ramin; Mahaki, Behzad

    2016-01-01

    Background: The application of the nursing research findings is one of the most important indicators of development in the nursing profession, which leads to providing efficient and effective patient care and improving the quality of nursing care. According the result of some studies, transferring the evidence-based findings to the nurses’ practice and education in the world has been slow and sometimes unsuccessful. This study aimed to investigate the most important barriers to the application of research findings from the nurses’ perspective. Materials and Methods: This cross-sectional study conducted on a sample of 210 nurses in a teaching hospital in Tehran in 2013. The data were collected using a researcher-made questionnaire consisted of two parts, including items about nurses’ demographic characteristics and 30 items to identify the most important barriers to the application of research findings from the studied nurses’ perspective. Results: “The lack of sufficient time for reading the studies,” “the lack of sufficient time to implement the new ideas,” “the lack of adequate facilities to implement the ideas,” “nurses’ little interest in conducting studies,” and “the lack of authority to change the methods and patterns of care” with, respectively, 85%, 84.6%, 83.8%, 83.4%, and 80.5% agreement with the existence of barriers were the most barriers to application of research findings from the studied nurses’ perspective. Conclusion: The lack of time was the most important barrier to the use of research findings from the perspective of studied nurses. Therefore, some effective strategies should be used by hospital managers and health policy makers to overcome this barrier. Some of these strategies can be employing new personnel and hiring skilled and efficient human resources in order to decrease the workload of nurses, organizing the nurses’ work shifts, providing right balance between patients and nurses in the wards, etc. PMID

  15. Clinical and Microbiological Characteristics of Heteroresistant and Vancomycin-Intermediate Staphylococcus aureus from Bloodstream Infections in a Brazilian Teaching Hospital

    PubMed Central

    da Costa, Thaina Miranda; Morgado, Priscylla Guimarães Migueres; Cavalcante, Fernanda Sampaio; Damasco, Andreia Paredes; Nouér, Simone Aranha; dos Santos, Kátia Regina Netto

    2016-01-01

    This study analyzed clinical and microbiological characteristics of heteroresistant (hVISA) and vancomycin-intermediate Staphylococcus aureus (VISA) from bloodstream infections (BSI) in a Brazilian teaching hospital, between 2011 and 2013. Minimum inhibitory concentrations (MIC) of antimicrobials were determined by broth microdilution method and SCCmec was detected by PCR. Isolates with a vancomycin MIC ≥ 2mg/L were cultured on BHI agar with 3, 4 or 6 mg/L (BHIa3, BHIa4 or BHIa6) of vancomycin and BHIa4 with casein (BHIa4ca). Macromethod Etest® and Etest® Glicopeptides Resistance Detection were also used. VISA and hVISA isolates were confirmed by the population analysis profile then typed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. Medical data from the patients were obtained from their medical records. Among 110 consecutive isolates, 31 (28%) were MRSA and carried the SCCmec type II (15 isolates) or IV (16 isolates). Vancomycin MIC50 and MIC90 were 1 and 2 mg/L, respectively. MRSA isolates had increased non-susceptibility to daptomycin (p = 0.0003). Six (5%) isolates were VISA, four of which were MRSA, three SCCmec type II/USA100/ST5 and one type IV/USA800/ST3192. One MRSA SCCmec II isolate grew on agar BHIa3, BHIa4 and BHIa4ca, and it was confirmed as hVISA. Among the six VISA isolates, five (83%) grew on BHIa3 and three (50%) on BHI4ca. Four of the six VISA isolates and the one hVISA isolate were from patients who had undergone dialysis. Thus, a possible dissemination of the SCCmec II/USA100/ST5 lineage may have occurred in the hospital comprising the VISA, hVISA and daptomycin non-susceptible S. aureus Brazilian isolates from health care associated bloodstream infections. PMID:27575698

  16. Phenotypic and molecular characteristics of carbapenem-non-susceptible Enterobacteriaceae from a teaching hospital in Wenzhou, southern China.

    PubMed

    Zhou, Tieli; Zhang, Xiaolei; Guo, Meiyan; Ye, Jianbo; Lu, Yamin; Bao, Qiyu; Chi, Wenjie

    2013-01-01

    Carbapenem resistance in Enterobacteriaceae is increasing and has become a matter of great concern. The aim of this study was to characterize carbapenem-non-susceptible Enterobacteriaceae from a teaching hospital. A total of 49 carbapenem-non-susceptible Enterobacteriaceae clinical isolates recovered in 2007-2010 from the First Affiliated Hospital of Wenzhou Medical College were analyzed by antimicrobial susceptibility testing. The carbapenemase phenotype, outer membrane protein profiles, and clonal relatedness were investigated using the modified Hodge test, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and pulsed-field gel electrophoresis (PFGE). Multilocus sequence typing (MLST) of Klebsiella pneumoniae was also performed. β-Lactamase genes were examined by PCR and sequencing, and the transferability of carbapenemase genes was determined by a conjugation experiment. The rates of imipenem, meropenem, and ertapenem resistance were 59.2%, 40.8%, and 96.0%, respectively. Thirty isolates exhibited carbapenemase activity, and 32 isolates carried carbapenemase genes. Furthermore, 10 and 9 clinical isolates posessed AmpC β-lactamase and extended-spectrum β-lactamase (ESBL) genes, respectively. Eight of 32 carbapenemase-producing isolates were proved to be carried by conjugative plasmids, and there was porin loss in 34.7% (17/49) of the isolates. PFGE analysis demonstrated that 9 KPC-2-producing Serratia marcescens belonged to a clonal strain, suggesting the clonal dissemination of these KPC-2-bearing isolates among different wards. The MLST of K. pneumoniae revealed that two KPC-2 producers were ST11. This study suggests that KPC-2-type carbapenemase is the main contributor to carbapenems resistance in carbapenemase-producing Enterobacteriaceae, and that ESBL, AmpC β-lactamase overproduction, and porin loss contribute to the resistance level among these isolates; in carbapenemase-non-producing Enterobacteriaceae, ESBL, AmpC enzyme, and porin loss

  17. Medication errors in an internal intensive care unit of a large teaching hospital: a direct observation study.

    PubMed

    Vazin, Afsaneh; Delfani, Saadat

    2012-01-01

    Medication errors account for about 78% of serious medical errors in intensive care unit (ICU). So far no study has been performed in Iran to evaluate all type of possible medication errors in ICU. Therefore the objective of this study was to reveal the frequency, type and consequences of all type of errors in an ICU of a large teaching hospital. The prospective observational study was conducted in an 11 bed internal ICU of a university hospital in Shiraz. In each shift all processes that were performed on one selected patient was observed and recorded by a trained pharmacist. Observer would intervene only if medication error would cause substantial harm. The data was evaluated and then were entered in a form that was designed for this purpose. The study continued for 38 shifts. During this period, a total of 442 errors per 5785 opportunities for errors (7.6%) occurred. Of those, there were 9.8% administration errors, 6.8% prescribing errors, 3.3% transcription errors and, 2.3% dispensing errors. Totally 45 interventions were made, 40% of interventions result in the correction of errors. The most common causes of errors were observed to be: rule violations, slip and memory lapses and lack of drug knowledge. According to our results, the rate of errors is alarming and requires implementation of a serious solution. Since our system lacks a well-organize detection and reporting mechanism, there is no means for preventing errors in the first place. Hence, as the first step we must implement a system where errors are routinely detected and reported. PMID:22837122

  18. Reptiles with dermatological lesions: a retrospective study of 301 cases at two university veterinary teaching hospitals (1992-2008).

    PubMed

    White, Stephen D; Bourdeau, Patrick; Bruet, Vincent; Kass, Philip H; Tell, Lisa; Hawkins, Michelle G

    2011-04-01

    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

  19. Clinical and Microbiological Characteristics of Heteroresistant and Vancomycin-Intermediate Staphylococcus aureus from Bloodstream Infections in a Brazilian Teaching Hospital.

    PubMed

    da Costa, Thaina Miranda; Morgado, Priscylla Guimarães Migueres; Cavalcante, Fernanda Sampaio; Damasco, Andreia Paredes; Nouér, Simone Aranha; Dos Santos, Kátia Regina Netto

    2016-01-01

    This study analyzed clinical and microbiological characteristics of heteroresistant (hVISA) and vancomycin-intermediate Staphylococcus aureus (VISA) from bloodstream infections (BSI) in a Brazilian teaching hospital, between 2011 and 2013. Minimum inhibitory concentrations (MIC) of antimicrobials were determined by broth microdilution method and SCCmec was detected by PCR. Isolates with a vancomycin MIC ≥ 2mg/L were cultured on BHI agar with 3, 4 or 6 mg/L (BHIa3, BHIa4 or BHIa6) of vancomycin and BHIa4 with casein (BHIa4ca). Macromethod Etest® and Etest® Glicopeptides Resistance Detection were also used. VISA and hVISA isolates were confirmed by the population analysis profile then typed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. Medical data from the patients were obtained from their medical records. Among 110 consecutive isolates, 31 (28%) were MRSA and carried the SCCmec type II (15 isolates) or IV (16 isolates). Vancomycin MIC50 and MIC90 were 1 and 2 mg/L, respectively. MRSA isolates had increased non-susceptibility to daptomycin (p = 0.0003). Six (5%) isolates were VISA, four of which were MRSA, three SCCmec type II/USA100/ST5 and one type IV/USA800/ST3192. One MRSA SCCmec II isolate grew on agar BHIa3, BHIa4 and BHIa4ca, and it was confirmed as hVISA. Among the six VISA isolates, five (83%) grew on BHIa3 and three (50%) on BHI4ca. Four of the six VISA isolates and the one hVISA isolate were from patients who had undergone dialysis. Thus, a possible dissemination of the SCCmec II/USA100/ST5 lineage may have occurred in the hospital comprising the VISA, hVISA and daptomycin non-susceptible S. aureus Brazilian isolates from health care associated bloodstream infections. PMID:27575698

  20. Clinical, Microbiological, and Genetic Characteristics of Heteroresistant Vancomycin-Intermediate Staphylococcus aureus Bacteremia in a Teaching Hospital

    PubMed Central

    Di Gregorio, Sabrina; Perazzi, Beatriz; Ordoñez, Andrea Martinez; De Gregorio, Stella; Foccoli, Monica; Lasala, María Beatriz; García, Susana; Vay, Carlos; Famiglietti, Angela

    2015-01-01

    The emergence of vancomycin intermediate Staphylococcus aureus (VISA) and heterogeneous VISA (hVISA) is of major concern worldwide. Our objective was to investigate the prevalence, phenotypic and molecular features of hVISA strains isolated from bacteremic patients and to determine the clinical significance of the hVISA phenotype in patients with bacteremia. A total of 104 S. aureus blood isolates were collected from a teaching hospital of Argentina between August 2009 and November 2010. No VISA isolate was recovered, and 3 out of 92 patients (3.3%) were infected with hVISA, 2 of them methicillin-resistant S. aureus (MRSA) (4.5% of MRSA). Macro Etest and prediffusion method detected 3/3 and 2/3 hVISA respectively. Considering the type of bacteremia, the three cases were distributed as follows: two patients had suffered multiple episodes of bacteremia (both hVISA strains recovered in the second episode), while only one patient had suffered a single episode of bacteremia with hVISA infection. MRSA bloodstream isolates exhibiting the hVISA phenotype were related to HA-MRSA Cordobes clone (ST5-SCCmec I-spa t149) and MRSA Argentinean pediatric clone (ST100-SCCmec IVNV-spa t002), but not to CA-MRSA-ST30-SCCmec IV-spa t019 clone that was one of the most frequent in our country. Although still relatively infrequent in our hospital, hVISA strains were significantly associated with multiple episodes of bacteremia (p=0.037) and genetically unrelated. PMID:25535825

  1. A detailed analysis of theatre training activity in a UK teaching hospital.

    PubMed

    McIndoe, A K; Underwood, S M

    2000-05-01

    We examined the placement of anaesthetists in our department over a 2 yr period. Data were collected from an in-theatre system to provide details of caseload and supervision for 34,856 operations. There was wide variation between anaesthetic sub-specialties with overall supervision levels of 35% of cases for senior house officers (SHOs) and 32% for specialist registrars (SpRs). The consultant data showed the size and areas of teaching reserve in the department. We then examined individual logbooks in order to validate our data, and departmental rotas to put these data into perspective with previous attempts to quantify trainee supervision. Supervision data derived from the rota allocations showed that 86% of SHO lists and 62% of SpR lists were scheduled to be supervised. This study has described our training activity and facilitated departmental changes, as well as highlighting the need for great care in interpreting trainee supervision data acquired from different sources, particularly when comparisons are being made. PMID:10844835

  2. Pattern of Adverse Drug Reactions Reported with Cardiovascular Drugs in a Tertiary Care Teaching Hospital

    PubMed Central

    Palaniappan, Muthiah; George, Melvin; Subramaniyan, Ganesan; Dkhar, Steven Aibor; Pillai, Ajith Ananthakrishna; Jayaraman, Balachander; Chandrasekaran, Adithan

    2015-01-01

    Background Cardiovascular diseases (CVD) are one of the leading causes of non-communicable disease related deaths globally. Patients with cardiovascular diseases are often prescribed multiple drugs and have higher risk for developing more adverse drug reactions due to polypharmacy. Aim To evaluate the pattern of adverse drug reactions reported with cardiovascular drugs in an adverse drug reaction monitoring centre (AMC) of a tertiary care hospital. Settings and Design Adverse drug reactions related to cardiovascular drugs reported to an AMC of a tertiary care hospital were included in this prospective observational study. Materials and Methods All cardiovascular drugs related adverse drug reactions (ADRs) received in AMC through spontaneous reporting system and active surveillance method from January 2011 to March 2013 were analysed for demographic profile, ADR pattern, severity and causality assessment. Statistical Analysis used The study used descriptive statistics and the values were expressed in numbers and percentages. Results During the study period, a total of 463 ADRs were reported from 397 patients which included 319 males (80.4%) and 78 females (19.6%). The cardiovascular drug related reports constituted 18.1% of the total 2188 ADR reports. In this study, the most common ADRs observed were cough (17.3%), gastritis (7.5%) and fatigue (6.5%). Assessment of ADRs using WHO-causality scale revealed that 62% of ADRs were possible, 28.2% certain and 6.8% probable. As per Naranjo’s scale most of the reports were possible (68.8%) followed by probable (29.7%). According to Hartwig severity scale majority of the reports were mild (95%) followed by moderate (4.5%). A system wise classification of ADRs showed that gastrointestinal system (20.7%) related reactions were the most frequently observed adverse reactions followed by respiratory system (18.4%) related adverse effects. From the reported ADRs, the drugs most commonly associated with ADRs were found to be

  3. Cut throat injuries at a university teaching hospital in northwestern Tanzania: a review of 98 cases

    PubMed Central

    2014-01-01

    Background Cut throat injuries though rarely reported in literature pose a great therapeutic challenge because multiple vital structures are vulnerable to injuries in the small, confined unprotected area. A sudden increase in the number of cut throat patients in our centre in recent years prompted the authors to analyze this problem. This study was conducted in our local setting to describe the etiology, patterns and treatment outcome of these injuries. Methods This was a combined retrospective and prospective study of cut throat injury patients who were managed at Bugando Medical Centre between February 2009 and January 2013. Statistical data analysis was done using SPSS software version 17.0. Results A total of 98 patients with cut throat injuries were studied. Males outnumbered females by a ratio of 2.4: 1. The median age of patients was 26 years (range 8 to 78 years). Majority of patients (79.6%) had no employment and most of them (65.3%) came from rural community. Homicide was the commonest (55.1%) cause, followed by suicidal attempts (34.7%) and accidental (10.2%) injuries. Interpersonal conflict (24.4%) was the most common motivating factor for homicidal injury whereas psychiatric illness (16.2%) and road traffic accidents (9.2%) were the most frequent motivating factors of suicidal attempt and accidental injuries respectively. The majority of injuries were in Zone II accounting for 65.3% of cases and most of them had laryngeal (57.1%) injury. Surgical debridement, laryngeal/hypopharynx repair and tracheostomy were the most common surgical procedures performed in 93.9%, 73.5% and 70.4% of patients respectively. Postoperative complication rate was 57.1%, the commonest being surgical site infections in 28.1% of patients and it was significantly associated with late presentation and anatomical zones (P < 0.001). The overall median duration of hospitalization was 12 days. Patients who had postoperative complications stayed longer in the hospital and this was

  4. A Survey on the Users’ Satisfaction with the Hospital Information Systems (HISs) based on DeLone and McLean’s Model in the Medical-Teaching Hospitals in Isfahan City

    PubMed Central

    Saghaeiannejad-Isfahani, Sakineh; Jahanbakhsh, Maryam; Habibi, Mahboobeh; Mirzaeian, Razieh; Nasirian, Mansoreh; Rad, Javad Sharifi

    2014-01-01

    Background and purpose: The user’s satisfaction with information system in fact denotes the extent the user is satisfied with the system’s achievement in fulfilling his/her information requirements. This study tries to explore the users’ satisfaction with hospital information systems (HISs) based on DeLone and McLean’s model focusing on the medical-teaching hospitals of Isfahan city. Methodology: This study which was applied and descriptive-analytical in nature was carried out in the medical-teaching hospitals of Isfahan city in 2009. Research population consisted of the system users from which a sample was selected using random sampling method. The size of the sample was 228. Data collection instrument was a self-developed questionnaire produced based on the satisfaction criterion in the DeLone and McLean’s model. Its content validity was assessed based on the opinions given by the computer sciences professionals with its estimated Cronbach’s alpha found to be 92.2%. The data were analyzed using SPSS software. Findings: As the findings of the study showed, the differences among the mean scores obtained for the satisfaction with different kinds of HISs in use in the hospitals were statistically significant (p value≤0.05). Generally, Kowsar System (old version) and Pouya Samaneh Diva system gained the highest and lowest mean scores for the criterion in question, respectively. The overall mean score for the satisfaction was 54.6% for different types of systems and 55.6% among the hospitals. Conclusion: Given the findings of the study, it can be argued that based on the used model, the level of users’ satisfaction with the systems in question was relatively good. However, to achieve the total optimum condition, when designing the system, the factors affecting the enhancement of the users’ satisfaction and the type of hospital activity and specialty must be given special consideration. PMID:25132711

  5. Neuroinfection survey at a neurological ward in a Brazilian tertiary teaching hospital

    PubMed Central

    Marchiori, Paulo E; Lino, Angelina M M; Machado, Luis R; Pedalini, Livia M; Boulos, Marcos; Scaff, Milberto

    2011-01-01

    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. PMID:21808869

  6. Characterization of carbapenem-resistant Acinetobacter baumannii isolates in a Chinese teaching hospital

    PubMed Central

    Chang, Yaowen; Luan, Guangxin; Xu, Ying; Wang, Yanhong; Shen, Min; Zhang, Chi; Zheng, Wei; Huang, Jinwei; Yang, Jingni; Jia, Xu; Ling, Baodong

    2015-01-01

    Carbapenem-resistant Acinetobacter baumannii (CRAB) presents a serious therapeutic and infection control challenge. In this study, we investigated the epidemiological and molecular differences of CRAB and the threatening factors for contributing to increased CRAB infections at a hospital in western China. A total of 110 clinical isolates of A. baumannii, collected in a recent 2-year period, were tested for carbapenem antibiotic susceptibility, followed by a molecular analysis of carbapenemase genes. Genetic relatedness of the isolates was characterized by multilocus sequence typing. Sixty-seven of the 110 isolates (60.9%) were resistant to carbapenems, 80.60% (54/67) of which carried the blaOXA-23 gene. Most of these CRAB isolates (77.62%) were classified as clone complex 92 (CC92), and sequence type (ST) 92 was the most prevalent STs, followed by ST195, ST136, ST843, and ST75. One CRAB isolate of ST195 harbored plasmid pAB52 from a Chinese patient without travel history. This plasmid contains toxin–antitoxin elements related to adaptation for growth, which might have emerged as a common vehicle indirectly mediating the spread of OXA-23 in CRAB. Thus, CC92 A. baumannii carrying OXA-23 is a major drug-resistant strain spreading in China. Our findings indicate that rational application of antibiotics is indispensable for minimizing widespread of drug resistance. PMID:26388854

  7. Denture care practice among patients attending the prosthetic clinic in a Nigerian teaching hospital

    PubMed Central

    Ogunrinde, Tunde Joshua; Opeodu, Olanrewaju Ige

    2015-01-01

    Background: Good denture care practice by individuals using Removable Partial Denture (RPD) is an important component of oral health measures. An assessment of denture care practice of such individuals by dental care practitioners is necessary. Objective: To evaluate the denture care practice among prosthetics patients attending a tertiary Hospital Dental Centre in Nigeria. Materials and Methods: An interviewer administered questionnaire was used to obtain information from RPD wearers that were willing to participate. The questionnaire assessed among other things, patients’ bio-data, frequency, techniques and device used for cleaning their dentures. Data was analyzed using Chi-square test (P < 0.05). Results: One hundred and ninety eight denture wearers consisting of 100 (50.5%) males and 98 (49.5%) females participated in the study. Majority 110 (55.6%) cleaned their dentures once daily and toothbrush and pastes were used by 105 (53%) of the participants. More than 70% of the respondents removed their dentures at night. One hundred and sixty-six (83.8%) visited the dentist only when they needed treatment. There was a statistical significant relationship between frequency and technique of cleaning denture, and denture cleanliness (P < 0.05). Conclusion: This study shows that once daily cleaning of dentures and cleaning the denture with rest of the teeth are ineffective in prevention of plaque accumulation. PMID:26229229

  8. Modified supine versus prone percutaneous nephrolithotomy: Surgical outcomes from a tertiary teaching hospital

    PubMed Central

    Jones, Madeleine Nina; Cetti, Richard; Newell, Bradley; Chu, Kevin; Harper, Matthew; Kourambas, John; McCahy, Philip

    2016-01-01

    Purpose The traditional prone positioning of percutaneous nephrolithotomy (PCNL) is associated with various anesthetic and logistic difficulties. We aimed to compare the surgical outcomes of PCNLs performed using our modified supine position with those performed in the standard prone position. Materials and Methods A prospective group of 236 renal units (224 patients) undergoing PCNL were included in this 2 site study: 160 were performed in the modified supine position were compared with 76 undergoing PCNL in the prone position. The outcomes of radiation dose, radiation time, stone free rate, body mass index (BMI), stone size, operative time, length of stay (LOS), in hospital and complications were compared. Chi-square and t-tests were used. Results There were no significant differences in mean radiation time, radiation dose or stone size between the modified supine and prone groups. The supine group had a higher mean BMI (31 kg/m2 vs. 28 kg/m2, p=0.03), shorter mean surgical time (93 minutes vs. 123 minutes, p<0.001), shorter mean LOS (2 days vs. 3 days, p=0.005) and higher stone free rate (70% vs. 50%, p=0.005). There were no differences in septic or bleeding complications but the prone group had a higher rate of overall complications. Conclusions Modified supine PCNL has significantly lower operative time, shorter LOS and higher stone-free rate compared with prone in our series, while remaining a safe procedure. PMID:27437536

  9. Molecular epidemiology of Acinetobacter baumannii in central intensive care unit in Kosova Teaching Hospital.

    PubMed

    Raka, Lul; Kalenć, Smilja; Bosnjak, Zrinka; Budimir, Ana; Katić, Stjepan; Sijak, Dubravko; Mulliqi-Osmani, Gjyle; Zoutman, Dick; Jaka, Arbëresha

    2009-12-01

    Infections caused by bacteria of genus Acinetobacter pose a significant health care challenge worldwide. Information on molecular epidemiological investigation of outbreaks caused by Acinetobacter species in Kosova is lacking. The present investigation was carried out to enlight molecular epidemiology of Acinetobacter baumannii in the Central Intensive Care Unit (CICU) of a University hospital in Kosova using pulse field gel electrophoresis (PFGE). During March - July 2006, A. baumannii was isolated from 30 patients, of whom 22 were infected and 8 were colonised. Twenty patients had ventilator-associated pneumonia, one patient had meningitis, and two had coinfection with bloodstream infection and surgical site infection. The most common diagnoses upon admission to the ICU were politrauma and cerebral hemorrhage. Bacterial isolates were most frequently recovered from endotracheal aspirate (86.7%). First isolation occurred, on average, on day 8 following admission (range 1-26 days). Genotype analysis of A. baumannii isolates identified nine distinct PFGE patterns, with predominance of PFGE clone E represented by isolates from 9 patients. Eight strains were resistant to carbapenems. The genetic relatedness of Acinetobacter baumannii was high, indicating cross-transmission within the ICU setting. These results emphasize the need for measures to prevent nosocomial transmission of A. baumannii in ICU. PMID:20464330

  10. Epidemiology and antifungal susceptibilities of yeasts causing vulvovaginitis in a teaching hospital.

    PubMed

    Gamarra, Soledad; Morano, Susana; Dudiuk, Catiana; Mancilla, Estefanía; Nardin, María Elena; de Los Angeles Méndez, Emilce; Garcia-Effron, Guillermo

    2014-10-01

    Vulvovaginal candidiasis is one of the most common mycosis. However, the information about antifungal susceptibilities of the yeasts causing this infection is scant. We studied 121 yeasts isolated from 118 patients with vulvovaginal candidiasis. The isolates were identified by phenotypic and molecular methods, including four phenotypic methods described to differentiate Candida albicans from C. dubliniensis. Antifungal susceptibility testing was performed according to CLSI documents M27A3 and M27S4 using the drugs available as treatment option in the hospital. Diabetes, any antibacterial and amoxicillin treatment were statistically linked with vulvovaginal candidiasis, while oral contraceptives were not considered a risk factor. Previous azole-based over-the-counter antifungal treatment was statistically associated with non-C.albicans yeasts infections. The most common isolated yeast species was C. albicans (85.2 %) followed by C. glabrata (5 %), Saccharomyces cerevisiae (3.3 %), and C. dubliniensis (2.5 %). Fluconazole- and itraconazole-reduced susceptibility was observed in ten and in only one C. albicans strains, respectively. All the C. glabrata isolates showed low fluconazole MICs. Clotrimazole showed excellent potency against all but seven isolates (three C. glabrata, two S. cerevisiae, one C. albicans and one Picchia anomala). Any of the strains showed nystatin reduced susceptibility. On the other hand, terbinafine was the less potent drug. Antifungal resistance is still a rare phenomenon supporting the use of azole antifungals as empirical treatment of vulvovaginal candidiasis. PMID:25005365

  11. Pattern of hand injuries in children and adolescents in a teaching hospital in Abha, Saudi Arabia.

    PubMed

    Mirdad, T

    2001-03-01

    Over a seven-year period, 136 children and adolescents with hand injuries were prospectively studied at the Accident and Emergency Department of Asir Central Hospital, Abha, Kingdom of Saudi Arabia, to determine the pattern of hand injury. The male:female ratio was 1.7:1.0, both left and right hands were relatively equally injured. The age group ranged from two months to 16 years (average 5.3 years). The finger most commonly injured was the middle finger (24.6%) followed by the index finger (18.7%). The most common type of hand injury was crush injuries caused by doors at home (52.2%), heavy objects (6.6%) and injuries caused by grinding machines (6.6%). Since youngsters are often unaware of the dangers in their environment it is necessary to redesign the doors of our homes with safety devices to prevent injuries. Application of hydraulic automatic door closures is a simple but useful way of ensuring smooth and safe closing of doors in homes. PMID:11329697

  12. Potential drug-drug interactions in cardiothoracic intensive care unit of a pulmonary teaching hospital.

    PubMed

    Farzanegan, Behrooz; Alehashem, Maryam; Bastani, Marjan; Baniasadi, Shadi

    2015-02-01

    Little is known about clinically significant drug-drug interactions (DDIs) in respiratory settings. DDIs are more likely to occur in critically ill patients due to complex pharmacotherapy regimens and organ dysfunctions. The aim of this study was to identify the pattern of potential DDIs (pDDIs) occurring in cardiothoracic intensive care unit (ICU) of a pulmonary hospital. A prospective observational study was conducted for 6 months. All pDDIs for admitted patients in cardiothoracic ICU were identified with Lexi-Interact program and assessed by a clinical pharmacologist. The interacting drugs, reliability, mechanisms, potential outcomes, and clinical management were evaluated for severe and contraindicated interactions. The study included 195 patients. Lung cancer (14.9%) was the most common diagnosis followed by tracheal stenosis (14.3%). The rate of pDDIs was 720.5/100 patients. Interactions were more commonly observed in transplant patients. 17.7% of pDDIs were considered as severe and contraindicated interactions. Metabolism (54.8%) and additive (24.2%) interactions were the most frequent mechanisms leading to pDDIs, and azole antifungals and fluoroquinolones were the main drug classes involved. The pattern of pDDIs in cardiothoracic ICU differs from other ICU settings. Specialized epidemiological knowledge of drug interactions may help clinical practitioners to reduce the risk of adverse drug events. PMID:25369984

  13. Uterine Fibroid Embolization for Symptomatic Fibroids: Study at a Teaching Hospital in Kenya

    PubMed Central

    Mutai, John Kiprop; Vinayak, Sudhir; Stones, William; Hacking, Nigel; Mariara, Charles

    2015-01-01

    Objective: Characterization of magnetic (MRI) features in women undergoing uterine fibroid embolization (UFE) and identification of clinical correlates in an African population. Materials and Methods: Patients with symptomatic fibroids who are selected to undergo UFE at the hospital formed the study population. The baseline MRI features, baseline symptom score, short-term imaging outcome, and mid-term symptom scores were analyzed for interval changes. Assessment of potential associations between short-term imaging features and mid-term symptom scores was also done. Results: UFE resulted in statistically significant reduction (P < 0.001) of dominant fibroid, uterine volumes, and reduction of symptom severity scores, which were 43.7%, 40.1%, and 37.8%, respectively. Also, 59% of respondents had more than 10 fibroids. The predominant location of the dominant fibroid was intramural. No statistically significant association was found between clinical and radiological outcome. Conclusion: The response of uterine fibroids to embolization in the African population is not different from the findings reported in other studies from the west. The presence of multiple and large fibroids in this study is consistent with the case mix described in other studies of African-American populations. Patient counseling should emphasize the independence of volume reduction and symptom improvement. Though volume changes are of relevance for the radiologist in understanding the evolution of the condition and identifying potential technical treatment failures, it should not be the main basis of evaluation of treatment success. PMID:25883858

  14. Quality Control in Linen and Laundry Service at A Tertiary Care Teaching Hospital in India

    PubMed Central

    Singh, Dara; Qadri, GJ; Kotwal, Monica; Syed, AT; Jan, Farooq

    2009-01-01

    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. PMID:21475509

  15. [Community-acquired bacteremia in adult patients attending the emergency service of a teaching hospital].

