Arodiwe, Ijeoma; Chinawa, Josephat; Ujunwa, Fortune; Adiele, Dabere; Ukoha, Mildred; Obidike, Egbuna
Background and Objectives: Children with congenital heart disease (CHD) are prone to malnutrition. This can have a significant effect on the outcome of surgery. Our objective was to determine the burden and determinant of malnutrition in children with several types of congenital heart disease (CHD). Methods: This is a descriptive cross sectional study of children attending the outpatient clinic of UNTH, Ituku – Ozalla, Enugu State, over a six year period from March 2007 to April 2014. Data analysis was done with Statistical Package for Social Sciences (SPSS) version 19 (Chicago IL). Results: Forty thousand one hundred and twenty three (40,123) children attended the outpatient clinic during the study period. Of these, 50 had congenital heart disease, from which 46 were found to have various degree of malnutrition, giving a prevalence of 92% among children with congenital disease and 0.11% in the general population. Malnutrition showed significant correlation between age in years, age appropriate dietary adequacy and pulmonary hypertension. (r= 0.22, p = 0.01; r = 0.20, p = 0.02; r = 0.15, p = 0.01). Conclusion: Children with CHD develop severe malnutrition and growth failure. The significant contributing factors are mean age at presentation and age appropriate dietary adequacy.
Mezue, Wilfred C; Ohaegbulam, Samuel C; Ndubuisi, Chika C; Chikani, Mark C; Achebe, David S
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
Isiguzo, Chimaobi; Ogbonnaya, Sunday Iheuko; Udezue, Anthonia O
Context: Large breast is a major problem because of associated symptomatology and aesthetic concerns. Reduction mammoplasty (RM) resolves the symptom and at the same time improves the aesthetic appearance of the breast, hence improving self-esteem and social integration. Aims: To describe the pattern of RM in a hospital in the developing world and its impact on postgraduate surgical training. Settings and Design: A retrospective review of all the RMs done in the National Orthopaedic Hospital, Enugu (a major plastic surgery training center in Nigeria) over a ten-year period (2001–2010), in the developing country of Nigeria. Subjects and Methods: All RMs done in the hospital were reviewed after retrieving their records from operation register and medical records department. Fifteen (15) cases were retrieved and analyzed. Data Analysis: Data was analyzed with Microsoft excel 2007. Results: Average age of female patients who had RM was 26.5 years and 83.3% were single. The most common complaint was abnormally large breast (macromastia). Inferior pedicle technique was commonly used. Conclusions: The results of RM are remarkable as it impact positively on the quality of life of the patients. However, the level of awareness about the availability of this service is still low in the region as shown by few cases done over the period of review and this impacts negatively on the training. The need for public awareness cannot be overemphasized. PMID:25838761
Green, Alan C.
Planning and design criteria are established for educational facilities in VA hospitals, rendering them more effective for medical education. Rather than developing plans for prototype teaching hospitals, guidelines are presented which may be utilized to meet the needs of a particular situation. Three broad categories of facilities are…
Despite the prestige and reputation of teaching hospitals, as a group they are in financial distress. If this trend continues, one would expect to see a higher incidence of mergers and acquisitions or divestitures of assets and services, and other strategies designed to combat failing businesses. Nearly one out of every six teaching hospitals sampled was predicted to be near immediate bankruptcy, and the overwhelming majority was not far behind. It will take a significant effort for these hospitals to continue to treat their operations as a clinical and research "business," but they must do just that if they are to survive the continually turbulent market. PMID:19175242
Reves, J G; Smith, Stuart; Greenberg, Ray; Johnson, Donald
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
Achigbu, Kingsley I.; Odetunde, Odutola I.; Chinawa, Josephat M.; Achigbu, Eberechukwu O.; Ikefuna, Anthony N.; Emodi, Ifeoma J.; Ibe, Bede C.
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
Njoku-Obi, A N; Ojiegbe, G C
A study of the level and significance of air contamination in the four operating theatres and four surgical wards of the University of Nigeria Teaching Hospital, Enugu, Nigeria was carried out. A total of 48 air samples were taken from each of the operating theatres while a total of 36 air samples were taken from each surgical ward, using a "Casella slit Sampler". The means of the bacterial carrying particles per cubic foot of air varied, from theatre to theatre, from 12.29 to 14.29 (in the mornings) and 9.79 to 11.4 (in the evening). Statistically, these differences were insignificant (t-value < 1.96). Recognised pathogens were not recovered from both the air and the fomites in the operating theatres. However, free-living fungi were isolated. The air of the surgical wards showed levels of contamination from 20.39 to 35.28 (in the mornings) and 20.33 to 39.55 (in the evenings) bacterial carrying particles per cu.ft. of air. The differences between the counts in the mornings and evenings were also not statistically significant. Some pathogens were isolated from the air in the wards. The findings indicated that the level of air contamination of the surgical wards influenced the rates of post-operative wound sepsis. PMID:7839891
Silber, Jeffrey H.; Rosenbaum, Paul R.; Romano, Patrick S.; Rosen, Amy K.; Wang, Yanli; Teng, Yun; Halenar, Michael J.; Even-Shoshan, Orit; Volpp, Kevin G.
Objectives To determine if the lower mortality often observed in teaching-intensive hospitals is due to lower complication rates or lower death rates after complications (failure-to-rescue), and whether the benefits at these hospitals accrue equally to white and black patients, since blacks receive a disproportionate share of their care at teaching-intensive hospitals. Design A retrospective study of patient outcomes and teaching intensity using logistic regression models, with and without adjusting for hospital fixed and random effects. Main Outcome Measures 30-day mortality, in-hospital complications and failure-to-rescue (“FTR”, the probability of death following complications). Setting 3,270 acute care hospitals in the United States. Patients Medicare claims on general, orthopedic and vascular surgery admissions in the U.S. for 2000 – 2005 (N = 4,658,954 unique patients). Results Combining all surgeries, compared to non-teaching hospitals, patients at very major teaching hospitals demonstrated a 15% lower odds of death (P<0.0001), no difference in complications, and a 15% lower odds of death after complications (FTR) (P<0.0001). These relative benefits associated with higher RB ratio were not experienced by black patients, for whom the odds of mortality and FTR are similar at teaching and non-teaching hospitals, a pattern that is significantly different from that of white patients (P<0.0001). Conclusions Survival after surgery is higher at hospitals with higher teaching intensity. Improved survival is due to lower mortality after complications (better FTR), and generally not due to fewer complications. However, this better survival and FTR at teaching intensive hospitals is seen for whites, not for blacks. PMID:19221321
Lambiase, Louis R; Harrison, Jeffrey P
This quantitative research study assesses the efficiency of university teaching hospitals in providing hospital services and graduate medical education, identifying areas in which inefficient teaching hospitals differed from their efficient counterparts. The study analyzed American Hospital Association (AHA) data from 2002 in order to examine the efficiency of Council of Teaching Hospital (COTH) hospitals. An efficiency frontier was determined using Data Envelopment Analysis, an effective method of measuring efficiency widely accepted within the health care management literature. The study found that the performance of teaching hospitals increased approximately 6.6 percent when graduate medical education (GME) was included as a key measure of output. Additionally, average excess operating expenses per hospital went from $29,447,581 without residents to $8,321,407 with residents. The average excess full-time employees decreased by 24 percent from 187 without residents to 143 with residents. Conversely, the shortage of outpatient visits increased from an average of 29,461 per hospital without residents to 36,155 with residents. This study clearly documents the need to include GME when benchmarking teaching hospitals. It also shows inefficient COTH hospitals could save approximately $1.6 billion in excess overhead expenses if they emulate the practices of the most efficient members. PMID:18972982
Ulasi, Ifeoma I.; Ijoma, Chinwuba K.
Background. The magnitude of the problem of chronic kidney disease (CKD) is enormous, and the prevalence keeps rising. To highlight the burden of CKD in developing countries, the authors looked at end-stage renal disease (ESRD) patients seen at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Method. ESRD patients seen from 01/05/1990 to 31/12/2003 were recruited. Records from A&E Department, medical-out-patients, wards and dialysis unit were used. Results. A total of 1001 male versus 537 female patients were reviewed. About 593 male versus 315 female patients had haemodialysis. The mean age was 42.55 ± 15.43 years and 86.5% were <60 years. Primary renal disease could not be determined in 51.6% while hypertension and glomerulonephritis accounted for ?17.2% and 14.6%, respectively. Death from renal causes constituted 22.03% of medical deaths. Conclusion. The prognosis for CKD patients in Nigeria is abysmal. Only few patients had renal-replacement-therapy (RRT). The prohibitive cost precludes many patients. This underscores the need for preventive measures to reduce the impact of CKD in the society. PMID:20613945
Okezie, A O; Oyefara, B; Chigbu, C O
Between January 2001 and December 2004, a total of 2,922 deliveries were conducted at the University of Nigeria Teaching Hospital , Enugu. Caesarean section accounted for 740 deliveries, an incidence of 25.3%. A total of 62.2% of caesarean sections were done as emergencies, while 37.8% were done as elective procedures and 64.8% were booked patients. Repeat caesarean sections accounted for 59.2% of elective cases and 18.7% of emergency cases. Fetal distress was responsible for 11. 6% of emergency cases, however 35.6% of babies delivered for clinically diagnosed fetal distress had Apgar scores 7 and above. A total of 85.6% of patients were between 25 - 29 years of age; 31% were primigravida, while 54.4% were Gravida 2 - 4. There were seven (0.6%) maternal deaths and 73 (9.2%) stillbirths. It was concluded that reduction of primary caesarean section rate and repeat caesarean rates should be the main target of any strategy to reduce caesarean section rate. Other measures to reduce the caesarean section rate and recommendations are discussed. PMID:17701792
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
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…
Varallo, Fabiana Rossi; Capucho, Helaine Carneiro; da Silva Planeta, Cleópatra; de Carvalho Mastroianni, Patrícia
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
Mauro, Marianna; Cardamone, Emma; Cavallaro, Giusy; Minvielle, Etienne; Rania, Francesco; Sicotte, Claude; Trotta, Annarita
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
REZAEE, RITA; MARHAMATI, SAADAT; NABEIEI, PARISA; MARHAMATI, RAHELEH
Introduction: Organization structure and manpower constitute two basic components of anorganization and both are necessary for stablishing an organization. The aim of this survey was to investigate the type of the organization structure (mechanic and organic) from viewpoint of senior and junior managers in Shiraz teaching hospitals and creativity in each of these two structures. Methods: In this cross-sectional and descriptive-analytic study, organization structure and organizational creation questionnaires were filled out by hospital managers. According to the statistical consultation and due to limited target population, the entire study population was considered as sample. Thus, the sample size in this study was 84 (12 hospitals and every hospital, n = 7). For data analysis, SPSS 14 was used and Spearman correlation coefficient and t-test were used. Results: Results showed that there is a negative association between centralization and complexity with organizational creation and its dimensions. Also there was a negative association between formalization and 4 organizational creation dimensions: reception change, accepting ambiguity, abet new view and less control outside (p=0.001). Conclusion: The results of this study showed that the creation in hospitals with organic structure is more than that in hospitals with mechanic structure. PMID:25512934
... 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...
... services furnished in a teaching hospital. (g) Aggregate per diem methods of apportionment—(1) For the... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE... BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN...
Liu, Li-Lin; Forgione, Dana A; Younis, Mustafa Z
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
Ogbu, I Si; Okoro, O Io; Ugwuja, E I
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
Rabkin, Mitchell T.
The social and economic changes of Medicare and Medicaid broadened the patient base for teaching, universalized student involvement in the teaching hospital, and improved the care of both the poor and the well-to-do. (MLW)
McCorkel, J; Cook, V
To respond to the increasing demand for information from medical educators and clinicians and to persuade administrators to purchase the newly available microcomputer library systems, medical librarians in community teaching hospitals may find it useful to engage in intermediate term (for example, five-year) program planning. To increase the probability that the plan which emerges will be implemented, the planning process should fit the organizational nexus. Planning involves needs assessment, prioritized program elements, a written plan, and facilities planning (if applicable), which lead to program implementation. Components of a model program plan are presented. PMID:4027443
Oyewumi, L K
The sociodemographic and clinical characteristics of 84 adolescents admitted to the psychiatric unit of a teaching hospital in Nigeria were studied. Their ages ranged from 12-20 years (mean 17). The pattern of psychiatric disorders in this population reflected the pattern in the adult population. Major psychoses comprising schizophrenia (44%), organic brain syndrome (23%), and affective disorders (16%) predominated. Infections and drug abuse are preventable causes of organic brain syndrome. Male adolescents were as likely to be hospitalized for a major psychiatric disorder as female adolescents. The peak period for psychopathology is late adolescence. The contributions of such factors as rural-urban migration, birth order, family size, polygamy and genetics to the etiology of major mental disorders in this population require further investigations. Understanding the prevalence and pattern of presentation of mental disorders in all age groups is essential for effective mental health planning. PMID:2618786
...This notice announces the closure of two teaching hospitals and the initiation of an application process where hospitals must apply to the Centers for Medicare & Medicaid Services (CMS) for consideration of Infirmary West Hospital's and Montgomery Hospital's full time equivalent (FTE) resident cap...
Van Steirteghem, S; Umuhoza, C; Casimir, G
We present the case of a 12-year-old girl referred to Kigali University Teaching Hospital (KUTH) for persistent cough, fever and haemoptysis. Respiratory symptoms started acutely with a stridor at age 4. Thereafter she developed a chronic cough with intermittent fever. She was treated ambulatory in the health care centre with oral antibiotics and finally referred to the district hospital at age 7. The chest X-ray then suggested tuberculosis for which a 6 month treatment was given with no improvement. The cough persisted and haemoptysis appeared so the patient was referred to the reference hospital (KUTH). Chest X-ray showed diffuse lesions of the left lung with bronchiectasis. Bronchoscopy revealed the presence of a foreign body in the left intermediary bronchus and a piece of plastic was extracted. Symptoms rapidly disappeared with antibiotic treatment. This case illustrates how important it is to include foreign body inhalation in the differential diagnosis of respiratory disease in children. Bronchoscopy plays a key role in diagnosis and treatment. The authors point out the advantages of the joint efforts of the Belgian Development Aid Agency (BTC) and the Université libre de Bruxelles (ULB) in the development of this activity in the Rwandese context. PMID:24303659
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…
M Chinawa, Josephat; T Chinawa, Awoere
Objective: Primary health care (PHC) is a vital in any community. Any health centre with a well implemented PHC program can stand the test of time in curbing under five mortality and morbidity. This study was therefore aimed at assessing the activities in a health centre located in a rural area in Enugu state and to determine the pattern and presentation of various diseases in the health centre. Methods: This is retrospective study undertaken in a primary health care centre in Abakpa Nike in Enugu east LGA of Enugu State of Nigeria from December 2011 to December 31st 2013. Data retrieved were collected with the aid of a structured study proforma and analyzed using SPSS Version 18. Results: Total number of children that attended immunization program in the health centre over 20 months period was 25,438 (12,348 males and 13090 females), however only 17745 children (7998 males and 9747 females) were actually registered in the hospital records. None of the children was immunized for DPT2 and OPV0 and HBV1 in the course of this study. The dropout rate using DPT1, 2 and 3 (DPT1-DPT2/DPT3) was very high (494%). The mean immunization coverage rate was 8.3%. Family planning activities, integrated management of childhood illnesses program were also carried out in the health centre but at very low level. Conclusions: The major fulcrum of events in the health centre which include immunization coverage, IMCI, and management of common illnesses were simply non operational. However the health centre had a well knitted referral system. PMID:25878615
Davis, Christopher K; Smith, Harry
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
... 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....