    PubMed

    Artico, Muriel J; Rocchi, Marta; Gasparotto, Ana; Ocaña Carrizo, Valeria; Navarro, Mercedes; Mollo, Valeria; Avilés, Natalia; Romero, Vanessa; Carrillo, Sonia; Monterisi, Aída

    2012-01-01

    Bacteremia is an important cause of morbimortality. This study describes the episodes of community-acquired bacteremia in adult patients registered at our hospital. Between January 2005, and December 2009, 271 episodes were studied. The diagnostic yield of blood cultures was 13.5 %. A total of 52 % of patients were male and 48 % female. The mean age was 60. The most frequent comorbidities were: diabetes (21 %), neoplasia (18 %), cardiopathy (11 %), and HIV infection (8 %). The focus was- respiratory (21 %), urinary (15 %), cutaneous (9 %), and others (13 %). Gram-positive bacteria prevailed (51.4%). The most frequent microorganisms were Escherichia coli (25 %), Streptococcus pneumoniae (22.9 %), and Staphylococcus aureus (12.3 %). Bacteremia was polymicrobial in 7 % of the cases. Thirty three percent of E. coli isolates were resistant to ciprofloxacin and 6 % to ceftazidime. Fourteen percent of S. aureus strains were resistant to oxacillin whereas only 7 % of S. pneumoniae expressed high resistance to penicillin with MICs = 2 ug/ml, according to meningitis breakpoints. PMID:22610291

  16. Emergency Obstetric Hysterectomy: A Retrospective Study from a Teaching Hospital in North India over Eight Years

    PubMed Central

    Chawla, Jaya; Arora, D.; Paul, Mohini; Ajmani, Sangita N.

    2015-01-01

    Objectives We sought to determine the frequency, demographic characteristics, indications, and feto-maternal outcomes associated with emergency peripartum hysterectomy in an easily accessible urban center. Methods We conducted a retrospective, observational, and analytical study over a period of eight years, from August 2006 to July 2014. A total of 56 cases of emergency obstetric hysterectomy (EOH) were studied in the Department of Obstetrics and Gynecology, Kasturba Hospital, New Delhi. Results The incidence of EOH in our study was 30 per 100,000 following vaginal delivery and 270 per 100,000 following cesarean section. The overall incidence was 83 per 100,000 deliveries. Atonic postpartum hemorrhage (25%) was the most common indication followed by placenta accreta (21%) and uterine rupture (17.5%). The most frequent sequelae were febrile morbidity (19.2%) and disseminated intravascular coagulation (13.5%). Maternal mortality was 17.7% whereas perinatal mortality was 37.5%. Conclusions A balanced approach to EOH can prove to be lifesaving at times when conservative surgical modalities fail and interventional radiology is not immediately available. Our study highlights the place of extirpative surgery in modern obstetrics in the face of rising rates of cesarean section and multiple pregnancies particularly in urban settings in developing countries. PMID:26171124

  17. Airway accidents in critical care unit: A 3-year retrospective study in a Public Teaching Hospital of Eastern India

    PubMed Central

    Dasgupta, Sugata; Singh, Shipti Shradha; Chaudhuri, Arunima; Bhattacharya, Dipasri; Choudhury, Sourav Das

    2016-01-01

    Background: Although tracheal tubes are essential devices to control and protect airway in a critical care unit (CCU), they are not free from complications. Aims: To document the incidence and nature of airway accidents in the CCU of a government teaching hospital in Eastern India. Methods: Retrospective analysis of all airway accidents in a 5-bedded (medical and surgical) CCU. The number, types, timing, and severity of airway accidents were analyzed. Results: The total accident rate was 19 in 233 intubated and/or tracheostomized patients over 1657 tube days (TDs) during 3 years. Fourteen occurred in 232 endotracheally intubated patients over 1075 endotracheal tube (ETT) days, and five occurred in 44 tracheostomized patients over 580 tracheostomy TDs. Fifteen accidents were due to blocked tubes. Rest four were unplanned extubations (UEs), all being accidental extubations. All blockages occurred during night shifts and all UEs during day shifts. Five accidents were mild, the rest moderate. No major accident led to cardiorespiratory arrest or death. All blockages occurred after 7th day of intubation. The outcome of accidents were more favorable in tracheostomy group compared to ETT group (P = 0.001). Conclusions: The prevalence of airway accidents was 8.2 accidents per 100 patients. Blockages were the most common accidents followed by UEs. Ten out of the 15 blockages and all 4 UEs were in endotracheally intubated patients. Tracheostomized patients had 5 blockages and no UEs. PMID:27076709

  18. Risk factors for endoparasitism in dogs: retrospective case-control study of 6578 veterinary teaching hospital cases

    PubMed Central

    Gates, Maureen C.

    2009-01-01

    Summary OBJECTIVES The diagnostic utility of routine fecal examinations can be greatly enhanced through an appreciation of risk factors most commonly associated with endoparasitism. METHODS From a sample of 6,578 canine patients presenting to a veterinary teaching hospital between 1996 and 2006, this study used univariate and multivariable techniques to examine putative signalment, medical history, and demographic factors predisposing dogs to intestinal parasites. RESULTS Age and median household income were the strongest predictors of endoparasitism. The odds of a patient being diagnosed with endoparasites were 0.82 times smaller for every 1 year increase in age (OR=0.82, 95%CI: 0.80 – 0.84) and for every $10,000 increase in Median Household Income, the odds were 0.86 times lower (OR=0.86, 95% CI: 0.83 – 0.89). The variables gender, neuter status, month of diagnosis, admitting clinical service, and primary diagnosis were not significant predictors. Animals that presented for underlying medical conditions were less likely to have parasites and the presence of diarrhea was associated with 76% lower odds of endoparasitism compared to healthy animals (OR=0.76, 95%CI: 0.64 – 0.90). CLINICAL SIGNIFICANCE Clinicians should maintain a high index of suspicion for parasites in younger patients that live in high population density, low income neighborhoods. PMID:19972636

  19. Transfusion-Transmissible Infections among Voluntary Blood Donors at Wolaita Sodo University Teaching Referral Hospital, South Ethiopia.

    PubMed

    Bisetegen, Fithamlak Solomon; Bekele, Fanuel Belayneh; Ageru, Temesgen Anjulo; Wada, Fiseha Wadilo

    2016-01-01

    Background. Transfusion-transmissible infections, human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis are among the greatest threats to blood safety and pose a serious public health problem. Objective. To determine the magnitude of blood borne infections among blood donors at Wolaita Sodo University Teaching Referral Hospital. Methods and Materials. A cross-sectional study was conducted from 10/11/2015 up to 10/12/2015. 390 donors were consecutively included and data on donor's age, sex, blood type, and serum screening results were obtained by structured questionnaire and laboratory investigation. The collected data were entered into Epi Data version 1.4 and then exported to SPSS version 20.0 for analysis. Result. The seroprevalence of blood borne pathogens is 29.5% of which HCV, HBV, HIV, and syphilis account for 8.5%, 9.5%, 6.4%, and 7.5%, respectively. Multiple infections were observed among 2.8% of the infected individuals. In addition, age ≥ 30 has a significant association with HCV. Conclusion. Significantly higher prevalence of transfusion-transmissible infections was identified from blood donors and they remain to be the greatest threat to blood safety, so comprehensive screening of donors' blood for HIV, HBV, HCV, and syphilis using standard methods is highly recommended to ensure the safety of blood recipient. PMID:27597875

  20. Current Microbial Isolates from Wound Swabs, Their Culture and Sensitivity Pattern at the Niger Delta University Teaching Hospital, Okolobiri, Nigeria

    PubMed Central

    Pondei, Kemebradikumo; Fente, Beleudanyo G.; Oladapo, Oluwatoyosi

    2013-01-01

    Background: Wound infections continue to be problematic in clinical practice where empiric treatment of infections is routine. Objectives: A retrospective cross-sectional study to determine the current causative organisms of wound infections and their antibiotic susceptibility patterns in the Niger Delta University Teaching Hospital (NDUTH), Okolobiri, Bayelsa State of Nigeria. Methods: Records of wound swabs collected from 101 patients with high suspicion of wound infection were analysed. Smears from the wound swabs were inoculated on appropriate media and cultured. Bacterial colonies were Gram stained and microscopically examined. Biochemical tests were done to identify pathogen species. The Kirby-Bauer disk diffusion method was used for antibiotic testing. Results: Prevalence of wound infection was 86.13% (CI: 79.41–92.85). Most bacteria were Gram negative bacilli with Pseudomonas aeruginosa being the most prevalent pathogen isolated. The bacterial isolates exhibited a high degree of resistance to the antibiotics tested (42.8% to 100% resistance). All isolates were resistant to cloxacillin. Age group and sex did not exert any effect on prevalence, aetiological agent or antimicrobial resistance pattern. Conclusion: We suggest a multidisciplinary approach to wound management, routine microbiological surveillance of wounds, rational drug use and the institution of strong infection control policies. PMID:23874138

  1. Ventilator-associated pneumonia in a teaching hospital in Tehran and use of the Iranian Nosocomial Infections Surveillance Software.

    PubMed

    Afhami, Sh; Hadadi, A; Khorami, E; Seifi, A; Bazaz, N Esmailpour

    2013-10-01

    Ventilator-associated pneumonia is the most common health-care-associated infection in the intensive care unit (ICU) and computer-assisted diagnosis and surveillance is called for. The frequency of ventilator-associated pneumonia was assessed prospectively during a 6-month period in the ICUs of a teaching hospital in Tehran, Islamic Republic of Iran. To determine the accuracy of the Iranian Nosocomial Infections Surveillance (INIS) system, patient data were input to the software and compared with physicians' judgement. The frequency of ventilator-associated pneumonia was 21.6%, or 9.96 episodes per 1000 ventilator days. The duration of admission to the ICU, duration of mechanical ventilator and number of re-intubations were significantly higher in patients who developed pneumonia. The INIS system identified 100% of cases, with no false-positive or false-negative results. Compared with developed countries, the frequency of ventilator-associated pneumonia was high in our ICUs, and INIS software was accurate in diagnosing nosocomial infection. PMID:24313153

  2. Ovarian Tumors in Children and Adolescents: A 10-Yr Histopathologic Review in Korle-Bu Teaching Hospital, Ghana.

    PubMed

    Akakpo, Patrick K; Derkyi-Kwarteng, Leonard; Quayson, Solomon E; Gyasi, Richard K; Anim, Jehoram T

    2016-07-01

    To determine the histopathologic types, frequency of occurrence, age distribution, presenting signs, and symptoms of ovarian tumors in children and adolescents diagnosed at the Korle-Bu Teaching Hospital all histopathology slides and request cards of ovarian tumors diagnosed in subjects aged, 0 to 19 yr over a 10-yr period (2001-2010) were reviewed. Biographical and clinical data of the patients were collected. The results were entered into Epi-info to determine the frequency of various ovarian tumors in different age groups and their association with presenting signs and symptoms. A total of 67 (9.5%) ovarian tumors were diagnosed in patients aged 0 to 19 yr of a total of 706 diagnosed in all age groups during the period. The majority [44 (65.7%)] were germ cell tumors, the commonest being mature cystic teratoma. Burkitt lymphoma was the single most common malignant tumor, comprising 6(9%) of all the tumors, although as a group malignant germ cell tumors were still the most common malignant ovarian tumors in children and adolescents. Although germ cell tumors were the most common tumors in this age group (both benign and malignant), Burkitt lymphoma, a peculiar malignant tumor in this subregion, was the single most common malignant tumor of the ovary. PMID:26630227

  3. Bacterial Epidemiology and Antimicrobial Resistance in the Surgery Wards of a Large Teaching Hospital in Southern Italy

    PubMed Central

    Esposito, Silvano; Gioia, Renato; De Simone, Giuseppe; Noviello, Silvana; Lombardi, Domenico; Di Crescenzo, Vincenzo Giuseppe; Filippelli, Amelia; Rega, Maria Rosaria; Massari, Angelo; Elberti, Maria Giovanna; Grisi, Lucilla; Boccia, Giovanni; De Caro, Francesco; Leone, Sebastiano

    2015-01-01

    Objectives Surgical infections represent an increasingly important problem for the National Health System. In this study we retrospectively evaluated the bacterial epidemiology and antimicrobial susceptibility of the microorganisms concerned as well as the utilization of antibiotics in the General and Emergency Surgery wards of a large teaching hospital in southern Italy in the period 2011–2013. Methods Data concerning non-duplicate bacterial isolates and antimicrobial susceptibility were retrieved from the Vitek 2 database. The pharmacy provided data about the consumption of antibiotics in the above reported wards. Chi-square or Fisher’s exact test were used. Results In all, 94 Gram-negative were isolated in 2011, 77 in 2012, and 125 in 2013, Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa always being the most frequently isolated microorganisms. A. baumannii showed high rates of resistance to carbapenems (with values of 100% in 2011 and 2012) and low rates of resistance to tigecycline, colistin and amikacin. In the same years, there were respectively 105, 93, and 165 Gram-positive isolated. The rate of MRSA isolates ranged from 66% to 75% during the study period. Conclusions Our results show no significant increase in antimicrobial resistance over the period in question, and a higher rate of both MRSA isolates and resistance to carbapenems in A. baumannii compared with other European data. PMID:26075047

  4. In Vitro Analysis of Activities of 16 Antimicrobial Agents against Gram-Negative Bacteria from Six Teaching Hospitals in China.

    PubMed

    Chen, Hongbin; Wang, Zhanwei; Li, Henan; Wang, Qi; Zhao, Chunjiang; He, Wenqiang; Wang, Xiaojuan; Zhang, Feifei; Wang, Hui

    2015-01-01

    To evaluate the in vitro antimicrobial activities of biapenem, arbekacin, and cefminox against different gram-negative bacterial isolates in China, a total of 100 non-duplicated Escherichia coli, 100 Acinetobacter baumannii, 100 Pseudomonas aeruginosa, and 99 Klebsiella pneumoniae isolates were collected from 6 teaching hospitals in China in 2012. The minimal inhibitory concentrations (MICs) of biapenem, arbekacin, cefminox and 13 other antibiotics were determined by the broth microdilution method. The carbapenems (biapenem, meropenem, and imipenem) exhibited high antimicrobial activity against E. coli (98%) and K. pneumoniae (≥95%), followed by colistin and amikacin. The MIC50 and MIC90 of biapenem against E. coli were ≤0.06 mg/L and 0.25 mg/L, respectively. For K. pneumoniae, the MIC50 and MIC90 of biapenem were 0.25 mg/L and 1.0 mg/L, respectively. The MIC50 and MIC90 of cefminox against E. coli were 1.0 mg/L and 4.0 mg/L, respectively. The resistance rates of A. baumannii to most of the antibiotics were more than 50%, except for colistin. Amikacin was the most active antibiotic against P. aeruginosa (97%), followed by colistin (93%). The MIC50 and MIC90 of arbekacin against P. aeruginosa were 2.0 mg/L and 8.0 mg/L, respectively. In conclusion, carbapenems, colistin, amikacin, and arbekacin exhibited high antimicrobial activities against gram-negative bacteria, except A. baumannii. PMID:25672407

  5. Non-venomous snake bite and snake bite without envenoming in a Brazilian teaching hospital. Analysis of 91 cases.

    PubMed

    Silveria, P V; Nishioka, S de A

    1992-01-01

    A retrospective survey of 473 cases of snake bite admitted to a Brazilian teaching hospital from 1984 to 1990 revealed 91 cases of bite without envenoming and/or caused by non-venomous snakes. In 17 of these cases the snake was identified, and one patient was bitten by a snake-like reptile (Amphisbaena mertensii). In 43 cases diagnosis was made on clinical grounds (fang marks in the absence of signs of envenoming). The other 30 cases were of patients who complained of being bitten but who did not show any sign of envenoming or fang mark. Most cases occurred in men (66;73%), in the 10-19 years age group (26;29%), in the lower limbs (51/74;69%), between 6 A. M. and 2 P.M. (49;61%) and in the month of April (16;18%). One patient bitten by Philodryas olfersii developed severe local pain, swelling and redness at the site of the bite, with normal clotting time. The patient bitten by Drymarcon corais was misdiagnosed as being bitten by a snake of the genus Bothrops, was given the specific antivenom, and developed anaphylaxis. One patient bitten by Sibynomorphus mikanii presented prolonged clotting time, and was also given antivenom as a case of Bothrops bite. Correct identification of venomous snakes by physicians is necessary to provide correct treatment to victims of snake bite, avoiding unnecessary distress to the patient, and overprescription of antivenom, which may eventually cause severe untoward effects. PMID:1342117

  6. Phenotypic Detection of Genitourinary Candidiasis among Sexually Transmitted Disease Clinic Attendees in Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria

    PubMed Central

    Obisesan, Oluranti J.; Olowe, Olugbenga A.; Taiwo, Samuel S.

    2015-01-01

    The management of genitourinary candidiasis (GC) is fraught with challenges, especially, in an era of increasing antifungal resistance. This descriptive cross-sectional study conducted between May 2013 and January 2014 determined the prevalence and characteristics of GC and the species of Candida among 369 attendees of a Sexually Transmitted Disease (STD) clinic of Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria. Appropriate urogenital specimen collected from each attendee was examined by microscopy and culture for Candida, with preliminary species identification by CHROMAgar Candida and confirmation by Analytical Profile Index (API) 20C AUX. The age range of attendees was 1-80 years, mean age was 36.32 ± 11.34 years, and male to female ratio was 1 to 3. The prevalence of genitourinary candidiasis was 47.4%, with 4.9% in males and 42.5% in females (p < 0.0001). The age groups 31–45 and 16–30 have the highest prevalence of 23.3% and 16.8%, respectively. The species of Candida recovered include Candida glabrata 46.9%, Candida albicans 33.7%, Candida dubliniensis 9.7%, Candida tropicalis 5.7%, Candida krusei 1.7%, Candida lusitaniae 1.7%, and Candida utilis 0.6%. This study reported non-C. albicans Candida, especially C. glabrata, as the most frequently isolated species in GC, contrary to previous studies in this environment and elsewhere. PMID:26064140

  7. Neisseria gonorrhoea, Chlamydia trachomatis, and Treponema pallidum infection in antenatal and gynecological patients at Korle-Bu Teaching Hospital, Ghana.

    PubMed

    Apea-Kubi, Kwasi Akyem; Yamaguchi, Shinya; Sakyi, Bright; Kishimoto, Toshio; Ofori-Adjei, David; Hagiwara, Toshikatsu

    2004-12-01

    Five hundred and seventeen women attending the gynecology and obstetrics clinics of the Korle-Bu Teaching Hospital were examined for sexually transmitted infections (STIs). Vaginal swabs were examined for Trichomonas vaginalis, Candida albicans, and Gardnerella vaginalis infection. Endocervical swabs were examined for Neisseria gonorrhoea and Chlamydia trachomatis using a recently developed RNA detection kit. Strain typing was performed to identify serovars of C. trachomatis. Sera were analyzed for Treponema pallidum with a passive-particle agglutination assay kit. The prevalence of infection with N. gonorrhoea was 0.6%, C. trachomatis 3.0%, and T. pallidum 5.6%. Eight samples were PCR-positive for C. trachomatis. Five of these were serovar G, and the rest were serovar E. All cases of mixed infections occurred in pregnant women. In conclusion, a high transmissible risk of T. pallidum infection was observed among our study population and in particular among our pregnant women. The absence of association between the presenting symptoms, clinical findings, and specific pathogens has implications for the syndromic approach to STI case management. The low prevalence of C. trachomatis and N. gonorrhoea may be due to self medication and requires further research in primary health institutions in rural areas to compare rates. PMID:15623949

  8. Periodontal disease status and associated risk factors in patients attending a Dental Teaching Hospital in Rawalpindi, Pakistan

    PubMed Central

    Bokhari, Syed Akhtar Hussain; Suhail, Agha Mohammad; Malik, Abdul Razzaq; Imran, Mian Farrukh

    2015-01-01

    Background: Investigators have identified an association of socio-demographic and medical factors with periodontal risk. This study observed status and association of periodontal disease and associated risk factors/indictors. Materials and Methods: All patients attending a dental teaching hospital were interviewed for socio-demographic and medical information through a structured questionnaire. Participants were examined for periodontal status using the community periodontal index (CPI), by a single examiner during September to November 2012. An association of age, gender, smoking habit, systemic conditions, and oral hygiene measures with periodontal status ([periodontitis CPI score ≥3]/nonperiodontitis [CPI score ≤2]) was analyzed by applying Chi-square test and forward selection stepwise regression analysis. Results: One thousand nine hundred and eighteen patients were examined during the study period. The findings revealed that 63.5% of the subjects had CPI score ≤2 (nonperiodontitis), while 34.5% were found with CPI score ≥3 (periodontitis). Age, gender, occupation, smoking, diabetes, arthritis, cardiovascular disease, kidney disease, stress, medications, and oral hygiene habits of using tooth powder or tooth brushing were significantly (P ≤ 0.037) associated with periodontal status. Regression analysis showed a significant association of age, occupation, and smoking with periodontitis. Conclusion: This study observed prevalence of periodontitis in one-fourth of study sample. The study confirmed various socio-demographic risk factors/indictors associated with increased risk of periodontitis. PMID:26941520

  9. Study of prevalence of hypertension in Chronic Obstructive Pulmonary Disease patients admitted at Nepal Medical College and Teaching Hospital.

    PubMed

    Dhungel, Sanjib; Paudel, Badri; Shah, Shristi

    2005-12-01

    A retrospective study of 237 cases of Chronic Obstructive Pulmonary Disease (COPD) patients admitted in medical ward of Nepal Medical College Teaching Hospital (NMCTH) was performed to find out the prevalence of hypertension in such COPD subjects. The prevalence of COPD amongst the total number of patients admitted at NMCTH medical ward was 17.3%. Prevalence of COPD was more after the onset of middle age, the peak was found to be at the age of 60-69 years. Out of these COPD subjects, 98 patients (37 patients were known case of hypertension) had hypertension. Thus prevalence of hypertension was 41.3% in COPD subjects studied. Prevalence increased with age after the age of 50 years and the highest prevalence was at the age of 60-69 years which directly correlates with the prevalence of COPD. The prevalence of hypertension in COPD patients was significantly higher than the normal population that may reflect COPD itself as a risk factor for developing hypertension. A larger and detailed study is needed to confirm such finding. PMID:16519071

  10. Transfusion-Transmissible Infections among Voluntary Blood Donors at Wolaita Sodo University Teaching Referral Hospital, South Ethiopia

    PubMed Central

    Bekele, Fanuel Belayneh; Ageru, Temesgen Anjulo; Wada, Fiseha Wadilo

    2016-01-01

    Background. Transfusion-transmissible infections, human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis are among the greatest threats to blood safety and pose a serious public health problem. Objective. To determine the magnitude of blood borne infections among blood donors at Wolaita Sodo University Teaching Referral Hospital. Methods and Materials. A cross-sectional study was conducted from 10/11/2015 up to 10/12/2015. 390 donors were consecutively included and data on donor's age, sex, blood type, and serum screening results were obtained by structured questionnaire and laboratory investigation. The collected data were entered into Epi Data version 1.4 and then exported to SPSS version 20.0 for analysis. Result. The seroprevalence of blood borne pathogens is 29.5% of which HCV, HBV, HIV, and syphilis account for 8.5%, 9.5%, 6.4%, and 7.5%, respectively. Multiple infections were observed among 2.8% of the infected individuals. In addition, age ≥ 30 has a significant association with HCV. Conclusion. Significantly higher prevalence of transfusion-transmissible infections was identified from blood donors and they remain to be the greatest threat to blood safety, so comprehensive screening of donors' blood for HIV, HBV, HCV, and syphilis using standard methods is highly recommended to ensure the safety of blood recipient. PMID:27597875

  11. Phenotypic Detection of Genitourinary Candidiasis among Sexually Transmitted Disease Clinic Attendees in Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria.

    PubMed

    Obisesan, Oluranti J; Olowe, Olugbenga A; Taiwo, Samuel S

    2015-01-01

    The management of genitourinary candidiasis (GC) is fraught with challenges, especially, in an era of increasing antifungal resistance. This descriptive cross-sectional study conducted between May 2013 and January 2014 determined the prevalence and characteristics of GC and the species of Candida among 369 attendees of a Sexually Transmitted Disease (STD) clinic of Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria. Appropriate urogenital specimen collected from each attendee was examined by microscopy and culture for Candida, with preliminary species identification by CHROMAgar Candida and confirmation by Analytical Profile Index (API) 20C AUX. The age range of attendees was 1-80 years, mean age was 36.32 ± 11.34 years, and male to female ratio was 1 to 3. The prevalence of genitourinary candidiasis was 47.4%, with 4.9% in males and 42.5% in females (p < 0.0001). The age groups 31-45 and 16-30 have the highest prevalence of 23.3% and 16.8%, respectively. The species of Candida recovered include Candida glabrata 46.9%, Candida albicans 33.7%, Candida dubliniensis 9.7%, Candida tropicalis 5.7%, Candida krusei 1.7%, Candida lusitaniae 1.7%, and Candida utilis 0.6%. This study reported non-C. albicans Candida, especially C. glabrata, as the most frequently isolated species in GC, contrary to previous studies in this environment and elsewhere. PMID:26064140

  12. Assessment of quality of life in epilepsy patients receiving anti-epileptic drugs in a tertiary care teaching hospital

    PubMed Central

    Pimpalkhute, Sonali A.; Bajait, Chaitali S.; Dakhale, Ganesh N.; Sontakke, Smita D.; Jaiswal, Kavita M.; Kinge, Parag

    2015-01-01

    Objectives: Health-related quality of life (QOL) is an important outcome in epilepsy treatment. Very few studies have been carried out on the quality of life in epilepsy (QOLIE-31) in India. The present study aimed to determine the level of health-related QOLIE-31 in patients of epilepsy. Materials and Methods: This was a cross-sectional, questionnaire-based study conducted in a tertiary care teaching hospital. Respondents were adults aged at least 18-year-old with a diagnosis of epilepsy. QOLIE-31 was used for collecting data on health-related QOL. The unpaired t-test or one-way analysis of variance was used to compare means of QOL scores between groups. Results: Totally, 60 patients of epilepsy were included in the study. The mean (standard deviation) total score of QOLIE-31 was 64.61. A score of cognitive and medication effect were significantly better in carbamazepine group as compared to valproate group. Conclusions: Patients on monotherapy had a better QOL as compared to patients receiving polytherapy. PMID:26600647

  13. A survey of the oral health knowledge and practices of pregnant women in a Nigerian teaching hospital.

    PubMed

    Abiola, Adeniyi; Olayinka, Agbaje; Mathilda, Braimoh; Ogunbiyi, Ogunbanjo; Modupe, Sorunke; Olubunmi, Onigbinde

    2011-12-01

    To describe the self-reported oral health knowledge, attitudes and oral hygiene habits, among pregnant women receiving antenatal care at the Lagos State University teaching Hospital (LASUTH). A cross-sectional questionnaire-based survey was conducted at the LASUTH antenatal clinic during the period January - June 2008. Most of the respondents demonstrated a reasonable level of oral health knowledge and positive attitudes towards oral health. However, there were gaps in the oral health knowledge of the women surveyed. The relationship between the level of oral health knowledge and ethnicity (p=0.856), level of education (p=0.079), age category (p=0.166), and trimester of pregnancy (p=0.219) were not statistically significant. In addition, the women's knowledge and attitude towards oral health was not reflected in their oral hygiene practices. There is a need to provide oral health education for pregnant women during antenatal care in order to highlight the importance of good oral health in achieving good health for both the mother and her baby. PMID:22571100

  14. Sensitivity profile of Staphylococcus spp. and Streptococcus spp. isolated from toys used in a teaching hospital playroom☆

    PubMed Central

    Boretti, Vanessa Stolf; Corrêa, Renata Nunes; dos Santos, Silvana Soléo Ferreira; Leão, Mariella Vieira Pereira; Silva, Célia Regina Gonçalves e

    2014-01-01

    Objective: To evaluate the presence of microorganisms of the genus Staphylococcus and Streptococcus on toys in the playroom of a teaching hospital, as well to as analyze the antimicrobial resistance from isolated strains. Methods: Samples were collected from 60 toys, using wet swabs, soon after being used by the children. The samples were inoculated in enriched and selective agar for isolation and later identification of the microorganisms. Antibiogram testing was performed by agar diffusion technique. Results: The genus Staphylococcus was present in 87.0% (52/60) of the toys. Seventy-three strains were isolated, with 29.0% (21/73) coagulase-positive and 71.0% (52/73) coagulasenegative. Among the coagulase-negative strains, 90.4% were resistant to penicillin, 65.4% to oxacillin, 28.8% to clarithromycin, 61.5% to clindamycin, and none to vancomycin. Among the coagulase-positive strains, 76.2% were resistant to penicillin, 23.8% to oxacillin, 23.8% to clarithromycin, 47.6% to clindamycin, and none to vancomycin. The genus Streptococcus was not detected in any of the evaluated toys. Conclusions: Toys can be contaminated with potentially pathogenic bacteria with antimicrobial resistance, representing a possible source of nosocomial infection for patients who are already debilitated. PMID:25479842

  15. Prospects of using community directed intervention strategy in delivering health services among Fulani Nomads in Enugu State, Nigeria

    PubMed Central

    2013-01-01

    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

  16. Frequency of medication errors in an emergency department of a large teaching hospital in southern Iran.

    PubMed

    Vazin, Afsaneh; Zamani, Zahra; Hatam, Nahid

    2014-01-01

    This study was conducted with the purpose of determining the frequency of medication errors (MEs) occurring in tertiary care emergency department (ED) of a large academic hospital in Iran. The incidence of MEs was determined through the disguised direct observation method conducted by a trained observer. A total of 1,031 medication doses administered to 202 patients admitted to the tertiary care ED were observed over a course of 54 6-hour shifts. Following collection of the data and analysis of the errors with the assistance of a clinical pharmacist, frequency of errors in the different stages was reported and analyzed in SPSS-21 software. For the 202 patients and the 1,031 medication doses evaluated in the present study, 707 (68.5%) MEs were recorded in total. In other words, 3.5 errors per patient and almost 0.69 errors per medication are reported to have occurred, with the highest frequency of errors pertaining to cardiovascular (27.2%) and antimicrobial (23.6%) medications. The highest rate of errors occurred during the administration phase of the medication use process with a share of 37.6%, followed by errors of prescription and transcription with a share of 21.1% and 10% of errors, respectively. Omission (7.6%) and wrong time error (4.4%) were the most frequent administration errors. The less-experienced nurses (P=0.04), higher patient-to-nurse ratio (P=0.017), and the morning shifts (P=0.035) were positively related to administration errors. Administration errors marked the highest share of MEs occurring in the different medication use processes. Increasing the number of nurses and employing the more experienced of them in EDs can help reduce nursing errors. Addressing the shortcomings with further research should result in reduction of MEs in EDs. PMID:25525391

  17. Frequency of medication errors in an emergency department of a large teaching hospital in southern Iran

    PubMed Central

    Vazin, Afsaneh; Zamani, Zahra; Hatam, Nahid

    2014-01-01

    This study was conducted with the purpose of determining the frequency of medication errors (MEs) occurring in tertiary care emergency department (ED) of a large academic hospital in Iran. The incidence of MEs was determined through the disguised direct observation method conducted by a trained observer. A total of 1,031 medication doses administered to 202 patients admitted to the tertiary care ED were observed over a course of 54 6-hour shifts. Following collection of the data and analysis of the errors with the assistance of a clinical pharmacist, frequency of errors in the different stages was reported and analyzed in SPSS-21 software. For the 202 patients and the 1,031 medication doses evaluated in the present study, 707 (68.5%) MEs were recorded in total. In other words, 3.5 errors per patient and almost 0.69 errors per medication are reported to have occurred, with the highest frequency of errors pertaining to cardiovascular (27.2%) and antimicrobial (23.6%) medications. The highest rate of errors occurred during the administration phase of the medication use process with a share of 37.6%, followed by errors of prescription and transcription with a share of 21.1% and 10% of errors, respectively. Omission (7.6%) and wrong time error (4.4%) were the most frequent administration errors. The less-experienced nurses (P=0.04), higher patient-to-nurse ratio (P=0.017), and the morning shifts (P=0.035) were positively related to administration errors. Administration errors marked the highest share of MEs occurring in the different medication use processes. Increasing the number of nurses and employing the more experienced of them in EDs can help reduce nursing errors. Addressing the shortcomings with further research should result in reduction of MEs in EDs. PMID:25525391

  18. Maternal mortality -- aetiological factors: analytic study from a teaching hospital of Punjab.

    PubMed

    Sarin, A R; Singla, P; Kaur, H

    1992-01-01

    A review of maternal deaths at Rajendra Hospital, Punjab, from January 1978 to December 1991 yielded important data for the planning of maternal health services in this area of India, During the 14 year study period, there were 33,160 births and 339 deaths, for a maternal mortality rate of 1002/100,000 live births. Women who had received no prenatal care accounted for 47.4% of deliveries but 92.8% of maternal deaths. In addition, a disproportionate number of deaths involved rural women (74.6%) and poor women (76.4%). 57.8% of maternal deaths involved women 21-30 years of age; 37.1% occurred among primigravidas. Direct obstetrical causes were considered the etiologic factor in 83.1% of these deaths. Primary among these causes were sepsis (37.1%), obstetric hemorrhage (26.2%), hypertensive disorders of pregnancy (21.4%), and obstructed labor (15.3%). 30.6% of deaths occurred during pregnancy, 50.3% during labor, and 19.1% in the postpartum period. Indirect obstetrical causes, notably severe anemia and anesthesia complications, were implicated in 15.3% of the maternal deaths. Critical analysis of the maternal deaths in this series suggested that 89.6% were totally preventable, 9.6% were probably preventable, and only 0.8% were not avoidable. Factors that would reduce the high rate of maternal mortality in this region include more widespread use of prenatal care, training of traditional birth attendants in asepsis, referral of high-risk pregnancies, and improved transportation in rural areas. PMID:12288813

  19. Asymptomatic bacteriurea among pregnant women visiting Nepal Medical College Teaching Hospital, Kathmandu, Nepal.

    PubMed

    Marahatta, R; Dhungel, B Acharya; Pradhan, P; Rai, S K; Choudhury, D Roy

    2011-06-01

    Urinary tract infection is the commonest bacterial infection in pregnancy. The overall incidence is 5.0-10.0% of all pregnancy. During pregnancy bacterial growth is favoured by increased urinary content of glucose, aminoacids and other nutrients. Other factors responsible for infection are basically related to hormonal effect and mechanical factors. Prolonged stasis of urine in urinary bladder favours growth of micro organism, relaxation of vesico-ureteric junction leads to reflux of urine from bladder to ureter and later up to renal pelvis and later can affect the renal parenchyma affecting the function of kidneys. In addition, some maternal defense mechanism are less effective during pregnancy. Bacteriuria either asymptomatic (5.0%) or symptomatic is common in pregnancy, if left untreated, asymptomatic bacteriuria will lead to acute pyelonephritis in 20.0-30.0%. This may result in abortion, premature delivery, low birth baby and even still birth. About 12.0% of antenatal admission are sepsis due to pyelonephritis. Keeping in mind that UTI in pregnancy leads to increase in maternal morbidity as well as neonatal morbidity and mortality. In this prospective study all asymptomatic consecutive antenatal women were included 200 from each trimester with total of 600 in number to see the incidence in different trimester, most prevalent organisms and it's sensitivity. They were followed up till delivery to see the incidence of asymptomatic bacteriurea in different trimester and its outcome in terms of type of delivery, baby weight, apgar score given at the time of birth and hospital admission for morbidity. PMID:22364093

  20. Molecular Epidemiology of Clostridium difficile Infection in a Large Teaching Hospital in Thailand

    PubMed Central

    Ngamskulrungroj, Popchai; Sanmee, Sittinee; Pusathit, Papanin; Piewngam, Pipat; Elliott, Briony; Riley, Thomas V.; Kiratisin, Pattarachai

    2015-01-01

    Clostridium difficile infection (CDI) is a leading cause of healthcare-associated morbidity and mortality worldwide. In Thailand, CDI exhibits low recurrence and mortality and its molecular epidemiology is unknown. CDI surveillance was conducted in a tertiary facility (Siriraj Hospital, Bangkok). A total of 53 toxigenic C. difficile strains from Thai patients were analyzed by multi-locus sequence typing (MLST), PCR ribotyping, and pulse-field gel electrophoresis (PFGE). The mean age of the cohort was 64 years and 62.3% were female; 37.7% of patients were exposed to > two antibiotics prior to a diagnosis of CDI, with beta-lactams the most commonly used drug (56.3%). Metronidazole was used most commonly (77.5%; success rate 83.9%), and non-responders were treated with vancomycin (success rate 100%). None of the isolates carried binary toxin genes. Most isolates (98.2–100%) were susceptible to metronidazole, vancomycin, tigecycline and daptomycin. There were 11 sequence types (STs), 13 ribotypes (RTs) and four PFGE types. Six previously identified STs (ST12, ST13, ST14, ST33, ST41 and ST45) and five novel STs unique to Thailand (ST66, ST67, ST68, ST69 and ST70) were identified. PCR RTs UK 017 (ST45) (45.3%) and UK 014/020 (ST33) (24.5%) were the most common. High concordance was observed between the MLST and ribotyping results (p<0.001). C. difficile isolates from Thai patients were highly susceptible to standard antimicrobial agents. In conclusion, the five STs indicate the high genetic diversity and unique polymorphisms in Thailand. Moreover, the emergence of antimicrobial resistance to vancomycin warranted continuous surveillance to prevent further spread of the toxigenic C. difficile isolates. PMID:26000789

  1. Effect of Concept Mapping and Outline Note-Taking Patterns in Students Academic Achievement in Geography in Secondary Schools in Enugu South Lga of Enugu State

    ERIC Educational Resources Information Center

    Okafor, Gabriel A.

    2016-01-01

    The WAEC Chief Examiner's report of 2013 pointed out that mass failure in geography had badly affected students who have the desire to study science related subjects in our Universities. The poor image of geography among students was attributed partly to its wide content and partly to the old fashioned approach to its teaching. This study…

  2. Established Osteoporosis and Gaps in the Management: Review from a Teaching hospital

    PubMed Central

    Sadat-Ali, Mir; Al-Omran, AS; Al-Bakr, WI; Azam, Md Quamar; Tantawy, AM; Al-Othman, AA

    2014-01-01

    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

  3. Surgical management of Diabetic foot ulcers: A Tanzanian university teaching hospital experience

    PubMed Central

    2011-01-01

    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

  4. 'The pregnant women are here for the sake of the teaching institution': The lying-in hospital of Göttingen University, 1751 to c. 1830.

    PubMed

    Schlumbohm, J

    2001-01-01

    Drawing on the admission records, the medical casebooks and the publications of its director, this article explores how the University of Göttingen's maternity hospital achieved its three official goals: teaching medical students, training female midwives, and providing shelter for needy parturient women. Since educating medical men was the most important aim of the hospital, the paper particularly focuses on how the demands of instruction shaped day-to-day obstetrical practices, especially under the directorship of Professor Friedrich Benjamin Osiander (1792-1822). He was a keen advocate of the forceps, whereas the first director, Professor Johann Georg Roederer (1751-63), had taken a moderate, that is a much less interventionist, approach to obstetrics. Osiander avowedly was determined to subordinate the parturient women to the demands of the clinic and to treat them as 'living manikins'. In spite of that, there is evidence that the pregnant and parturient women, most of whom were unmarried and from the lower classes, made use of the lying-in hospital for their own purposes, and that sometimes they refused to play the role assigned to them. The link between the maternity hospital and the rise of the man-midwife and of 'scientific' obstetrics appears to have been particularly strong in the case of Göttingen and other German university hospitals, compared with lying-in hospitals in other countries where the link was more indirect. PMID:14524351

  5. Sources of drug information and their influence on the prescribing behaviour of doctors in a teaching hospital in Ibadan, Nigeria

    PubMed Central

    Oshikoya, Kazeem Adeola; Oreagba, Ibrahim; Adeyemi, Olayinka

    2011-01-01

    Background Pharmaceutical drug promotion is a means of informing health professionals about new drugs. The approach is often times unethical and inappropriate and may promote irrational prescribing. Dearth of information on impact of pharmaceutical drug promotion on prescribing behaviour of doctors in developing African countries has necessitated this study. We therefore aimed to determine the sources of drug information for doctors working in a teaching hospital in Nigeria and to assess the self-reported impact of the sources on their prescribing behaviour. Methods A total of 163 doctors working at the University College Hospital (UCH), Ibadan in Nigeria were evaluated with a questionnaire for their demographics and sources of drug information. For doctors who relied on drug promotion, they were asked to self-report and self-rate their opinion on extent of interactions with pharmaceutical companies as well as how such interactions had impacted on their prescribing behaviour. Apart from the demographics, each question was evaluated with a typical five-level Likert item. Data analyses were with simple descriptive statistics. Results Of the 400 doctors working at UCH, only 40.8% participated in the study. Drug information was sourced from colleagues (161, 98.8%), reference books (158, 96.9%), pharmaceutical sales representatives-PSRs (152, 93.2%), promotion materials (151, 92.6%), scientific papers/journals/internet (149, 91.4%), and drug promotion forum/product launches (144, 88.3%). Each source was highly utilized but there was no wide variation in their pattern of use. According to the self-report of over a half of the respondents, PSRs was an accurate and reliable drug information resource; PSRs increased their awareness of the promoted drugs; and their prescribing behaviours were influenced by information from PSRs. Conclusion Respondents tend to rely on a broad range of drug information resources which include potentially inappropriate resources such as PSRs

  6. Susceptibility of bacterial etiological agents to commonly-used antimicrobial agents in children with sepsis at the Tamale Teaching Hospital

    PubMed Central

    2013-01-01

    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

  7. Identification and characterization of CTX-M-15 producing Klebsiella pneumoniae clone ST101 in a Hungarian university teaching hospital.

    PubMed

    Melegh, Szilvia; Schneider, György; Horváth, Marianna; Jakab, Ferenc; Emődy, Levente; Tigyi, Zoltán

    2015-09-01

    We investigated the molecular epidemiology of extended spectrum β-lactamase (ESBL) producing Klebsiella pneumoniae isolates derived from the teaching hospitals of University of Pécs, Pécs, Hungary in the time period 2004-2008. Molecular typing, antimicrobial susceptibility testing, detection of common β-lactamase genes (bla(CTX-M), bla(TEM) and bla(SHV)) and virulence associated traits (hypermucoviscosity, magA, k2a, rmpA, siderophores, type 1 and 3 fimbria, biofilm formation, serum resistance) were performed for 102 isolates. The results showed the presence of three major ciprofloxacin resistant CTX-M-15 producing clones (ST15 n = 69, ST101 n = 10, and ST147 n = 9), of which ST15 was predominant and universally widespread. Considering distribution in time and place, ST101 and ST147 were detected at fewer inpatient units and within a narrower time frame, as compared to ST15. Beside major clones, eleven minor clones were identified, and were shown to harbour the following β-lactamase genes: six clones carried bla(CTX-M), four clones harboured bla(SHV-5) and one clone possessed both bla(CTX-M) and ESBL type bla(SHV). Among the SHV-5 producing K. pneumoniae clones a novel sequence type was found, namely ST1193, which harboured a unique infB allele. Different virulence factor content and peculiar antimicrobial susceptibility profile were characteristic for each clone. In contrast to major clone isolates, which showed high level resistance to ciprofloxacin, minor clone isolates displayed significantly lower MIC values for ciprofloxacin suggesting a role for fluoroquinolones in the dissemination of the major K. pneumoniae clones. This is the first description of the CTX-M-15 producing K. pneumoniae clone ST101 in Hungary. PMID:26551567

  8. “Chase CRP”, “Review patient”: Improving the Quality of Weekend Medical Handover at a London Teaching Hospital

    PubMed Central

    Saifuddin, Aamir; Magee, Lucia; Barrett, Rachael

    2015-01-01

    Clinical handover has been identified as a “major preventable cause of harm” by the Royal College of Physicians (RCP). Whilst working at a London teaching hospital from August 2013, we noted substandard weekend handover of medical patients. The existing pro forma was filled incompletely by day doctors so it was difficult for weekend colleagues to identify unwell patients, with inherent safety implications. Furthermore, on-call medical staff noted that poor accessibility of vital information in patients' files was affecting acute clinical management. We audited the pro formas over a six week period (n=83) and the Friday ward round (WR) entries for medical inpatients over two weekends (n=84) against the RCP's handover guidance. The results showed poor documentation of several important details on the pro formas, for example, ceiling of care (4%) and past medical history (PMH) (23%). Problem lists were specified on 62% of the WR entries. We designed new handover pro formas and ‘Friday WR sheets’ to provide prompts for this information and used Medical Meetings and emails to explain the project's aims. Re-audit demonstrated significant improvement in all parameters; for instance, PMH increased to 52% on the pro formas. Only 10% of Friday WR entries used our sheet. However, when used, outcomes were much better, for example, problem list documentation increased to 100%. In conclusion, our interventions improved the provision of crucial information needed to prioritise and manage patients over the weekend. Future work should further highlight the importance of safe handover to all doctors to induce a shift in culture and optimise patient care. PMID:26732516

  9. Treatment of Non-ST Elevation Myocardial Infarction: A Process Analysis of Patient and Program Factors in a Teaching Hospital.

    PubMed

    Shepple, Benjamin I; Thistlethwaite, William A; Schumann, Christopher L; Akosah, Kwame O; Schutt, Robert C; Keeley, Ellen C

    2016-09-01

    As part of a quality improvement project, we performed a process analysis to evaluate how patients presenting with type 1 non-ST elevation myocardial infarction (STEMI) are diagnosed and managed early after the diagnosis has been made. We performed a retrospective chart review and collected detailed information regarding the timing of the first 12-lead electrocardiogram, troponin order entry and first positive troponin result, administration of anticoagulation and antiplatelet medications, and referral for coronary angiography to identify areas of treatment variability and delay. A total of 242 patients with type 1 non-STEMI were included. The majority of patients received aspirin early after presentation to the emergency department; however, there was significant variability in the time from presentation to administration of other medications, including anticoagulation and P2Y12 therapy, even after an elevated troponin level was documented in the chart. Lack of a standardized non-STEMI admission order set, inconsistency regarding whether the emergency department physician or the cardiology admitting team order these medications after the diagnosis is made, and per current protocol, the initial call regarding the patient made to the cardiology fellow, not the admitting house staff, were identified as possible contributors to the delay. Patients who presented during "nighttime" hours had higher rates of atypical symptoms (P = 0.036) and longer delays to coronary angiography (46.5 versus 24 hours, P < 0.001) even in those deemed intermediate to high risk. A process analysis revealed considerable variation in non-STEMI treatment in our teaching hospital and identified specific areas for quality improvement measures. PMID:27465006

  10. Perceptions of burden of caregiving by informal caregivers of cancer patients attending University of Calabar Teaching Hospital, Calabar, Nigeria

    PubMed Central

    Akpan-Idiok, Paulina Ackley; Anarado, Agnes Nonye

    2014-01-01

    Introduction Cancer care is devastating to families. This research studied the informal caregivers’ perceptions of burden of caregiving to cancer patients attending University of Calabar Teaching Hospital, Calabar. Methods The research adopted a cross-sectioned descriptive design and 210 caregivers providing care to advanced cancer patients were purposively selected. Data were collected using a researcher developed questionnaire and standardized Zarit Burden Interview scale (ZBIS). Data collected were analysed using descriptive and chi-square statistics with the help of SPSS 18.0 and PAS 19.0 softwares. Results The results indicated that the caregivers were in their youthful and active economic age, dominated by females, Christians, spouses, partners and parents. The burden levels experienced by the caregivers were as follows: severe (46.2%), moderate (36.2%) and trivial of no burden (17.6%). The forms of burden experienced were physical (43.4%), psychological (43.3%), financial (41.1%) and social (46.7%), quite frequently and nearly always. Psychological and social forms of burden had the highest weighted score of 228 in terms of magnitude of burden. The result further showed that there was a significant (P = 0.001) and inverse association between caregivers’ burden and the care receivers’ functional ability. The level of burden also increased significantly (P = 0.000) with the duration of care, while there was also a significant (P = 0.01) relationship between caregivers’ experience of burden and their desire to continue caregiving. Conclusion Caregiving role can be enhanced by provision of interventions such as formal education programme on cancer caregiving, oncology, home services along side with transmural care. PMID:25419297

  11. Drug utilization evaluation of meropenem and correlation of side effects with renal status of patients in a teaching based hospital.

    PubMed

    Khan, Muhammad Umair; Yousuf, Rabia Ismail; Shoaib, Muhammad Harris

    2014-09-01

    Meropenem is a restricted, broad spectrum and expensive antibiotic. The major consequences of irrational use of restricted antibiotics are increase drug resistance and drug expenditure. The use of antibiotics, specifically restricted antibiotics, must be monitored continuously to increase its adherence to the standard guidelines to avoid such problems. The objective of this study was to evaluate the appropriateness of meropenem use with respect to renal status of patients in a teaching based hospital. A retrospective study was carried out from 1st January 2013 to 30th June 2013 to determine the evaluation of meropenem use in accordance to the criteria developed through national (Infectious disease society of Pakistan) and international guidelines (Health care infection control practices advisory committee). The data was recorded on data collection form by thorough reviewing of patients' medical records. Main outcomes measured were indication, dose, interval, duration, creatinine clearance, complete blood count and culture sensitivity test. Correlation of different variable (side effects and generalized health) was also observed with reference to renal status of patients. Statistical analyses were performed using descriptive statistics. A total of 201 cases of meropenem prescription were identified during the study period. The variable, which was most consistent with the criteria was 'indication', in which 97.52% of meropenem prescription was indicated in diseases encouraged by guidelines. However, the use of meropenem as an empirical therapy was the major problem reported in this study as it adhered to in only 43% of the cases. It was also noted that prevalence of side effects increased when meropenem was prescribed in renal compromised patients, and also observed that generalized health of patients decreased with meronem use in renal unstable patients. Thrombocytopenia was the major problem associated with the meropenem use (37.81%). The study detected various

  12. Prevalence of Needlestick Injuries Among Healthcare Workers in the Accident and Emergency Department of a Teaching Hospital in Nigeria

    PubMed Central

    Isara, AR; Oguzie, KE; Okpogoro, OE

    2015-01-01

    Background: Healthcare workers (HCWs) are continually exposed to hazards from contact with blood and body fluids of patients in the healthcare setting. Aim: To determine the prevalence of needlestick injuries (NSIs) and associated factors among HCWs in the Accident and Emergency Department of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. Subjects and Methods: This was a cross-sectional study. Data were collected using a structured, self-administered questionnaire and analyzed using IBM SPSS version 20. Univariate, bivariate, and binary logistic regression analyses were done. The level of significance was set at P < 0.05. Results: The prevalence of NSIs 12 months preceding the study was 51.0% (50/98). Doctors 8/10 (80.0%) and nurses 28/40 (70.0%) had the highest occurrence. Recapping of needles 19/50 (38.0%) and patient aggression 13/50 (26.0%) were responsible for most injuries. The majority 31/50 (62.0%) of the injuries were not reported. The uptake of postexposure prophylaxis (PEP) was low 11/50 (22.0%). The factors that were significantly associated with NSI include age 30 years and above (odds ratio [OR] =0.28, confidence interval [CI] = 0.11–0.70), work duration of three years and above (OR = 0.29, CI = 0.11–0.75), and being a nurse (OR = 3.38, CI = 1.49–9.93) or a paramedic (OR = 0.18, CI = 0.06–0.52). Conclusion: The high prevalence of NSIs among the HCWs, especially in doctors and nurses is an indication that HCWs in UBTH are at great risk of contracting blood-borne infections. Efforts should be made to ensure that injuries are reported and appropriate PEP undertaken following NSIs. PMID:27057376

  13. Healthcare's crown jewels. A looming 15% reduction in Medicare payments could tarnish the financial viability of teaching hospitals, studies say. Others, however, say they'll keep shining despite the scheduled cuts.

    PubMed

    Lovern, Ed

    2002-05-27

    Though saddled with higher costs than other hospitals, teaching hospitals reap plump margins on Medicare. But that could change this fall. A volley of studies say a looming 15% cut in indirect medical education payments and disproportionate-share payments could threaten the financial viability of healthcare's crown jewels unless Congress reverses current law. PMID:12066397

  14. Methicillin-Resistant Staphylococcus aureus spa Type t002 Outbreak in Horses and Staff at a Veterinary Teaching Hospital after Its Presumed Introduction by a Veterinarian

    PubMed Central

    Masarwa, Samira; Tirosh-Levy, Sharon; Gleser, Dan; Kelmer, Gal; Adler, Amos; Carmeli, Yehuda; Schwaber, Mitchell J.

    2015-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization, involving MRSA strains which differ from common human health care-associated clones, have become serious emerging conditions in equine veterinary hospitals. In 2010, MRSA spa type t535 caused an outbreak involving both horses and personnel in a veterinary teaching hospital in Israel. Since then, surveillance continued, and occasional MRSA isolation occurred. Two years later, MRSA of another spa type, t002, was isolated from a veterinarian and, 3 weeks later, from a horse. The appearance of spa type t002, a common clone in human medicine in Israel, among both personnel and horses, prompted a point-prevalence survey of hospital personnel and hospitalized horses. Fifty-nine staff members (n = 16 equine; n = 43, other) and 14 horses were screened. Ten of 59 staff members (16.9%) and 7 of 14 horses (50%) were MRSA carriers. Among the staff, 44% of large animal department (LAD) personnel, compared with only 7% of non-LAD personnel, were carriers. Isolates from all horses and from 9 of 10 personnel were found to be of MRSA spa type t002. This clone was later isolated from an infected postoperative wound in a hospitalized horse. Measures were taken to contain transmission between horses and personnel, as was done in the previous outbreak, resulting in reduction of transmission and, finally, cessation of cross-transmission between horses and personnel. PMID:26085620

  15. Health-care waste incineration and related dangers to public health: case study of the two teaching and referral hospitals in Kenya.

    PubMed

    Njagi, Nkonge A; Oloo, Mayabi A; Kithinji, J; Kithinji, Magambo J

    2012-12-01

    There are practically no low cost, environmentally friendly options in practice whether incineration, autoclaving, chemical treatment or microwaving (World Health Organisation in Health-care waste management training at national level, [2006] for treatment of health-care waste. In Kenya, incineration is the most popular treatment option for hazardous health-care waste from health-care facilities. It is the choice practiced at both Kenyatta National Hospital, Nairobi and Moi Teaching and Referral Hospital, Eldoret. A study was done on the possible public health risks posed by incineration of the segregated hazardous health-care waste in one of the incinerators in each of the two hospitals. Gaseous emissions were sampled and analyzed for specific gases the equipment was designed and the incinerators Combustion efficiency (CE) established. Combustion temperatures were also recorded. A flue gas analyzer (Model-Testos-350 XL) was used to sample flue gases in an incinerator under study at Kenyatta National Hospital--Nairobi and Moi Teaching and Referral Hospital--Eldoret to assess their incineration efficiency. Flue emissions were sampled when the incinerators were fully operational. However the flue gases sampled in the study, by use of the integrated pump were, oxygen, carbon monoxide, nitrogen dioxide, nitrous oxide, sulphur dioxide and No(x). The incinerator at KNH operated at a mean stack temperature of 746 °C and achieved a CE of 48.1 %. The incinerator at MTRH operated at a mean stack temperature of 811 °C and attained a CE of 60.8 %. The two health-care waste incinerators achieved CE below the specified minimum National limit of 99 %. At the detected stack temperatures, there was a possibility that other than the emissions identified, it was possible that the two incinerators tested released dioxins, furans and antineoplastic (cytotoxic drugs) fumes should the drugs be subjected to incineration in the two units. PMID:22718254

  16. Evaluation of a primary-care setting at a veterinary teaching hospital by a student business group: implementing business training within the curriculum.

    PubMed

    Louisa Poon, W Y; Covington, Jennifer P; Dempsey, Lauren S; Goetgeluck, Scott L; Marscher, William F; Morelli, Sierra C; Powell, Jana E; Rivers, Elizabeth M; Roth, Ira G

    2014-01-01

    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

  17. Taking Risk: Early Results From Teaching Hospitals' Participation in the Center for Medicare and Medicaid Innovation Bundled Payments for Care Improvement Initiative.

    PubMed

    Kivlahan, Coleen; Orlowski, Janis M; Pearce, Jonathan; Walradt, Jessica; Baker, Matthew; Kirch, Darrell G

    2016-07-01

    The authors describe observations from the 27 teaching hospitals constituting the Association of American Medical Colleges (AAMC) cohort in the Center for Medicare and Medicaid Innovation (CMMI) Bundled Payments for Care Improvement (BPCI) initiative. CMMI introduced BPCI in August 2011 and selected the first set of participants in January 2013. BPCI participants enter into Medicare payment arrangements for episodes of care for which they take financial risk. The first round of participants entered risk agreements on October 1, 2013 and January 1, 2014. In April 2014, CMMI selected additional participants who started taking financial risk in 2015. Selected episodes include congestive heart failure (CHF), major joint replacement (MJR), and cardiac valve surgery. The AAMC cohort of participating hospitals selected clinical conditions on the basis of patient volume, opportunity to impact savings and quality, organizational and clinical team readiness, and prior process improvement experience. Early financial results suggest that focused attention to postacute care utilization and outcomes, rapid changes in care processes, program pricing rules, and team composition drove savings and losses. The first cohort of participants generated savings in MJR, CHF, and cardiac valve episodes; losses were experienced in stroke, percutaneous coronary intervention, and spine surgery. Although about one-quarter of U.S. teaching hospitals are participating in BPCI, the proliferation of existing and new payment models, as well as the 2015 announcement to increasingly pay providers according to value, mandates close scrutiny of program outcomes. The authors conclude by proposing additional opportunities for research related to alternative payment models. PMID:26886810

  18. Prescribing patterns of antibiotics and sensitivity patterns of common microorganisms in the Internal Medicine ward of a teaching hospital in Western Nepal: a prospective study

    PubMed Central

    Shankar, Ravi Pathiyil; Partha, Praveen; Shenoy, Nagesh Kumar; Easow, Joshy Maducolil; Brahmadathan, Kottallur Narayanan

    2003-01-01

    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. PMID:12904265

  19. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.

    PubMed

    2014-08-22

    are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. In addition, we are making technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching hospitals and hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers. We are aligning the reporting and submission timelines for clinical quality measures for the Medicare HER Incentive Program for eligible hospitals and critical access hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program. In addition, we provide guidance and clarification of certain policies for eligible hospitals and CAHs such as our policy for reporting zero denominators on clinical quality measures and our policy for case threshold exemptions. In this document, we are finalizing two interim final rules with comment period relating to criteria for disproportionate share hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program. PMID:25167590

  20. Mammotome(®) biopsy system for the resection of breast lesions: Clinical experience in two high-volume teaching hospitals.