... 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....
... 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....
Yarmohammadian, Mohammad H; Ebrahimipour, Hossein; Doosty, Farzaneh
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
Yarmohammadian, Mohammad H.; Ebrahimipour, Hossein; Doosty, Farzaneh
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
Kyalo Mutisya, Albanus; KagureKarani, Anna; Kigondu, Christine
Introduction: In the era of evidence based practice (EBP), health care delivery should be grounded on new or validated knowledge and evidence from research. The aim of the study was to assess research utilization by nurses and the influencing factors at Kenyatta National Hospital (KNH), the largest teaching hospital in Kenya. Methods: The study employed a descriptive design that utilized both quantitative and qualitative methods of data collection. It incorporated the Barriers to Research Utilization Scale. It was conducted in six specialized care areas at KNH. Data was collected using questionnaires, Focus Group Discussion and in-depth interviews. Data was analyzed using SPSS version 13 and qualitative data analyzed using themes. Results: The study found that 20.6% of the nurses were participating in research related to their work and 53.6% of these were implementing research findings to practice. Over 2/3 (70.5%) of the respondents were basing their evidence for practice on the knowledge gained during their nursing school. The three greatest barriers to research utilization were that research reports are not readily available (68.7%), unclear implications for practice (66.5%) and inadequate facilities for implementation (66.4%). Conclusion: It is recommended that sensitization trainings on nursing research/ utilization of findings in nursing practice be established to create awareness, motivate and enhance nurses' abilities and also facilities should be provided to enable implementation. PMID:26161364
Raehl, Cynthia; Bond, C. A.
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…
Harrison, Jeffrey P; Lambiase, Louis R; Zhao, Mei
This study is unique because it uses multiple regression and data envelopment analysis (DEA) to evaluate teaching hospital quality. The results support the premise that teaching hospital leadership through the effective allocation of resources can improve the quality of care. This study has managerial implications by demonstrating the positive correlation between HMO market penetration and improved clinical quality outcomes. This would suggest that improved efficiency caused by limited HMO reimbursement and tight utilization controls encourage hospitals to cut waste as well as improve their clinical care processes. Additionally, our research found that teaching hospitals with higher levels of long-term debt also had improved quality. This shows that increased investments in facilities and advanced technology at teaching hospitals can lead to enhanced quality. PMID:22329326
Aziz, Nousheen; Yousfani, Sajida
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
... (2) Payment for certain medical school costs may be made as provided...staff of the teaching hospital or medical school as provided for in paragraph...for the services furnished by a medical school or related organization in a...
... (2) Payment for certain medical school costs may be made as provided...staff of the teaching hospital or medical school as provided for in paragraph...for the services furnished by a medical school or related organization in a...
... (2) Payment for certain medical school costs may be made as provided...staff of the teaching hospital or medical school as provided for in paragraph...for the services furnished by a medical school or related organization in a...
...This document corrects a typographical error that appeared in the notice published in the Federal Register on May 31, 2013 entitled ``Notification of Closure of Teaching Hospitals and Opportunity to Apply for Available...
Background Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors. Methods Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects. Results Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care. Conclusion Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions. PMID:22409837
Nuss, Michelle A; Robinson, Ben; Buckley, Peter F
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
Jamaazghandi, Alireza; Emadzadeh, Ali; Vakili, Vida; Bazaz, Seyed Mojtaba Mousavi
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
Okafor, II; Arinze-Onyia, SU; Ohayi, SAR; Onyekpa, JI; Ugwu, EO
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 complications develop. PMID:26229721
Galanter, William L; Applebaum, Andrew; Boddipalli, Viveka; Kho, Abel; Lin, Michael; Meltzer, David; Roberts, Anna; Trick, Bill; Walton, Surrey M; Lambert, Bruce L
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
Mirhosseini, Seyyed-Abdolhamid; Fattahi, Hossein
This article explores the practice of false patient out-referral by medical students in Iranian teaching hospital emergency departments. Drawing on participant-observations and interviews during eight months in six hospitals in Tehran, we investigate how discourse is appropriated to construct and legitimate out-referrals through four general strategies of sympathy, mystification, intimidation, and procrastination. Based on a critical approach to false out-referral discourse, we revisit the medical and educational functioning of teaching hospitals in Iran: Focusing on medical students involved in false out-referrals, their discursive reproduction of deception is examined along with their legitimate challenges to institutional structures. Moreover, focusing on the institution of hospital, institutional corruption is discussed along with the problematic of covert cultural defiance faced by a modernist organizational construct in a nonmainstream cultural context. Finally, we argue that the discourse of false out-referral calls for more profound public awareness in dealing with health institutions. PMID:20949838
Hospital records of children admitted to the department of Paediatrics, University Hospital, Kuala Lumpur, from January 1981 to December 1990, who were diagnosed to have acute rheumatic fever (ARF) were studied. 134 children satisfied the Jones' modified criteria, thus giving a hospital incidence of 21.2/100,000 paediatric admission per year, of which incidence of first attack was 15.8/100,000 per year and recurrent attack was 5.38/100,000 per year. The M:F ratio is 1.39:1. Majority of cases occur in the 6-11 years age group with 6 cases encountered below the age of 5. The Indians had a higher relative risk to develop both the first acute attack as well as recurrences with a relative risk of 2.4 and 4.10 respectively as compared to the Malays. Majority of the patients, irrespective of the ethnic group, came from families with low income. PMID:7565180
Okoye, Augustine Ejike; Ibegbulam, Obike Godswill; Onoh, Robinson Chukwudi; Ugwu, Ngozi Immaculata; Anigbo, Chukwudi Simon; Nonyelu, Charles Emeka
Background Human T-cell lymphotrophic/leukemia virus (HTLV-1) is a retrovirus implicated in transfusion-transmitted infection. Objective The objective of this study was to determine the seroprevalence of HTLV-1 antibodies among blood donors at the University of Nigeria Teaching Hospital, Enugu, Eastern Nigeria. Methods A cross-sectional study was carried out on consented participants over 4 months. A total of 300 blood donors were recruited consecutively from the blood bank. The serum of the collected 5 mL of blood obtained from each participant was stored at ?20°C until required for analysis. The serum samples were then analyzed for antibodies to HTLV-1 using a one-step incubation double-antigen sandwich ELISA (enzyme-linked immunosorbent assay) kit. Participants’ demographic characteristics and degree of exposure to the risk factors associated with HTLV-1 infection were captured using a questionnaire. Statistical analysis of results was done using SPSS version 17. Results Of the 300 blood donors, 288 (96%) were male, while 12 (4%) were female. The average age of the blood donors was 26.85±8.52 years. The age group with the highest representation among the blood donors were those aged between 21 and 25 years. Only 22.3% of the blood donors were above 30 years. None of the 300 screened blood donors tested positive to HTLV-1 antibodies. Hence, the seroprevalence of HTLV-1 infection among blood donors was 0%. Of the blood donors, 5% had history of previous sexually transmitted disease, while 34.7% used condoms during sexual intercourse. Conclusion The seroprevalence obtained in this study cannot statistically support the justification of routine screening of blood donors for HTLV-1 infection. More prospective and multicentered studies are required to determine the infectivity of HTLV-1 in blood donors in Nigeria. PMID:25632240
...is not available for assistants at surgery in hospitals...program relating to the medical specialty required for...available to serve as an assistant at surgery. (b...for the services of an assistant at surgery in a teaching...result of exceptional medical circumstances....
...is not available for assistants at surgery in hospitals...program relating to the medical specialty required for...available to serve as an assistant at surgery. (b...for the services of an assistant at surgery in a teaching...result of exceptional medical circumstances....
... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions of payment: Assistants at surgery in teaching hospitals. 415.190 Section 415.190 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN...
Van Peenen, Hubert J.
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)
Lane, India F; Cornell, Karen K
Effective clinical teaching rounds are facilitated by adequate and specific orientation, a positive climate, interpersonal rapport, and dynamic discussions. Using fewer and better-quality questions also promotes effective learning and saves valuable time, while providing multiple opportunities for student engagement and for assessing student performance. This paper provides a brief review of these key points and offers tips and examples for clinicians or other team members leading conference room rounds sessions in veterinary settings. PMID:23697541
Navathe, Amol S; Silber, Jeffrey H; Small, Dylan S; Rosen, Amy K; Romano, Patrick S; Even-Shoshan, Orit; Wang, Yanli; Zhu, Jingsan; Halenar, Michael J; Volpp, Kevin G
Objective To examine whether hospital financial health was associated with differential changes in outcomes after implementation of 2003 ACGME duty hour regulations. Data Sources/Study Setting Observational study of 3,614,174 Medicare patients admitted to 869 teaching hospitals from July 1, 2000 to June 30, 2005. Study Design Interrupted time series analysis using logistic regression to adjust for patient comorbidities, secular trends, and hospital site. Outcomes included 30-day mortality, AHRQ Patient Safety Indicators (PSIs), failure-to-rescue (FTR) rates, and prolonged length of stay (PLOS). Principal Findings All eight analyses measuring the impact of duty hour reform on mortality by hospital financial health quartile, in postreform year 1 (“Post 1”) or year 2 (“Post 2”) versus the prereform period, were insignificant: Post 1 OR range 1.00–1.02 and Post 2 OR range 0.99–1.02. For PSIs, all six tests showed clinically insignificant effect sizes. The FTR rate analysis demonstrated nonsignificance in both postreform years (OR 1.00 for both). The PLOS outcomes varied significantly only for the combined surgical sample in Post 2, but this effect was very small, OR 1.03 (95% CI 1.02, 1.04). Conclusions The impact of 2003 ACGME duty hour reform on patient outcomes did not differ by hospital financial health. This finding is somewhat reassuring, given additional financial pressure on teaching hospitals from 2011 duty hour regulations. PMID:22862427
Goudarzi, Reza; Pourreza, Abolghasem; Shokoohi, Mostafa; Askari, Roohollah; Mahdavi, Mahdi; Moghri, Javad
Background: Hospitals are highly resource-dependent settings, which spend a large proportion of healthcare financial resources. The analysis of hospital efficiency can provide insight into how scarce resources are used to create health values. This study examines the Technical Efficiency (TE) of 12 teaching hospitals affiliated with Tehran University of Medical Sciences (TUMS) between 1999 and 2011. Methods: The Stochastic Frontier Analysis (SFA) method was applied to estimate the efficiency of TUMS hospitals. A best function, referred to as output and input parameters, was calculated for the hospitals. Number of medical doctors, nurses, and other personnel, active beds, and outpatient admissions were considered as the input variables and number of inpatient admissions as an output variable. Results: The mean level of TE was 59% (ranging from 22 to 81%). During the study period the efficiency increased from 61 to 71%. Outpatient admission, other personnel and medical doctors significantly and positively affected the production (P< 0.05). Concerning the Constant Return to Scale (CRS), an optimal production scale was found, implying that the productions of the hospitals were approximately constant. Conclusion: Findings of this study show a remarkable waste of resources in the TUMS hospital during the decade considered. This warrants policy-makers and top management in TUMS to consider steps to improve the financial management of the university hospitals. PMID:25114947
This study aimed to explore the effect of standardized teaching ward rounds in clinical nursing on preventing hospital-acquired infection. The experimental group comprised 120 nursing students from our hospital selected between June 2010 and June 2012. The control group consisted of 120 nursing students selected from May 2008 to May 2010. Traditional teaching ward rounds for nursing education were carried out with the control group, while a standardized teaching ward round was carried out with the experimental group. The comprehensive application of nursing abilities and skills, the mastering of situational infection knowledge, and patient satisfaction were compared between the two groups. The applied knowledge of nursing procedures and the pass rate on comprehensive skill tests were significantly higher in the experimental group than in the control group (P < 0.05). The rate of mastery of sterilization and hygiene procedures was also higher in the experimental group than in the control group (P < 0.05). The patient satisfaction rate with infection control procedures in the experimental group time period was 98.09%, which was significantly higher than patient satisfaction in the control group time period (93.05%, P < 0.05). Standardized teaching ward rounds for nursing education expanded the knowledge of the nursing staff in controlling hospital-acquired infection and enhanced the ability of comprehensive application and awareness of infection control procedures. PMID:25966144
Trotta, Annarita; Cardamone, Emma; Cavallaro, Giusy; Mauro, Marianna
Teaching hospitals (THs) simultaneously serve three different roles: offering medical treatment, teaching future doctors and promoting research. The international literature recognises such organisations as 'peaks of excellence' and highlights their economic function in the health system. In addition, the literature describes the urgent need to manage the complex dynamics and inefficiency issues that threaten the survival of teaching hospitals worldwide. In this context, traditional performance measurement systems that focus only on accounting and financial measures appear to be inadequate. Given that THs are highly specific and complex, a multidimensional system of performance measurement, such as the Balanced Scorecard (BSC), may be more appropriate because of the multitude of stakeholders, each of whom seek a specific type of accountability. The aim of the paper was twofold: (i) to review the literature on the BSC and its applications in teaching hospitals and (ii) to propose a scorecard framework that is suitable for assessing the performance of THs and serving as a guide for scholars and practitioners. In addition, this research will contribute to the ongoing debate on performance evaluation systems by suggesting a revised BSC framework and proposing specific performance indicators for THs. PMID:23081849
Ojo, Adebowale I; Popoola, Sunday O
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
Wray, J L; Sadowski, S M
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
Mubuuke, Aloysius Gonzaga; Businge, Francis; Mukule, Emmanuel
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
Murphy, I; Lavelle, L; Ni Mhurchu, E; McCarthy, R; Heffernan, E
There has been an increase in gun-related crime in Ireland over the last decade to gangland violence, especially in west Dublin. This places a burden on hospital services not previously encountered. The aim of this study was to examine the demographics of gunshot: injuries presenting to a Dublin teaching hospital, and the impact on radiology over a ten year period. A total of 65 gunshot injuries were seen. Mortality for high velocity wounds was much higher (10/23, 43%) than for low-velocity shotgun injuries (2/34, 6%). PMID:25282967
Thakur, Heenopama; Thawani, Vijay; Raina, Rangeel Singh; Kothiyal, Gitanjali; Chakarabarty, Mrinmoy
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
Sedlár, Drahomír; Potomková, Jarmila; Rehorová, Jarmila; Seckár, Pavel; Sukopová, Vera
Information explosion and globalization make great demands on keeping pace with the new trends in the healthcare sector. The contemporary level of computer and information literacy among most health care professionals in the Teaching Hospital Olomouc (Czech Republic) is not satisfactory for efficient exploitation of modern information technology in diagnostics, therapy and nursing. The present contribution describes the application of two basic problem solving techniques (brainstorming, SWOT analysis) to develop a project aimed at information literacy enhancement. PMID:15034614
Akinde, Olakanmi Ralph; Phillips, Adekoyejo Abiodun; Oguntunde, Olubanji Ajibola; Afolayan, Olatunji Michael
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
Akinde, Olakanmi Ralph; Phillips, Adekoyejo Abiodun; Oguntunde, Olubanji Ajibola; Afolayan, Olatunji Michael
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
McCorkel, J; Cook, V
This paper reports on five years of experience with computer-assisted instruction (CAI) at Winthrop-University Hospital, a major affiliate of the SUNY at Stony Brook School of Medicine. It compares CAI programs available from Ohio State University and Massachusetts General Hospital (accessed by telephone and modem), and software packages purchased from the Health Sciences Consortium (MED-CAPS) and Scientific American (DISCOTEST). The comparison documents one library's experience of the cost of these programs and the use made of them by medical students, house staff, and attending physicians. It describes the space allocated for necessary equipment, as well as the marketing of CAI. Finally, in view of the decision of the National Board of Medical Examiners to administer the Part III examination on computer (the so-called CBX) starting in 1988, the paper speculates on the future importance of CAI in the community teaching hospital. PMID:3518839
Nwosu, Jones N; Nnadede, Peter C
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
Seyedin, Hesam; Goharinezhad, Salime; Vatankhah, Soodabeh; Azmal, Mohammad
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
Elom, Sampson Omena; Egba, Nwamaka A.
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…
Adeleke, A. O.; Makan, R. S.; Ibitoye, S. A.
The Nigerian Enugu and Polish Bellview coals were subjected to proximate analysis and Gray-King coke assay type tests. Proximate analysis gave the ash content as 7.57 and 5.56%, the volatile content as 51.76 and 31.06%, respectively for Enugu and Bellview coals. For the Gray-King coke type assay test, the coke types of B and G, the percentage coke yield of 71.70 and 80.40% and percentage tar yield of 23.30 and 11.40%, respectively, were determined for Enugu and Bellview coals. The coke type, the ash content and percentage coke yield confirms Bellview coal as a medium coking coal, suitable for cokemaking but with a volatile content that exceeds the upper limit of 30.3% for cokemaking at Ajaokuta and Enugu coal as a high volatile non-caking coal. However, the higher yield of tar from Enugu coal may be an advantage in its use as a binder in producing formed coke.
Zairi, M; Cooke, M; Whymark, J
Measuring organisational effectiveness in a health-care delivery context is quite a challenging task. Although there are numerous performance assessment models, audit tools and managerial diagnostic tools, they all, however, tend to fall short in their attempts to scrutinize how health-care organizations deploy their capabilities to deliver optimum quality in service provision and what performance levels they achieved as a result of their approach. The project reported here attempted to address these issues, reflecting the experience of Leeds Teaching Hospitals, one of a series of Trusts whose approach to organizational effectiveness was closely examined. PMID:10848174
Salins, Naveen Sulakshan; Jansen, Wendy
Aim: The purpose of this clinical audit was to determine how accurately documentation of anticipatory Not for Resuscitation (NFR) orders takes place in a major metropolitan teaching hospital of Australia. Materials and Methods: Retrospective hospital-based study. Independent case reviewers using a questionnaire designed to study NFR documentation reviewed documentation of NFR in 88 case records. Results: Prognosis was documented in only 40% of cases and palliative care was offered to two-third of patients with documented NFR. There was no documentation of the cardiopulmonary resuscitation (CPR) process or outcomes of CPR in most of the cases. Only in less than 50% of cases studied there was documented evidence to suggest that the reason for NFR documentation was consistent with patient’s choices. Conclusion: Good discussion, unambiguous documentation and clinical supervision of NFR order ensure dignified and quality care to the dying. PMID:21633620
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 should provide anxiety related information for patients. PMID:25189274
Huang, C.; Long, Q.; Qian, K.; Fu, T.; Zhang, Z.; Liao, P.; Xie, J.
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
Suthar, Neeraj; Roy, Sandip; Call, Douglas R.; Besser, Thomas E.; Davis, Margaret A.
Veterinary nosocomial infections caused by antibiotic resistant bacteria cause increased morbidity, higher cost and length of treatment and increased zoonotic risk because of the difficulty in treating them. In this study, an individual-based model was developed to investigate the effects of movements of canine patients among ten areas (transmission points) within a veterinary teaching hospital, and the effects of these movements on transmission of antibiotic susceptible and resistant pathogens. The model simulates contamination of transmission points, healthcare workers, and patients as well as the effects of decontamination of transmission points, disinfection of healthcare workers, and antibiotic treatments of canine patients. The model was parameterized using data obtained from hospital records, information obtained by interviews with hospital staff, and the published literature. The model suggested that transmission resulting from contact with healthcare workers was common, and that certain transmission points (housing wards, diagnostics room, and the intensive care unit) presented higher risk for transmission than others (lobby and surgery). Sensitivity analyses using a range of parameter values demonstrated that the risk of acquisition of colonization by resistant pathogens decreased with shorter patient hospital stays (P<0.0001), more frequent decontamination of transmission points and disinfection of healthcare workers (P<0.0001) and better compliance of healthcare workers with hygiene practices (P<0.0001). More frequent decontamination of heavily trafficked transmission points was especially effective at reducing transmission of the model pathogen. PMID:24893006
Rath, Shakti; Dubey, Debasmita; Sahu, Mahesh C.; Padhy, Rabindra N
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.
Luiz, Raíssa Bianca; Simões, Ana Lúcia de Assis; Barichello, Elizabeth; Barbosa, Maria Helena
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 (?=0.05). To identify predictors for the safety climate scores, multiple linear regression was used, having the safety climate domain as the main outcome (?=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
At the 125 U.S. medical schools and their affiliated teaching hospitals, most of the nation's basic and clinical research advances are made, and these translate into topflight medical care and great reductions in health care costs (e.g., $30 billion a year for polio). But these medical schools and teaching hospitals and their capacities to provide critical education and research are threatened by escalating erosion of their infrastructure, the declining academic workforce, the diminishing of quality and access as a result of growing marketplace forces, and shrinking funds. The author provides details about the forces threatening academic medical centers (i.e., medical schools and their affiliated teaching hospitals) and then presents a variety of strategies that individual academic medical centers can carry out to more efficiently use their resources. But sufficient resources ae still needed if centers are to function as they should. What is to save them? The author indicates that centers should not overly depend on managed care, the pharmaceutical industry, or foundations to provide the necessary support, and that centers' internal strategies can go only so far. He proposes that the importance of centers and the dangers they face must be communicated convincingly to the nation's citizens, business leaders, government representatives, and purchasers of health care. The message must be repeated frequently so it will sink in, and must be given in terms that are relevant to individuals and their families. He also advises that certain types of partnerships may be helpful. But most critical is the need to persuade the government to mandate separate revenue streams for research, education, and care for the underserved. As hard as this will be to achieve, there are many allies of academic medicine, from the president to numerous legislators; the author discusses what they have said and done to help. He concludes by urging everyone in academic medicine to do their parts to make a powerful case for the value of academic medical centers to society, and affirms his belief that American society will sustain these centers. PMID:9040243
Teymourzadeh, Ehsan; Rashidian, Arash; Arab, Mohammad; Akbari-Sari, Ali; Hakimzadeh, Seyyed Mostafa
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
How do Supervising Clinicians of a University Hospital and Associated Teaching Hospitals Rate the Relevance of the Key Competencies within the CanMEDS Roles Framework in Respect to Teaching in Clinical Clerkships?
Jilg, Stefanie; Möltner, Andreas; Berberat, Pascal; Fischer, Martin R.; Breckwoldt, Jan
Background and aim: In German-speaking countries, the physicians’ roles framework of the “Canadian Medical Education Directives for Specialists” (CanMEDS) is increasingly used to conceptualize postgraduate medical education. It is however unclear, whether it may also be applied to the final year of undergraduate education within clinical clerkships, called “Practical Year” (PY). Therefore, the aim of this study was to explore how clinically active physicians at a university hospital and at associated teaching hospitals judge the relevance of the seven CanMEDS roles (and their (role-defining) key competencies) in respect to their clinical work and as learning content for PY training. Furthermore, these physicians were asked whether the key competencies were actually taught during PY training. Methods: 124 physicians from internal medicine and surgery rated the relevance of the 28 key competencies of the CanMEDS framework using a questionnaire. For each competency, following three aspects were rated: “relevance for your personal daily work”, “importance for teaching during PY”, and “implementation into actual PY teaching”. Results: In respect to the main study objective, all questionnaires could be included into analysis. All seven CanMEDS roles were rated as relevant for personal daily work, and also as important for teaching during PY. Furthermore, all roles were stated to be taught during actual PY training. The roles “Communicator”, “Medical Expert”, and “Collaborator” were rated as significantly more important than the other roles, for all three sub-questions. No differences were found between the two disciplines internal medicine and surgery, nor between the university hospital and associated teaching hospitals. Conclusion: Participating physicians rated all key competencies of the CanMEDS model to be relevant for their personal daily work, and for teaching during PY. These findings support the suitability of the CanMEDS framework as a conceptual element of PY training. PMID:26413171
Haddad, Mariana Lourenço; Medeiros, Marcelo; Marcon, Sonia Silva
The objective of this study was to verify the effect of acupuncture on the sleep quality of obese workers in a teaching hospital. Data were collected from July to October 2009, focusing on 37 workers who attended eight weekly acupuncture sessions. The Pittsburgh Sleep Quality Index was used to assess their sleep quality before and after the intervention. Results show that before the intervention, five (13.5%) people experienced good quality of sleep whereas at the end of the study 14 (37.8%) showed this condition. Statistic significance (p=0.0001) was found in comparing the mean scores obtained before and after acupuncture. Acupuncture had effects on the quality of sleep in the studied sample, presenting itself as a complementary technique for treating sleep disorders and consequently improving the quality of life in this population. PMID:22441269
Aiyeloja, A. A.; Bello, O. A.
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…
Amadi, Eugenia Ada
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…
Saghaeiannejad-Isfahani, Sakineh; Saeedbakhsh, Saeed; Jahanbakhsh, Maryam; Habibi, Mahboobeh
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
Akinboboye, BO; Akeredolu, PA; Sofola, O; Ogunrinde, BO; Oremosu, OA
Background: Tooth replacement service is generally available in our environment. However, its utilization by the elderly has not been extensively studied. Aim: To determine the utilization of tooth replacement services among the elderly. Materials and Methods: This was a retrospective study of 440 patients aged 60 years and above attending the prosthetic out-patient clinics of Lagos University teaching hospital (LUTH) and Lagos state University teaching hospital (LASUTH) from January, 2008 to March, 2010. record books or case records: Age, sex, and number of teeth replaced. Results were collated and analyzed using Epi Info 2004. Values were presented as simple percentages. Results: There were 229/440 (52.0%) males and 211/440 (48.0%) females and were aged 60-90 years with a mean age of 68.9 (6.92). A total number of 4,062 teeth were replaced. Average number of tooth replaced among the patients was 9.45 for LUTH and 8.94 for LASUTH. The maxillary anterior teeth were the most frequently replaced 1422/4062 (35.0%) and the least replaced were the mandibular posterior teeth 812/4062 (20.0%). The average number of tooth replaced generally increased with age in both sexes. A total of 90 complete maxillary and mandibular dentures were fabricated, while six single arch complete dentures were made. The remaining were partial dentures. Conclusion: The most common age of presentation is 60-65 years. Patients that were 90 years and above appear to utilize teeth replacement facilities in this environment less than those in developed countries. Maxillary anterior teeth were the most frequently replaced. PMID:24669332
Salehifar, Ebrahim; Eslami, Gohar; Ahangar, Nematollah; Rafati, Mohammad Reza; Eslami, Shafagh
Background: Resistance to antimicrobial agents including aminoglycosides (AGs) is a great concern that is mainly related to inappropriate use. Since there were not adequate data regarding how rationally AGs are being prescribed in our critically ill patients, this study was conducted to determine the main issues in the area of appropriate use of this antibiotic class. Methods: One hundred patients who were in the intensive care units (ICUs) of Imam Khomeini Teaching Hospital from February 2012 to August 2012 were included. A data gathering form was prepared based upon the recommendations provided by Up-to-date (20.1) 2012 and Medscape 2013. All demographic characteristics and other information about time of beginning and duration of dosage, interval of administration of AGs and creatinine (Cr) level were collected. In statistical analysis, SPSS Version 16 software was used. Independent samples t-test was used to compare the quantitative and chi-square for qualitative variables. Results: Sixty six (66%) of patients received gentamicin and 38% received amikacin. In 27% of patients, serum creatinine (Cr) had been checked before and after AGs administration and 4 patients had no renal function monitoring. Monitoring of serum concentration and Cr clearance estimation was not carried out for any patients. Culture and laboratory sensitivity tests were done on 17 patients and E-coli (57%) was the most common isolated organism. Conclusion: The results of this study revealed that majority of the hospitalized patients in the ICU and the dosage of AGs had not been adjusted to renal function.
Núñez, Fidel A; González, Odalys M; Bravo, José R; Escobedo, Angel A; Gonzaléz, Ida
A study on intestinal parasitism was conducted among 401 children admitted in the Pediatric Teaching Hospital of Cerro, from May to June, 1999. To this end, a representative, randomized and stratified sample by service was taken. 3 samples of feces per child were collected, preserved in formaldehyde, and processed by 3 parasitological methods. There was an intestinal parasitism prevalence of 15% at the hospital and there were no differences between the stratum of children admitted in Gastroenterology and the rest of the services as regards commensals and parasites in general (p > 0.05); however, commensals predominated in the second group (p < 0.01) The intestinal coccidia, Cryptosporidium parvum and Cyclospora cayetanensis prevailed in the Gastroenterology service over the rest of the services (p < 0.01). The age group over 4 (school children) was the most affected, both by protozoa and commensals (p < 0.01), excepting Cryptosporidium parvum that affected the infants more (p < 0.05). The analysis of some epidemiological antecedents showed that those children eating fruit without peeling and washing them, having vegetables withouth washing them first and walking barefooted were more prone to infection (RR > 1). A higher frequency of infection due to intestinal parasites was found among those living in rural areas, drinking well or river water, and defecating in latrines or in the open air (RR > 1). These results suggested that in spite of the existing knowledge of the epidemiological and risk factors, the intestinal parasites continue affecting the child population PMID:15849948
Rasoulinejad, Seyed Ahmad; Hajian-Tilaki, Karimollah; Mehdipour, Elnaz
Background: Information regarding the frequency and severity of eye involvement in diabetic patients and its risk factors can be useful for prevention and treatment. This study aimed to determine the prevalence of diabetic retinopathy and its associated risk factors in diabetic patients who referred to teaching hospitals in Babol, Mazandaran. Methods: In this study a total of 1562 patients with the definite diagnosis of diabetes mellitus were chosen and referred to the eye clinic of Shahid Beheshti and Ayatollah Rouhani Hospitals of Babol during 2006-2010. Information about age, duration of diabetes, hypertension family history of diabetes, history of other organs involvement, BMI and laboratory findings were recorded. Retinopathy was classified according to early treatment of diabetic retinopathy study. Data were collected and analyzed. Results: Of the 1562 patients, 357 (22.9%) were males and 1205 (77.1%) were females. The mean age was 54.6±10.6 years, diabetic retinopathy was found in 990 (64.1%) patients, the frequency of non-proliferative diabetic retinopathy was 37.3% and proliferative was 26.8%.Age, duration of diabetes, FBS, HbA1C, BUN, Cr, Hb were significantly different between the patient’s with diabetic retinopathy and no diabetic retinopathy (p<0.05). No relationship was found between smoking, gender, hypertension and serum lipid profile. Conclusion: Poor diabetes control, anemia and nephropathy were the most associated factors of diabetic retinopathy but hypertension BMI smoking, dyslipidemia and gender showed no association. PMID:26644897
Iliyasu, G; Lawal, H; Habib, A G; Hassan-Hanga, F; Abubakar, I S; Bashir, U; Tanko-Yakasai, U; Abubakar, S; Abba, M S; Rano, I S; Abdu, H; Musa, B; Gwarzo, G D
In December 2008 an outbreak of Meningococcal Meningitis swept across sub Saharan Africa with Nigeria, especially its northern states worst affected. The management of Aminu Kano Teaching Hospital constituted an Emergency Preparedness & Response (EPR) committee. Over the course of 18 weeks from 5 January 2009 to 15 May 2009, AKTH managed 222 cases of suspected meningitis with 14 deaths (case fatality rate [CFR] of 6.3%). Twenty three per cent (23%) were microbiologically proven as meningococcal meningitis while 9% were confirmed to be pneumococcal meningitis. Male to female ratio was 1:1 with most patients (81%) aged below 14 years. The epidemic peaked in weeks 10 and 13 with 38 admissions in the respective weeks. Meningococcemia with purpura fulminans, post meningitic immune complex cutaneous vasculitis and polyarthritis were observed. Control measures instituted included provision of free ceftriaxone, chemoprophylaxis to contacts, vaccines to staff/families, and creation of dedicated isolation wards. Clinical management guidelines were developed and hospital staffs were also enlightened. Lessons learnt included the difficulty of discriminating between nosocomial transmission and community clusters; relative increase in pneumococcal meningitis during the epidemic; unreliability of penicillin/chloramphenicol; the utility of internet for communication; and the inadequacy of vaccines to meet staff & public demand. PMID:20120153
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
Sehgal, Kriti; Hebbar, Shripad; Nambiar, Jayaram; Bhat, Rajeshwari G.