    PubMed

    Jiang, Yangping; Lan, Huanrong; Ye, Qian; Jin, Ketao; Zhu, Min; Hu, Xiaoyan; Teng, Lisong; Cao, Feilin; Lin, Xianfang

    2013-09-01

    Ultrasound-guided vacuum-assisted breast biopsy (VABB) is regarded as a feasible, effective, minimally invasive and safe method for the removal of benign breast lesions, without the occurrence of serious complications. The aim of this study was to evaluate the feasibility, efficacy and safety of ultrasound-guided VABB using the Mammotome(®) biopsy system in the treatment of breast lesions. The clinical outcomes of 3,681 patients with breast lesions were evaluated following excisions by ultrasound-guided VABB in two high-volume teaching hospitals. From January 2008 to December 2012, a total of 4,867 ultrasound-guided VABB procedures were performed in the 3,681 patients, who had a mean age of 37.8 years (range, 16-73 years). The parameters examined in this analysis included lesion size, lesion location in the inner breast, Breast Imaging Reporting and Data System (BI-RADS) ultrasound category and histopathological diagnosis. Ultrasonography follow-up was performed at 3-6 month intervals in order to assess recurrence. The size of the investigated lesions ranged between 6 and 62 mm and a histopathological diagnosis was made in 100% of cases. The results indicated that the majority of specimens (98.89%) were benign. On average, the ultrasound-guided VABB was performed in 10.3 min (range, 7.5-43 min) and the mean number of cores removed in the procedure was 8.1 (range, 3-32). A complete excision was achieved in the majority of cases (99.7%). The presence of a hematoma was the most common complication following the biopsy, and was observed in 27.5% of patients. The mean follow-up period was 25.5 months (range, 1-60 months), during which the rate of recurrence was 4.4%. The results indicated that ultrasound-guided VABB using the Mammotome biopsy system is an effective and safe procedure that is able to rapidly remove the majority of benign breast lesions using a small incision and without the occurrence of scarring or complications. PMID:24137261

  1. Mammotome® biopsy system for the resection of breast lesions: Clinical experience in two high-volume teaching hospitals

    PubMed Central

    JIANG, YANGPING; LAN, HUANRONG; YE, QIAN; JIN, KETAO; ZHU, MIN; HU, XIAOYAN; TENG, LISONG; CAO, FEILIN; LIN, XIANFANG

    2013-01-01

    Ultrasound-guided vacuum-assisted breast biopsy (VABB) is regarded as a feasible, effective, minimally invasive and safe method for the removal of benign breast lesions, without the occurrence of serious complications. The aim of this study was to evaluate the feasibility, efficacy and safety of ultrasound-guided VABB using the Mammotome® biopsy system in the treatment of breast lesions. The clinical outcomes of 3,681 patients with breast lesions were evaluated following excisions by ultrasound-guided VABB in two high-volume teaching hospitals. From January 2008 to December 2012, a total of 4,867 ultrasound-guided VABB procedures were performed in the 3,681 patients, who had a mean age of 37.8 years (range, 16–73 years). The parameters examined in this analysis included lesion size, lesion location in the inner breast, Breast Imaging Reporting and Data System (BI-RADS) ultrasound category and histopathological diagnosis. Ultrasonography follow-up was performed at 3–6 month intervals in order to assess recurrence. The size of the investigated lesions ranged between 6 and 62 mm and a histopathological diagnosis was made in 100% of cases. The results indicated that the majority of specimens (98.89%) were benign. On average, the ultrasound-guided VABB was performed in 10.3 min (range, 7.5–43 min) and the mean number of cores removed in the procedure was 8.1 (range, 3–32). A complete excision was achieved in the majority of cases (99.7%). The presence of a hematoma was the most common complication following the biopsy, and was observed in 27.5% of patients. The mean follow-up period was 25.5 months (range, 1–60 months), during which the rate of recurrence was 4.4%. The results indicated that ultrasound-guided VABB using the Mammotome biopsy system is an effective and safe procedure that is able to rapidly remove the majority of benign breast lesions using a small incision and without the occurrence of scarring or complications. PMID:24137261

  2. Bacterial profile and antimicrobial susceptibility patterns of otitis media in Ayder Teaching and Referral Hospital, Mekelle University, Northern Ethiopia.

    PubMed

    Wasihun, Araya Gebereyesus; Zemene, Yilikal

    2015-01-01

    Middle Ear infection is a common problem for both children and adults particularly in resource limited countries. Nevertheless, in Ethiopia and particularly in the study area, there is scarcity of recent data that indicate the magnitude of the problem. Thus this study aimed to identify bacterial isolates and determine their drug susceptibility patterns from patients who had ear infection. Cross sectional study was carried out on patients with ear infection and who visited the Ear, Nose and Throat clinic of Ayder referral and teaching hospital from November 2014 to June 2015. Middle ear discharges were collected and processed for bacterial culture and antimicrobial susceptibility testing using standard bacteriological techniques. Clinical and demographic data were collected using standard questionnaire. Data were entered and analyzed using SPSS version 20 software and p value of < 0.05 was considered statistically significant. Of the total of 162 patients with ear discharges, 68.5 % were from rural areas, 71 % with chronic infection, 54.9 % referred cases and 67.3 % of them had decreased hearing status. Pathogens were isolated from 157 (98.2 %) of the patients with a total of 216 isolates. Staphylococcus aureus 46 (28.4 %), Proteus mirabilis 39 (24.1 %), Pseudomonas aeruginosa 27 (16.7 %), Klebsiella spp. and Haemophilus influenzae 18 (11.1 % each) were the dominant bacteria. Out of the individuals with ear infection, single and mixed bacterial infection was seen among 185 (90.7 %) and 59 (39.5 %) respectively. Age group of 0-5 years (p = 0.02), chronic patients (p = 0.042) and referred cases (p = 0.045) showed high bacterial isolates. High resistance was seen to most antibiotics. Ciprofloxacin, Gentamicin Norfloxacin and Erythromycin were effective against isolated bacteria. The overall multi drug resistance rate of bacteria in this study was 74.5 %. Prevalence of bacteria associated with otitis media and multidrug resistance was very high in

  3. Glucose-6-phosphate dehydrogenase deficiency among children attending the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

    PubMed Central

    Isaac, IZ; Mainasara, AS; Erhabor, Osaro; Omojuyigbe, ST; Dallatu, MK; Bilbis, LS; Adias, TC

    2013-01-01

    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

  4. Seroprevalence of human immunodeficiency virus among voluntary counseling and testing clients at the University of Gondar Teaching Hospital, Northwest Ethiopia

    PubMed Central

    Sinku, Yohannes; Gezahegn, Takele; Gashaw, Yalewayiker; Workineh, Meseret; Deressa, Tekalign

    2016-01-01

    Background The epidemiology of human immunodeficiency virus (HIV) infection in Ethiopia varies with regions, study population, and time. Thus, timely information on HIV epidemiology is critical for the combat of the epidemic. In this study, we aim to update HIV prevalence and risk factors among voluntary counseling and testing (VCT) clients at the University of Gondar Teaching Hospital, Northwest Ethiopia. Methods A total of 2,120 VCT clients’ records from September 2007 to August 2010 were analyzed retrospectively. Bivariate logistic regression analysis was used to identify significant predictors. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. Statistical significance was set at P-value <0.05. Results Of 2,120 VCT clients, 363 (17.1%) were seropositive for HIV. A higher rate of HIV positivity was observed among female clients (20.4%) than that in male clients (14.0%) (OR 1.58, 95% CI 1.26–1.98, P=0.00). Widowed (95% CI 10.42–34.92, P=0.00), married (95% CI 3.42–5.94, P=0.00), divorced (95% CI 2.79–5.32, P=0.00), and illiterate (95% CI 2.33–5.47, P=0.00) clients were associated with HIV infection with the odds ratios of 19.07, 4.51, 3.85, and 3.57, respectively. Clients within the age category of 35–49 years (OR 5.03, 95% CI 3.56–7.12, P=0.00) and above the age of 50 years (OR 4.99, 95% CI 2.67–9.34, P=0.00) were more likely to be infected with HIV. Conclusion HIV is still the major concern of public health in the Gondar area as evidenced by our data. Being female, widowed, married, illiterate, and older age were the identified risk factors for HIV infection. Thus, consideration of these factors in future intervention and clinical practice is recommended. PMID:27574468

  5. A Survey of the quantity and type of biological aerosols in selected wards of a teaching hospital in Ghazvin

    PubMed Central

    Eslami, Akbar; Karimi, Fatemeh; Karimi, Zainab; Rajabi, Zahra

    2016-01-01

    Introduction Bioaerosols are agents that can cause infection, allergy or induce other toxic effects in the human body. If the person exposed to such particles is not capable of their destruction or elimination from the body, the established chemical and physiological disorders can result in disease or death. The aim of this study was to assess the concentrations of bioaerosols in several wards of a teaching hospital. Methods Given that gas air-conditioners (split and window types) were used for ventilation in the eye operating room, internal intensive care unit, and the respiratory isolation room, these wards were selected for passive sampling. Sterile plates containing culture medium were exposed for two hours to the wards’ indoor ambient air. After this time, they were transferred to a lab to undergo incubation, colony count, and identification of the microorganisms. The data were analyzed using SPSS software, version 18, and the significance level of less than 0.05 was used. Results Based on our findings, the highest colony-forming bacterial unit was observed 22 cfu/plate/h in the eye operating room and, the highest colony-forming fungal unit was observed 4 cfu/plate/h in the internal intensive care unit. Based on the results of the differential tests, the most prevalent bacteria identified were Staphylococcus epidermidis (75%) in the air of eye operating room and Staphylococcus saprophyticus (52%) in the internal intensive care unit and isolation room. The most prevalent identified fungi in the air of selected wards were related to Alternaria alternata (43%), Aspergillus flavus (24%), Penicillium (36%) and Curvularia (21%) types. Based on Spearman’s correlation test, no significant relationship was observed between the factor of temperature and the number of fungal and bacterial colonies (r = 0.201, p = 0.42; r = −0.197, p = 0.41). Moreover, a meaningful relationship was observed only between the number of individuals and the bacterial colonies present in

  6. A nursing care classification system for assessing workload and determining optimal nurse staffing in a teaching hospital in China: A pre-post intervention study.

    PubMed

    Yu, Dongmei; Ma, Yuqin; Sun, Qingwen; Lu, Gendi; Xu, Ping

    2015-08-01

    We aimed to evaluate the effectiveness of a nursing care classification system for re-assessing nurse workload and determining staffing needs. Adequate bed-nurse ratios help manage hospital cost-efficiency, quality of care and patient safety. A prospective pre-post intervention study was conducted from January 2010 to December 2012 in 16 medical-surgical units of a tertiary teaching hospital. Nursing tasks were classified into four grades of care reflecting actual workload. Units were re-staffed accordingly and bed-nurse ratios compared with government-authorized bed-nurse ratios. Patient satisfaction, hospital stays and mortality were evaluated pre- and poststaffing changes. Average bed-nurse ratio (1:0.41) exceeded the national standard (1:0.40) in 16 units, but was inadequate in five units. Re-staffing increased average bed-nurse ratio from 1:0.41 to 1:0.48. Patients' satisfaction increased from 96.9% to 97.6%, and hospital stays decreased significantly. Nursing care classification effectively distributes nurse staffing to match patients' care levels, improving patient outcomes. PMID:24754507

  7. Frequency of bacterial agents isolated from patients with nosocomial infection in teaching hospitals of Mazandaran University of Medical Sciences in 2012

    PubMed Central

    Davoudi, Ali Reza; Najafi, Narges; Hoseini Shirazi, Mohsen; Ahangarkani, Fatemeh

    2014-01-01

    Background: The antibiotic resistance of nosocomial organisms is rapidly increasing. The purpose of this study was to determine the frequency of bacterial agents isolated from patients with nosocomial infection. Methods: This study was performed in the different wards of teaching hospitals of Mazandaran University of Medical Sciences (northern Iran). The study population consists of the patients with the symptoms of nosocomial infection admitted in these hospitals in 2012. The patient data (including age, sex, type of infection, type of isolated organisms and their antibiotic susceptibility) were collected and analyzed. Results: The total number of hospitalizations was 57122 and the number of nosocomial infection was 592. The overall prevalence of nosocomial infection was 1.03% that was mostly in Burn unit and intensive care unit. The most common nosocomial infection was wound infection (44.6%) and the most common organisms were Pseudomonas aeruginosa and Acinetobacter. Conclusion: Given the increasing numbers of nosocomial infection in this region, especially infection with Pseudomonas aeruginosa, it is necessary to make a precise reporting and improve the procedures of infection control in hospitals. PMID:25489435

  8. Strategic planning and designing of a hospital disaster manual in a tertiary care, teaching, research and referral institute in India

    PubMed Central

    Talati, Shweta; Bhatia, Prateek; Kumar, Ashok; Gupta, A. K.; Ojha, Col. D

    2014-01-01

    BACKGROUND: As per the “Disaster Management Act, 2005” of India, it is mandatory for government hospitals in India to prepare a disaster plan. This study aimed to prepare a disaster manual of a 1 900 bed tertiary care hospital, in consultation and involvement of all concerned stakeholders. METHODS: A committee of members from hospital administration, clinical, diagnostic and supportive departments worked on an initial document prepared according to the Act and gave their inputs to frame a final disaster manual. RESULTS: The prepared departmental standard operating procedures involved 116 people (doctors and paramedical staff), and were then synchronized, in 12 committee meetings, to produce the final hospital disaster manual. CONCLUSIONS: The present disaster manual is one of the few comprehensive plans prepared by the stakeholders of a government hospital in India, who themselves form a part of the disaster response team. It also helped in co-ordinated conduction of mock drills. PMID:25215145

  9. Hospital structure and consumer satisfaction.

    PubMed Central

    Fleming, G V

    1981-01-01

    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. PMID:7228714

  10. Incidence of Road Traffic Injury and Associated Factors among Patients Visiting the Emergency Department of Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia

    PubMed Central

    Tiruneh, Bewket Tadesse; Dachew, Berihun Assefa; Bifftu, Berhanu Boru

    2014-01-01

    Background. Road traffic injuries are a major public health issue. The problem is increasing in Africa. Objective. To assess the incidence of road traffic injury and associated factors among patients visiting the emergency department of Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia. Methods. Institutional based cross-sectional study design was conducted. A total of 356 systematically selected study subjects were included in the study. Bivariate and multivariate logistic regressions were performed to identify associated factors with road traffic injury. Odds ratios with 95% confidence interval were computed to determine the level of significance. Results. The incidence of road traffic injury in the emergency department of Tikur Anbessa Specialized Teaching Hospital was 36.8%. Being a farmer (AOR = 3.3; 95% CI = 1.06–10.13), conflict with family members (AOR = 7.7; 95% CI = 3.49–8.84), financial problem (AOR = 9.91; 95% CI = 4.79–6.48), psychological problem (AOR = 17.58; 95% CI = 7.70–12.14), and alcohol use (AOR = 2.98; 95% CI = 1.61–5.27) were independently associated with road traffic injury. Conclusion and Recommendation. In this study the incidence of road traffic injury was high. Alcohol is one of the most significant factors associated with Road Traffic Injury. Thus urgent education on the effect of alcohol is recommended. PMID:25165583

  11. Individual Potentials Related to Evidence-Based Nursing among Nurses in Teaching Hospitals Affiliated to Tabriz University of Medical Sciences, Tabriz, Iran

    PubMed Central

    Seyyedrasooli, Alehe; Zamanzadeh, Vahid; Valizadeh, Leila; Tadaion, Farideh

    2012-01-01

    Introduction: Knowledge, attitude, and skills of nurses regarding evidence-based medicine are some of the important individual potentials in the implementation of these cares. There is no evidence indicating Iranian nurses to have these individual potentials. Therefore, the aim of this study was to determination the perceptions of nurses about individual potentials in evidence-based nursing and its related factors. Methods: In this descriptive correlational study, all nurses (n = 600) working in teaching hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran were included. Valid and reliable translated questionnaires were used to collect data. Descriptive and inferential statistics were employed in SPSS to analyze the data. Results: Based on our findings, moderate levels of knowledge, attitude, and skills were possessed by 274 (45.7%), 394 (65.7%), and 411 (68.5%) nurses, respectively. In addition, male nurses (p = 0.002) and those with a master's degree (p = 0.001) were more knowledgeable. Likewise, more positive attitudes were demonstrated by females (p = 0.004) and nurses with a master's degree (p = 0.04). A statistically significant difference was found between skills and employment status of nurses (p = 0.002). Conclusion: The moderate level of attitude among nurses can provide a good potential in promoting evidence-based nursing in teaching hospitals affiliated to Tabriz University of Medical Sciences. Therefore, more attention should be paid to enhance the awareness and skills of nurses toward evidence-based care. PMID:25276682

  12. Evaluation of antioxidant status of female diabetic patients in Nnamdi Azikiwe University Teaching Hospital, Anambra State, Nigeria.

    PubMed

    Okuonghae, E O P; Onyenekwe, C C; Ahaneku, J E; Ukibe, N R; Nwani, P O; Asomugha, A L; Osakue, N O; Aidomeh, F; Awalu, C C

    2015-01-01

    Diabetes mellitus has become an onerous disease to developing countries such as Nigeria. Rapid acceptance of urbanisation and sedentary life styles pose an encumbrance to its prevention and management. Increased oxidative stress in diabetes mellitus has been implicated as a culprit in perpetuating antioxidant depletion and diabetic complications in diabetes mellitus individuals. This study aims to evaluate the level of antioxidant status in type 2 diabetes mellitus (DM) female participants visiting the out-patient diabetic clinic of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria. A total of 86 participants aged 51±10 years were recruited for this study. The test group consists of 43 already confirmed type 2 diabetes mellitus females, while the control group consists of 43 apparently healthy females. The test subjects were further subgrouped into good and poor glycaemic control groups, using a cut-off of <7% for HbA1c. Whole blood was collected from participants and aliquoted into specified sample containers for analysis of the following parameters: random blood glucose (RBG; mg/dL), glycosylated haemoglobin (HbA1c; %), glutathione reductase (GR; U/L) and total antioxidant status (TAS; mmol/L). Results from this study showed that the mean differences in RBG (197.74±49.29 mg/dL) and HbA1c (9.86±1.44%) were significantly higher in the test group compared to the control group RBG (104.79±11.33 mg/dL) and HbA1c (5.21±1.23%) (P<0.05). The mean differences of GR (45.81±20.45 U/L) and TAS (1.81±1.04 mmol/L) were significantly lower in the test group compared to the control group GR (61.21±14.34 U/L) and TAS (2.73±2.08 mmol/L) (P<0.05). The poor glycaemic test group was observed to have the highest RBG (200.34±50.4 mg/dL) and HbA1c (10.23±1.33%) compared both to good glycaemic test group RBG (186.38±45.39 mg/dL), HbA1c (6.54±0.45%) and non-diabetic group RBG (104.79±11.33 mg/dL) and HbA1c (5.21±1.23%) (P<0.05). Glutathione

  13. Impact of implementing an Internal Bed Regulation Committee on administrative and care indicators at a teaching hospital

    PubMed Central

    Rodrigues, Luciane Cristine Ribeiro; Juliani, Carmen Maria Casquel Monti

    2015-01-01

    Objective To compare hospital indicators before and after implementing an Internal Bed Regulation Committee at a reference hospital. Methods It is an quantitative, evaluation, exploratory, descriptive and cross-sectional research. The data was gathered from the hospital administrative reports for the period 2008-2013, provided by the Information Technology Center of the Complexo FAMEMA. Results The indicators improved after implementation of the Internal Bed Regulation Committee. Conclusion The individuals involved in the process acknowledged the improvement. It is necessary to carry on the regulatory actions, especially in a comprehensive and complex healthcare system, such as the brazilian Sistema Único de Saúde. PMID:25993075

  14. A questionnaire-based survey to ascertain the views of clinicians regarding rational use of antibiotics in teaching hospitals of Kolkata

    PubMed Central

    Chatterjee, Dattatreyo; Sen, Sukanta; Begum, Sabnam Ara; Adhikari, Anjan; Hazra, Avijit; Das, Anup Kumar

    2015-01-01

    Objectives: The objective was to assess the views of clinicians in teaching hospitals of Kolkata regarding the use of antibiotics in their own hospitals, focusing on perceived misuse, reasons behind such misuse and feasible remedial measures. Materials and Methods: A total of 200 clinicians from core clinical disciplines was approached in six teaching hospitals of Kolkata through purposive sampling. A structured, validated questionnaire adopted from published studies and modified to suit the responding population was completed by consenting respondents through face-to-face interaction with a single interviewer. Respondents were free to leave out questions they did not wish to answer. Results: Among 130 participating clinicians (65% of approached), all felt that antibiotic misuse occurs in various hospital settings; 72 (55.4% of the respondents) felt it was a frequent occurrence and needed major rectification. Cough and cold (78.5%), fever (65.4%), and diarrhea (62.3%) were perceived to be the commonest conditions of antibiotic misuse. About half (50.76%) felt that oral preparations were more misused compared to injectable or topical ones. Among oral antibiotics, co-amoxiclav (66.9%) and cefpodoxime (63.07%) whereas among parenteral ones, ceftriaxone and other third generation cephalosporins (74.6%) followed by piperacillin-tazobactam (61.5%) were selected as the most misused ones. Deficient training in rational use of medicines (70.7%) and absence of institutional antibiotic policy (67.7%) were listed as the two most important predisposing factors. Training of medical students and interns in rational antibiotic use (78.5%), implementation of antibiotic policy (76.9%), improvement in microbiology support (70.7%), and regular surveillance on this issue (64.6%) were cited as the principal remedial measures. Conclusions: Clinicians acknowledge that the misuse of antibiotics is an important problem in their hospitals. A system of clinical audit of antibiotic usage

  15. Case report of post sheep brain rabies vaccine neuroparalytic complications at Tikur Anbessa Teaching Hospital, in Ethiopia.

    PubMed

    Azazh, Aklilu; Kacha, Ermias

    2011-10-01

    We report four cases of ascending paralysis admitted to Tikur Anbessa Specialized Hospital (TASH) within six months period between December 2010 and June 2011 following administration of sheep brain tissue anti rabies vaccine for presumed rabies exposure. The paralysis started after a minimum of twelve doses of the vaccine. Two of the patients were discharged with severe paralysis and two died in the hospital. PMID:23409403

  16. Increasing incidence of Clostridium difficile infections: results from a 5-year retrospective study in a large teaching hospital in the Italian region with the oldest population.

    PubMed

    Alicino, C; Giacobbe, D R; Durando, P; Bellina, D; DI Bella, A M; Paganino, C; Del Bono, V; Viscoli, C; Icardi, G; Orsi, A

    2016-09-01

    Limited information is available on the incidence of Clostridium difficile infections (CDIs) in Italian hospitals. In this study, we assessed the changes in the incidence of CDI over a 5-year period in a teaching hospital in Liguria, the Italian region with the oldest population. Secondary endpoints were the development of severe CDI and 30-day mortality. The annual incidence of CDI/10000 patient-days significantly increased from 0·54 in 2010 to 3·04 in 2014 (χ 2 for trend, P < 0·001). The median age of patients with CDI was 81 years. As many as 81% and 89% of these patients had comorbid conditions and previous exposure to antibiotics, respectively. In the multivariate analysis of risk factors for severe CDI, previous therapy with histamine 2 blockers and low serum albumin were associated with severe CDI, while diabetes appeared to be protective. In the multivariate model of risk factors for 30-day mortality, high leukocyte count, low serum albumin, and increased serum creatinine were unfavourably associated with outcome. Strict adherence to infection control measures was of utmost importance to counteract the increasing incidence of CDI in our hospital, particularly because of the advanced age of the patients and their very high frequency of chronic conditions and use of antibiotics, which readily predispose them to the development of CDI. PMID:27193828

  17. [Blood exposure accidents: Knowledge, attitudes and practices of nursing and midwifery students at the Bobo-Dioulasso teaching hospital (Burkina Faso)].

    PubMed

    Zoungrana, J; Yaméogo, T M; Kyelem, C G; Aba, Y T; Sawadogo, A; Millogo, A

    2014-01-01

    Blood exposure accidents are the source of major risks of contamination of healthcare personnel. The objective of this study was to describe the knowledge of standard precautions, and the attitudes and practices of nursing and midwifery students in relation to this accidental exposure. This cross-sectional survey, conducted in November 2011, was based on voluntary anonymous questionnaires completed by students working in the medical ward of the Bobo-Dioulasso teaching hospital. Of the 275 students asked to participate, 219 (92.8%) completed the questionnaire: 138 (63,0%) were student nurses and 81 (37.0%) student midwives. Their mean age was 27.9 ± 5 years. Among them, 64 (29.1%) acknowledged accidental exposure to blood during treatment performed as part of their hospital work. Only 30 of these 64 cases were reported at the time. The standard precautions for the prevention of these accidents were known to 131 students (59.8%); 58.4% always wore gloves for invasive procedures; 74.9% reported that the syringe container was "always" or "often" used. The needles used were "always" or "often" recapped before disposal in only 39.1% of cases. Only 11.0% were fully vaccinated against hepatitis B. Blood exposure accidents were not uncommon among these students and their knowledge of the standard precautions and actions to take in case of an accident is insufficient. These data show the need for further training and awareness campaigns to improve these hospital practices. PMID:24922618

  18. Updates on the Epidemiology and Pattern of Traumatic Maxillofacial Injuries in a Nigerian University Teaching Hospital: A 12-Month Prospective Cohort In-Hospital Outcome Study

    PubMed Central

    Olusanya, Adeola Adenike; Adeleye, Amos Olufemi; Aladelusi, Timothy Olukunle; Fasola, Abiodun Olubayo

    2014-01-01

    Many studies have been undertaken in Nigeria on maxillofacial trauma. However, only a few have considered both the skeletal and soft tissue injuries (in general) involving all the aspects of the maxillofacial region or considered other etiological sources of trauma apart from road traffic crashes. Fewer still have reviewed the outcome of management of facial injuries in our low-resource environment. This study sets out to examine the recent trends in both the clinical and epidemiological patterns of all facial injuries from all causes seen in a low-resource practice of a developing country. It also assessed the in-hospital treatment outcomes, and the levels of the patients' satisfaction with treatment received in this setting. Over a 12-month period, the clinical records of consecutive patients who were evaluated and treated for maxillofacial injuries in our unit were prospectively acquired, entered into predesigned forms and subsequently analyzed. There were 259 patients (79.5% males) during the study period. The mean age was 32.21( ± 16.588) years. Overall, motor bike crashes, 42.1%, were the commonest source of these traumas; and armed robbery was the commonest form (69.0%) of assault. Mandibular fractures were the commonest maxillofacial fractures (37.8%) whereas head injury had the highest frequency among the associated injuries (71.4%). Closed reduction and immobilization was deployed in 88.0% of those who had treatment and majority was satisfied with the esthetic outcome of the treatment received. Mean length of hospital stay was 12.6 ( ± 4.423) days. Maxillofacial trauma poses a significant socioeconomic burden on affected individuals in this study population. This is made worse by the presence of associated injuries in the other body systems. More local studies on the outcome of management of maxillofacial trauma will improve the available literature in this region. PMID:25709753

  19. Prevalence of CTX-M-Type and PER Extended-Spectrum β-Lactamases Among Klebsiella spp. Isolated From Clinical Specimens in the Teaching Hospital of Kashan, Iran

    PubMed Central

    Amiri, Atena; Firoozeh, Farzaneh; Moniri, Rezvan; Zibaei, Mohammad

    2016-01-01

    Background: Extended-spectrum β-lactamases (ESBLs) is one of the most important mechanisms of resistance to β-lactams especially among Enterobacteriaceae family including Klebsiella spp. Different types of extended-spectrum β-lactamases including CTX-M-type and PER enzymes are identified among gram negative bacteria. Objectives: The current study aimed to determine the prevalence of CTX-M-type and PER extended-spectrum β-lactamases among Klebsiella spp. isolated from clinical specimens in the teaching hospital of Kashan, Iran. Patients and Methods: One hundred Klebsiella spp. were isolated from clinical specimens of hospitalized patients at Shahid-Beheshti hospital from December 2012 to November 2013. Disk diffusion method was used to determine the susceptibility of these isolates to 14 different antimicrobial agents; disks were purchased from MAST company (United Kingdom). The phenotypic double disk synergy confirmatory test was used to screen the isolates to produce extended-spectrum β-lactamase. DNAs of isolates were extracted using boiling method and PCR assay was used to characterize the blaCTX-M type and blaPER genes. The purified PCR products were sent to Macrogen research company (Korea) for sequencing. Results: Of the total 100 Klebsiella isolates, %93 was susceptible to imipenem. Resistance to ampicillin, ceftazidime, ceftriaxone, aztreonam and cefotaxime was (92%), (67%), (65%), (64%) and (59%), respectively. The phenotypic confirmatory test (PCT) confirmed that 35% (n = 35) of the isolates were ESBL-producing Klebsiella strains. The prevalence of blaCTX-M type and blaRER genes among Klebsiella isolates were 28% (n = 28) and 9% (n = 9), respectively. Conclusions: The prevalence of ESBL-producing Klebsiella strains in Shahid-Beheshti hospital in Kashan has increased. The study concluded that there was a high prevalence of the blaCTX-M type gene among ESBL positive isolates. PMID:27247786

  20. The Relationship Between the Managerial Skills and Results of “Performance Evaluation “Tool Among Nursing Managers in Teaching Hospitals of Iran University of Medical Science

    PubMed Central

    Isfahani, Haleh Mousavi; Aryankhesal, Aidin; Haghani, Hamid

    2015-01-01

    Performance of different organizations, such as hospitals is mainly influenced by their managers’ performance. Nursing managers have an important role in hospital performance and their managerial skills can improve the quality of the services. Hence, the present study was conducted in order to assess the relationship between the managerial skills and the results of their performance evaluation in Teaching Hospitals of Iran University of Medical Science in 2013. The research used the cross sectional method in 2013. It was done by distributing a managerial skills assessment questionnaire, with close-ended questions in 5 choice Likert scale, among 181 managers and head nurses of hospitals of Iran university of Medical Sciences; among which 131 answered the questions. Another data collection tools was a forms to record evaluation marks from the personnel records. We used Pearson and Spearman correlation tests and SPSS for analysis and description (frequency, mean and standard deviation). Results showed that the managerial skills of the nursing mangers were fair (2.57 out of 5) and the results of the performance evaluation were in a good condition (98.44). The mangers’ evaluation results and the managerial skills scores were not in a meaningful correlation (r=0.047 np=0.856). The research showed no correlation between different domains of managerial skills and the performance evaluation marks: decision making skills (r=0.074 and p=0.399), leadership (correlation coefficient 0.028 and p=0.654), motivation (correlation coefficient 0.118 and p=0.163), communication (correlation coefficient 0.116 and p=0.122), systematic thinking (correlation coefficient 0.028 and p=0.828), time management (correlation coefficient 0.077 and p=0.401) and strategic thinking (correlation coefficient 0.041 and p=0.756). Lack of any correlation and relation between managers’ managerial skills and their performance evaluation results shows need to a fundamental revision at managers

  1. Biomedical waste management: study on the awareness and practice among healthcare workers in a tertiary teaching hospital.