Objective. Aim of this audit was to analyze indications, complications, and correlation of preoperative diagnosis with final histopathology report of all hysterectomies, performed in a premier teaching hospital. Methods. Present study involved all patients who underwent hysterectomy at a premier university hospital in Southern India, in one year (from 1 January, 2012, to 31 December, 2012). Results. Most common surgical approach was abdominal (74.7%), followed by vaginal (17.8%), and laparoscopic (6.6%) hysterectomy. Most common indication for hysterectomy was symptomatic fibroid uterus (39.9%), followed by uterovaginal prolapse (16.3%). Overall complication rate was 8.5%. Around 84% had the same pathology as suspected preoperatively. Only 6 (5 with preoperative diagnosis of abnormal uterine bleeding and one with high grade premalignant cervical lesion) had no significant pathology in their hysterectomy specimen. Conclusion. Hysterectomy is used commonly to improve the quality of life; however at times it is a lifesaving procedure. As any surgical procedure is associated with a risk of complications, the indication should be carefully evaluated. With the emergence of many conservative approaches to deal with benign gynecological conditions, it is prudent to discuss available options with the patient before taking a direct decision of surgically removing her uterus. PMID:25763395
Lamichhane, DC; Giri, BR; Pathak, OK; Panta, OB; Shankar, PR
Background Recent studies on prescribing among outpatients in hospitals in Western Nepal are lacking. The main objectives of the study were to obtain information on the morbidity pattern among outpatients and to analyze prescribing using drug use indicators. Methods A retrospective hospital record based study from 01.01.2004 to 31.12.2004 was carried out among individuals attending the outpatient department (OPD) of the Manipal Teaching hospital, Pokhara, Western Nepal. A total of 32,017 new patients attended the OPD during the study period. Systematic random sampling (1 in every 20 patients) was done and 1600 patients selected. After excluding patients visiting the emergency department, those who got admitted and whose records were not available, 1261 cases were analyzed. The demographic details, morbidity pattern, average number of drugs prescribed, percentage of drugs prescribed by generic names and from the Essential drug list of Nepal (Essential drugs are those which satisfy the priority healthcare needs of the population), percentage of encounters with an antibiotic and an injection prescribed were noted. Results 1261 patients made 1772 visits. Upper respiratory tract infection and acid peptic disease were the most common diagnoses. The mean number of drugs was 1.99. Only 19.5% and 39.6% of drugs were prescribed by generic name and from the Essential drug list. Antibiotics and injections were prescribed in 26.4% and 0.96% of encounters. Cetrizine, vitamins, amoxicillin, the combination of paracetamol and ibuprofen and ranitidine were most commonly prescribed. Conclusions Upper respiratory tract infections and acid peptic disease were the common illnesses. Generic prescribing and use of essential drugs were low. Some of the drug combinations being used were irrational. Prescriber education may be helpful in encouraging rational prescribing. PMID:18523618
Objective To measure the incidence of maternal and early neonatal mortality in women who gave birth at Moi Teaching and Referral Hospital (MTRH) in Kenya and describe clinical and other characteristics and circumstances associated with maternal and neonatal deaths following deliveries at MTRH. Methods A retrospective audit of maternal and neonatal records was conducted with detailed analysis of the most recent 150 maternal deaths and 200 neonatal deaths. Maternal mortality ratios and early neonatal mortality rates were calculated for each year from January 2004 to December 2011. Results Between 2004 and 2011, the overall maternal mortality ratio was 426 per 100,000 live births and the early neonatal mortality rate (<7?days) was 68 per 1000 live births. The Hospital record audit showed that half (51%) of the neonatal mortalities were for young mothers (15–24?years) and 64% of maternal deaths were in women between 25 and 45?years. Most maternal and early neonatal deaths occurred in multiparous women, in referred admissions, when the gestational age was under 37?weeks and in latent stage of labour. Indirect complications accounted for the majority of deaths. Where there were direct obstetric complications associated with the delivery, the leading cause of maternal death was eclampsia and the leading cause of early neonatal death was pre-mature rupture of membranes. Pre-term birth and asphyxia were leading causes of early neonatal deaths. In both sets of records the majority of deliveries were vaginal and performed by midwives. Conclusion This study provides important information about maternal and early neonatal mortality in Kenya’s second largest tertiary hospital. A range of socio demographic, clinical and health system factors are identified as possible contributors to Kenya’s poor progress towards reducing maternal and early neonatal mortality. PMID:23421605
Doshmangir, Leila; Rashidian, Arash; Ravaghi, Hamid; Takian, Amirhossein; Jafari, Mehdi
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 policies in the past and their outcomes were overlooked, while the context was not prepared appropriately and key stakeholders, particularly the government, did not support the decentralization of Iran’s health system. PMID:25844379
Eze, Boniface I.; Ibegbulam, Godswill O.; Ocheni, Sunday
Purpose: To determine the prevalence and pattern of leukemic ophthalmopathy among adults at the University of Nigeria Teaching Hospital (UNTH), Enugu, south-eastern, Nigeria. Materials and Methods: This prospective, observational case series surveyed adult leukemia patients presenting at UNTH’s departments of Hematology/Immunology and Ophthalmology from July 2003 to August 2008. The demographic profile, clinical data from for each individual in the cohort were statistically collated and analyzed. A P <0.05 was considered as statistically significant. Results: There were 72 participants (45 males and 27 females), aged 32.7 ± 9.8 years (range, 18 years to 72 years). Leukemic ophthalmopathy was present in 77.8% of subjects. The leading ophthalmic manifestations of leukemia were retinal vascular abnormalities in 50.0% of subjects, conjunctival pallor in 27.8% of subjects, sub-conjunctival hemorrhage in 19.4% of subjects, and retinal hemorrhage in 16.7% of subjects. Ocular co-morbidity was present in 47.2% of subjects. Vision loss occurred in 37.5% of subjects, of which 32.1% was leukemia related, and the remaining due to ocular co-morbidity. Leukemic ophthalmopathy was more prevalent in chronic leukemia (P <0.05), frequently affected the ocular posterior segment (P < 0.05), and often resulted from secondary hematologic complications (P <0.05). There was no gender difference in the prevalence of leukemia (P = 0.0822) or leukemic ophthalmopathy (P = 0.6624). Conclusion: The prevalence of leukemic ophthalmopathy in Enugu is high. It is often associated with significant ocular co-morbidity and vision loss. These have implications for clinicians involved in leukemia management. Early diagnosis and regular ophthalmic examinations are recommended to optimize treatment outcomes. PMID:21180433
Taleschian-Tabrizi, Negar; Farhadi, Fereshteh; Madani, Neda; Mokhtarkhani, Mohaddeseh; Kolahdouzan, Kasra; Hajebrahimi, Sakineh
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
Baniardalan, Mahtash; Sabzghabaee, Ali Mohammad; Jalali, Mohammad; Badri, Shirinsadat
Background: This study aimed to investigate and compare the bacterial safety of handmade and commercial ready-to-use enteral feeding formulas used in an Iranian teaching hospital. Methods: In this experimental study, a total number of 70 samples (21 handmade formulas sampled at two sampling times, i.e. the time of preparation and 18 h after preparation, and 28 commercial ready-to-use formulas) were studied. Total count of viable microorganisms, coliform count and Staphylococcus aureus count for all samples were conducted. Results: Out of 42 handmade samples, 16 samples (76%) had total viable counts greater than 103 CFU/g in the first sampling time and 17 samples (81%) had total viable counts greater than 103 CFU/g in the second sampling time. Also, 11 (52%) had coliform contamination in the first sampling time which reached 76% (16 samples) in the second sampling time. Regarding contamination with S. aureus, 5 samples (24%) were contaminated in the first- and 13 samples (62%) were contaminated in the second-sampling time. Out of 28 commercial formulas, 27 samples (96%) had total viable counts greater than 103 CFU/g. Also, 24 samples (86%) were contaminated with S. aureus and 27 samples (96%) were contaminated with coliforms. In order to compare these two formulas, the results of Mann-Whitney test showed that contamination of ready-to-use formulas in all three microbiological samples was significantly more than that for handmade samples. Conclusions: The results of the present study indicate that the microbial safety of enteral feeding solutions in this hospital is much lower than standard values, demonstrating that the development of protocols for clean techniques in the preparation, handling and storage of both commercial and handmade enteral feeds is necessary. PMID:24932392
Czarniak, Petra; Bint, Lewis; Favié, Laurent; Parsons, Richard; Hughes, Jeff; Sunderland, Bruce
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 official product information. PMID:25756896
Elachi, Itodo C.; Okunola, Benjamin B.; Yongu, Williams T.; Onyemaechi, Ndubuisi OC; Odatuwa-Omagbemi, Odoyoh D.; Ahachi, Chukwukadibia N.; Mue, Daniel D.
Background: Motorcycle-related injuries lead to considerable morbidity and mortality. The aim of this study is to determine the pattern and outcome of motorcycle-related injuries at Benue State University Teaching Hospital, Makurdi, Nigeria. Patients and Methods: Case records of all patients who presented to the accident and emergency department with motorcycle-related injuries between July 2012 and June 2013 were analysed for age, gender, injury host status (i.e. rider, pillion or pedestrian), nature of collision (motorcycle versus other vehicles, motorcycle versus motorcycle, motorcycle versus pedestrian or lone riders), body region injured, injury severity score (ISS) at arrival, length of hospital stay (LOS) and mortality. Results: Seventy - nine patients with motorcycle-related injuries were included in the study. They consisted of 63 males (61.8%) and 16 females (15.7%). The age range was 5-65 years with a mean of 32.4 ± 14.0. Motorcycle versus vehicle collisions were the most common mechanism of injury (n = 46, 58.2%). Musculoskeletal injuries constituted the most common injuries sustained (n = 50, 47.6%) and the tibia was the most frequently fractured bone (n = 14, 35.9%). The majority of patients (57.0%) sustained mild/moderate injuries (ISS ? 15). There was no statistically significant difference between the sexes for sustaining mild/moderate injuries or severe/profound injuries (P > 0.05). Mortality rate was 6.3% with head injuries being involved in all cases. Conclusion: Young males were mostly injured in motorcycle-related trauma. Musculoskeletal injuries were the most common injuries sustained and head injuries were involved in all the deaths. Enforcement of motorcycle crash bars and helmet usage is recommended. PMID:25538360
Zohoun, A; Ngoh Akwa, E; El Ochi, M; Oragwu, N; Akhaddar, A; Albouzidi, A; El Ouennass, M
To review the bacteriological features of infectious spondylodiscitis and provide recommendations for the initial therapy which remains empirical in our context. Retrospective study including patients diagnosed with spondylodiscitis over a period of 4 years (2006-2009) at the Rabat Military Teaching Hospital. During the study period, we analysed 30 cases: the mean age was 49.9 years and 21 cases (70%) were male. The patients were predominantly hospitalized in neurosurgery department (15/30) followed by rheumatology department (10/30). The site of infection was lumbar in 21 cases (21/30), dorsal in 7 cases (7/30). 26 cultures were positive of which 19 (19/26) were monomicrobial. Tuberculosis (TB) was implicated in 10 cases (10/30) including 4 cases in association with common organisms (Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium species). Brucella melitensis was isolated in 1 case. Infections caused by pyogenic bacteria were isolated in 15 cases of which 12 (12/15) revealed simple organisms including Gram-positive cocci in 9 cases (9/12) with 3 cases of S. aureus and Gram-negative bacilli in 3 cases (3/12) with 2 cases of P. aeruginosa. Blood cultures carried out for 16 patients were positive in 7 cases. The anatomopathologic exams carried out for 20 patients found in 6 cases epithelioid granulomata and giants cells with caseous necrosis in total concordance with TB culture. TB is the most frequent cause of spondylodiscitis in Morocco. Our study found the same frequency for non-specific and specific germs. Empirical treatment must take into account S. aureus and M. tuberculosis. PMID:24031960
Zohoun, A; Ngoh Akwa, E; El Ochi, M; Oragwu, N; Akhaddar, A; Albouzidi, A; El Ouennass, M
To review the bacteriological features of infectious spondylodiscitis and provide recommendations for the initial therapy which remains empirical in our context. Retrospective study including patients diagnosed with spondylodiscitis over a period of 4 years (2006–2009) at the Rabat Military Teaching Hospital. During the study period, we analysed 30 cases: the mean age was 49.9 years and 21 cases (70%) were male. The patients were predominantly hospitalized in neurosurgery department (15/30) followed by rheumatology department (10/30). The site of infection was lumbar in 21 cases (21/30), dorsal in 7 cases (7/30). 26 cultures were positive of which 19 (19/26) were monomicrobial. Tuberculosis (TB) was implicated in 10 cases (10/30) including 4 cases in association with common organisms (Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium species). Brucella melitensis was isolated in 1 case. Infections caused by pyogenic bacteria were isolated in 15 cases of which 12 (12/15) revealed simple organisms including Gram-positive cocci in 9 cases (9/12) with 3 cases of S. aureus and Gram-negative bacilli in 3 cases (3/12) with 2 cases of P. aeruginosa. Blood cultures carried out for 16 patients were positive in 7 cases. The anatomopathologic exams carried out for 20 patients found in 6 cases epithelioid granulomata and giants cells with caseous necrosis in total concordance with TB culture. TB is the most frequent cause of spondylodiscitis in Morocco. Our study found the same frequency for non-specific and specific germs. Empirical treatment must take into account S. aureus and M. tuberculosis. PMID:24031960
Emegoakor, Fausta Chioma J; Iyoke, Chukwuemeka Anthony; Ezegwui, Hyginus Uzo; Ezugwu, Frank Okechukwu; Umeora, Odidika Ugochukwu; Ibeagha, Izuchukwu Obumneme
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
Johnson, Ofonime E
People living with human immunodeficiency virus and acquired immune deficiency syndrome (PLWHA) face numerous social challenges. The objectives of this study were to assess the level of self-disclosure of status by PLWHA, to describe the level and patterns of stigma and discrimination, if any, experienced by the PLWHA and to assess the effect of sero-positivity on the attitude of friends, family members, health workers, colleagues and community. This was a cross-sectional descriptive study carried out among PLWHA attending the University of Uyo Teaching Hospital, Uyo, Southern Nigeria. Information was obtained using an interviewer-administered semi-structured questionnaire, which was analysed using the Epi 6 software. A total of 331 respondents were interviewed. A majority, 256 (77.3%), of the respondents were within the age range of 25-44 years. A total of 121 (36.6%) PLWHA were single and 151 (46.6%) were married, while the rest were widowed, divorced or separated. A majority, 129 (85.4%), of the married respondents disclosed their status to their spouses and 65 (50.4%) were supportive. Apart from spouses, disclosure to mothers (39.9%) was highest. Most clients (57.7%) did not disclose their status to people outside their immediate families for fear of stigmatization. Up to 111 (80.4%) of the respondents working for others did not disclose their status to their employers. Among those whose status was known, discrimination was reported to be highest among friends (23.2%) and at the workplace (20.2%). Attitudes such as hostility (14.5%), withdrawal (11.7%) and neglect (6.8%) were reported from the private hospitals. Apart from disclosure to spouses, the level of disclosure to others was very low. Those whose status was known mainly received acceptance from their families but faced discriminatory attitudes such as hostility, neglect and withdrawal from friends, colleagues and hospital workers. There is a need for more enlightenment campaigns on HIV/AIDS by stakeholders to reduce stigma and discrimination and ensure adequate integration of PLWHA into the society. PMID:23237039
Chopra, Deepti; Sharma, Vibha; Kapoor, Rohan; Dwivedi, Shridhar
Background Pharmacotherapy is often impeded by adverse drug reactions (ADRs). Among these ADRs cutaneous reactions are the major class being easily identified and reported. If not noted early it has potential to develop into serious lesions. Objective To evaluate the clinical patterns of various drug induced cutaneous reactions. Setting A Teaching hospital in India. Methods All suspected cutaneous reactions to systemic drugs which were submitted to the ADR monitoring centre during a 6-month period (March 2014-August 2014) were analysed. Causality relationship, severity assessment and preventability assessment was also done. Results Out of 134 cutaneous ADRs, 56 % occurred in females, majority of cases were found in the age group of 41-50 years. The most common type of ADR was maculopapular rash (46.3 %) and majorly implicated drug class was antibiotics (51.3 %). Most (72.3 %) were mild. Polypharmacy and multiple comorbid conditions were important predisposing factors. Over half of the cases (58 %) were not preventable. Conclusion Cutaneous adverse reaction patterns and their causes vary as the result of changing use of drugs. In India, antibiotics are responsible for the majority of the cutaneous adverse drug reactions, and maculopapular rash is the side effect that is most reported. PMID:26238222
Tandon, Vishal R.; Khajuria, Vijay; Mahajan, Vivek; Sharma, Aman; Gillani, Zahid; Mahajan, Annil
Background & objectives: Drug-induced diseases (DIDs) are well known but least studied. Data on DIDs from India are not available. Hence, this retrospective cross-sectional study was undertaken using suspected adverse drug reaction (ADR) data collected form Pharmacovigilance Programme of India (PvPI) to evaluate profile of DIDs over two years, in a tertiary care teaching hospital from north India. Methods: The suspected ADRs in the form of DID were evaluated for drug and disease related variables and were classified in terms of causality. Results: DID rate was 38.80 per cent. Mean duration of developing DIDs was 26.05 ± 9.6 days; 25.16 per cent had more than one co-morbid condition. Geriatric population (53.99%) accounted for maximum DIDs followed by adult (37.79%) and paediatric (8.21%). Maximum events were probable (93.98%) followed by possible (6.04%). All DIDs required intervention. Gastritis (7.43%), diarrhoea (5.92%), anaemia (4.79%), hypotension (2.77%), hepatic dysfunction (2.69%), hypertension (1.51%), myalgia (1.05%), and renal dysfunction (1.01%) were some of the DIDs. Anti tubercular treatment (ATT), anti retroviral treatment (ART), ceftriaxone injection, steroids, non-steroidal anti-inflammatory drugs, antimicrobials and anticancer drugs were found as commonly offending drugs. Interpretation & conclusions: Our findings show that DIDs are a significant health problem in our country, which need more attention. PMID:26261164
Harvey, R; Jarrett, P G; Peltekian, K M
OBJECTIVE: To assess the patterns of paging medical interns during night calls. DESIGN: Descriptive study; diaries were used to log calls between 7 pm and 7 am for 1 week in February 1991. SETTING: Two teaching hospitals in Halifax. PARTICIPANTS: All 10 interns assigned to the 15 medical units and nurses from 3 representative medical units. MAIN OUTCOME MEASURES: Number and nature of calls. RESULTS: The overall response rate was 90%. A total of 309 calls were logged by the interns and 107 by the nurses. Each intern had 17 calls on average (range 6 to 33) per 12-hour period. Of the calls 27% occurred after midnight, 25% disrupted sleeping, and 19% interrupted direct patient contact. Overall, the most common reasons for paging interns were related to prescribing of medications (42% of the calls), direct patient assessment (25%) and reporting of laboratory results (18%). According to the nurses, there were no delays in the interns' responding to the pages, and 61% of the calls led to a new physician order. CONCLUSIONS: Paging frequently interrupts interns during work and rest on night calls. Assessment of paging patterns may be useful in identifying specific interventions to reduce the number of calls so that interns will have fewer interruptions during patient encounters and more rest. The collection of data from nurses in a routine nursing audit may be useful for evaluating the communication between interns and nurses and, indirectly, for assessing interns' workload. PMID:8039084
El-Sergany, Amr; Darwish, Alex; Mehta, Pratik; Mahmoud, Ahmed
Introduction Although more commonly thought of as a surgical problem affecting children, surgeons evaluating the adult acute abdomen should remain vigilante in diagnosing intussusception. In this case series, we reviewed 6 years of medical records at a community teaching hospital in order to analyze the etiology, presentation, and management of nine cases of adult intussusception. Presentation of cases Most of the patients in our series shared symptoms of nausea, vomiting, and abdominal pain. Computed tomography scan was crucial in distinguishing adult intussusception from other causes of acute abdomen. Eight patients underwent operative exploration, five of whom underwent bowel resection. One patient’s symptoms resolved with no surgical intervention. All nine patients had excellent outcomes. Discussion Although detailed history and physical examination are essential in all cases of acute abdomen, CT scan findings of “target” signs are pathognomonic of intussusception. Laparoscopy should be strongly considered in select cases. Current literature suggests that reduction may be performed before resection if the lesion meets certain stringent parameters. The primary concern with regards to reduction before resection is potential embolization of malignant cells. Colonic intussusception is almost always treated with resection without reduction, while small intestinal intussusception could be treated by reduction before resection, if the small bowel lead points are less likely to be malignant. Conclusion Intussusception is a rare but serious etiology of the acute abdomen in adults. Each case should be evaluated independently according to the specific type of lead-point lesion. Excellent outcomes may be anticipated with prompt diagnosis and surgical treatment. PMID:25989258
This study was conducted to determine the incidence of rotavirus infection in children with gastroenteritis attending Jos university teaching hospital, Plateau State. A total of 160 children with acute diarrhea were selected by random sampling. Stool samples were obtained and assayed for rotavirus antigens by enzyme linked immunosorbent assay technique using standard diagnostic BIOLINE Rotavirus kit. Demographic data of parents were also recorded. Rotavirus were detected in faeces of 22(13.8%) children with acute diarrhea, 90.9% of positive cases of rotavirus gastroenteritis were under 2 years of age with highest prevalence in children 7-12 months of age. Males excreted rotavirus at a significant higher rate than females (P < 0.05). Rotavirus excretion was highest when all three symptoms (diarrhea, fever and vomiting) occurred in the same child (7.5%) and lower when 2 symptoms occurred together (diarrhea and vomiting) with 3.8%, diarrhea and fever with 1.3% and lowest when diarrhea occurred alone with 1.3%. Playing with toys, attending day care, distance of source of water from toilet, eating of food not requiring cooking and playing with other children may serve as predisposing factors of rotavirus disease in these children. PMID:21575246
Der, Edmund M; Gyasi, Richard K; Tettey, Yao; Edusei, Lawrence; Bayor, Marcel T; Jiagge, Evelyn; Gyakobo, Mawuli; Merajver, Sofia D; Newman, Lisa A
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 Caucasian Americans and African Americans. The triple-negative molecular marker pattern was the most common subtype of breast cancer seen among this sample of Ghanaian women, regardless of age, tumor grade, or stage of diagnosis. Research into the molecular pathogenesis of TNBC may help elucidate the reasons for its increased prevalence among women with African ancestry. PMID:26547900
Background Despite education and availability of drugs and vaccines, hepatitis B virus (HBV) is still the most common severe liver infection in the world accounting for >1 million annual deaths worldwide. Transfusion of infected blood, unprotected sex and mother to child transmission are 3 key transmission routes of HBV in Ghana. There is high incidence of blood demanding health situations in northern Ghana resulting from anemia, accidents, malnutrition, etc. The higher the demand, the higher the possibility of transmitting HBV through infected blood. The aim of the investigation was to estimate the prevalence of HBV in blood donors which will provide justification for interventions that will help minimize or eliminate HBV infection in Ghana. Findings We investigated the prevalence of HBV infection among blood donors at Tamale Teaching Hospital. The Wondfo HBsAg test kit was used to determine the concentration of HBsAg in 6,462 (576 voluntary and 5,878 replacement) donors as being ?1 ng/ml. 10.79% of voluntary donors and 11.59% of replacement donors were HBsAg+. The 20-29 year group of voluntary donors was >2 times more likely to be HBsAg + than 40-60. Also the 20-29 year category of replacement donors was >4 times as likely to be HBsAg + than 50-69. Conclusions Risk of infection was age, sex and donor type dependent. The 20-29 year category had the highest prevalence of HBsAg + cases, mostly males residing within the metropolis. PMID:22357100
Background: More than 40 oral manifestations of human immunodeficiency virus (HIV) infection have been recorded and between 70% and 90% of persons with HIV infection will have at least one oral manifestation at some time during the course of their disease. Oral health-care workers (OHCWs) are therefore, key players in the prevention and management of HIV-infection. Aim: The aim of this study was toassess the perceptions of the OHCWs from a Teaching Hospital in Nigeria toward HIV transmission in dental practice and occupational risk. Subjects and Methods: A cross-sectional study. A self-administered questionnaire was used for data collection. A total of 113 OHCWs comprising students, house officers, resident doctors, dental nurses and consultants participated. Analysis was by Statistical Package for the Social Sciences version 17 (SPSS Inc., Chicago, IL, USA). Data analysis included descriptive statistics (frequency distribution and cross tabulation). Results: More than half 64/113 (56%) of the respondents were in the age group 20-30 years and females 68/113 (60%). Though 88% (100/113) of the respondents demonstrated a good knowledge about HIV transmission, 82/113 respondents (72%) disagreed that the risk of HIV transmission in the dental clinic was very low. 82.4% (93/113) did not know that saliva contains anti-HIV activity while 46% (52/113) agreed that pure saliva does not contain the virus except when contaminated by blood. 86.7% (98/113) of the OHCWs disagreed that dental professionals have a lower risk of being infected with HIV compared with other health-care providers. Conclusion: The OHCWs studied manifested some inaccurate perception of occupational risks as regards HIV transmission in dental practice. This could lead to potential stigma and discrimination of people living with HIV/acquired immune deficiency syndrome and thus hindering efforts geared at curtailing the spread of the virus. PMID:25184095
Gates, Maureen C.; Nolan, Thomas J.