    PubMed

    Joseph, L; Paul, H; Premkumar, J; Paul, R; Michael, J S

    2015-01-01

    Bio-medical waste has a higher potential of infection and injury to the healthcare worker, patient and the surrounding community. Awareness programmes on their proper handling and management to healthcare workers can prevent the spread of infectious diseases and epidemics. This study was conducted in a tertiary care hospital to assess the impact of training, audits and education/implementations from 2009 to 2012 on awareness and practice of biomedical waste segregation. Our study reveals focused training, strict supervision, daily surveillance, audits inspections, involvement of hospital administrators and regular appraisals are essential to optimise the segregation of biomedical waste. PMID:25560016

  2. Implementing an online reporting system in the anatomical pathology department of a tertiary care teaching hospital in India: a case study.

    PubMed

    Radhakrishna, Kedar; Correa, Marjorie; Thounaojam, Deepak; Raj, Tony D S

    2013-01-01

    This article presents a case study in designing, developing, and implementing a web-enabled reporting application for the anatomical pathology (histopathology) department of a tertiary care teaching hospital in India. The article describes workflows, requirements assessment, and implementation methods that the investigators adopted for deploying the solution. The primary focus of the study was to demonstrate the requirements assessment performed, the strategies adopted, and the challenges encountered during the development and implementation. The study demonstrates a successful deployment as well as successful adoption of healthcare information technology by the end users. Factors that played a crucial role in adoption included the combination of people, processes, and technology. The lessons learned from this study would help application developers design efficient systems that suit the requirements of the end users while keeping in mind the ever-changing need for workflows and scalability in a developing country. PMID:23861673

  3. Implementing an Online Reporting System in the Anatomical Pathology Department of a Tertiary Care Teaching Hospital in India: A Case Study

    PubMed Central

    Radhakrishna, Kedar; Correa, Marjorie; Thounaojam, Deepak; Raj, Tony D. S.

    2013-01-01

    This article presents a case study in designing, developing, and implementing a web-enabled reporting application for the anatomical pathology (histopathology) department of a tertiary care teaching hospital in India. The article describes workflows, requirements assessment, and implementation methods that the investigators adopted for deploying the solution. The primary focus of the study was to demonstrate the requirements assessment performed, the strategies adopted, and the challenges encountered during the development and implementation. The study demonstrates a successful deployment as well as successful adoption of healthcare information technology by the end users. Factors that played a crucial role in adoption included the combination of people, processes, and technology. The lessons learned from this study would help application developers design efficient systems that suit the requirements of the end users while keeping in mind the ever-changing need for workflows and scalability in a developing country. PMID:23861673

  4. Clonal transmission of a rare methicillin-resistant Staphylococcus aureus genotype between horses and staff at a veterinary teaching hospital.

    PubMed

    Schwaber, Mitchell J; Navon-Venezia, Shiri; Masarwa, Samira; Tirosh-Levy, Sharon; Adler, Amos; Chmelnitsky, Inna; Carmeli, Yehuda; Klement, Eyal; Steinman, Amir

    2013-03-23

    Methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization has become a serious emerging condition in equine hospitals. Following the detection of MRSA in asymptomatic hospitalized horses and in two horses with post-operative wound infections, an investigation was conducted. Twelve of 84 horses (14.3%) and 16 of 139 personnel (11.5%) were MRSA carriers. The profile of the dominant MRSA strain common to horses and staff was multi-drug-resistant, spa-type t535, SCCmec type V, pvl-negative. MLST of a representative isolate yielded sequence type (ST) 5. The risk of MRSA carriage among veterinary personnel was greater in equine veterinarians and full-time technicians in comparison to part-time technicians and to other personnel not working with horses. Strict infection control measures were implemented, horses infected or colonized with MRSA were isolated and decolonization of personnel was attempted. Six months after the intervention, the large animal department personnel and hospitalized horses were all MRSA-negative and the decolonization was considered successful. This outbreak, caused by a rare MRSA strain and involving both hospitalized horses and personnel, further demonstrates the ability of MRSA to spread between animals and humans and emphasizes the importance of infection control measures to decrease the risk for MRSA colonization and infection of both horses and personnel. PMID:23265243

  5. Challenges faced by primary care physicians when prescribing for patients with chronic diseases in a teaching hospital in Malaysia: a qualitative study

    PubMed Central

    Sellappans, Renukha; Lai, Pauline Siew Mei; Ng, Chirk Jenn

    2015-01-01

    Objective The aim of this study was to identify the challenges faced by primary care physicians (PCPs) when prescribing medications for patients with chronic diseases in a teaching hospital in Malaysia. Design/setting 3 focus group discussions were conducted between July and August 2012 in a teaching primary care clinic in Malaysia. A topic guide was used to facilitate the discussions which were audio-recorded, transcribed verbatim and analysed using a thematic approach. Participants PCPs affiliated to the primary care clinic were purposively sampled to include a range of clinical experience. Sample size was determined by thematic saturation of the data. Results 14 family medicine trainees and 5 service medical officers participated in this study. PCPs faced difficulties in prescribing for patients with chronic diseases due to a lack of communication among different healthcare providers. Medication changes made by hospital specialists, for example, were often not communicated to the PCPs leading to drug duplications and interactions. The use of paper-based medical records and electronic prescribing created a dual record system for patients’ medications and became a problem when the 2 records did not tally. Patients sometimes visited different doctors and pharmacies for their medications and this resulted in the lack of continuity of care. PCPs also faced difficulties in addressing patients’ concerns, and dealing with patients’ medication requests and adherence issues. Some PCPs lacked time and knowledge to advise patients about their medications and faced difficulties in managing side effects caused by the patients’ complex medication regimen. Conclusions PCPs faced prescribing challenges related to patients, their own practice and the local health system when prescribing for patients with chronic diseases. These challenges must be addressed in order to improve chronic disease management in primary care and, more importantly, patient safety. PMID:26316648

  6. A Nationwide Analysis of Outcomes of Weekend Admissions for Intracerebral Hemorrhage Shows Disparities Based on Hospital Teaching Status

    PubMed Central

    Patel, Achint A.; Benjo, Alexandre; Pathak, Ambarish; Kar, Jitesh; Jani, Vishal B.; Annapureddy, Narender; Agarwal, Shiv Kumar; Sabharwal, Manpreet S.; Simoes, Priya K.; Konstantinidis, Ioannis; Yacoub, Rabi; Javed, Fahad; El Hayek, Georges; Menon, Madhav C.; Nadkarni, Girish N.

    2015-01-01

    Background and Purpose: With the “weekend effect” being well described, the Brain Attack Coalition released a set of “best practice” guidelines in 2005, with the goal to uniformly provide standard of care to patients with stroke. We attempted to define a “weekend effect” in outcomes among patients with intracranial hemorrhage (ICH) over the last decade, utilizing the Nationwide Inpatient Sample (NIS) data. We also attempted to analyze the trend of such an effect. Materials and Methods: We determined the association of ICH weekend admissions with hospital outcomes including mortality, adverse discharge, length of stay, and cost compared to weekday admissions using multivariable logistic regression. We extracted our study cohort from the NIS, the largest all-payer data set in the United States. Results: Of 485 329 ICH admissions from 2002 to 2011, 27.5% were weekend admissions. Overall, weekend admissions were associated with 11% higher odds of in-hospital mortality. When analyzed in 3-year groups, excess mortality of weekend admissions showed temporal decline. There was higher mortality with weekend admissions in nonteaching hospitals persisted (odds ratios 1.16, 1.13, and 1.09, respectively, for 3-year subgroups). Patients admitted during weekends were also 9% more likely to have an adverse discharge (odds ratio 1.09; 95% confidence interval: 1.07-1.11; P < .001) with no variation by hospital status. There was no effect of a weekend admission on either length of stay or cost of care. Conclusion: Nontraumatic ICH admissions on weekends have higher in-hospital mortality and adverse discharge. This demonstrates need for in-depth review for elucidating this discrepancy and stricter adherence to standard-of-care guidelines to ensure uniform care. PMID:27053981

  7. Does labour epidural slow the progress of labour and lead to complications? Obstetricians’ perception working in private and public sector teaching hospitals in a developing country

    PubMed Central

    Sohaib, Muhammad; Ismail, Samina

    2015-01-01

    Background and Aims: Obstetricians play a major role in the decision making for provision of analgesia for the woman in labour. As epidural analgesia (EA) is the most preferred technique, it is important to know obstetricians' perception regarding its effect on progress of labour and associated complications. Methods: The 6 months cross-sectional study included 114 obstetricians from teaching hospitals. After informed consent, obstetricians were asked to fill a predesigned questionnaire containing 13 close ended questions regarding their perception on the effect of EA on progress of labour, EA complications and whether they would recommend EA to their patients or not. Other variables included age, gender, training in EA, practice type and hospital settings (private or public sector). Results: Majority of the obstetricians had the perception of EA prolonging the first stage (89.5%) and second stage (98.2%) of labour, increasing the rate of caesarean section (87.7%), instrumental delivery (58.8%) and increasing the incidence of backache (85.5%). None of the obstetricians received any formal training in EA. Majority (84.2%) were not sure if they would recommend EA to their patients. When these responses were compared between public and private sector, a statistically higher percentage (P < 0.001) of public sector obstetricians had negative perception of EA. Conclusion: Perception of obstetrician regarding EA is contrary to the current evidence. There is a need to introduce formal curriculum on EA in obstetric training program and conduct regular refresher courses. PMID:26903670

  8. Pattern of MRI brain in neuro-psychiatric SLE. Effect of anti-phospholipid antibodies: A study at a tertiary care teaching hospital

    PubMed Central

    Parvez, Khalid; Al-Arfaj, Abdul Rahman Saud; Hamdani, Muhammad Afzal; Naseeb, Faisal; Daif, Abdulkader; Hussain, Sajjad

    2015-01-01

    Objective: To compare the neuro-radiologic findings in Systemic lupus erythematosus (SLE) patients with and without antiphospholipid antibodies (aPL) in different neuro-psychiatric manifestations. Methods: This cross-sectional comparative study was carried out at King Khalid University Hospital, a tertiary care teaching hospital, Riyadh, Saudi Arabia from June 2012 to January 2015. Ninety seven SLE patients with neuro-psychiatric manifestations were included in the study and divided into two groups. Group I (50 patients) SLE with aPL and group II (47 patients) SLE without aPL. We compared Demographic features, clinical manifestations and magnetic resonance imaging (MRI) brain findings. Results: Demographic and clinical characteristics of two groups were similar. In Group-I, anticardiolipin antibodies (aCL) were most common (86%). In patients with headache, most of the patients in Group-I had white matter hyperintensities (WMHIs) (50% vs 27%) while most of the patients in Group-II had normal MRI brain (38% vs 73%). Similarly WMHIs were found more in Group-I patients with seizures (60% vs 21%), while ischemia/infarction, atrophy and normal MRI were found in Group-II. MRI brain in patients with neurological deficit and psychiatric disorder were not much different in both the groups. Conclusion: We found no statistically significant differences in frequencies of MRI brain abnormalities in SLE patients with and without aPL antibodies. Each of the three aPL may have a variable effect on the brain. PMID:26649010

  9. A Survey on the Knowledge, Attitude and the Practice of Pharmacovigilance Among the Health Care Professionals in a Teaching Hospital in Northern India

    PubMed Central

    Hardeep; Bajaj, Jagminder Kaur; Rakesh, Kumar

    2013-01-01

    Objective: To assess the pharmacovigilance awareness among the healthcare professionals in a teaching hospital in Northern India. Material and Methods: A questionnaire which was suitable for assessing the basic Knowledge, Attitude and the Practice (KAP) of pharmacovigilance was designed and distributed among 100 doctors of the Punjab Institute of Medical Sciences (PIMS) Hospital, Jalandhar, Punjab, India. Results: Among the 100 doctors, 61 responded. The data was analyzed by using the SPSS statistical software. Although 77% of the subjects knew the term ‘pharmacovigilance’, only 59% were aware of the existence of the National Pharmacovigilance Program. 23% volunteered to reports Adverse Drug Reactions (ADRs), but more than 60% doctors did not know how and where to report the ADRs. Conclusion: There is a need for a regular training and the reenforcement for the ADR reporting among the health care personnel. The perception of the reporting process being tedious, the lack of time, a poor knowledge on the reporting mechanism and inadequate expertise seemed to be the main reasons for not reporting the ADRs. A majority of the respondents suggested regular training sessions on a priority basis for the success of the pharmacovigilance program and for the better clinical management of the patients in general. PMID:23449824

  10. Left in the dark: Seven years after Katrina, Sandy is teaching hospitals more lessons on how to survive nature's fury.

    PubMed

    Evans, Melanie; Carlson, Joe; Barr, Paul; Kutscher, Beth; Zigmond, Jessica

    2012-11-01

    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

  11. Study of knowledge and attitude regarding prenatal diagnostic techniques act among the pregnant women at a tertiary care teaching hospital in Mumbai

    PubMed Central

    Shidhaye, Pallavi R.; Giri, Purushottam A.; Nagaonkar, Shashikant N.; Shidhaye, Rahul R.

    2012-01-01

    Background: Sex ratio, an important social indicator measuring extent of prevailing equity between males and females in society, is defined as number of females per 1000 males. Changes in sex ratio reflect underlying socioeconomic, cultural patterns of a society. As per 2011 census sex ratio in India is 914/1000 males, which continues to be significantly adverse towards women. Objectives: This study was conducted to assess the knowledge and attitude regarding Prenatal Diagnostic Techniques (PNDT) Act among the pregnant women at a tertiary care teaching hospital in Mumbai. Materials and Methods: A cross-sectional study was carried out in the antenatal ward of Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai during the period of January to April 2008. A total of 143 women were included and a pre-designed and pre-tested questionnaire was used to get information regarding socio-demographic details of the pregnant women. They were asked regarding the knowledge and attitude towards the PNDT Act. Data was analyzed by using Statistical Package of Social Sciences (SPSS) 16.0. Results: In the present study, out of 143 women, 105 (73.5%) knew about sex determination. Even out of those who had heard, the correct knowledge regarding PNDT act was very less. Sonography as a technique for sex determination done at private hospital was known to the majority of women. Conclusion: Education of women about gender equality and recommendations under PNDT act in order to improve declining sex ratio in our country must be done. Wide publicization in the media of the Act must be scaled up. PMID:23555139

  12. Susceptibility Pattern and Distribution of Oxacillinases and blaPER-1 Genes among Multidrug Resistant Acinetobacter baumannii in a Teaching Hospital in Iran

    PubMed Central

    Bagheri Josheghani, Sareh; Moniri, Rezvan; Firoozeh, Farzaneh; Sehat, Mojtaba; Dasteh Goli, Yasaman

    2015-01-01

    Acinetobacter baumannii (A. baumannii) is an important nosocomial pathogen in healthcare institutions. β-Lactamase-mediated resistance is the most common mechanism for carbapenem resistance in A. baumannii. The aim of this study was to determine the antibiotic resistance pattern, to detect OXA encoding genes, class A, blaPER-1, and to detect the presence of ISAba1. A total of 124 A. baumannii isolates were collected from hospitalized patients in a teaching hospital in Kashan, Iran. The susceptibility of isolates to different antibiotics was determined by disk-diffusion method. PCR was used to detect blaPER-1, blaOXA-23, blaOXA-24, blaOXA-51, blaOXA-58, and ISAba1 genes. All isolates were resistant to ceftazidime, ceftriaxone, and cefotaxime. All of the isolates revealed susceptibility to polymyxin B and colistin. Ninety-six percent of the isolates were extensive drug resistance (XDR), 5.6% extended spectrum beta-lactamase (ESBL), and 54.8% metallo-beta-lactamase (MBL). All isolates were positive for blaOXA-51 and ISAba1. blaOXA-23,  blaOXA-24, and blaOXA-58 were found in 79.8%, 25%, and 3.2%, respectively. The frequency rate of blaPER-1 gene was 52.4%. Multidrug resistant A. baumannii isolates are increasing in our setting and extensively limit therapeutic options. The high rate presence of class D carbapenemase-encoding genes, mainly blaOXA-23 carbapenemases, is worrying and alarming as an emerging threat in our hospital. PMID:26881082

  13. Hospital diversification strategy.

    PubMed

    Eastaugh, Steven R

    2014-01-01

    To determine the impact of health system restructuring on the levels of hospital diversification and operating ratio this article analyzed 94 teaching hospitals and 94 community hospitals during the period 2008-2013. The 47 teaching hospitals are matched with 47 other teaching hospitals experiencing the same financial market position in 2008, but with different levels of preference for risk and diversification in their strategic plan. Covariates in the analysis included levels of hospital competition and the degree of local government planning (for example, highly regulated in New York, in contrast to Texas). Moreover, 47 nonteaching community hospitals are matched with 47 other community hospitals in 2008, having varying manager preferences for service-line diversification and risk. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as jointly dependent. Institutional diversification is found to yield better financial position, and the better operating profits provide the firm the wherewithal to diversify. Some services are in a growth phase, like bariatric weight-loss surgery and sleep disorder clinics. Hospital managers' preferences for risk/return potential were considered. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification, and divestiture, occasionally leading to closure or merger. PMID:25223156

  14. Hospitality Services. Curriculum Guide.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    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…

  15. A report on infection dynamics of inducible clindamycin resistance of Staphylococcus aureus isolated from a teaching hospital in India

    PubMed Central

    Dubey, Debasmita; Rath, Shakti; Sahu, Mahesh C.; Rout, Subhrajita; Debata, Nagen K.; Padhy, Rabindra N.

    2013-01-01

    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

  16. The relationship between the managerial skills and results of "performance evaluation "tool among nursing managers in teaching hospitals of Iran University of Medical Science.

    PubMed

    Isfahani, Haleh Mousavi; Aryankhesal, Aidin; Haghani, Hamid

    2015-01-01

    Performance of different organizations, such as hospitals is mainly influenced by their managers' performance. Nursing managers have an important role in hospital performance and their managerial skills can improve the quality of the services. Hence, the present study was conducted in order to assess the relationship between the managerial skills and the results of their performance evaluation in Teaching Hospitals of Iran University of Medical Science in 2013. The research used the cross sectional method in 2013. It was done by distributing a managerial skills assessment questionnaire, with close-ended questions in 5 choice Likert scale, among 181 managers and head nurses of hospitals of Iran university of Medical Sciences; among which 131 answered the questions. Another data collection tools was a forms to record evaluation marks from the personnel records. We used Pearson and Spearman correlation tests and SPSS for analysis and description (frequency, mean and standard deviation). Results showed that the managerial skills of the nursing mangers were fair (2.57 out of 5) and the results of the performance evaluation were in a good condition (98.44). The mangers' evaluation results and the managerial skills scores were not in a meaningful correlation (r=0.047 np=0.856). The research showed no correlation between different domains of managerial skills and the performance evaluation marks: decision making skills (r=0.074 and p=0.399), leadership (correlation coefficient 0.028 and p=0.654), motivation (correlation coefficient 0.118 and p=0.163), communication  (correlation coefficient 0.116 and p=0.122), systematic thinking  (correlation coefficient 0.028 and p=0.828), time management (correlation coefficient 0.077 and p=0.401) and strategic thinking  (correlation coefficient 0.041 and p=0.756). Lack of any correlation and relation between managers' managerial skills and their performance evaluation results shows need to a fundamental revision at managers

  17. Temporomandibular joint ankylosis caused by condylar fractures: a retrospective analysis of cases at an urban teaching hospital in Nigeria.

    PubMed

    Anyanechi, C E

    2015-08-01

    Mandibular condylar fractures are common presentations to hospitals across the globe and remain the most important cause of temporomandibular joint (TMJ) ankylosis. This study aimed to analyze cases of mandibular condylar fracture complicated by TMJ ankylosis after treatment. A 16-year retrospective analysis was performed at the dental and maxillofacial surgery clinic of the study institution; patient data were collected from the hospital records and entered into a pro-forma questionnaire. It was found that 56/3596 (1.6%) fractures resulted in TMJ ankylosis. The age of patients with ankylosis ranged from 12 to 47 years. The age (P=0.03) and gender (P=0.01) distributions were significant, with most cases of ankylosis occurring in those aged 11-30 years (n=43/56, 76.8%). Fractures complicated by ankylosis were intracapsular (n=22/56, 39.3%) and extracapsular (n=34/56, 60.7%). Ankylosis increased significantly with the increase in time lag between injury and fracture treatment (P=0.001). Ankylosis was associated with concomitant mandibular (85.7%) and middle third (66.1%) fractures. Treatment methods were not significantly related to ankylosis (P=0.32). All cases of ankylosis were unilateral, and complete (n=36, 64.3%) and incomplete ankylosis (n=20, 35.7%) were diagnosed clinically. The incorporation of computed tomography scans and rigid internal fixation in the management of condylar fractures will reduce ankylosis. PMID:26008733

  18. Nosocomial infections and risk factors in the intensive care unit of a teaching and research hospital: A prospecive cohort study

    PubMed Central

    Ak, Oznur; Batirel, Ayse; Ozer, Serdar; Čolakoğlu, Serhan

    2011-01-01

    Summary Background To evaluate the incidence, risk factors and etiology of nosocomial infections (NIs) in the intensive care unit (ICU) of our hospital in order to improve our infection control policies. Material/Methods A 1-year prospective cohort study of nosocomial infection (NI) surveillance was conducted in our ICU in 2008. Results Out of 1134 patients hospitalized in the ICU for a period of 6257 days, 115 patients acquired a total of 135 NIs distributed as follows: 36.3% bacteremia, 30.4% ventilator-associated pneumonia (VAP), 18.5% catheter-associated urinary tract infection, 7.4% central-line infection, 5.9% cutaneous infection, and 1.3% meningitis. The incidence rate of NI was 21.6 in 1000 patient-days, and the rate of NI was 25.6%. Length of ICU stay, central venous catheterisation, mechanical ventilation and tracheostomy were statistically significant risk factors for NI. Of all NI, 112 (83%) were microbiologically-confirmed and 68.8% of the isolates were Gram-negative, 27.6% were Gram-positive, and 3.6% were fungi. 23 (17%) were clinically-defined infections. The most frequently isolated organism was P. aeruginosa (25%), followed by S. aureus (21.4%), E. coli (18.7%) and A. baumannii (16.9%). Conclusions The bloodstream was the most common site and Gram-negatives were the most commonly reported causes of ICU infections. PMID:21525819

  19. Exploring Consumer Perceptions and Economic Burden of Onchocerciasis on Households in Enugu State, South-East Nigeria

    PubMed Central

    Ibe, Ogochukwu; Onwujekwe, Obinna; Uzochukwu, Benjamin; Ajuba, Miriam; Okonkwo, Paul

    2015-01-01

    Introduction Onchocerciasis or river blindness constitutes a major burden to households especially in resource-poor settings, causing a significant reduction in household productivity. There has been renewed interest from policy makers to reduce the burden of Neglected Tropical Diseases (NTDs) such as onchocerciasis on individuals and households. This paper provides new information on the patient’s perceptions of onchocerciasis and its economic burden on households in South-eastern Nigeria. The information will be useful to health providers and policy makers for evidence-informed resource allocation decisions. Methods Information was generated from a cross-sectional household survey conducted in Achi community, Oji River Local Government Area (LGA) of Enugu State, Southeast Nigeria. A pre-tested interviewer-administered questionnaire was used to collect data. A total of 747 households were visited randomly and data were collected using pre-tested interviewer administered questionnaire from 370 respondents. The respondents’ knowledge of the cause of symptoms of the disease, costs incurred for seeking treatment and productivity losses were elicited. Data were analyzed using tabulations and inferential statistics. A socio-economic status (SES) index was used to disaggregate some key variables by SES quintiles for equity analysis. Results Many people had more than one type of manifestation of onchocerciasis. However, more than half of the respondents (57%) had no knowledge of the cause of their symptoms. Male respondents had significantly more knowledge of the cause of symptoms than females (P = 0.04) but knowledge did not differ across SES (P = 0.82). The average monthly treatment cost per respondent was US$ 14.0. Drug cost (US$10) made up about 72% of total treatment cost. The per capita productivity loss among patients was US$16 and it was higher in the poorest (Q1) (US$20) and the third SES quintiles (Q3) (US$21). The average monthly productivity loss among

  20. Peer-driven contraceptive choices and preferences for contraceptive methods among students of tertiary educational institutions in Enugu, Nigeria

    PubMed Central

    Iyoke, CA; Ezugwu, FO; Lawani, OL; Ugwu, GO; Ajah, LO; Mba, SG

    2014-01-01

    Purpose To describe the methods preferred for contraception, evaluate preferences and adherence to modern contraceptive methods, and determine the factors associated with contraceptive choices among tertiary students in South East Nigeria. Methods A questionnaire-based cross-sectional study of sexual habits, knowledge of contraceptive methods, and patterns of contraceptive choices among a pooled sample of unmarried students from the three largest tertiary educational institutions in Enugu city, Nigeria was done. Statistical analysis involved descriptive and inferential statistics at the 95% level of confidence. Results A total of 313 unmarried students were studied (194 males; 119 females). Their mean age was 22.5±5.1 years. Over 98% of males and 85% of females made their contraceptive choices based on information from peers. Preferences for contraceptive methods among female students were 49.2% for traditional methods of contraception, 28% for modern methods, 10% for nonpharmacological agents, and 8% for off-label drugs. Adherence to modern contraceptives among female students was 35%. Among male students, the preference for the male condom was 45.2% and the adherence to condom use was 21.7%. Multivariate analysis showed that receiving information from health personnel/media/workshops (odds ratio 9.54, 95% confidence interval 3.5–26.3), health science-related course of study (odds ratio 3.5, 95% confidence interval 1.3–9.6), and previous sexual exposure prior to university admission (odds ratio 3.48, 95% confidence interval 1.5–8.0) all increased the likelihood of adherence to modern contraceptive methods. Conclusion An overwhelming reliance on peers for contraceptive information in the context of poor knowledge of modern methods of contraception among young people could have contributed to the low preferences and adherence to modern contraceptive methods among students in tertiary educational institutions. Programs to reduce risky sexual behavior among

  1. [Time trends of incidence rates of work accident with blood contamination in a North Italian teaching hospital].

    PubMed

    Ferrario, M M; Landone, S; De Biasi, M; Tagliasacchi, R; Riva, R; Veronesi, G; Sassi, M; Borchini, R; Bonzini, M

    2012-01-01

    Unbiased estimates of incidence rates of accidents with blood contaminations (ABC) and time trends is the milieu for assessing the effectiveness of preventive interventions. A standardised procedure for registration and follow-up of ABC was et up in a North Italian hospital since 2002. Accurate estimates of rate denominator, as full-time equivalent (FTE) person-years, was calculated, for exposed workers only and excluding periods of prolonged absence. In the observation period (2004-2011), training courses for head nurses on security procedures were repeatedly carried out as well as the progressive introduction of vacuum blood collection systems (since 2009). 1287 ABC have been reported, corresponding to an overall annual crude incidence rate of 4.73 per 100 FTE. Temporal trends, calculated on the biennial incidence, resulted in a reductions over the time period considered, in particular for needlestick injuries. Our results support the notions on the efficacy of the adopted prevention measures. PMID:23405640

  2. Colorectal cancer in patients seen at the teaching hospitals of Guadeloupe and Martinique: discrepancies, similarities in clinicopathological features, and p53 status

    PubMed Central

    2014-01-01

    Background In Guadeloupe and Martinique, two French Overseas Departments, colorectal cancer (CRC) has become an essential public health issue. However, little is known about CRC characteristics and the p53 status in these populations, particularly in Guadeloupe, whereas certification of a cancer registry has been recently validated. Methods This was a descriptive retrospective study of 201 patients who, between 1995 and 2000, underwent surgery for CRC in the Guadeloupe Teaching Hospital (GlpeTH; 83 patients) and in the Martinique Teaching Hospital (MqueTH; 118 patients). The clinicopathological features and the p53 expression, evaluated with immunohistochemistry, were compared at the time of diagnosis. A relationship between these parameters and the p53 expression was also studied. Data were analysed, using the SPSS computer software version 17.0. Results No statistical difference was found between the two groups of patients regarding age (p = 0.60), percentage of young patients (≤50 years; p = 0.94)), sex (p = 0.47), histological type (p = 0.073) and tumour sites (p = 0.65), although the GlpeTH patients were diagnosed with more distal colon cancers (54.2%) than the Mque TH patients (47.4%). By contrast, a significant difference was found regarding the tumour grade (p < 0.0001), the pTNM stage (p = 0.045) and the pT stage (p < 0.0001). Regarding p53 expression, solely for the MqueTH patients, nuclear expression was associated with pTNM, the percentage of p53 negative tumours increasing with the progression of the pTNM stages (p = 0.029). Conclusions For the first time, this study reveals discrepancies in clinicopathological features and in the p53 status between the two groups of patients. The GlpeTH patients were diagnosed with more moderated CRCs but with few CRCs at pTNM IV stage. By contrast, the MqueTH patients were diagnosed with more differentiated tumours, but with many more CRCs at pTNM IV stage. This paradox may be

  3. The Pattern of Pediatric Respiratory Illnesses Admitted in Ebonyi State University Teaching Hospital South-East Nigeria

    PubMed Central

    Ezeonu, CT; Uneke, CJ; Ojukwu, JO; Anyanwu, OU; Okike, CO; Ezeanosike, OB; Agumadu, HU

    2015-01-01

    Background: Reports from the developed nations reveal respiratory tract infections as the leading cause of childhood hospital admissions. Children may be admitted for a variety of respiratory illnesses. Data on the spectrum of pediatric respiratory illnesses admitted in the hospital is scarce. Aim: To determine the pattern of pediatrics respiratory illness admissions, seasonal frequency, underlying risk factors and outcome. Subjects and Methods: A retrospective assessment of respiratory cases admitted in the pediatric ward from 2005 to 2010 was conducted using case notes. Parameters considered included month of presentation, age, sex, immunization and nutritional status, tools of diagnosis and patient outcome. Results were analyzed using the Statistical Package for the Social Sciences with the level of significance P ≤ 0.05. Results: Of the 239 cases admitted, there were more males than females (1.4:1). The commonest case was Bronchopneumonia, 71.6% (171/239 out of which 161 were uncomplicated, 5 had effusions and 6 were associated with measles). Other cases were Pulmonary Tuberculosis, 10.9% (26/239), Lobar pneumonia 8.8% (21/239), Bronchiolitis, 5% (12/239), Aspiration pneumonitis 2.1% (5/239) and Bronchial asthma, 0.8% (2/239). Mortality was 7.5% (18/239) mostly from Bronchopneumonia amongst the 1–5 years old. Mortality was significantly associated with malnutrition (P < 0.001) and poor immunization status (P < 0.01). Conclusion: Bronchopneumonia was found to be the commonest illness with significant mortality and peak occurrence in the rainy season. More emphasis must be laid on anticipatory guidance and prevention by encouraging the immunization, good nutrition and increased attention on children even after 1 year of age. PMID:25745580

  4. Outcomes after same-day oral surgery: a review of 1,180 cases at a major teaching hospital.

    PubMed

    Chye, E P; Young, I G; Osborne, G A; Rudkin, G E

    1993-08-01

    Outcome was measured from data collected on 1,180 consecutive ambulatory oral surgery patients, two thirds of whom were treated under general anesthesia and the remainder who were treated under local anesthesia supplemented with intravenous sedation. Three patients (0.25%) required admission on the day of surgery; all had undergone general anesthesia. The surgery-related complication rate in the general anesthesia group (1:132) was similar to that for local anesthesia and sedation (1:128). However, anesthesia-related complications had an incidence of 1:99 in the general anesthesia group, but were absent in those receiving local anesthesia and sedation. Eight patients (0.7%) required hospital readmission after being discharged, mostly because of complications of surgery. The incidence of postoperative nausea and vomiting in the recovery room after local anesthesia and sedation (6%) was less than after general anesthesia (14%) (P < .01) Average recovery times to sitting out of bed and being ready for discharge were less after local anesthesia and sedation (38 +/- 15 minutes and 120 +/- 39 minutes, respectively) than after general anesthesia (61 +/- 50 minutes and 141 +/- 62 minutes). At the time of follow-up during the first few postoperative days, 7% of patients had gone to a family doctor and 4% to hospital accident and emergency departments, usually for minor problems. Paracetamol 500 mg plus codeine phosphate 30 mg was effective in 97% of cases when provided as a take-home analgesic. Ninety-nine percent of patients were satisfied with their management. PMID:8336221

  5. Clinical and economic outcomes of Acinetobacter vis a vis non-Acinetobacter infections in an Indian teaching hospital

    PubMed Central

    Asim, Priyendu; Naik, Nagappa Anantha; Muralidhar, Varma; Vandana, K. Eshwara; Varsha, A. Prabhu

    2016-01-01

    Context: Acinetobacter infections are a major nosocomial infection causing epidemics of infection in the Intensive Care Units (ICU). Aims: This study estimates the clinical and economic outcomes of Acinetobacter infections and compares them with those of non-Acinetobacter bacterial infections. Settings and Design: Prospective cross-sectional observational study carried out for 6 months in the medicine ICU of a tertiary care hospital. Materials and Methods: Patients were divided in two groups, one group with Acinetobacter infections and the other with non-Acinetobacter infections. The data was collected for infection, length of stay (LOS), mortality and cost along with patient demographics from the hospital records for analysis. Statistical Analysis Used: The data was analyzed using Statistical Package for the Social Sciences Version 15.0. The LOS and cost of treatment (COT) for the two groups were compared using the nonparametric Mann–Whitney U-test. Results: A total of 220 patients were studied out of which 91 had Acinetobacter infections. The median LOS was 20 days in Group-A and 12 days in Group-B (P < 0.0001). The median COT was INR 125,862 in Group-A and INR 68,228 in the Group-B (P < 0.0001). Mortality in Group-A and Group-B was 32.97 and 32.56 (P = 0.949) respectively. Conclusion: The burden of Acinetobacter infections in ICUs is increasing with the increase in LOS and COT for the patients. The infection control team has to play a major role in reducing the rate of nosocomial infections. PMID:26955573

  6. Level of awareness of mammography among women attending outpatient clinics in a teaching hospital in Ibadan, South-West Nigeria

    PubMed Central

    2013-01-01

    Background Mammography has been used in developed countries with considerable success but very little is known about this imaging modality in low resource settings. This study examined the level of awareness of mammography and determined factors influencing the level of awareness. Methods We conducted a hospital based cross sectional study to investigate the level of awareness of mammography among 818 randomly selected women attending the General Outpatient clinics (GOP) of the University College Hospital (UCH), Ibadan, Nigeria. Independent predictors of level of awareness of mammography were identified using multiple logistic regression analysis. Results The proportion of women who ever heard of mammography was 5%, and they demonstrated poor knowledge of the procedure. Those with primary or secondary levels of education were about three times less likely to be aware of mammography when compared with those with tertiary level of education (OR = 0.3, 95% CI, 0.12 – 0.73). Also, participation in community breast cancer prevention activities (OR = 3.4, 95% CI, 1.39 – 8.36), and previous clinical breast examination (OR = 2.34, 95% CI, 1.10 – 4.96) independently predicted mammography awareness. Newspapers and magazines appeared to be the most important sources of information about mammography screening. Conclusion The level of awareness of mammography is poor among women attending outpatient clinics in the studied population. Interventions promoting awareness of this screening procedure should give particular attention to the illiterate and older women while clinicians performing breast examinations should utilize the opportunity to inform women about the mammography procedure. Promotion of educational articles on breast cancer and its screening methods via media remains vital for the literate. PMID:23324312

  7. Prevalence of nontyphoidal Salmonella serogroups and their antimicrobial resistance patterns in a university teaching hospital in Eastern Province of Saudi Arabia

    PubMed Central

    Elhadi, Nasreldin; Aljindan, Reem; Aljeldah, Mohammed

    2013-01-01

    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. PMID:24285925

  8. A six-year study of the clinical presentation of cervical cancer and the management challenges encountered at a state teaching hospital in southeast Nigeria.

    PubMed

    Eze, Justus N; Emeka-Irem, Esther N; Edegbe, Felix O

    2013-01-01

    Cervical cancer is still a major contributor to cancer-related mortality amongst women living in poor, rural communities of developing countries. The objective of this study is to establish the clinical presentation of cervical cancer and the management challenges encountered in Abakaliki, southeast Nigeria, with a view to finding intervention strategies. This study is a retrospective descriptive assessment of cases of clinically diagnosed cervical cancer managed at a state teaching hospital over six years. Of 76 cases managed, 61 (80.3%) cases notes were available for study. The mean age and parity of patients were 53.8 years and 6.8 years, respectively. The majority (75.4%) were illiterate. All had been married, but 42.6% were widowed. The main occupations were farming or petty trading. One patient (1.6%) had had a single Pap smear in her life. The major presenting complaints were abnormal vaginal bleeding (86.9%), offensive vaginal discharge (41.0%), and weight loss. Twenty patients (32.8%) were lost to follow-up prior to staging. Of the remaining 41 patients, 16 (39.0%) had stage III disease and 17.1% stage IV. Fifteen patients (24.6%) with late stage disease accepted referral, and were referred for radiotherapy. Those who declined were discharged home on request, though 4 (9.8%) died in the hospital. There was no feedback from referred patients confirming that they went and benefitted from the referral. The presentation followed known trends. Illiteracy, poverty, early marriages, high parity, widowhood, non-use of screening methods, late presentation, non-acceptance of referral, and lack of communication after referral were some of the major challenges encountered. These underscore the needs for health education and awareness creation, women educational and economic empowerment, legislation against early marriages and in protection of widows, and creation of a well-staffed and well-equipped dedicated gynecologic oncology unit to forestall further referral

  9. Experience of newly constructed echocardiography-database with video clips and color still images at the Echocardiography Lab of Nepal Medical College Teaching Hospital.

    PubMed

    Shrestha, B; Dhungel, S

    2008-09-01

    Reporting system after performing echocardiography is very poor in almost all hospitals of Nepal. Special but simple attempt effort has been introduced to transfer analog video images and color still images of echocardiographic investigation into a desk top computer using a locally available imported video capture system, Snazzi Movie Studio S4. Analog video signals are converted into MPEG2 and still color snaps are converted into JPEG format. Window media player can be used later on to review the video clips. All together 1059 patients including pediatric, adults and geriatric patients underwent echocardiographic evaluation at the Echo-lab of Nepal Medical College Teaching Hospital during 10th January 2007 to 9th May 2008. Age ranged from 2 months to 98 years. Mean+SD was 52.4 +/- 18.5 years. Male/female ratio was 0.8:1. More than half of the patients (64.3%) came from Kathmandu. Brahman/Chhetri (478, 45.1%), Tamang, Sherpa etc 278 (26.3%) and Newar (226, 21.3%) were the main echo-users. Elderly age group (>60 yr) comprised of more than one third of the patients (42.0%) followed by the age group of 45-59 yr (27.7%). No abnormality was detected in 133 (12.6%) patients. Valvular heart disease was noticed in more than half of patients (60.7%), followed by diastolic dysfunction (393, 14.0%) and left ventricular hypertrophy (210, 7.5%). This database is not very expensive but demand minimal extra time and energy. It will be a valuable tool to increase diagnostic accuracy and a great resource for academic purpose aiding in the improvement of cardiac care in Nepal. PMID:19253863

  10. A questionnaire study on the knowledge, attitude, and the practice of pharmacovigilance among the healthcare professionals in a teaching hospital in South India

    PubMed Central

    Gupta, Sandeep Kumar; Nayak, Roopa P.; Shivaranjani, R.; Vidyarthi, Surendra Kumar

    2015-01-01

    Objective: The primary objective of this study was to evaluate the knowledge, attitude, and practices (KAP) of the healthcare professionals about pharmacovigilance in Dhanalakshmi Srinivasan Medical College and Hospital (DSMCH), Perambalur (Tamil Nadu), a tertiary care teaching hospital. The second primary objective was to assess the causation of underreporting of adverse drug reactions (ADRs) as it needs to be well-assessed in India. The secondary objective was to compare the findings of this study with the results of the published studies from India on evaluation of the KAP of pharmacovigilance among healthcare professional. Materials and Methods: A cross-sectional study was carried out using a pretested questionnaire. The questionnaire was designed to assess the KAP regarding pharmacovigilance. The healthcare professionals (doctors, nurses, and pharmacists) working in the DSMCH, Perambalur (Tamil Nadu) during the study period were included. Only those who gave their consent to participate were included in the study. The data was analyzed by using the Statistical Package for Social Sciences (SPSS) statistical software, version 16. Results: One hundred and fifty pretested questionnaires were distributed among the healthcare professionals and 101 responded. 62.4% healthcare workers gave correct response regarding the definition of pharmacovigilance. 75.2% of healthcare workers were aware regarding the existence of a National Pharmacovigilance Program of India. 69.3% healthcare professional agreed that ADR reporting is a professional obligation for them. Among the participants, 64.4% have experienced ADRs in patients, but only 22.8% have ever reported ADR to pharmacovigilance center. Unfortunately only 53.5% healthcare workers have been trained for reporting adverse reactions. But, 97% healthcare professionals agreed that reporting of ADR is necessary and 92.1% were of the view that pharmacovigilance should be taught in detail to healthcare professional. Conclusion

  11. Users’ Perspectives on a Picture Archiving and Communication System (PACS): An In-Depth Study in a Teaching Hospital in Kuwait

    PubMed Central

    Al-Shamali, Dawood Ameer; Sharma, Prem; Haidar, Salwa; Al-Shawaf, Hamza

    2016-01-01

    Background Picture archiving and communication system (PACS) is a well-known imaging informatics application in health care organizations, specifically designed for the radiology department. Health care providers have exhibited willingness toward evaluating PACS in hospitals to ascertain the critical success and failure of the technology, considering that evaluation is a basic requirement. Objective This study aimed at evaluating the success of a PACS in a regional teaching hospital of Kuwait, from users’ perspectives, using information systems success criteria. Methods An in-depth study was conducted by using quantitative and qualitative methods. This mixed-method study was based on: (1) questionnaires, distributed to all radiologists and technologists and (2) interviews, conducted with PACS administrators. Results In all, 60 questionnaires were received from the respondents. These included 39 radiologists (75% response rate) and 21 technologists (62% response rate), with the results showing almost three-quarters (74%, 44 of 59) of the respondents rating PACS positively and as user friendly. This study’s findings revealed that the demographic data, including computer experience, was an insignificant factor, having no influence on the users’ responses. The findings were further substantiated by the administrators’ interview responses, which supported the benefits of PACS, indicating the need for developing a unified policy aimed at streamlining and improving the departmental workflow. Conclusions The PACS had a positive and productive impact on the radiologists’ and technologists’ work performance. They were endeavoring to resolve current problems while keeping abreast of advances in PACS technology, including teleradiology and mobile image viewer, which is steadily increasing in usage in the Kuwaiti health system. PMID:27307046

  12. Clinical and Laboratory Predictors of Articular Disorders Among HIV-infected Patients Seen at Teaching Hospital Southeast Nigeria

    PubMed Central

    Okwara, CC; Ozoh, G; Nwatu, BC

    2015-01-01

    Background: HIV infection may be associated with different arthropathies that are often underdiagnosed. There is also paucity of reported studies of relationship between clinical and laboratory features of HIV-infected patients and articular disorders. Aims: To determine the predictors of articular disorders among HIV-infected patients seen at tertiary hospital Nigeria. Subjects and Methods: Hospital-based cross-sectional descriptive study. Subjects were recruited from outpatient clinics of the study centers. Persons aged 16 years and above were recruited via stratified sampling method. Subjects with trauma, degenerative arthritis, malignancy, hepatitis B surface antigen and anti-hepatitis C virus positivity or previously known to have pulmonary tuberculosis or rheumatological disorders were excluded. Pretest-improved semi-structured questionnaire was administered to the recruited 480 subjects comprising 240 HIV positive subjects (HPS) and 240 HIV-negative subjects (HNS). Blood for relevant laboratory tests and radiographs were done where necessary. Diagnosis of articular disorder was based on American College of Rheumatology and European Spondyloarthropathy Study Group classification guidelines. Statistical Package for Social Sciences version 15 (SPSS Inc., Chicago, IL, USA) was used for data entry, validation, and analysis. Results: Of the 480 participants, both HPS and HNS were made up of 95 males and 145 females. There was statistically significant difference between the frequency of occurrence of articular disorders among the HPS of 37.1% (89/240) and the HIV-negative controls of 16.2% (39/240) (χ2 = 26.63 P = <0.01). Arthralgia frequency of 29.6% (71/240), HIV-associated arthritis 4.6%, (11/240) (Reiter's disease 1.3% (3/240), undifferentiated spondyloarthropathy 1.3%, (3/240) and gout 0.4% (1/240) (were seen among the HPS. Only arthralgia was found among HNS. Erythrocyte sedimentation rate (ESR) and age were the best predictors of arthralgia presence. CD4

  13. Assessment of clinico-immunological profile of newly diagnosed HIV patients presenting to a teaching hospital of eastern India

    PubMed Central

    Bishnu, Saptarshi; Bandyopadhyay, Dipanjan; Samui, Samiran; Das, Indrani; Mondal, Pradip; Ghosh, Pramit; Roy, Deeptarka; Manna, Sukanta

    2014-01-01

    Background & objectives: Newly diagnosed HIV patients may be asymptomatic or present with a wide range of symptoms related to opportunistic infections, acute seroconversion illness or other medical illnesses. This study was designed to evaluate the socio-demographic parameters, spectrum of the presenting clinical conditions and concurrent immunological status of newly diagnosed HIV patients and document the WHO clinical stages at the time of HIV diagnosis. Methods: This cross-sectional, observational study was undertaken over a 12 month period at a tertiary referral hospital in eastern India. Three hundred sixty consecutive newly diagnosed HIV patients were selected for the study from the HIV clinic and medicine wards of this hospital. Demographic and clinical data and relevant laboratory investigations of the patients were recorded and analyzed. Results: Mean age of patients was 36.38 ± 10.62 yr, while 63.89 per cent were males. The main mode of transmission of HIV for males and females were unprotected exposure to commercial sex (139, 60.44%) and intercourse with HIV seropositive spouses (89, 68.46%), respectively. Fever (104, 28.89%), weight loss (103, 28.61%) and generalized weakness (80, 22.22%) were the predominant symptoms. Overall mean CD4 count was 176.04 ± 163.49 cells/μl (males 142.19 ± 139.33 cells/μl; females 235.92 ± 185.11 cells/μl). Overall, 224 opportunistic infections were documented in 160 patients, opportunistic diarrhoea (44, 12.22%) and pulmonary tuberculosis (39, 10.83%) being the commonest. There were 83 and 133 patients in WHO clinical stages 3 and 4, respectively; 291 (80.83%) patients were eligible for initiation of first-line antiretrovirals at presentation. Interpretation & conclusions: Advanced immunodeficiency and burden of opportunistic infections characterize newly diagnosed HIV patients in eastern India. The physicians should keep in mind that these patients may have more than one clinical condition at presentation. PMID

  14. Large Outbreak Caused by Methicillin Resistant Staphylococcus pseudintermedius ST71 in a Finnish Veterinary Teaching Hospital – From Outbreak Control to Outbreak Prevention

    PubMed Central

    Grönthal, Thomas; Moodley, Arshnee; Nykäsenoja, Suvi; Junnila, Jouni; Guardabassi, Luca; Thomson, Katariina; Rantala, Merja

    2014-01-01

    Introduction The purpose of this study was to describe a nosocomial outbreak caused by methicillin resistant Staphylococcus pseudintermedius (MRSP) ST71 SCCmec II-III in dogs and cats at the Veterinary Teaching Hospital of the University of Helsinki in November 2010 – January 2012, and to determine the risk factors for acquiring MRSP. In addition, measures to control the outbreak and current policy for MRSP prevention are presented. Methods Data of patients were collected from the hospital patient record software. MRSP surveillance data were acquired from the laboratory information system. Risk factors for MRSP acquisition were analyzed from 55 cases and 213 controls using multivariable logistic regression in a case-control study design. Forty-seven MRSP isolates were analyzed by pulsed field gel electrophoresis and three were further analyzed with multi-locus sequence and SCCmec typing. Results Sixty-three MRSP cases were identified, including 27 infections. MRSPs from the cases shared a specific multi-drug resistant antibiogram and PFGE-pattern indicated clonal spread. Four risk factors were identified; skin lesion (OR = 6.2; CI95% 2.3–17.0, P = 0.0003), antimicrobial treatment (OR = 3.8, CI95% 1.0–13.9, P = 0.0442), cumulative number of days in the intensive care unit (OR = 1.3, CI95% 1.1–1.6, P = 0.0007) or in the surgery ward (OR = 1.1, CI95% 1.0–1.3, P = 0.0401). Tracing and screening of contact patients, enhanced hand hygiene, cohorting and barrier nursing, as well as cleaning and disinfection were used to control the outbreak. To avoid future outbreaks and spread of MRSP a search-and-isolate policy was implemented. Currently nearly all new MRSP findings are detected in screening targeted to risk patients on admission. Conclusion Multidrug resistant MRSP is capable of causing a large outbreak difficult to control. Skin lesions, antimicrobial treatment and prolonged hospital stay increase the probability of acquiring

  15. Microbial isolates in open fractures seen in the accident and emergency unit of a teaching hospital in a developing country.

    PubMed

    Alonge, T O; Ogunlade, S O; Salawu, S A; Fashina, A N

    2002-01-01

    In this prospective study, superficial and deep swabs of all open fractures seen at the accident and emergency unit of our hospital between January and June 2000 were taken (before wound debridement was done or anitibiotics commenced). Routine microscopy, culture and sensitivities for aerobic and anaerobic organisms were carried out on these specimens. The organisms were cultured and identified using standard techniques and the antibiotic sensitivity testing was carried out using the disc diffusion method of Stokes. Within six hours of injury, single-organism isolates were commonly found whilst after 48 hours a mixed or poly-microbial organism load were isolated. In 90% of the positive isolates, the organisms isolated form the superficial and the deep swabs were the same. The antibiotic sensitivity pattern of all the isolates shows that pefloxacin, ciprofloxacin and ceftriaxone were more effective compared to cefuroxime and amoxycillin which had substantial resistance to most of the isolates. 41 fractures were followed to union and 4 (9.7%) developed osteomyelitis. PMID:12665270

  16. HIV/AIDS Knowledge, Attitude and Risk Perception among Pregnant Women in a Teaching Hospital, Southwestern Nigeria

    PubMed Central

    Ojieabu, Winifred Aitalegbe; Femi-Oyewo, M. N.; Eze, Uchenna I.

    2011-01-01

    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. PMID:24826022

  17. Identification of airborne bacterial and fungal species in the clinical microbiology laboratory of a university teaching hospital employing ribosomal DNA (rDNA) PCR and gene sequencing techniques.

    PubMed

    Nagano, Yuriko; Walker, Jim; Loughrey, Anne; Millar, Cherie; Goldsmith, Colin; Rooney, Paul; Elborn, Stuart; Moore, John

    2009-06-01

    Universal or "broad-range" PCR-based ribosomal DNA (rDNA) was performed on a collection of 58 isolates (n = 30 bacteria + 28 fungi), originating from environmental air from several locations within a busy clinical microbiology laboratory, supporting a university teaching hospital. A total of 10 bacterial genera were identified including both Gram-positive and Gram-negative genera. Gram-positive organisms accounted for 27/30 (90%) of total bacterial species, consisting of seven genera and included (in descending order of frequency) Staphylococcus, Micrococcus, Corynebacterium, Paenibacillus, Arthrobacter, Janibacter and Rothia. Gram-negative organisms were less frequently isolated 3/30 (10%) and comprised three genera, including Moraxella, Psychrobacter and Haloanella. Eight fungal genera were identified among the 28 fungal organisms isolated, including (in descending order of frequency) Cladosporium, Penicillium, Aspergillus, Thanatephorus, Absidia, Eurotium, Paraphaeosphaeria and Tritirachium, with Cladosporium accounting for 10/28 (35.7%) of the total fungal isolates. In conclusion, this study identified the presence of 10 bacterial and eight fungal genera in the air within the laboratory sampled. Although this reflected diversity of the microorganisms present, none of these organisms have been described previously as having an inhalational route of laboratory-acquired infection. Therefore, we believe that the species of organisms identified and the concentration levels of these airborne contaminants determined, do not pose a significant health and safety threat for immunocompotent laboratory personnel and visitors. PMID:20183192

  18. The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study.

    PubMed

    Jones, Andrew R; Williams, Tim; Paringe, Vishal; White, Simon P

    2016-02-01

    The number of total hip replacements taking place across the UK continues to grow. In an ageing population, with people placing greater demands on their prostheses, the number of peri-prosthetic fractures is increasing. We studied the economic impact this has on a large teaching hospital. All patients with peri-prosthetic femoral fracture in a 7.5 year period were identified. Radiographic and case note analysis was performed. Costings from the finance departments were obtained. 90 cases were identified, 58 female and 32 male, with a mean age of 76 (range: 38-91). 89 of the cases were managed surgically, 66% undergoing revision and 33% receiving open reduction and internal fixation. According to the Vancouver Classification, 3% were Type A, 79% Type B and 18% Type C. The mean length of stay was 43 days. The mean cost of management was £31,370 (range: £6885-£112,327). Patients with type C fractures had the highest mean length of stay at 53 days and mean cost of £33,417. Including rehabilitation costs, our study illustrated a mean cost of £31,370, roughly four times the current basic NHS tariff of £8552. Although implant costs are greater, treatment with revision where appropriate allows earlier weight bearing, reduced length of stay and lower overall cost. PMID:26689495

  19. Neck masses in paediatric population: An experience with children attended the Central Teaching Hospital of Pediatrics in Baghdad 2008-2009

    PubMed Central

    Al-Mayoof, Ali F.

    2015-01-01

    Background: Pediatric neck mass is a frequent cause for surgical consultation. Neck masses can be simply classified into congenital, inflammatory, and neoplastic. Although most of the cases are due to benign processes, malignant causes must not be overlooked. The aim of this study is to assess the paediatric neck masses in Iraqi patients highlighting the distribution of cases according to their demographic characteristics and etiology. Patients and Methods: A cross-sectional observed study is conducted in the Department of Pediatric Surgery, at the Central Teaching Hospital of Pediatrics in Baghdad from April 2008 to March 2009. Sixty four patients with neck masses aged 14 years and below were examined and managed. The underlying causes of the neck masses were addressed and categorized. Results: Among the 64 patients, 42 (65.6%) were male. The inflammatory group represents 57% of the cases, while the malignant neoplasm accounts for approximately 10% of the conditions mainly due to lymphoma 5 (7.8%). Sixteen patients (25%) fall in the congenital group, in which the thyroglossal duct cyst was the commonest type. Wound infection developed in two patients, while one patient with cystic hygroma showed recurrence. Conclusion: Pediatrics neck masses are distributed in categories that similar in pattern and distribution in the world except the infectious/inflammatory category that shows variation in distribution in respect to the socioeconomic status. The surgical intervention and procedures are related to the facility as well as to the experience. PMID:26168753

  20. Syphilis serology in pregnancy: an eight-year study (2005-2012) in a large teaching maternity hospital in Dublin, Ireland.

    PubMed

    McGettrick, Padraig; Ferguson, Wendy; Jackson, Valerie; Eogan, Maeve; Lawless, Mairead; Ciprike, Vaneta; Varughese, Alan; Coulter-Smith, Sam; Lambert, John S

    2016-03-01

    All cases of positive syphilis serology detected in antenatal and peripartum screening in a large teaching maternity hospital in inner city Dublin, Ireland over an eight-year period (2005-2012 inclusive) were reviewed and included in our study. Demographic, antenatal registration, laboratory (including co-infections), partner serology, treatment and delivery data were recorded in our database. Infant follow-up, treatment and outcome data were also collected. During this period, 194 women had positive syphilis serology, of which 182 completed their pregnancies at the institution. This accounts for 0.28% of the total number of women completing their pregnancies during this time (N = 66038); 79 had no previous diagnosis of infection. There was one case of re-infection during pregnancy. Thirty-two women were co-infected with human immunodeficiency virus, hepatitis B or hepatitis C. There was one case suggestive of congenital syphilis infection. Our study is a comprehensive analysis of the diagnosis, management and clinical outcomes of women testing positive for syphilis infection in pregnancy. It reveals the relatively high prevalence of syphilis infection in the population utilising the maternity services in north inner-city Dublin. It re-enforces the importance of continued active surveillance to prevent morbidity and mortality associated with maternal syphilis infection. It also highlights the importance of strategies such as re-testing high-risk groups and definitive screening of spouse serology. PMID:25829517

  1. Pseudo-outbreak of Mycobacterium gordonae in a teaching hospital: importance of strictly following decontamination procedures and emerging issues concerning sterilization.

    PubMed

    Scorzolini, Laura; Mengoni, Fabio; Mastroianni, Claudio M; Baldan, Rossella; Cirillo, Daniela M; De Giusti, Maria; Marinelli, Lucia; Cottarelli, Alessia; Fattorini, Lanfranco; Vullo, Vincenzo

    2016-01-01

    Aim of this study was to investigate a pseudo-outbreak of Mycobacterium gordonae analyzing isolates detected from clinical and environmental samples. Mycobacterium gordonae was detected in 7 out of 497 broncho-alveolar lavage (BAL) samples after bronchoscopy procedure in patients admitted to a teaching hospital between January and April 2013. During this pseudo-outbreak clinical, epidemiological, environmental and molecular investigations were performed. None of the patients met the criteria for non-tuberculous mycobacterial (NTM) lung disease and were treated for M. gordonae lung disease. Environmental investigation revealed M. gordonae in 3 samples: in tap water and in the water supply channel of the washer disinfector. All the isolates were subjected to genotyping by pulsed-field gel electrophoresis (PFGE). The PFGE revealed that only patients' isolates presented the same band pattern but no correlation with the environmental strain was detected. Surveillance of the outbreak and the strict adherence to the reprocessing procedure and its supplies resulted afterwards in no detection of M. gordonae in clinical respiratory samples. Clinical surveillance of patients was crucial to establish the start of NTM treatment. Regular screening of tap water and endoscopic equipment should be adopted to compare the clinical strains with the environmental ones when an outbreak occurs. PMID:26922983

  2. Assessment of Knowledge and Practices regarding Injection Safety and Related Biomedical Waste Management amongst Interns in a Tertiary Care Teaching Hospital, Delhi

    PubMed Central

    Acharya, Anita Shankar; Priyanka; Khandekar, Jyoti; Bachani, Damodar

    2014-01-01

    Injuries caused by needle sticks and sharps due to unsafe injection practices are the most common occupational hazard amongst health care personnel. The objectives of our study were to determine the existing knowledge and practices of interns and change in their level following an information education and communication (IEC) package regarding safe injection practices and related biomedical waste management and to determine the status of hepatitis B vaccination. We conducted a follow-up study among all (106) interns in a tertiary care teaching hospital, Delhi. A predesigned semistructured questionnaire was used. IEC package in the form of hands-on workshop and power point presentation was used. A highly significant (P < 0.001) improvement in the knowledge of interns was observed after intervention with respect to the “three criteria of a safe injection” and cleaning of injection site. Thus, the baseline knowledge of interns was good in certain aspects of injection safety, namely, diseases transmitted by unsafe injections and their prevention. We conclude that IEC intervention package was effective in significantly improving the interns' knowledge regarding safe injection practices and biomedical waste management. Almost two-thirds of interns were immunised against hepatitis B before the intervention and this proportion rose significantly after the intervention.