The introduction of modern heartworm, flea, and tick preventatives has provided a safe and effective means of controlling companion animal endoparasites, but achieving good owner compliance remains an ongoing challenge for the veterinary profession. Based on a sample of patients from the veterinary teaching hospital at the University of Pennsylvania, this study retrospectively examined factors associated with preventative use and areas of potential weakness in client communication. Between 1999 and 2006, records of 5,276 canine and 1,226 feline patients were searched for signalment, survey results for heartworm, flea, and tick preventative use, date of visit, presenting complaint, vaccination history, and owner zip code. Data were analyzed using bivariate and multivariate techniques. Overall, only 13 - 23 % of patients were questioned about heartworm, flea, or tick preventative use during routine medical history taking. Patients with a prior history of parasites, younger patients, or those presenting with signs of cardiac disease were no more likely to be questioned about preventative use than healthy animals. Patients presenting to a specialty service were also less likely to be questioned. Approximately 74 - 79% of dogs and 12 – 38 % of cats in the sample were on preventative products at any given time. There was a distinct seasonality to preventative use corresponding to the heartworm transmission season from June through November in the northeastern United States. Only 50% of patients seen for a yearly physical examination in winter were reported to be using preventative products when surveyed later in the year, compared to the roughly 85% on patients in heartworm preventatives when they received their routine physical exam in spring. Month of presentation and neuter status were the only signalment factors significantly (P<0.05) associated with preventative use in the multivariate analysis. Findings from this study emphasize target areas for increasing owner compliance. PMID:19931925
Ahmad, Akram; Khan, Muhammad Umair; Ivan, Rahul; Dasari, Ram; Revanker, Megha; Pravina, A.; Kuriakose, Sheetal
Background: Polypharmacy is considered as one of the major risk factors in precipitation of drug-drug interactions (DDIs). Patient population at high risk include the elderly and patients with co morbidities as they are usually prescribed with more number of drugs. Critical evaluation of such prescriptions by pharmacist could result in identification and reduction of such problems. Objective: The study aims to assess the prevalence, severity and significance of potential DDI (pDDI) in general medicine wards of South Indian tertiary care teaching hospital. Materials and Method: A prospective observational study was conducted in a general medicine ward for a period of six months (September 2012 to February 2013). The socio-demographic, clinical characteristics and medication prescribed was documented in a specially designed form. Analysis was carried out to assess the prevalence, severity and significance of identified pDDIs using Micromedex. Descriptive and Univariate analysis were used to report the findings. Results: A total of 404 case records reviewed, 78 (19.3%) patients had pDDIs. A total of 139 (34.4%) pDDIs were reported during the study period. Majority (53.95%, n=75) of the interactions were moderate in intensity and significant in nature (53.23%, n=74). Positive association between number of pDDIs and age was observed. Conclusion: The prevalence of pDDIs was 19.3% which is lesser then previously reported studies from India. Patient with more co-morbidities and elders were observed with more pDDIs. The study highlighted the need to effectively monitor and patients prevent pDDIs to improve patient safety. PMID:25859467
Kosecoff, J; Fink, A; Brook, R H; Davies, A R; Goldberg, G; Linn, L S; Clark, V A; Salisbury, P C
Fifteen general internal medicine group practices in university teaching hospitals were studied to evaluate their primary care services and education. Data were collected over 9 months from physicians, patients, and medical records, and by observation. All institutions had closed their general medical clinics. Many patients being treated in group practices were very sick; 57% had hypertension; 21% were diabetic; and 45% could not work. Most were satisfied with their care. Care for acute problems from a health care provider in the practice was available quickly; regular physicians were harder to see. House staff and faculty spent little time in the practices. Few practices used teams; most used traditional attending and house staff models. Practice physicians could not easily determine when patients were seen in the institution's emergency department or were hospitalized. Quality of care standards were not uniformly met. Finally, the structure of academic centers appeared to inhibit the practices' performance, suggesting a need for further appraisal of relationships between university hospitals and their ambulatory care units. PMID:3966761
Inoue, Satoki; Abe, Ryuichi; Tanaka, Yu; Kawaguchi, Masahiko
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
Okpala, Nonso Ejikeme; Umeh, Rich Enujioke; Onwasigwe, Ernest Nnemeka
A cross-sectional survey of the prevalence of eye injuries among primary school children in two noncontiguous local government areas of Enugu State of Nigeria was undertaken. One of the local government areas was urban, while the other one was rural. Children who were <15 years in two randomly selected primary schools in the urban area and three randomly selected schools in the rural area were interviewed and examined with Snellen chart, pen torch, head loupe, and direct ophthalmoscope. The findings were recorded using a semi-structured questionnaire and the World Health Organization Programme for Prevention of Blindness (WHO/PBL) eye examination form. Training on visual acuity measurement was done for each of the class teachers. A total of 1,236 children <15 years of age were studied and analyzed. Slightly more females, 652 (52.8%), than males, 584 (47.2%), constituted the sample population giving a female/male ratio of 1.1:1. A total of 98 (7.93%) children had evidence of injury to the eye or its adnexa. Eyelid scar was the commonest (5.34%) followed by eyebrow scar (2.10%). Canthal scar was the next (0.32%). Two girls had monocular blindness from eye trauma (0.16%). One had leucoma, while the other had a dislocated lens. All the monocular blind children of this study were from the urban area. The home was the commonest environment for an eye injury (69.39%) followed by the school (20.41%). The farm was next in frequency (7.14%), especially among boys in the rural area. The church and the road/street constituted the remainder. Regarding persons causing the injury, the child's playmate was the commonest (55.10%) followed by self (27.55%). Parents and guardians were the next (9.18%). These were injuries associated with corporal punishment. Corporal punishment-related eye injury, according to this study, appears to be common in the rural area and affects boys predominantly. Other human intermediary agents that cause an eye injury include passersby (2.04%), RTA (2.04%), 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
Okpala, Nonso Ejikeme; Umeh, Rich Enujioke; Onwasigwe, Ernest Nnemeka
A cross-sectional survey of the prevalence of eye injuries among primary school children in two noncontiguous local government areas of Enugu State of Nigeria was undertaken. One of the local government areas was urban, while the other one was rural. Children who were <15 years in two randomly selected primary schools in the urban area and three randomly selected schools in the rural area were interviewed and examined with Snellen chart, pen torch, head loupe, and direct ophthalmoscope. The findings were recorded using a semi-structured questionnaire and the World Health Organization Programme for Prevention of Blindness (WHO/PBL) eye examination form. Training on visual acuity measurement was done for each of the class teachers. A total of 1,236 children <15 years of age were studied and analyzed. Slightly more females, 652 (52.8%), than males, 584 (47.2%), constituted the sample population giving a female/male ratio of 1.1:1. A total of 98 (7.93%) children had evidence of injury to the eye or its adnexa. Eyelid scar was the commonest (5.34%) followed by eyebrow scar (2.10%). Canthal scar was the next (0.32%). Two girls had monocular blindness from eye trauma (0.16%). One had leucoma, while the other had a dislocated lens. All the monocular blind children of this study were from the urban area. The home was the commonest environment for an eye injury (69.39%) followed by the school (20.41%). The farm was next in frequency (7.14%), especially among boys in the rural area. The church and the road/street constituted the remainder. Regarding persons causing the injury, the child’s playmate was the commonest (55.10%) followed by self (27.55%). Parents and guardians were the next (9.18%). These were injuries associated with corporal punishment. Corporal punishment-related eye injury, according to this study, appears to be common in the rural area and affects boys predominantly. Other human intermediary agents that cause an eye injury include passersby (2.04%), RTA (2.04%), 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
Covington, Matthew F.; Agan, Donna L.; Liu, Yang; Johnson, John O.; Shaw, David J.
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
James, Olutayo; Adeyemo, Wasiu L.; Emeka, Christian I.; Ogunlewe, Mobolanle O.; Ladeinde, Akinola L.; Butali, Azeez
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
Zhang, XiaoYu; Li, XianPing; Yue, HeJia; Li, PengLing; Liu, YaPing; Cao, Wei; Yao, DongMei; Liu, Li; Zhou, XiaoLan; Zheng, Rong; Bo, Tao
The emergence and spread of bacteria carrying the blaNDM-1 gene has become a worldwide concern. Here, we report eight cases of Klebsiella pneumoniae with blaNDM-1 in the neonatal ward of a teaching hospital in mainland China. Multilocus sequence typing showed that seven isolates were clonally related and confirmed them as sequence type 17 (ST17). One isolate belonged to ST433. These findings suggest continuous spread of blaNDM-1 in mainland China and emphasize the need for intensive surveillance and precautions. PMID:25941224
Tess, Anjala; Vidyarthi, Arpana; Yang, Julius; Myers, Jennifer S
Integrating the quality and safety mission of teaching hospitals and graduate medical education (GME) is a necessary step to provide the next generation of physicians with the knowledge, skills, and attitudes they need to participate in health system improvement. Although many teaching hospital and health system leaders have made substantial efforts to improve the quality of patient care, few have fully included residents and fellows, who deliver a large portion of that care, in their efforts. Despite expectations related to the engagement of these trainees in health care quality improvement and patient safety outlined by the Accreditation Council for Graduate Medical Education in the Clinical Learning Environment Review program, a structure for approaching this integration has not been described.In this article, the authors present a framework that they hope will assist teaching hospitals in integrating residents and fellows into their quality and safety efforts and in fostering a positive clinical learning environment for education and patient care. The authors define the six essential elements of this framework-organizational culture, teaching hospital-GME alignment, infrastructure, curricular resources, faculty development, and interprofessional collaboration. They then describe the organizational characteristics required for each element and offer concrete strategies to achieve integration. This framework is meant to be a starting point for the development of robust national models of infrastructure, alignment, and collaboration between GME and health care quality and safety leaders at teaching hospitals. PMID:26039138
Tette, Edem; Yawson, Alfred E.; Tettey, Yao
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 doctors to attend autopsy demonstrations and for pathologists to attend clinicopathological meetings in the hospital. PMID:24499743
Ossai, Okechukwu Paulinus; Dankoli, Raymond; Nwodo, Chimezie; Tukur, Dahiru; Nsubuga, Peter; Ogbuabor, Daniel; Ekwueme, Osaeloka; Abonyi, Godwin; Ezeanolue, Echezona; Nguku, Patrick; Nwagbo, Douglas; Idris, Suleiman; Eze, George
Introduction According to a study conducted in1989, Enugu State has an estimated urinary schistosomiasis prevalence of 79%. Recently, studies have implicated bacteriuria co-infection in bladder cancer. These bacteria accelerate the multi-stage process of bladder carcinogenesis. Knowledge about the prevalence of this co-infection is not available in Enugu and the information provided by the 1989 study is too old to be used for current decision making. Methods We carried out a cross-sectional survey of primary school children aged5-15years, who were randomly selected through a multi stage sampling method using guidelines recommended by WHO for schistosomiasis surveys. An interviewer administered questionnaire was used to collect data on demography, socioeconomic variables and clinical presentations. Urine samples were collected between 10.00am and 2.00pm. Each sample was divided into two: (A) for prevalence and intensity using syringe filtration technique and (B) for culture. Intensity was categorized as heavy (>50ova/10mls urine) and light (<50ova/10mls urine). Significant bacteriuria was bacteria count ? 105 colony forming units/ml of urine. Results Of the 842 pupils, 50.6% were females. The prevalence of urinary schistosomiasis was 34.1%. Infection rate was higher(52.8%) among 13-15 years(Prevalence Ratio = 2.45, 95% Confidence Interval 1.63-3.69). Heavy infections wad 62.7% and egg count/10mls urine ranged from 21-1138. Significant bacteriuria among pupils with urinary schistosomiasis was 53.7% compared to 3.6% in the uninfected(PR = 30.8,95% CI 18.91- 52.09). The commonest implicated organism was Escherchia coli. Conclusion We found high prevalence of bacteriuria co-infection among children with urinary schistosomiasis in Enugu State. This underscores the need for concurrent antibiotics administration and follow-up to avert later complications. PMID:25328634
Myers, Jennifer S; Nash, David B
The Accreditation Council for Graduate Medical Education recently announced its Clinical Learning Environment Review (CLER) program, which is designed to catalyze and promote the engagement of physician trainees in health care quality and patient safety activities that are essential to the delivery of high-quality patient care in U.S. teaching hospitals. In this Commentary, the authors argue that a strong organizational culture in quality improvement and patient safety is a necessary foundation for resident engagement in these areas. They describe residents' influence via their social networks on the behaviors and attitudes of peers and other health care providers and highlight this as a powerful driver for culture change in teaching hospitals. They also consider some of the potential unintended consequences of the CLER program and offer strategies to avoid them. The authors suggest that the CLER program provides an opportunity for health care and graduate medical education leaders to closely examine organizational quality and safety culture and the degree to which their residents are integrated in these efforts. They highlight the importance of developing collaborative interprofessional strategies to reach common goals to improve patient care. By sharpening the focus on patient safety, supervision, professionalism, patient care transitions, and the overall quality of health care delivery in the clinical learning environment during residents' formative training years, the hope is that the CLER program will inspire a new generation of physicians who possess and value these skills. PMID:25054414
Tetteh, Raymond A; Nartey, Edmund T; Lartey, Margaret; Mantel-Teeuwisse, Aukje K; Leufkens, Hubert G M; Nortey, Priscilla A; Dodoo, Alexander N O
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
Kooti, Sara; Motamedifar, Mohammad; Sarvari, Jamal
Background: The emergence of multidrug-resistant Acinetobacter baumannii complicates the therapy of the related infections. Hospital isolates of A. baumannii are usually multidrug-resistant. The problem is compounded by increasing resistance to broad-spectrum antibiotics including carbapenems. Objectives: The aim of this study was to determine antimicrobial susceptibility patterns and distribution of blaOXA-type carbapenemases genes among A. baumannii isolates from hospitalized patients in Shiraz, Southwest Iran. Materials and Methods: Two hundred A. baumannii isolates were recovered from different clinical specimens in four Shiraz teaching hospitals. Isolates were detected as A. baumannii by Microgen kit and PCR with specific primers of blaOXA-51-like gene. Antimicrobial susceptibility testing was determined by disk diffusion method for all the isolates. Multiplex PCR assays were performed for detection of blaOXA-23-like, blaOXA-24-like and blaOXA-58-like genes. Results: All the isolates were susceptible to colistin and polymyxin B. Moreover, all of them were resistant to piperacillin, piperacillin-tazobactam, ampicillin, ceftazidime, cefoxitin and aztreonam. Eighty (40%) isolates had positive results for blaOXA-23-like, 14 (7%) for blaOXA-24-like and 1 (0.5%) isolate for blaOXA-58-like. The co-existence of studied genes was detected for blaOXA-23-like plus blaOXA-24-like in nine (4.5%) isolates. Conclusions: The prevalence of carbapenem resistant A. baumannii isolates in Shiraz hospitals is high. The blaOXA-23-like gene was the most frequent carbapenemase identified among resistant A. baumannii isolated in Shiraz hospitals. The increasing incidence of A. baumannii is a serious concern, therefore control of this pathogen and taking preventive measures are emphasized. PMID:26464764
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
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
Datta, Supratim; Sengupta, Shramana
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.
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Ugwu, Emmanuel O; Odoh, Godwin U; Obi, Samuel N; Ezugwu, Frank O
Background Male factor infertility presents one of the greatest challenges with respect to infertility treatment in Africa. Artificial insemination by donor semen (AID) is a cost-effective option for infertile couples, but its practice may be influenced by sociocultural considerations. The purpose of this study was to determine the awareness and acceptability of AID among infertile couples in Enugu, southeastern Nigeria, and identify the sociocultural factors associated with its practices. Methods Questionnaires were administered to a cross-section of 200 consecutive infertile couples accessing care at the infertility clinics of two tertiary health institutions in Enugu, Nigeria, between April 1, 2012 and January 31, 2013. Results Among the 384 respondents, the level of awareness and acceptability of AID were 46.6% (179/384) and 43% (77/179), respectively. The acceptability rate was significantly higher among female respondents, women with primary infertility, and those whose infertility had lasted for 5 years and beyond (P<0.05). The major reasons for nonacceptance of AID were religious conviction (34.7%, n=33), cultural concern (17.9%, n=17), fear of contracting an infection (17.9%, n=17), and fear of possibility of failure of the procedure (12.6%, n=12). Conclusion Health education and public enlightenment are advocated to increase awareness and dispel the current misconceptions about AID in our environment. PMID:24611022
Nkwo, Peter O; Lawani, Lucky O; Ubesie, Agozie C; Onodugo, Vincent A; Obu, Herbert A; Chinawa, Josephat M
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
Giri, Purushottam A.; Singh, Kailash K.; Phalke, Deepak B.
Background: Esophageal cancer has a peculiar geographical distribution and shows marked differences in incidence within a particular geographical region. Presently, as there seems little prospect of early detection of this cancer, an understanding of the etiological factors may suggest opportunities for its primary prevention. Objectives: The present study was carried out to find out the socio-demographic determinants of esophageal cancer in a tertiary care teaching hospital of western Maharashtra, India. Materials and Methods: A retrospective hospital record-based study was carried out for the period of five years (2007-2011) in the department of Radiotherapy of Pravara Rural Hospital, Loni, western Maharashtra, India. A total of 5879 patients were diagnosed with cancer, of them, 207 (3.52%) patients had esophageal cancer. Data was collected on the basis of the patients’ record in the hospital and analyzed in the form of percentage and proportions whenever appropriate. Results: Out of total 5879 patients who were diagnosed with cancer during the five studied years, 207 (3.52%) patients had esophageal cancer, of which 121 (58.46%) were males and 86 (41.54%) were females, which show predominance of males over females. Most of the patients (28.50%) belonged to lower class, while only 9.66% were from upper class. Majority of the patients (54.14%) had a history of tobacco chewing, followed by smoking (cigarette, bidi, or both) in 36.94% and alcohol in 21.65%. Conclusion: The present study shows that esophageal cancer constitutes 3.52% of cancer cases. There is a need to screen the high-risk group of people, improve socio-economic status, and efforts must be made to introduce a set of preventive measures that have the potential to significantly reduce the burden of disease and to help bridge the gap between research and public awareness. PMID:24665448
english to children in school setting; 1 year contracts. No application fees. Excellent salary, furnishedOPPORTUNITIES IN HOTELS-HOSPITALITY, SUMMER CAMP, TEACHING, AU PAIR, CHILDCARE, HOMECARE & MORE ------------------------------------------------------------------------------ 1. Summer Tutoring English in Italy and Spain Job Location: Locations across Italy and Spain Job
Tan, Kar Way; Shankararaman, Venky
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%…
... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM SERVICES FURNISHED... this section and apportioned to program beneficiaries as provided by paragraph (g) of this section. (4... to the hospital by CMS under the Medicare program provided that the costs would be payable...