  3. [The issue of dialysis withdrawal and palliative cares. A 3-year retrospective study carried out at Grenoble university teaching hospital development of a decision-making tool].

    PubMed

    Jarrin, Guillemette; Maurizi-Balzan, Jocelyne; Laval, Guillemette

    2007-07-01

    Dialysis-related constraints encourage questioning about discontinuation of treatment. In France, the 04/22/2005 law, related to patients' rights and end-of-life issues, defines bounds to treatment withdrawal, authorizing it in specific conditions, to avoid foolish obstinacy. Shortly before the publication of this law, a study has been conducted at Grenoble University Teaching Hospital, involving 31 patients followed by the dialysis service and the palliative care service, in order to analyse the circumstances in which withdrawals from dialysis happen. These patients were old and their general condition was very poor. After initiation of the questioning, treatment was removed in older patients and in those who had been dialysed for short time, which suggests they may have poor adaption to the treatment. No dialysis withdrawal was ever decided without the patient consent or without his nearest and dearest consent. After multidisciplinary discussions, a decision-making tool for dialysis withdrawal has been developed, with a view to be a starting point in the thinking process, for each decision to be adapted to each situation. This tool emphasizes the importance of time and collegial consultation in the decision-making process. It points out to that the decision lies with the referent nephrologist. After withdrawing dialysis, palliative cares must be implemented, since stopping the treatment does not mean stopping cares. PMID:17658440

  4. Criterion-referenced evaluation of day one clinical competencies of veterinary students: VOLES-the VMTH (Veterinary Medicine Teaching Hospital) Online Evaluation System.

    PubMed

    Zeck, Steven; Wall, Judy A; Smith, Bradford P; Wilson, W David; Walsh, Donal A

    2012-01-01

    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

  5. Antimicrobial agents’ utilization and cost pattern in an Intensive Care Unit of a Teaching Hospital in South India

    PubMed Central

    Anand, Nikhilesh; Nagendra Nayak, I. M.; Advaitha, M. V.; Thaikattil, Noble J.; Kantanavar, Kiran A.; Anand, Sanjit

    2016-01-01

    Background and Aims: High utilization and inappropriate usage of antimicrobial agents (AMAs) in an Intensive Care Unit (ICU) increases resistant organisms, morbidity, mortality, and treatment cost. Prescription audit and active feedback are a proven method to check the irrational prescription. Measuring drug utilization in DDD/100 bed-days is proposed by the WHO to analyze and compare the utilization of drugs. Data of AMAs utilization are required for planning an antibiotic policy and for follow-up of intervention strategies. Hence, in this study, we proposed to evaluate the utilization pattern and cost analysis of AMA used in the ICU. Methodology: A prospective observational study was conducted for 1 year from January 1, 2014, to December 31, 2014, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, relevant investigation, the utilization of different classes of AMAs (WHO-ATC classification) as well as individual drugs and their costs were recorded. Results: One thousand eight hundred and sixty-two prescriptions of AMAs were recorded during the study period with an average of 1.73 ± 0.04 prescriptions/patient. About 80.4% patients were prescribed AMAs during admission. Ceftriaxone (22.77%) was the most commonly prescribed AMA followed by piperacillin/tazobactam (15.79%), metronidazole (12%), amoxicillin/clavulanic acid (6.44%), and azithromycin (4.34%). Ceftriaxone, piperacillin/tazobactam, metronidazole, and linezolid were the five maximally utilized AMAs with 38.52, 19.22, 14.34, 8.76, and 8.16 DDD/100 bed-days respectively. An average cost of AMAs used per patient was 2213 Indian rupees (INR). Conclusion: A high utilization of AMAs and a high cost of treatment were noticed which was comparable to other published data, though an increased use of newer AMAs such as linezolid, clindamycin, meropenem, colistin was noticed. PMID:27275075

  6. The impact of brush cytology from endoscopic retrograde cholangiopancreatography (ERCP) on patient management at a UK teaching hospital

    PubMed Central

    Sethi, Rajiv; Singh, Kaushiki; Warner, Ben; Mahadeva, Ula; Wilkinson, Mark

    2016-01-01

    Introduction Patients with suspected pancreaticobiliary cancers frequently undergo endoscopic retrograde cholangiopancreatography (ERCP) to obtain brush cytology for confirmatory diagnosis. The outcome of this often leads to the management of the patient and can avoid more invasive investigations. There is a wide range of sensitivities and specificities reported in the literature. Aims To determine the accuracy of the brush cytology obtained at ERCP by performing a retrospective audit of all patients admitted to Guy's and St. Thomas’ Hospital for ERCP during 2008–2013. Also, to evaluate the impact of cytology results on patient care following ERCP. Method Data were collected from 4 January 2008 to 27 December 2013. This involved analysing EndoSoft (the in-house software for endoscopic data entry), Pathnet (the pathology database) and Electronic Patient Records. Results 162 patients underwent brush cytology during ERCP. 58 patients had positive cytology. With intention-to-treat analysis, sensitivity was 54.7%, specificity was 100.0% and negative predictive value was 53.9% with a positive predictive value of 100%. Patients with a positive brush cytology result required fewer investigations compared with patients with a negative cytology result. Conclusions Our results compare favourably with previous studies in the field. Brush cytology has been ignored in recent times due to perceived poor results and efficacy. Our audit shows that it can reduce the number of investigations required to reach a diagnosis of malignancy and so is a valuable tool in the diagnosis of pancreaticobiliary malignancies. However, better guidance on preparation of samples for cytology is needed to reduce the number of insufficient samples. PMID:27103983

  7. Drug utilisation and off-label use of medications in anaesthesia in surgical wards of a teaching hospital

    PubMed Central

    Patil, Amol E; Shetty, Yashashri C; Gajbhiye, Snehalata V; Salgaonkar, Sweta V

    2015-01-01

    Background and Aims: When a drug is used in a way that is different from that described in regulatory body approved drug label, it is said to be ‘off label use’. Perioperative phase is sensitive from the point of view of patient safety and off-label drug use in this setup can prove to be hazardous to patient. Hence, it was planned to assess the pattern of drug utilisation and off-label use of perioperative medication during anaesthesia. Methods: Preoperatively, demographic details and adverse events check list were filled from a total of 400 patients from general surgery, paediatric surgery and orthopaedics departments scheduled to undergo surgery. The perioperative assessment form was assessed to record all prescriptions followed by refilling of adverse events checklist in case record form. World Health Organization (WHO) prescribing indicators were used for analysis of drug utilisation data. National Formulary of India 2011 was used as reference material to decide off-label drug use in majority instances along with package insert. Results: A total of 3705 drugs were prescribed to the 400 participants and average number of drugs per patient was 9.26 ± 3.33. Prescriptions by generic name were 68.07% whereas 85.3% drugs were prescribed from hospital schedule. Off-label drugs overall formed 20.19% of the drugs prescribed. At least one off-label drug was prescribed to 82.5% of patients. Inappropriate dose was the most common form of off-label use. There was 1.6 times greater risk of occurrence of adverse events associated with the use of off-label drugs. Conclusion: Prescription indicators were WHO compliant. Off-label drug use was practiced in anaesthesia department with questionable clinical justification in some instances. PMID:26755837

  8. Investigation of the Relationship Between Organizational Learning and Organizational Citizen Behavior Among the Staff of Teaching Hospital

    PubMed Central

    Kiaei, Mohammad Zakaria; Hasanpoor, Edris; Sokhanvar, Mobin; Mohseni, Mohammad; Ziaiifar, Hajarbibi; Moradi, Mahin

    2014-01-01

    Background: Today, the concept of organizational learning has attracted the attention of many managers and researchers in scientific and research circles as well as those in the organization-related studies. Taking the organizational learning into account might offer a means of organizational effectiveness that has gone unnoticed. Thus the present study aimed at investigating the relationship between the organizational learning in each of its four aspects as independent variables and organizational citizen behavior of the staff as constituting the dependent variable of the study. Methods: This was a descriptive-analytical study with a practical approach conducted in 2010. The sample included 167 staff members working in educational health centers affiliated with Qazvin University of Medical Sciences. The data were collected via both the organizational learning questionnaire and organizational citizen behavior questionnaire and analyzed by using SPSS software and Spearman test. Results: The results indicated that the mean of organizational learning indicator was 2.9±0.648 and that of organizational citizen behavior 3.78±0.413. In addition, the spearman correlation coefficient ranging from 0.058 to 0.129 between the elements of the organizational learning and the organizational citizen behavior was not statistically significant (p>0.05). The findings also indicated that the correlation between them was average among the staff of Shahid Raja’ee Educational health center (0.319), thus the relationship between the two sets of variables proved significant (p=0.031). However, the same was not true in other centers. Conclusion: It was concluded that management commitment, open space, transfer of knowledge, and systemic vision could all enhance the level of organizational learning in hospitals which calls for focus on the elements of organizational citizen behavior. PMID:25568629

  9. A retrospective drug use evaluation of cabergoline for lactation inhibition at a tertiary care teaching hospital in Qatar

    PubMed Central

    AlSaad, Doua; ElSalem, Samah; Abdulrouf, Palli Valapila; Thomas, Binny; Alsaad, Tayseer; Ahmed, Afif; AlHail, Moza

    2016-01-01

    Background Breastfeeding is considered as gold standard for infant nutrition and should be interrupted only when a compelling indication exists. Certain medical conditions such as abortion, stillbirth, HIV infection, or infant galactosemia and certain medications such as chemotherapy necessitate lactation inhibition to protect the health of mother and infant. Drug use evaluation (DUE) studies are done to explore the current practice in a setting and help to identify areas in which further information and education may be needed by clinicians. Objective The aim of this study was to conduct a DUE of cabergoline to assess indications for lactation inhibition, dosage regimen, and its safety. Method A retrospective cross-sectional DUE study was conducted over a period of 4 months from September 1, 2013, till December 31, 2013, at the Women’s Hospital, Qatar. All cabergoline prescriptions written for lactation inhibition within 10 days of delivery or abortion were included in the study. A descriptive data analysis was undertaken. Results Of the 85 patients included, stillbirth (50.6%) was considered as the main reason for lactation inhibition, followed by abortion (27.1%) and neonatal death (12.9%). The remaining 9.4% of the patients had live baby, and the majority of them were prescribed cabergoline for lactation inhibition because their maternal medical conditions required the use of drugs with insufficient safety data (n=6). Seventy-four percent of patients received cabergoline at accurate time and dose. However, 14% of the patients had preexisting hypertensive disorder and 58.3% of them were diagnosed as uncontrolled hypertension. Conclusion The current DUE study found that cabergoline was mainly used to inhibit lactation for patients with stillbirth, abortion, and neonatal death. In mothers who use medications for other medical conditions, benefits and risks of breastfeeding should be carefully balanced before prescribing cabergoline. Current prescribing pattern

  10. The association between work ethics and attitudes towards organizational changes among the administrative, financial and support employees of general teaching hospitals

    PubMed Central

    Ravangard, Ramin; Sajjadnia, Zahra; Jafari, Abdosaleh; Shahsavan, Najme; Bahmaie, Jamshid; Bahadori, Mohammadkarim

    2014-01-01

    In order to achieve success in today’s competitive world, organizations should adapt to environmental changes. On the other hand, managers should have a set of values and ethical guidelines for their administrative and organizational functions. This study aimed to investigate the association between work ethics and attitudes towards organizational changes among the administrative, financial and support employees of general teaching hospitals affiliated to Shiraz University of Medical Sciences. This was an applied, cross-sectional and descriptive-analytic study conducted in 2013. A sample of 124 employees was selected using stratified sampling proportional to size and simple random sampling methods. Data were collected using 2 questionnaires measuring the dimensions of employees' work ethics (four dimensions) and attitudes towards organizational changes (three dimensions). The collected data were analyzed using SPSS 18.0 and statistical tests, including ANOVA, independent samples t-test, and Pearson’s correlation coefficient. A P < 0.05 was considered statistically significant. The maximum and minimum score of work ethic dimensions were related to being cooperative (4.60 ± 0.38) and dependable (4.29 ± 0.39) respectively. On the other hand, the maximum and minimum score of attitudes towards the various dimensions of organizational changes were related to the behavioral (3.83 ± 0.70) and the affective (3.55 ± 0.88) dimensions respectively. Furthermore, there was a significant relationship between the work ethics and education levels of the employees in this study (P = 0.003). Also, among work s dimensions, only being considerate had a significant association with attitudes towards organizational changes (P = 0.014) and their cognitive dimension (P = 0.005). To improve employees' work ethics and attitudes towards organizational changes, the following suggestions can be offered: training hospitals managers in participative management style and its application

  11. Pattern of Skin Diseases at University of Benin Teaching Hospital, Benin City, Edo State, South-South Nigeria: A 12 Month Prospective Study

    PubMed Central

    Ukonu, B. A.; Eze, E. U

    2012-01-01

    Background and Objective: This study aims to look at the pattern and incidence of skin diseases seen in Dermatology/Venereology clinic at the University of Benin Teaching Hospital, Benin City, Edo State, South-South Zone, Nigeria and compare it with other zones of Nigeria. Materials and Methods: This was a prospective study on pattern and incidence of skin diseases in new patients presenting at the Dermatology/Venereology outpatient clinic of the University of Benin Teaching Hospital, Benin City, Edo State, South-South, Nigeria, from September 2006 to August 2007. All patients were seen by the researchers. Diagnosis were made clinically and sometimes with the support of histopathology. Results: A total number of 4786 patients were seen during the study period and these comprised 2647 HIV/AIDS patients and 2112 pure Dermatological patients. Out of 4786 patients, 755 (15.8%) were new patients. The new patients comprised 96 (12.7%) children patients (< 15 years) and 659 (83.7%) adult patients (>15years). The ages of the patients ranged from 2 weeks to 80 years and more than two-third were < 40 years. There were 354 males (46.9%) and 401 females (53.1%). This represents female: male ratio of 1.1: 1. Eczematous dermatitis accounted for 20.9% of the skin diseases and was the most common of the skin diseases observed. This is consistent with observation from other zones in Nigeria. Other skin diseases observed in order of frequencies include: Papulosqamous disorder (9.0%), Infectious skin diseases like fungal, viral, bacterial and parasitic infestation, at 7.9%, 7.7%, 2.3% and 2.1% respectively. Pigmentary disorders (5.0%), hair disorders (4.2%) and Benign neoplastic skin disease (6.5%). All the patients that had neurofibromatosis were females (1.9%). HIV-related skin diseases were observed to have increased remarkably (7.9%) with Kaposi’s sarcoma, papular pruritic eruptions and drug eruptions being the commonest mode of presentation. Conclusion: The current pattern of

  12. New Alert Override Codes for the Drug Utilization Review System Derived from Outpatient Prescription Data from a Tertiary Teaching Hospital in Korea

    PubMed Central

    Yoo, Ki-Bong; Kim, Woojae; Park, Man Young; Ahn, Eun Kyoung; Park, Rae Woong

    2016-01-01

    Objectives This paper proposes new alert override reason codes that are improvements on existing Drug Utilization Review (DUR) codes based on an analysis of DUR alert override cases in a tertiary medical institution. Methods Data were obtained from a tertiary teaching hospital covering the period from April 1, 2012 to January 15, 2013. We analyzed cases in which doctors had used the 11 overlapping prescription codes provided by the Health Insurance Review and Assessment Service (HIRA) or had provided free-text reasons. Results We identified 27,955 alert override cases. Among these, 7,772 (27.8%) utilized the HIRA codes, and 20,183 (72.2%) utilized free-text reasons. According to the free-text content analysis, 8,646 cases (42.8%) could be classified using the 11 HIRA codes, and 11,537 (57.2%) could not. In the unclassifiable cases, we identified the need for codes for "prescription relating to operation" and "emergency situations." Two overlapping prescription codes required removal because they were not used. Codes A, C, F, H, I, and J (for drug non-administration cases) explained surrounding situations in too much detail, making differentiation between them difficult. These 6 codes were merged into code J4: "patient was not taking/will not take the medications involved in the DDI." Of the 11 HIRA codes, 6 were merged into a single code, 2 were removed, and 2 were added, yielding 6 alert override codes. We could codify 23,550 (84.2%) alert override cases using these codes. Conclusions These new codes will facilitate the use of the drug–drug interactions alert override in the current DUR system. For further study, an appropriate evaluation should be conducted with prescribing clinicians. PMID:26893949

  13. Laparoscopic Fimbrioplasty and Neosalpingostomy in Female Infertility: A Review of 402 Cases at the Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital in Yaoundé-Cameroon

    PubMed Central

    Kasia, Jean Marie; Ngowa, Jean Dupont Kemfang; Mimboe, Yolande Salome; Toukam, Michel; Ngassam, Anny; Noa, Claude Cyrile; Belinga, Etienne; Medou, Alexis

    2016-01-01

    Background: More than 70 million couples suffer from infertility worldwide. The aim of this study was to evaluate the fertility outcomes after laparoscopic fimbrioplasty and neosalpingostomy in female infertility. Methods: Laparoscopic distal tuboplasty was carried out for 402 cases at the Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital in Yaoundé-Cameroon in Central Africa from December 2002 to December 2007. Laparoscopic fimbrioplasty and neosalpingostomy were done using bipolar electrocoagulation and conventional endoscopic instruments. Log-rank test was used to compare cumulative rate curves of intrauterine pregnancy with respect to the tubal stages. P<0.05 was considered statistically significant. Results: The mean age of the patients was 31.6±5.45 years. Secondary infertility was the most frequent type of infertility (70.14%). The laparoscopic tubal surgery done consisted of fimbrioplasty in 185(46%) cases and neosalpingostomy in 217 (54%) cases. Of 260 women followed up after tuboplasty, there were overall 74 (28.48%) pregnancies; 68(26.1%) intrauterine pregnancies and 6(2.3%) ectopic pregnancies. Pregnancy rates were significantly associated to the tubal stage (63% in stage 1, 15% in stage 3 and 00% in stage 4; p<0.001) and the adnexal adhesion scores (73.91% in the absence of adnexal adhesions and 8.8% in the case of a severe adnexal adhesion score). Of the 68 intrauterine pregnancies, there were 60(88%) live births and 8(12%) spontaneous abortions. Conclusion: It is believed that laparoscopic fimbrioplasty and neosalpingostomy should be the preferred choice when faced with tubal distal occlusion in a context of female infertility. This implies that training in endoscopic surgery should be regarded as an important issue in developing countries. PMID:27141465

  14. Prevalence and healthcare costs associated with the management of diabetic foot ulcer in patients attending Ahmadu Bello University Teaching Hospital, Nigeria

    PubMed Central

    Danmusa, Umar Mukhtar; Terhile, Iorliam; Nasir, Idris Abdullahi; Ahmad, Auwal Alkasim; Muhammad, Habiba Yahaya

    2016-01-01

    Introduction Diabetic foot ulcers (DFU) are non-traumatic lesions of the skin on feet of diabetic patients. DFU require appropriate investigations, dietary placement and clinical management. These constitute huge healthcare costs in DFU care. Objective This study sought to determine the prevalence of DFU in relation to clinical, socio-demographic variables and healthcare costs expended. Methods This was a retrospective study. Hence, medical records and healthcare costs of 1573 DFU-diagnosed patients who visited the diabetic clinic and medical wards of Ahmadu Bello University Teaching Hospital, Nigeria were reviewed and analyzed for relevant data. Results The prevalence of DFU in patients with diabetic mellitus (DM) was 6.0% with more cases in men (67.2%) than women (32.8%). The prevalence of DFU in relation to type of DM was 6.5% and 0% for DM type-II and DM type-I respectively. The distribution of DFU in relation to clinical stages was 40%, 25.7%, 17.1% and 11.4% for stages-IV, III, II and I. Patients in the age group 51–60 years had the highest frequency of DFU (28.6%), but there was no DFU in those 10–20 years and > 80 years. It required an average of 1808 US$ to successfully treat patients with DFU stage IV, while 1104 US$ and 556 US$ was required to treat DFU stage III and II respectively. Cost of procuring drugs covered the highest burden of total healthcare cost in managing DFU (35%–46%). Conclusion The prevalence of DFU in DM patients attending ABUTH was high. Healthcare costs associated with DFU especially cost of drugs procurement contributed the highest financial burden in managing DFU. PMID:27103904

  15. First-line antiretroviral treatment failure and associated factors in HIV patients at the University of Gondar Teaching Hospital, Gondar, Northwest Ethiopia

    PubMed Central

    Ayalew, Mohammed Biset; Kumilachew, Dawit; Belay, Assefa; Getu, Samson; Teju, Derso; Endale, Desalegn; Tsegaye, Yemisirach; Wale, Zebiba

    2016-01-01

    Background Antiretroviral therapy (ART) restores immune function and reduces HIV-related adverse outcomes. But treatment failure erodes this advantage and leads to an increased morbidity and compromised quality of life in HIV patients. The aim of this study was to determine the prevalence and factors associated with first-line ART failure in HIV patients at the University of Gondar Teaching Hospital. Patients and methods A retrospective study was conducted on 340 adults who had started ART during the period of September 2011 to May 2015. Data regarding patients’ sociodemographics, baseline characteristics, and treatment-related information were collected through review of their medical charts. Data were analyzed using SPSS version 21. Descriptive statistics, cross-tabs, and binary and multiple logistic regressions were utilized. P<0.05 was used to declare association. Results Among the 340 patients enrolled, 205 were females (60.3%). The mean age at ART initiation was 34.4 years. A total of 14 (4.1%) patients were found to have treatment failure. The median duration of treatment failure from initiation of treatment was 17.5 months (8–36 months). Poor adherence to treatment and low baseline CD4 cell count were found to be significant predictors of treatment failure. Conclusion The prevalence of first-line ART failure was 4.1%. Treatment failure was most likely to occur for the patients who had poor drug adherence and those who were delayed to start ART till their CD4 cell count became very low (<100 cells/mm3). PMID:27621669

  16. Selected micronutrient levels and response to highly active antiretroviral therapy (HAART) among HIV/AIDS patients attending a teaching Hospital in Addis Ababa, Ethiopia.

    PubMed

    Eshetu, Amare; Tsegaye, Aster; Petros, Beyene

    2014-12-01

    Poor micronutrient levels are associated with an increased risk of progression to AIDS and are also suggested to influence outcome of highly active antiretroviral therapy (HAART), though existing data are inconclusive to support the latter. Few published data are available on micronutrient levels in Ethiopian HIV/AIDS patients taking HAART. The objective of the study was to determine the association of micronutrient levels and response to HAART (CD4(+) T cell count) among adult HIV/AIDS patients attending a teaching Hospital in Addis Ababa. CD4(+) T cell counts and micronutrient (retinol, zinc, and iron) levels for 171 subjects were determined using standard procedures. Some proportions of the study participants were found deficient for retinol (14.03 %), zinc (47.3 %), and iron (2.8 %). Patients who were deficient in retinol had a significantly lower median CD4(+) T cell counts (P = 0.002) compared to non-deficient subjects. Association of micronutrient quartiles with CD4+ T cell count was assessed using adjusted multivariate regression by taking quartile 4 as a reference category. Accordingly, patients who had retinol levels in quartile 4 had a significantly lower mean CD4(+) T cell count compared to quartile 3 (P = 0.02). The significantly higher CD4(+) T cell counts in patients who were non-deficient in retinol imply the role of retinol in improving the production of CD4(+) T cells. However, both lower and higher retinol levels were associated with suppressed immunity (CD4 < 200 cells/mm(3)), suggesting an adverse effect of higher retinol levels. Thus, retinol may be potentially harmful depending on the dose, emphasizing the need for optimized level of retinol in nutrient supplements in patients taking HAART. PMID:25256923

  17. Factors associated with antiretroviral treatment interruption in human immunodeficiency virus (HIV)-1-infected children attending the Jos University Teaching Hospital, Jos, Nigeria

    PubMed Central

    Ebonyi, Augustine O.; Ejeliogu, Emeka U.; Okpe, Sylvanus E.; Shwe, David D.; Yiltok, Esther S.; Ochoga, Martha O.; Oguche, Stephen

    2015-01-01

    Background: Interrupting anti-retroviral therapy (ART) for any number of reasons is an indication of a compromised adherence to ART. Several factors, including the pill burden from other drugs used in treating co-infections in children with human immunodeficiency virus (HIV), may influence ART adherence. The aim of this study was to identify the factors associated with ART interruption in HIV-1-infected children. Materials and Methods: A retrospective cohort study analysing data on 580 children consecutively enrolled on ART between February 2006 and December 2010 at the paediatric HIV clinic of Jos University Teaching Hospital (JUTH), Jos. Subjects were children aged 2 months — 15 years diagnosed with HIV-1 infection and on first-line ART. Cotrimoxazole prophylaxis was usually commenced at diagnosis while awaiting ART commencement. Children diagnosed with tuberculosis (TB) were also placed on multiple individual anti-TB drugs. Statistical analysis used: A comparison of the data on children with and without ART interruption was made. Variables associated with ART interruption in a univariate analysis were fit in a multivariate logistic model to determine the factors that were associated with ART interruption. Results: Children on anti-TB drugs were twice more likely to interrupt ART compared to those who were not, (adjusted odds ratio, AOR = 1.84 (1.03-3.28); P = 0.04). But children on cotrimoxazole prophylaxis had a 57% reduction in the odds of interrupting ART compared to those who were not, (AOR = 0.43 (0.20-0.93); P = 0.03). Conclusion: Children on ART and also taking multiple individual anti-TB drugs should be monitored closely for ART adherence. Cotrimoxazole prophylaxis should be encouraged in children diagnosed with HIV while awaiting ART commencement as this may prime them for a better ART adherence. PMID:25657493

  18. Quality of documentation on antibiotic therapy in medical records: evaluation of combined interventions in a teaching hospital by repeated point prevalence survey.

    PubMed

    Vercheval, C; Gillet, M; Maes, N; Albert, A; Frippiat, F; Damas, P; Van Hees, T

    2016-09-01

    This study aimed to improve the quality of documentation on antibiotic therapy in the computerized medical records of inpatients. A prospective, uncontrolled, interrupted time series (ITS) study was conducted by repeated point prevalence survey (PPS) to audit the quality of documentation on antibiotic therapy in the medical records before and after a combined intervention strategy (implementation of guidelines, distribution of educational materials, educational outreach visits, group educational interactive sessions) from the antimicrobial stewardship team (AST) in the academic teaching hospital (CHU) of Liège, Belgium. The primary outcome measure was the documentation rate on three quality indicators in the computerized medical records: (1) indication for treatment, (2) antibiotics prescribed, and (3) duration or review date. Segmented regression analysis was used to analyze the ITS. The medical records of 2306 patients receiving antibiotics for an infection (1177 in the pre-intervention period and 1129 in the post-intervention period) were analyzed. A significant increase in mean percentages in the post-intervention period was observed as compared with the pre-intervention period for the three quality indicators (indication documented 83.4 ± 10.4 % vs. 90.3 ± 6.6 %, p = 0.0013; antibiotics documented 87.9 ± 9.0 % vs. 95.6 ± 5.1 %, p < 0.0001; and duration or review date documented 31.9 ± 15.4 % vs. 67.7 ± 15.2 %, p < 0.0001). The study demonstrated the successful implementation of a combined intervention strategy from the AST. This strategy was associated with significant changes in the documentation rate in the computerized medical records for the three quality indicators. PMID:27255220

  19. Socio-Economic Status of Patients With Type 2 Diabetes and Hypertension Attending the Ahmadu Bello University Teaching Hospital, Zaria, North-West Nigeria

    PubMed Central

    Okoduwa, Stanley Irobekhian Reuben; Umar, Ismaila Alhaji; Ibrahim, Sani; Bello, Fatima; Ndidi, Uche Samuel

    2015-01-01

    Hypertension (HTN) and Type 2 diabetes (T2D) are lifestyle interrelated diseases of global significance. Interestingly, the prevalence of these diseases in Africa and indeed Nigeria seems to be on the increase. This study, therefore, investigated the socioeconomic status (based on income, education and occupational activity) of 400 subjects (52% female and 48% male) aged 20 years and above who were sampled randomly among the newly diagnosed HTN and/or T2D cases at the Ahmadu Bello University Teaching Hospital, Zaria, North-West Nigeria. A semi-structured questionnaire was used to collect information from the subjects. From the result obtained, most of the respondents who live in towns or city suffer from either HTN or T2D while more town dwellers (28%) suffer from a combination of both diseases. It was also discovered that most respondents who suffer from HTN and from a combination of HTN and T2D belong to the old generation (60-79 years). There is higher prevalence rate of diabetes among the respondents who had no formal education or attended only basic Arabic schools. Most respondents who earn good income (₦50,000-₦100,000 and above ₦100,000) suffer HTN, T2D and a combination of both diseases. Those engaged in heavy occupational activities had the lowest prevalence of the disease compared with those of light or moderate occupational activities. These data will be found useful in planning intervention healthcare preventive programs especially on public enlightenment workshops and seminars to educate the populace on the importance of lifestyle modification, healthy diet and regular exercises. PMID:25560354

  20. Evaluation of control of blood pressure in chronic kidney disease patients with hypertension attending echo-lab of Nepal Medical College Teaching Hospital.