Alqurashi, Maher Sulaiman M.
in Escherichia coli and Klebsiella pneumoniae. CTX-M type has been associated with many outbreaks of infections both in the hospitals and community. CTX-M-15 is now identified as the most predominantly distributed CTX-M enzyme. Clonal outbreaks of CTX-M-15...
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
Background Gastrointestinal and urinary tract pathogenic infections are aggravating the incidence and progression of the Human Immunodeficiency Virus (HIV) infection into Acquired Immune Deficiency Syndrome (AIDS) more especially in the developing countries. This study was conducted to assess the common gastrointestinal and urinary infections among HIV/AIDS patients at the Komfo Anokye Teaching Hospital (KATH) in Ghana between April and December 2008. Findings This work reports on gastrointestinal and urinary tract pathogenic infections among 500 HIV seropositive and 300 HIV seronegative patients. There was a 35% (175/500) prevalence of intestinal parasites among HIV seropositive patients compared to 4.3% (13/300) in HIV seronegative patients. Giardia lamblia and Cryptosporidium accounted for 19% (95/500) and 14% (70/500) respectively, while Schistosoma mansoni, Strongyloides stercoralis and hookworm together accounted for 2% (10/500) of intestinal parasitic infections among the HIV seropositive patients. There was no significant difference (p?>?0.05) in urinary parasitic infection between HIV seropositive 1% (2/500) and seronegative patients 0.7% (2/300). Most, 60 (86%) out of 70, of the urinary tract infection among the HIV seropositive patients was due to bacteria with E. coli being the most predominant isolate, 28 (47%) out of 60. There was no significant difference in infections based on age and gender. Conclusion G. lamblia and Cryptosporidium were the most common gastrointestinal parasites detected while bacteria accounted for majority of the urinary tract infections among the HIV seropositive patients at the hospital. PMID:22909315
Nippak, Pria Md; Veracion, Julius Isidro; Muia, Maria; Ikeda-Douglas, Candace J; Isaac, Winston W
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
Peterside, Oliemen; Pondei, Kemebradikumo; Akinbami, Felix O
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
Chah, Jane M; Dimelu, Mebel U; Ukwuani, Stella U
A study on the institutional and production characteristics of pig farming in Enugu State, Nigeria, was conducted using 80 randomly selected smallholder pig producers. Data were collected by using an interview schedule. Descriptive statistics were used to analyze data. The mean number of pigs owned by smallholder producer was 18. Only 20.0 and 6.3 % of the producers had access to credit and to extension services, respectively. Ninety percent of the respondents practiced intensive management system. The major housing type used by producers was cement brick walls with aluminum roofing sheets (97.6 %). The majority (80 %) of producers reared mostly crossbred pigs and family labor (68.7 %) was most prevalent. Fourteen (50 %) of the 28 routine management practices were always performed by the pig producers. Extension service providers should intensify efforts to provide producers with appropriate management practices and training for effective disease control and improve productivity. PMID:24906223
Dufresne, Francois; Simmons, Bonnie; Vlachostergios, Panagiotis J.; Fleischner, Zachary; Joudeh, Ramsey; Blakeway, Jill
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 with their chief complaint. Substantial practicality issues must be addressed to implement EM clinically in a hospital, however. PMID:26035025
beds in the hospital and the two largest Departments are Pediatrics and Maternity. The biggest "killer" disease in The Gambia is malaria, with young children and pregnant women being particularly vulnerable to this disease. Diabetes, high blood...,281 Children admitted to Pediatrics 9,352 Patients treated in the Eye Center 986 Out-Patient Appointments over 184,365 Out-Patients in the ER 24,334 Table 1: Number of patients seen at RVTH in 2008 7 Unfortunately, RVTH does not have any EMR system...
Banerjee, Indraneel; Teli, Ramdayal; Agarwal, Neeraj; Vyas, Nachiket; Priyadarshi, Shivam; Yadav, Shersingh; Tomar, Vinay
Introduction A substantial number of urology admissions constitute of emergency cases and sizeable proportion are urology emergency referral cases. There have been few studies conducted on this aspect but there lie geographical variations in the presentations of urological emergencies. Hence, this study was conducted to analyse various urological emergency presentations and their interventions. Objective To estimate the proportion of urological emergencies and analyse the different type of urological emergencies with the required management. Materials and Methods A hospital based observational descriptive study was undertaken in our institution over a period of one year. Results A total of 11,139 cases were admitted in the urology department; of which a significant percentage (21.05%) was from emergency room. Majority of cross references came from the Department of Medicine (22.59 %). Renal colic (24.2%) happened to be the most common presentation in emergency room followed by acute urinary retention (14.7%). Among referred cases, hematuria was the leading presentation with 17.75% followed by traumatic catheterization (11.97%). Most common urological intervention in referred cases was supra pubic catheterization (27.20%) while it was percutaneous nephrostomy (32.78%) in directly admitted cases. Conclusion Urological emergencies constitute a significant proportion of total urology admissions (27.18%). The most common non-traumatic injury was renal colic whereas traumatic was traumatic catheterization in our study. Most common surgical intervention in direct admitted emergency cases was percutaneous nephrostomy whereassuprapubic catheterization in within hospital emergency referral cases. PMID:26675409
Alshaikh, Mashael; Mayet, Ahmed; Adam, Mansour; Ahmed, Yusuf; Aljadhey, Hisham
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
Ilechukwu, GC; Ilechukwu, CGA; Ubesie, AC; Onyire, NB; Emechebe, G; Eze, JC
Background: Intestinal helminthiasis is associated with malnutrition in children. Aim: The objective of this study was to determine the intensity and effect of the common intestinal helminths on the nutritional status of children in Enugu, Nigeria. Subjects and Methods: A cross-sectional study of 460 children conducted in Enugu metropolis, south-east Nigeria between August and September 2003. Their stools were analyzed at the research laboratory of the Federal Ministry of Health, National Arbovirus and Vector Research Center, Enugu. The intensity of the common intestinal helminths was determined using the standard Kato-Katz method of fresh stool samples. The classification intensity of helminthic infestation was according to the World Health Organization classification. Data were analyzed using Statistical Software for Social Sciences version 11.0 (Chicago IL, USA). P < 0.05 was regarded as statistically significant. Results: 452 of 460 children (98.3%) had normal height for age, weight for age and weight for height Z-scores. Six of the 460 children (1.3% were wasted), 1/460 stunted (0.2%) and 1/460 wasted and stunted (0.2%). 150 out of 460 (32.6%) studied were infected with helminths. There was no significant relationship between the intensity of helminth infection and the nutritional status of the children. Conclusion: Although the prevalence of helminthiasis in children in Enugu was high, intensity of helminthiasis in these children was mainly mild. Hence, majority of them had normal weight and height measurements for age and sex. PMID:25184077
Iyoke, Chukwuemeka Anthony; Lawani, Lucky Osaheni; Ugwu, George Onyemaechi; Ajah, Leonard Ogbonna; Ezugwu, Euzebus Chinonye; Onah, Paul; Onwuka, Chidinma Ifechi
Background Interdisciplinary team working could facilitate the efficient provision and coordination of increasingly diverse health services, thereby improving the quality of patient care. The purpose of this study was to describe knowledge of interdisciplinary team working among obstetricians and gynecologists in two teaching hospitals in South East Nigeria and to determine their attitude toward an interdisciplinary collaborative approach to patient care in these institutions. Methods This was a questionnaire-based cross-sectional study. Data analysis involved descriptive statistics and was carried out using Statistical Package for the Social Sciences software version 17.0 for Windows. Results In total, 116 doctors participated in the study. The mean age of the respondents was 31.9±7.0 (range 22–51) years. Approximately 74% of respondents were aware of the concept of interdisciplinary team working. Approximately 15% of respondents who were aware of the concept of interdisciplinary team working had very good knowledge of it; 52% had good knowledge and 33% had poor knowledge. Twenty-nine percent of knowledgeable respondents reported ever receiving formal teaching/training on interdisciplinary team working in the course of their professional development. About 78% of those aware of team working believed that interdisciplinary teams would be useful in obstetrics and gynecology practice in Nigeria, with 89% stating that it would be very useful. Approximately 77% of those aware of team working would support establishment and implementation of interdisciplinary teams at their centers. Conclusion There was a high degree of knowledge of the concept and a positive attitude toward interdisciplinary team working among obstetricians and gynecologists in the study centers. This suggests that the attitude of physicians may not be an impediment to implementation of a collaborative interdisciplinary approach to clinical care in the study centers. PMID:26064058
Qidwai, Waris; Samani, Zahra Aziz; Azam, Iqbal; Lalani, Saima
Objective To determine the knowledge, attitude and practices regarding the use of vitamin supplements among patients visiting Out-Patient clinics of a teaching hospital. Methods Four hundred patients were interviewed during the period of July to September 2008, at the Out-patient clinics, Aga Khan University hospital, Karachi. A pre-tested and structured questionnaire was used to collect information. It consisted of questions regarding demographics, awareness of vitamin supplements and its consumption, reasons for usage and its effects. The purpose of the study was explained and assurance of confidentiality was given. After obtaining written consent, eligible individuals were interviewed. Statistical Package for the Social Sciences version 19.0 was used to analyze the data. Results The results revealed that 98% of the respondents were aware of vitamin supplements. The most known vitamin was found to be Vitamin C (16.9%) with Vitamin K being the least well-known (0.4%); while 51.8% of the respondents were unaware of the harmful effects of vitamin supplements. The results also showed that 84.8% of the study population had taken vitamin supplements, and 79% of the participants considered that vitamin supplements to be helpful. Taking vitamin supplements as a compensation for the deficiencies in the body was the most frequently chosen answer (17.7%) as the reason for use of vitamin supplements. On the other hand, a majority of the population was unaware of the indications for use of vitamin supplements. Conclusion This study highlights a very significant yet ignored issue of vitamin supplementation in Pakistan. A need exists to inform the general population about the use of vitamin supplementation. The media and the medical community are required to play their role in this regard. Short/ refresher training courses are needed for doctors to update and disseminate adequate knowledge of vitamin supplementation to their patients. PMID:22496935
McIndoe, A K; Underwood, S M
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
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 statistically significant (p?=?0.011). Mortality rate was 11.2% and was significantly associated with co-morbidities, delayed presentation and presence of complications (p?0.001). The follow up of patients was poor. Conclusions Cut throat injuries are a major cause of morbidity and mortality among young adult males in our setting. Addressing the root causes of violence such as poverty, unemployment, and substance abuse will reduce the incidence of these injuries in our environment. PMID:24423426
Tade, A O; Salami, B A; Musa, A A; Adeniji, A O
The objective of this study was to determine prospectively the prevalence of anal complaints amongst Nigerians attending the General Out-patient Department (GOPD) of the hospital and review the records of those admitted to the surgical service with related complications. All the 272 patients attending the GOPD of OOUTH in November, 1999 were interviewed using a structured questionnaire. Information concerning age, sex, educational status, present or past history of at least one of the following symptoms viz recurrent bleeding per rectum, anal prolapse, anal/perianal pain, pruritus ani and anal discharge were obtained. Also obtained were reason(s) for current hospital attendance and any previous medical consultation. Those with at least one of the symptoms were classified as symptomatic. The symptomatic group had rectal examination including proctoscopy. The results showed that 82/272 (30.15% ) were symptomatic. Rectal examination on these 82 patients showed that 10(3.7% of 272) had haemorrhoids, 2(0.7% ) had rectal prolapse, 0.7% had peri-anal warts; 15(5.5% ) anal tags, 10(3.7% ) chronic anal fissure, 2 (0.7% ) perianal fistulae. In 29(10.4% ), the examination was normal and in 12 the rectum was too loaded with feaces to permit proctoscopy. However, only 5/272 (1.84% ) attended the clinic for the anal complaint, while 12(4.4% ) had previously consulted a physician for same. Fear of impotence following surgery in 24 males and belief in herbal remedies in 32 patients were the main reasons for not consulting a physician. During the year 1999, out of a total of 558 admissions into our surgical service, only 4(0.6% ) were for complications related to anal complaints. This study indicated the prevalence of anal complaints in the study population of Nigerians as 30.15% , haemorrhoids constitute 3.7% and anal fissure 3.7% , contrary to low rates reported for developing countries. While this result cannot be extended to represent prevalence amongst Nigerians, it may be a pointer to what is to be expected. PMID:15505655
Palaniappan, Muthiah; George, Melvin; Subramaniyan, Ganesan; Dkhar, Steven Aibor; Pillai, Ajith Ananthakrishna; Jayaraman, Balachander; Chandrasekaran, Adithan
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 enalapril (17.5%), atorvastatin (14.9%), aspirin (8.4%) and metoprolol (8.4%). Conclusion The cardiovascular drug related adverse effects constituted 18.1% of the total ADRs reported during the study period. Cough, gastritis, fatigue and myalgia by enalapril, aspirin, ?-blockers and atorvastatin respectively were found to be the most commonly reported ADRs among the cardiovascular drugs. PMID:26675485
Obisesan, Oluranti J; Olowe, Olugbenga A; Taiwo, Samuel S
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
Patro, Nibedita; Panda, Maitreyee; Dash, Mrutyunjay
Background: Acne vulgaris is a common disease of the skin affecting the socially vulnerable young age group. There are multitudes of treatment options available but till now no studies have been reported to demonstrate the current prescribing pattern of drugs in acne vulgaris. Aim: To study the prescribing pattern of drugs in acne in a tertiary care teaching hospital in Odisha, India. Materials and Methods: The study was an observational study conducted for a period of one year on patients more than 10 yeras age and having acne attending the Skin & VD OPD. Drug induced acne and acneiform eruptions were excluded. Results: A total of 1210 prescriptions of acne were analysed. The male to female ratio was 1:1.29. Most patients presented with grade 2 (60%) acne followed by grade 3 (20.99%). Out of prescribed drugs, 47.44% were oral and 52.56% were topical formulations. Oral isotretinoin (68.10%) was the most frequently prescribed drug among oral formulations. Doxycycline (54.18%) was the most preferable oral antibiotic. The average number of drugs per prescription was 3.003. Polypharmacy was preferred over monotherapy. Conclusion: In the management of acne, judicious and early intervention with oral isotretinoin improves the overall treatment outcome, the fact which has increased its use in acne patients. PMID:25954687
Pimpalkhute, Sonali A.; Bajait, Chaitali S.; Dakhale, Ganesh N.; Sontakke, Smita D.; Jaiswal, Kavita M.; Kinge, Parag
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.
Obisesan, Oluranti J.; Olowe, Olugbenga A.; Taiwo, Samuel S.