    PubMed

    Shrestha, B; Dhungel, S

    2012-06-01

    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

  1. An epidemiological study on the predictors of health status of food handlers in food establishments of teaching hospitals of North India

    PubMed Central

    Singh, Arun; Katyal, Rashmi; Chaudhary, Varsha; Narula, Kusum; Upadhayay, Deepak; Singh, Shailendra Pratap

    2015-01-01

    Introduction: The US Centers for Disease Control and Prevention (USDHHS-CDC 1996) revealed that the outbreaks of food borne diseases include inadequate cooking, heating, or re-heating of foods consumption of food from unsafe sources, cooling food inappropriately and allowing too much of a time lapse. As we all know that the food handlers have been working in various types of community kitchen and their health status can affect the status of food hygiene which can lead to contamination of foods attributing to acute gastroenteritis and food poisoning in various subgroups of the population e.g., medical/dental/nursing students. The background characteristics of these food handlers may have important role to affect health status of these handlers. Methods: The indexed study was carried out among the food handlers working in the food establishments the 5 teaching hospitals of Bareilly city in U.P. India during one year i.e., from August 2013 to July 2014. The survey method using schedule was conducted to get information about the background characteristics and food handlers and each food handler was examined clinically for assessing health status. Chi-Square test was used as test of significance and regression analysis was also done to nullifying the effect of confounders. Results: The health status of the mess workers was found to be significantly associated with use of gloves, hand washing after toilet and hand washing before cooking and serving food. Conclusion: The rationale of this study was that though many studies have been carried out to show the health status of the food handlers and their background characteristics, no study has highlighted the association of these background characteristics and personal hygiene practices with the health status of food handlers. PMID:26957813

  2. Comparison study of QuantiFERON test with tuberculin skin testing to diagnose latent tuberculosis infection among nurses working in teaching hospitals of Ahvaz, Iran.

    PubMed Central

    Salmanzadeh, Shokrollah; Abbasissifar, Hajar; Alavi, Seyed Mohmmad

    2016-01-01

    Background: Prompt diagnosis and treatment of latent tuberculosis (TB) infection (LTBI) are needed to control TB. The aim of the study was to compare the performance of Quanti FERON-TB test (QFT) with conventional TST for the diagnosis of LTBI. Methods: In this analytical - comparison study, we enrolled 87 nurses working in teaching hospitals in Ahvaz. All study subjects were tested by TST. TST results were interpreted as positive if induration was more than 10 mm. If the level of QFT after stimulation was equal or greater than 0.35 IU/ml, test was considered as positive. Data were analyzed with SPSS program. QFT results compared with induration in TST and its relation to all variables were investigated. Results: The rate of LTB diagnosis by TST and QFT was 31% and 35.6%, respectively. There was no significant difference between TST and QFT in LTB diagnosis (P=0.62). Among the 56 subjects who were TST- negative, 14 cases (approximately 25%) were QFT- positive and 42 (75%) were QFT- negative. Among the 31 cases (35.6%) that had TST- positive, 13 (42%) were QFT-positive and 18 (58%) were QFT- negative. The overall percent agreement was 63.2% (k=0.139, P=0.69), discordance %=15.9-20.7, sensitivity= 41.5% and specificity=75.5%. Conclusion: Diagnostic value of QFT is similar to TST, when there is strong clinical and epidemiological evidence of LTB in a nurse with negative TST, adding QFT to diagnostic evaluation is associated with increased rate of LTB diagnosis.

  3. Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia: a cross sectional study of cost and birth outcomes

    PubMed Central

    2014-01-01

    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

  4. Device-associated infection rates and bacterial resistance in six academic teaching hospitals of Iran: Findings from the International Nocosomial Infection Control Consortium (INICC).

    PubMed

    Jahani-Sherafat, Somayeh; Razaghi, Maryam; Rosenthal, Victor D; Tajeddin, Elahe; Seyedjavadi, Simasadat; Rashidan, Marjan; Alebouyeh, Masoud; Rostampour, Maryam; Haghi, Arezo; Sayarbayat, Masoumeh; Farazmandian, Somayeh; Yarmohammadi, Tahere; Arshadi, Fardokht K; Mansouri, Nahid; Sarbazi, Mohammad R; Vilar, Mariano; Zali, Mohammad R

    2015-01-01

    Device-associated health care-acquired infections (DA-HAIs) pose a threat to patient safety, particularly in the intensive care unit (ICU). However, few data regarding DA-HAI rates and their associated bacterial resistance in ICUs from Iran are available. A DA-HAI surveillance study was conducted in six adult and pediatric ICUs in academic teaching hospitals in Tehran using CDC/NHSN definitions. We collected prospective data regarding device use, DA-HAI rates, and lengths of stay from 2584 patients, 16,796 bed-days from one adult ICU, and bacterial profiles and bacterial resistance from six ICUs. Among the DA-HAIs, there were 5.84 central line-associated bloodstream infections (CLABs) per 1000 central line-days, 7.88 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator-days and 8.99 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. The device utilization ratios were 0.44 for central lines, 0.42 for mechanical ventilators and 1.0 for urinary catheters. The device utilization ratios of mechanical ventilators and urinary catheters were higher than those reported in the ICUs of the INICC and the CDC's NHSN reports, but central line use was lower. The DA-HAI rates in this study were higher than the CDC's NHSN report. However, compared with the INICC report, the VAP rate in our study was lower, while the CLAB rate was similar and the CAUTI rate was higher. Nearly 83% of the samples showed a mixed-type infection. The most frequent pathogens were Acinetobacter baumannii, Staphylococcus aureus and Pseudomonas aeruginosa, followed by Klebsiella pneumoniae and Enterococcus spp. In the S. aureus isolates, 100% were resistant to oxacillin. Overall resistances of A. baumannii and K. pneumonia to imipenem were 70.5% and 76.7%, respectively. A multiple drug resistance phenotype was detected in 68.15% of the isolates. The DA-HAI rates in Iran were shown to be higher than the CDC-NHSN rates and similar to the INICC rates

  5. Prevalence of common canine digestive problems compared with other health problems in teaching veterinary hospital, Faculty of Veterinary Medicine, Cairo University, Egypt

    PubMed Central

    Rakha, Gamal M. H.; Abdl-Haleem, Mounir M.; Farghali, Haithem A. M.; Abdel-Saeed, Hitham

    2015-01-01

    Aim: The present study was conducted to ascertain the prevalence of common digestive problems compared to other health problems among dogs that were admitted to the teaching veterinary hospital, faculty of veterinary medicine, Cairo University, Egypt during 1 year period from January to December 2013. Also, study the effect of age, sex, breeds, and season on the distribution of digestive problems in dogs. Materials and Methods: A total of 3864 dogs included 1488 apparently healthy (included 816 males and 672 females) and 2376 diseased dogs (included 1542 males and 834 females) were registered for age, sex, breed, and the main complaint from their owners. A complete history and detailed clinical examination of each case were applied to the aids of radiographic, ultrasonographic, and endoscopic examination tools. Fecal examination was applied for each admitted case. Rapid tests for parvovirus and canine distemper virus detection were also performed. Results: A five digestive problems were commonly recorded including vomiting, diarrhea, concurrent vomiting with diarrhea, anorexia, and constipation with a prevalence (%) of 13.6, 19.1, 10.1, 13.1, and 0.5 respectively while that of dermatological, respiratory, urinary, neurological, cardiovascular, auditory, and ocular problems was 27.9, 10.5, 3.3, 0.84, 0.4, 0.25, and 0.17 (%) respectively. This prevalence was obtained on the basis of the diseased cases. Age and breed had a significant effect on the distribution of digestive problems in dogs (p<0.001). Gender had an effect on the distribution of digestive problems with significant (p≤0.01) while season had a non-significant effect (p>0.05) on the distribution of such problems. Conclusion: Digestive problems were the highest recorded problems among dogs, and this was the first records for such problems among dogs in Egypt. Age, gender, and breeds had a significant effect on the distribution of the digestive problems in dogs while season had a non-significant effect on

  6. A study of snake bite among children presenting to a paediatric ward in the main Teaching Hospital of North Central Province of Sri Lanka

    PubMed Central

    2014-01-01

    Background Snake bite is a common problem in the North Central province of Sri Lanka. Common krait (Bungarus careuleus), Ceylon krait (Bungarus ceylonicus), Cobra (Naja naja), Russell’s viper (Daboia russelii), Saw-scaled viper (Echis carinatus) and Hump-nosed pit viper (Hypnale hypnale) are the six species of venomous land snakes in Sri Lanka. A significant number of adults and children are bitten by snakes every year. However, the majority of research studies done in Sri Lanka and other countries show adults bitten by snakes and studies describing children bitten by snakes are very sparse. Methods A descriptive cross sectional study was performed in the Teaching Hospital Anuradhapura in the North Central Province of Sri Lanka from May 2010 to 2011 May to describe the characteristics associated with cases of snake bite. Results There were 24 males and 20 females. The highest numbers of bites (48%) were in the range of ages 6-12 years. The majority of the bites occurred between 6 pm to 6 am (59%).The foot was the most common bitten site (48%). Out of all the venomous bites, the Hump-nosed pit viper (Hypnale hypnale) accounted for the highest number (44%) and Russell’s viper (Daboia ruselii) accounted for the second highest number (27%). A significant number of venomous bites occurred indoors while sleeping (22%). Antivenom serum was given to (39%) of venomous bites. Deaths occurred in (11%) of the venomous bites. Conclusions Hump-nosed pit viper (Hypnale hypnale) accounted for the highest number of venomous bites. Majority of the bites occurred between 6 pm and 6 am. Foot was the most common bitten site. A significant number of venomous bites occurred indoor while sleeping. Antivenom serum was given to a significant number of venomous bites. Educating the public on making their houses snake proof and using a torch when going out during night time will help in the prevention of getting bitten by snakes. PMID:25073710

  7. [Hospital medicine in Chile].

    PubMed

    Eymin, Gonzalo; Jaffer, Amir K

    2013-03-01

    After 15 years of development of Hospital Medicine in Chile, there are several benefits of this discipline. Among others, a reduction in the length of hospital stay, readmissions, costs, and improved medical teaching of students, residents and fellows have been observed. However, in South América there are only isolated groups dedicated to Hospital Medicine in Chile, Argentina and Brazil, with a rather slow growth. The unjustified fear of competition from sub specialists, and the fee for service system of payment in our environment may be important factors to understand this phenomenon. The aging of the population makes imperative to improve the safety of our patients and to optimize processes and resources within the hospital, to avoid squandering healthcare resources. The following is a detailed and evidence-based article, on how hospital medicine might benefit both the public and prívate healthcare systems in Chile. PMID:23900327

  8. Practicing Hospitality in the Classroom

    ERIC Educational Resources Information Center

    Burwell, Rebecca; Huyser, Mackenzi

    2013-01-01

    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…

  9. Assessment of hydrogeochemical characteristics of groundwater quality in the vicinity of Okpara coal and Obwetti fireclay mines, near Enugu town, Nigeria

    NASA Astrophysics Data System (ADS)

    Utom, Ahamefula U.; Odoh, Benard I.; Egboka, Boniface C. E.

    2013-03-01

    Hydrogeochemical assessments were carried out in the vicinity of Okpara coal and Obwetti fireclay mines, Enugu, Nigeria to investigate the hydrogeochemical characteristics and constituents of shallow groundwater. A total of 12 representative shallow groundwater samples were collected and analyzed for major cations and anions as well as trace metals like Fe and Mn. Distribution of major ions in these groundwater samples was calculated and the general trend among cations and anions was found to be Ca → Na → Mg → K and SO4 → NO3 → Cl → HCO3, respectively. This means that water moving through the ground will react to varying degrees with the surrounding minerals (and other components), and it is these rock-water interactions that give the water its characteristic chemistry. Piper trilinear diagrams classified the hydrogeochemical facies into Ca-Mg-Cl, Ca-Fe-Mg-SO4 and Ca-Mg-Na-K-Cl-SO4 water types. Ratios of Cl to Na, K and Mg generally increased compared to those of Cl to Ca and SO4 which decreased indicating ion adsorption/exchange processes due to the dissolution of drainage materials. The aquiferous units mainly in the northwestern region of the study area yield water of better quality than those toward the southeastern region.

  10. Urinary screening for asymptomatic renal disorders in pre-school children in Enugu metropolis, South-east Nigeria: Useful or useless.

    PubMed

    Odetunde, Odutola Israel; Odetunde, Oluwatoyin Arinola; Neboh, Emeka Ernest; Okafor, Henrietta Uche; Njeze, Ngozi Rosemary; Azubuike, Jonathan Chukwuemeka

    2015-11-01

    To evaluate the usefulness of simple screening tests such as urinalysis and blood pressure measurement in the early detection of renal disorders in pre-School children, we used a multi-staged random sampling method to select subjects from registered nursery schools within Enugu metropolis in south-east Nigeria. We selected 630 children for this cohort study. There was a prevalence of 2.7%, 0% and 1.9% for asymptomatic proteinuria, hematuria and hypertension, respectively. There was no age, gender or social class preponderance (P = 0.44). Hypertension seemed to be limited to children close to the age group of five years (P <0.001). No correlations could be documented between asymptomatic proteinuria, hematuria or hypertension. The prevalence of persistent proteinuria was found to be 1.6% and the mean urinary protein excretion estimation (spot urine protein/creatinine) was 1.88 g/mg ± 0.53, with a mean glomerular filtration rate of 78.7 ± 12.6 mL/min/1.73 m³ . Renal ultrasonography revealed abnormal findings in 30% of the children with persistent proteinuria. Asymptomatic persistent proteinuria with or without hematuria and hypertension could be a presumptive evidence of an underlying renal parenchymal disease and should be properly investigated and followed-up. PMID:26586065

  11. RFID solution benefits Cambridge hospital.

    PubMed

    James, Andrew

    2013-10-01

    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

  12. Changes in Admissions, Length of Stay, and Discharge Diagnoses at a Major University-Affiliated Teaching Hospital: Implications for Medical Education.

    ERIC Educational Resources Information Center

    Rosevear, G. Craig; Gary, Nancy E.

    1989-01-01

    A study of changes in hospital care suggests that for medical students and residents to be exposed to the same case mix of clinical disorders seen in the hospital in 1980, they must have experience in the ambulatory setting. (Author/MSE)

  13. Teaching Notes

    NASA Astrophysics Data System (ADS)

    2001-05-01

    If you would like to contribute a teaching note for any of these sections please contact ped@iop.org. Contents: LET'S INVESTIGATE: Standing waves on strings MY WAY: Physics slips, trips and falls PHYSICS ON A SHOESTRING The McOhm: using fast food to explain resistance Eggs and a sheet STARTING OUT: After a nervous start, I'm flying ON THE MAP: Christ's Hospital CURIOSITY: The Levitron TECHNICAL TRIMMINGS: Brownian motion smoke cell LET'S INVESTIGATE

  14. Implementation of a Shoulder Soft Tissue Injury Triage Service in a UK NHS Teaching Hospital Improves Time to Surgery for Acute Rotator Cuff Tears.

    PubMed Central

    Bateman, Marcus; Davies-Jones, Gareth; Tambe, Amol; Clark, David I

    2016-01-01

    Shoulder problems account for 2.4% of GP consultations in the United Kingdom and of those 70% are related to the rotator cuff. Many rotator cuff tears are of a degenerate nature but they can occur as a result of trauma in 8% of cases. Evidence suggests that patients with traumatic rotator cuff tears gain a better outcome in terms of pain and function if the tear is repaired early after injury. A specialist shoulder soft tissue injury clinic was set up in a large UK NHS teaching hospital with the primary purpose in the first year to halve the length of time patients with traumatic rotator cuff tears had to wait to consult a specialist and double the number of patients undergoing surgical repair within three months. The secondary purpose was to ensure that the new clinic was utilised to capacity by the end of the first year. The clinic was later expanded to manage patients with acute glenohumeral joint (GHJ) or acromioclavicular joint (ACJ) dislocations and identify those patients requiring surgical stabilisation. The new service involved referral of all patients presenting to the Accident & Emergency department with recent shoulder trauma and either an inability to raise the arm over shoulder height with a normal set of radiographs, or a confirmed GHJ or ACJ dislocation; to a specialist clinic run by an experienced upper limb physiotherapist. Patients were reassessed and referred for further imaging if required. Those patients found to have traumatic rotator cuff tears or structural instability lesions were listed for expedited surgery. The clinic ran alongside a consultant-led fracture clinic giving fast access to surgical decision-making. The service was reviewed after 3, 6, and 12 months and findings compared to a sample of 30 consecutive patients having undergone rotator cuff repair surgery via the previous pathway. 144 patients were referred to the clinic in the first year: 62 with rotator cuff symptoms, 38 with GHJ instability, 13 with ACJ instability, and 33

  15. Implementation of a Shoulder Soft Tissue Injury Triage Service in a UK NHS Teaching Hospital Improves Time to Surgery for Acute Rotator Cuff Tears.

    PubMed

    Bateman, Marcus; Davies-Jones, Gareth; Tambe, Amol; Clark, David I

    2016-01-01

    Shoulder problems account for 2.4% of GP consultations in the United Kingdom and of those 70% are related to the rotator cuff. Many rotator cuff tears are of a degenerate nature but they can occur as a result of trauma in 8% of cases. Evidence suggests that patients with traumatic rotator cuff tears gain a better outcome in terms of pain and function if the tear is repaired early after injury. A specialist shoulder soft tissue injury clinic was set up in a large UK NHS teaching hospital with the primary purpose in the first year to halve the length of time patients with traumatic rotator cuff tears had to wait to consult a specialist and double the number of patients undergoing surgical repair within three months. The secondary purpose was to ensure that the new clinic was utilised to capacity by the end of the first year. The clinic was later expanded to manage patients with acute glenohumeral joint (GHJ) or acromioclavicular joint (ACJ) dislocations and identify those patients requiring surgical stabilisation. The new service involved referral of all patients presenting to the Accident & Emergency department with recent shoulder trauma and either an inability to raise the arm over shoulder height with a normal set of radiographs, or a confirmed GHJ or ACJ dislocation; to a specialist clinic run by an experienced upper limb physiotherapist. Patients were reassessed and referred for further imaging if required. Those patients found to have traumatic rotator cuff tears or structural instability lesions were listed for expedited surgery. The clinic ran alongside a consultant-led fracture clinic giving fast access to surgical decision-making. The service was reviewed after 3, 6, and 12 months and findings compared to a sample of 30 consecutive patients having undergone rotator cuff repair surgery via the previous pathway. 144 patients were referred to the clinic in the first year: 62 with rotator cuff symptoms, 38 with GHJ instability, 13 with ACJ instability, and 33

  16. Prevalence and Correlates of Microalbuminuria in Children with Sickle Cell Anaemia: Experience in a Tertiary Health Facility in Enugu, Nigeria

    PubMed Central

    Eke, Christopher Bismarck; Okafor, Henrietta Uche; Ibe, Bede Chidozie

    2012-01-01

    Microalbuminuria is a pre-clinical marker of renal damage in children with sickle cell anaemia and can predict renal failure. Reported prevalence rates increased with age. In Nigeria, burden of disease and prevailing poor health facilities necessitate its screening, determination of prevalence and associated risk factors. It is a cross-sectional as well as descriptive study. Screening microalbuminuria used subjects' early morning urine. Socio-demographic as well as clinical details were ascertained using semi-structured questionnaires and case files. Associations and statistical relationship of prevalence rates and clinical/epidemiological data were ascertained using chi-squared and multivariate analysis (P < 0.05). Two hundred children with sickle cell anaemia (4–17 years) in steady state and 200 age/gender-matched controls were enrolled. Prevalence of microalbuminuria was ,respectively, 18.5% and 2.5% for subjects and controls (P = 0.001). Microalbuminuria was commoner in females (19.8%) than males (17.4%) P = 0.70, increased with age (P = 0.016), significantly associated with haemoglobin level (P = 0.002) and hospitalizations (0.001). Subjects had normal renal function. Hospitalizations and haemoglobin levels showed statistical significance on multivariate analysis. Prevalence of microalbuminuria is 18.5%. Age, haemoglobin concentrations, and higher hospitalizations influenced microalbuminuria among subjects. Screening for microalbuminuria should be incorporated in the case management of subjects with identified risk factors. PMID:23056942

  17. Norovirus - hospital

    MedlinePlus

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

  18. Bacteriological Quality of Foods and Water Sold by Vendors and in Restaurants in Nsukka, Enugu State, Nigeria: A Comparative Study of Three Microbiological Methods

    PubMed Central

    Ibe, Nnenne I.; Iroegbu, Christian U.

    2011-01-01

    Bacterial count in prepared food or water is a key factor in assessing the quality and safety of food. It also reveals the level of hygiene adopted by food handlers in the course of preparation of such foods. This comparative study evaluated the bacteriological quality of food and water consumed in Nsukka, Enugu state, Nigeria, using three bacteria enumeration methods. Data obtained are assumed to reflect the level of personal and environmental hygiene in the study population. Ten types of foods—beans, yam, abacha, okpa, moimoi, pear, cassava foofoo, rice, agidi, and garri—and 10 water samples were evaluated for bacteriological quality, precisely determining the level of coliform contamination, using the most probable number (MPN), lactose fermentation count (LFC), and Escherichia coli count (ECC) methods. Bacterial counts differed significantly (p<0.05) among the various food samples. However, this did not differ significantly in the three methods used for the enumeration of coliforms, suggesting that any of the three methods could be validly used for such studies with confidence. Escherichia coli and Klebsiella pneumoniae were the two major coliforms identified among 98 coliform isolates obtained from the various food samples, of which 78 (79.6%) were assumed to be of human origin on account of their ability to grow at 44 °C. The level of coliform contamination in the food samples from vendors and restaurants (geometric mean count 7.64-9.21; MPN ≥50) were above the accepted 104 colony-forming unit/g or MPN ≤10 limits. The results of the study, therefore, call for stringent supervision and implementation of food-safety practices and regular education on food and personal hygiene among food vendors. PMID:22283029

  19. Lucinda Huffaker and the Hospitality of the Wabash Center

    ERIC Educational Resources Information Center

    Placher, William C.

    2007-01-01

    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…

  20. [A computerized system for the management of letters of authorization for access to sensitive data in a research and teaching hospital].

    PubMed

    Bodina, Annalisa; Brizzolara, Antonella; Vadruccio, Gianluca; Castaldi, Silvana

    2012-01-01

    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

  1. 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

    PubMed Central

    van Balen, Joany; Kelley, Christina; Nava-Hoet, Rocio C.; Bateman, Shane; Hillier, Andrew; Dyce, Jonathan; Wittum, Thomas E.

    2013-01-01

    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

  2. Outbreak by Ventilator-Associated ST11 K. pneumoniae with Co-production of CTX-M-24 and KPC-2 in a SICU of a Tertiary Teaching Hospital in Central China

    PubMed Central

    Hu, Longhua; Liu, Yanling; Deng, Linqiang; Zhong, Qiaoshi; Hang, Yaping; Wang, Zengzeng; Zhan, Lingling; Wang, Liangxing; Yu, Fangyou

    2016-01-01

    The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) often responsible for numerous hospital-associated outbreaks has become an important public health problem. From January 2013 to February 2014, a total of 41 non-duplicate K. pneumoniae isolates with carbapenem resistance, were collected at a tertiary teaching hospital in Nanchang, central China. Among 41 K. pneumoniae isolates, 28 were isolated from hospitalized patients including 19 from the patients in surgery intensive care unit (SICU) and 13 were isolated from ventilators. Twenty-four of 28 patients infected by CRKP have been submitted to mechanical ventilation using ventilator. More than 95% of the CRKP isolates were resistant to 13 antimicrobials tested. All CRKP isolates were confirmed as carbapenemase producer and were positive for blaKPC-2, with one positive for both blaKPC-2 and blaNDM-1. All carbapenemase-producing isolates harbored at least one of extended spectrum β-lactamase genes tested, among which 95.1% (39/41) of the tested isolates were found to harbor both blaCTX-M-24 and blaKPC-2, Of note, one isolate harbored simultaneously two carbapenemase genes (blaKPC-2 and blaNDM-1) and two ESBL genes (blaCTX-M-3 and blaTEM-104). To the best of our knowledge, coexistence of blaKPC-2 and blaCTX-M-24 in one isolate is first reported. MLST results showed that 41 CRKP isolates belonged to four sequence types (STs) including ST11, novel ST1854, novel ST1855, and ST1224. PFGE results displayed three PFGE clusters. Thirty-eight ST11 CRKP isolates (92.7%, 38/41) including all 13 isolates from ventilators and 25 isolates from patients from seven wards (18 from SICU) belonged to same PFGE cluster, indicating these isolates were clonally related. Fifteen isolates have an identical undistinguished pattern (100% similarity) forming a single clonal population. Moreover, this clone was exclusively linked to the cases attended in SICU and linked to the Ventilators. Additionally, the other SICU cases

  3. Computers in Hospital Clinical Nursing: Implications for Nursing Education.

    ERIC Educational Resources Information Center

    St. Thomas, Sister

    The use of computers in hospital clinical nursing and implications for the education of nurses were studied with a sample of 130 hospitals. Of concern was how computers were used, which hospital personnel used computers in health care, costs to educate staff nurses, and who teaches nurses about computers. Questionnaires completed by hospital data…

  4. An outbreak of infections caused by extensively drug-resistant Klebsiella pneumoniae strains during a short period of time in a Chinese teaching hospital: epidemiology study and molecular characteristics.

    PubMed

    Zhou, Tieli; Zhang, Yapei; Li, Meimei; Yu, Xiao; Sun, Yao; Xu, Jiru

    2015-07-01

    In this study, we comprehensively described the clinical risk factors, outcome, epidemiology, and molecular basis associated with an outbreak of extensively drug-resistant KPC-2-producing Klebsiella pneumoniae involving 15 patients in a teaching hospital from May 1 to June 27, 2013. Most of the patients were elderly and received long-term hospital treatment, and 40.0% (6/15) of them were dead. All strains carried bla(KPC-2), rmtB, bla(CTX-M-65), bla(SHV-11), oqxA, oqxB, and aac(6')-Ib-cr and even harbored additional other resistance genes, such as armA, bla(CTX-M-1), bla(TEM-1). bla(KPC-2), rmtB, and bla(CTX-M-65) were located on the same ~54.2-kb plasmid, and conjugation experiments further proved the cotransferable characteristic. Alterations of outer membrane proteins were confirmed by sodium dodecyl sulfate--olyacrylamide gelelectrophoresis and sequencing, which can lead to a drastic change in the permeability of cells. All isolates belonged to the clone complex 258, spreading rapidly across the world. Our study demonstrated that a high degree of awareness and surveillance of those drug resistance determinants is urgently needed. PMID:25865067

  5. Transport accidents among children and adolescents at the emergency service of a teaching hospital in the southern zone of the city of São Paulo☆☆☆

    PubMed Central

    Gorios, Carlos; de Souza, Renata Maia; Gerolla, Viviane; Maso, Bruno; Rodrigues, Cintia Leci; Armond, Jane de Eston

    2014-01-01

    Objective to describe the victim profile and circumstances of transport accidents involving children and adolescents who were attended at a teaching hospital in the southern zone of the city of São Paulo. Methods this was an individual observational case series study among patients up to the age of 19 years who were attended at a hospital in the southern zone of the city of São Paulo, state of São Paulo, Brazil, due to traffic accidents. The files notifying suspected or confirmed cases of violence and accidents (SIVVA files) covering January to December 2012 were analyzed. Results among the 149 cases notified, 64.4% related to males and 35.6% to females. The transport accidents were predominantly among males, irrespective of age. The main injury diagnoses were superficial head trauma (24.8%) followed by multiple non-specified trauma (36.4%), in both sexes. Conclusion transport accidents among children and adolescents occurred more often among males. The main transport accidents among the children and adolescents attended as emergency cases were caused by motor vehicles and motorcycles. Among the accident victims, the largest proportion was attended because of being run over. PMID:26229833

  6. Emergence and dissemination of a highly vancomycin-resistant vanA strain of Enterococcus faecium at a large teaching hospital.

    PubMed Central

    Pegues, D A; Pegues, C F; Hibberd, P L; Ford, D S; Hooper, D C

    1997-01-01

    We prospectively identified patients at the Massachusetts General Hospital from whom vancomycin-resistant enterococci (VRE) were isolated from a clinical specimen from 1 January 1991 through 31 December 1995. VRE strains were available from 139 (82%) of the 169 patients with clinical cases. Of these, 39 (28%) were identical or closely related by pulsed-field gel electrophoresis (i.e., VRE type A strain), including 38 (43%) of 89 VRE strains in 1995. By multivariate analysis, acquisition of the VRE type A strain was associated with receipt of clindamycin (odds ratio [OR] = 10.5), 15 or more days of hospitalization before the first isolation of VRE (OR = 2.9), and residence on one of the general medical floors (OR = 7.8). The VRE type A strain was a vanA strain of Enterococcus faecium and was highly resistant to all antimicrobial agents tested except chloramphenicol. These findings document the rapid dissemination of a highly resistant strain of E. faecium among patients and among other extant VRE strains at the Massachusetts General Hospital in 1995. PMID:9163483

  7. From cottage to community hospitals: Watlington Cottage Hospital and its regional context, 1874-2000.

    PubMed

    Hall, John

    2012-01-01

    The appearance in England from the 1850s of 'cottage hospitals' in considerable numbers constituted a new and distinctive form of hospital provision. The historiography of hospital care has emphasised the role of the large teaching hospitals, to the neglect of the smaller and general practitioner hospitals. This article inverts that attention, by examining their history and shift in function to 'community hospitals'within their regional setting in the period up to 2000. As the planning of hospitals on a regional basis began from the 1920s, the impact of NHS organisational and planning mechanisms on smaller hospitals is explored through case studies at two levels. The strategy for community hospitals of the Oxford NHS Region--one of the first Regions to formulate such a strategy--and the impact of that strategy on one hospital, Watlington Cottage Hospital, is critically examined through its existence from 1874 to 2000. PMID:23057181