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
Boretti, Vanessa Stolf; Corrêa, Renata Nunes; dos Santos, Silvana Soléo Ferreira; Leão, Mariella Vieira Pereira; Silva, Célia Regina Gonçalves e
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
Chomba, Elwyn; Murray, Laura; Kautzman, Michele; Haworth, Alan; Kasese-Bota, Mwaba; Kankasa, Chipepo; Mwansa, Kaunda; Amaya, Mia; Thea, Don; Semrau, Katherine
Objective. To improve care of sexually abused children by establishment of a “One Stop Centre” at the University Teaching Hospital. Methodology. Prior to opening of the One Stop Centre, a management team comprising of clinical departmental heads and a technical group of professionals (health workers, police, psychosocial counselors lawyers and media) were put in place. The team evaluated and identified gaps and weaknesses on the management of sexually abused children prevailing in Zambia. A manual was produced which would be used to train all professionals manning a One Stop Centre. A team of consultants from abroad were identified to offer need based training activities and a database was developed. Results. A multidisciplinary team comprising of health workers, police and psychosocial counselors now man the centre. The centre is assisted by lawyers as and when required. UTH is offering training to other areas of the country to establish similar services by using a Trainer of Trainers model. A comprehensive database has been established for Lusaka province. Conclusion. For establishment of a One Stop Centre, there needs to be a core group comprising of managers as well as a technical team committed to the management and protection of sexually abused children. PMID:20706671
Wilson, Nana O.; Ceesay, Fatou K.; Hibbert, Jacqueline M.; Driss, Adel; Obed, Samuel A.; Adjei, Andrew A.; Gyasi, Richard K.; Anderson, Winston A.; Stiles, Jonathan K.
Pregnancy in sickle cell disease (SCD) patients is associated with increased risk of maternal and fetal mortality. This study determines pregnancy outcomes among women with SCD delivering at Korle-Bu Teaching Hospital, Accra, Ghana. Nine hundred sixty (960) medical records of pregnant women (131 HbSS, 112 HbSC, and 717 comparison group) from 2007 to 2008 were reviewed. The HbSS women were at increased risk of eclampsia (adjusted odds ratio [AOR] = 10.56, 95% confidence interval [CI] = 3.60–30.96, P < 0.001), intrauterine growth restriction (AOR = 4.00, 95% CI = 1.38–11.64, P = 0.011), and placenta previa (AOR = 22.03, 95% CI = 9.87–49.14, P < 0.001) compared with the comparison group. The HbSC women had increased risk for intrauterine fetal death (AOR = 3.38, 95% CI = 1.15–9.96, P = 0.027) and decreased risk of delivering low birth weight babies (AOR = 0.21, 95% CI = 0.06–0.73, P = 0.014). Women with SCD in Ghana are at a greater risk of morbidity and mortality in pregnancy compared with women without hemoglobinopathies. Improved maternal and fetal outcomes in Ghanaian women with SCD can be achieved through effective intervention by health care providers with thorough knowledge about predisposing factors toward adverse outcomes. PMID:22665597
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
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
Saghaeiannejad-Isfahani, Sakineh; Jahanbakhsh, Maryam; Habibi, Mahboobeh; Mirzaeian, Razieh; Nasirian, Mansoreh; Rad, Javad Sharifi
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
Liu, Helu; Lü, Dongyue; Liang, Hong; Dou, Yuhong
The multidrug-resistant rate of Klebsiella pneumoniae has risen rapidly worldwide. To better understand the multidrug resistance situation and molecular characterization of Klebsiella pneumoniae, a total of 153 Klebsiella pneumoniae isolates were collected, and drug susceptibility test was performed to detect its susceptibility patterns to 13 kinds of antibiotics. Phenotypic tests for carbapenemases ESBLs and AmpC enzyme-producing strains were performed to detect the resistance phenotype of the isolates. Then PCR amplification and sequencing analysis were performed for the drug resistance determinants. The results showed that 63 strains harbored blaCTX-M gene, and 14 strains harbored blaDHA gene. Moreover, there were 5 strains carrying blaKPC gene, among which 4 strains carried blaCTX-M, blaDHA and blaKPC genes, and these 4 strains were also resistant to imipenem. Our data indicated that drug-resistant Klebsiella pneumoniae were highly prevalent in the hospital. Thus it is warranted that surveillance of epidemiology of those resistant isolates should be a cause for concern, and appropriate drugs should be chosen. PMID:24740167
Chang, Yaowen; Luan, Guangxin; Xu, Ying; Wang, Yanhong; Shen, Min; Zhang, Chi; Zheng, Wei; Huang, Jinwei; Yang, Jingni; Jia, Xu; Ling, Baodong
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
Dhabaan, Ghulam N; AbuBakar, Sazaly; Shorman, M A; Hassan, Hamimah
The In vitro susceptibility of clinical and environmental isolates of Acinetobacter baumannii to tigecycline and other antibiotics was determined by disk diffusion method. The E-test was used to determine the minimum inhibitory concentration (MIC). The growth curves of tigecycline treated environmental and clinical strains were established. Fifty-seven percent and 75% of the clinical and environmental isolates were MDR strains, respectively. Ninety-five percent of the clinical isolates were susceptible to tigecycline and 5% showed intermediate resistance with MIC ranging between 0.032 and 3 mg/l. Tigecycline susceptible and intermediate resistance among the environmental isolates were 40% and 60%, respectively, with a significantly lower MIC range of 0.5-4 mg/l. The bacterial growth curves demonstrated the higher ability of the environmental strains to tolerate the antibiotic effects than the clinical strains. The relatively high resistance profile among the environmental isolate suggests an insidious emergence of tigecycline resistance amongst A. baumannii. Strict infection control procedures are imperative to prevent the dissemination of tigecycline-resistant A. baumannii strains in the hospital environment. PMID:22546763
Tavakoli-Ardakani, Maria; Ghassemi, Samaneh; Alizadeh, Afshin Mohammad; Salamzadeh, Jamshid; Ghadiani, Mojtaba; Ghassemi, Sara
In order to investigate the effect of pharmacist intervention on vancomycin use, this study was performed on all patients receiving vancomycin in the intensive care unit (ICU) and hematology-oncology ward of Taleghani Educational Hospital in Tehran, Iran. Vancomycin use was assessed during a pre- and post-intervention period in accordance with the Center of Disease Control and prevention (CDC) and Infectious Diseases Society of America (IDSA) guidelines. Following the intervention, there was a significant change in appropriate initiation of vancomycin (P = 0.009) and no significant improvement was observed in adequate dosage and the duration of therapy (P = 0.15 and P = 0.54 respectively); however, informing the physician resulted in discontinuation of the drug in 50% of inappropriate cases and vancomycin dosage was adjustedin 31% of cases. Temperature charts, culture results and pre-treatment CBC tests changed significantly (P = 0.02, P = 0.009 and P = 0.04 respectively). The rate of infusion related adverse drug reactions did not decrease significantly (P = 0.06); yet in 100% of patients, these reactions were resolved after notifying the nursing team. After pharmacist intervention,vancomycin use improved in some aspects. A significant improvement in appropriate initiation of therapy was observed; however, treatments continued despite negative cultures. It is necessary to optimize the use of vancomycin by performing more educational interventions. PMID:26664398
Gamarra, Soledad; Morano, Susana; Dudiuk, Catiana; Mancilla, Estefanía; Nardin, María Elena; de Los Angeles Méndez, Emilce; Garcia-Effron, Guillermo
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
Mutai, John Kiprop; Vinayak, Sudhir; Stones, William; Hacking, Nigel; Mariara, Charles
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
Chawla, Jaya; Arora, D.; Paul, Mohini; Ajmani, Sangita N.
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
Hoffmeister, Louíse Viecili; de Moura, Gisela Maria Schebella Souto
OBJECTIVE: to evaluate the use of identification wristbands among patients hospitalized in inpatient units. METHOD: quantitative, descriptive and transversal research, with a sample of 385 patients. Data collection occurred through the observational method through the filling out of a structured questionnaire which aimed to check the presence of the identification wristband and the identifiers used. Descriptive statistics with absolute and relative frequencies was used for analysis. RESULTS: it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands. CONCLUSION: the study demonstrated the professionals' engagement in the process of patient identification, evidencing a high rate of conformity of the wristbands. Furthermore, it contributed to identify elements in the use of wristbands which may be improved for a safe identification process. PMID:25806629
Ogunrinde, Tunde Joshua; Opeodu, Olanrewaju Ige
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
Ajuwon, Grace Ada
Background The internet is an important source of up-to-date medical information. Although several studies in different countries have explored the extent to which health science students use the computer and the internet, few researches are available on this subject in Nigeria. The aim of this study was to assess the uptake of computer and internet by health science students studying in the country. Methods One hundred and eighty three first year medical and nursing students of the University College Hospital, Ibadan, Nigeria, completed a-25 item questionnaire during routine Library Orientation Program in the medical library. The EPI-Info software was used for data analysis. Results The mean ages for medical students and the student nurses were 22 and 24.6 years respectively. Overall, 42.6% of the entire sample could use the computer, 57.4% could not. While more than half (58%) of the medical students are computer literate, majority (75.9%) of the student nurses are not. Slightly more than two thirds (60.7%) of the entire students had ever used the internet, 33. 9% had not. E-mail was the most popular of internet services used by the students (76.4%) and the cyber café was the common place where students had accessed these services. The students' mean scores on a 15-point perceived self-efficacy scale for internet-related tasks was 3.8 for medical and 0.7 for nursing students (p = 0.00). Students who are computer literate had superior mean scores (4.8) than those without (0.6) (p = 0.000). Conclusion First year clinical and nursing students in Ibadan Nigeria have not fully utilised the opportunity that the use of computer and internet offer for medical education. Improved efforts such as inclusion of computer education in medical and nursing curricular and establishment of computer laboratories are required to increase the student's access to computers and internet. PMID:14498997
Mai-Phan, Tuong A; Patel, Bijendra; Walsh, Michael; Abraham, Ajit T; Kocher, Hemant M
Background Emergency admissions may account for over 50% of surgical admissions. The impact on service provision and implications for training are difficult to quantify. We performed a cohort study to analyse these workload patterns. Methods Data on emergency room (ER) surgical admissions over six months was collected including patient demographics, referral sources, diagnosis, operation and length of stay and analysed according to sub-speciality and age-groups. Results There were 1392 (median age 41 (IQR 28–60) years, M:F = 1.7:1) emergency surgical admissions over six months; 45% were under 40 years of age and 48% patients self-referred to the ER. The commonest diagnoses were abscesses (11%), non-specific abdominal pain (9.7%) and neuro-trauma (9.6%). The median length of stay was 4 (IQR 2–8) days; with older (>80 years) patient staying significantly longer than those <40 years of age (median 8 vs 2 two days, P < 0.0001, Kruskal-Wallis test). Vascular patients remained in hospital longer than trauma or general surgery patients (median 14 vs 3 days, P < 0.0001, Kruskal-Wallis test). A high proportion (43.5%) of the patients required operative intervention and service implications of various diagnoses and operative interventions are highlighted. Conclusion With the introduction of shortened training period in Europe and World over, trainees may benefit from increased exposure to trauma and surgical emergencies. Resource planning should be based on more comprehensive, prospective data such as these. PMID:18513422
Akaji, EA; Ashiwaju, MO
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
Ikpeme, Ikpeme A; Oku, Enembe O; Ngim, Ngim E; Abang, Innocent E; Udosen, Anthony M
Introduction: The global burden of road traffic injury (RTI)-related trauma is enormous and has the highest impact in low income economies. Loss of lives in the most productive age groups and the socio-economic costs to these weak economies, coupled with poor infrastructure for management of the severely injured dictate that well executed preventive measures be instituted in these countries. Low and middle income economies account for 90% RTI-related deaths in the world, yet in these regions, public health regulations on road safety hardly exist and where they do, are hardly enforced. Aim: To document variations in injury frequency, severity and outcomes following the ban on the use of motorcycles as a means of public transportation in Calabar. Patients and Methods: A prospective study of RTI patients who presented in our Emergency center over a 12 month period. Information recorded included biodata, anatomic location of injury, injury-arrival time, mode of transportation to hospital and final disposition at discharge. Chest injuries were excluded as there were no data for comparison. Results were analyzed by SPSS version 20 and compared with the 2005 Trauma Study Group results. Results: There were 366 road traffic injuries out of 5612 emergency room presentations during the period. There were 237 males and 99 females (M: F= 2.4: 1), mean age of patients was 30.13±12.62 years. Businessmen were the most commonly involved occupational group (n= 138; 38.7%) and the mean injury-arrival interval was 16.57±56.14 hours. Only 12 (3.6%) patients arrived by ambulance and 108 (32.1%) left against medical advice. Conclusion: RTIs constitute a major socioeconomic burden in the developing world. Lack of research, high risk behaviors and lack of enforceable road use regulations contribute to high rates of RTI-related mortality and morbidity. Preventive interventions and appropriate research to identify risk factors will reduce the burden of RTIs in low and middle income economies. PMID:24273697
The massive earthquake that rocked Southern California on January 17 left area hospitals facing both an influx of patients and heavily damaged facilities. Several hospitals were forced to shut down temporarily, although in most cases not before quake victims were triaged and other patients were safely transferred to other facilities. With damage totals still being calculated and repair projects just under way, several hospitals already are evaluating their response to the quake in an effort to be even more prepared should another disaster of that magnitude occur. This special report will provide an overview of the damages suffered by several hospitals; describe the role played by administrators and staff--particularly the security department--in the aftermath of the quake; and offer advice from hospital officials on how to best prepare for an earthquake or another natural disaster and how to function most effectively in the aftermath. PMID:10135868
Background Bloodstream infections in neonates and infants are life-threatening emergencies. Identification of the common bacteria causing such infections and their susceptibility patterns will provide necessary information for timely intervention. This study is aimed at determining the susceptibilities of bacterial etiological agents to commonly-used antimicrobial agents for empirical treatment of suspected bacterial septicaemia in children. Methods This is a hospital based retrospective analysis of blood cultures from infants to children up to 14 years of age with preliminary diagnosis of sepsis and admitted to the Neonatal Intensive Care Unit (NICU) and Paediatric Wards of the Teaching Hospital Tamale from July 2011 to January 2012. Results Out of 331 blood specimens cultured, the prevalence of confirmed bacterial sepsis was 25.9% (86/331). Point prevalence for confirmed cases from NICU was 44.4% (28/63) and 21.6% (58/268) from the Paediatric ward. Gram positive cocci (GPC) were the predominant isolates with Coagulase positive (32.2%) and Coagulase-negative (28.7%) Staphylococci accounting for 60.9% of the total isolates. Gram negative rods (GNR) comprised 39.1% of all isolates with Klebsiella, E.coli and Salmonella being the most common organisms isolated. Klebsiella was the most frequent GNR from the NICU and Salmonella typhi was predominantly isolated from the paediatric ward. Acinetobacter showed 100.0% susceptibility to Ceftriaxone and Cefotaxime but was resistant (100.0%) to Ampicillin, Tetracycline and Cotrimoxazole. Escherichia coli and Klebsiella were 80.0% and 91.0% susceptible to Ceftriaxone and Cefotaxime respectively. Klebsiella species showed 8.3% susceptibility to Tetracycline but was resistant to Ampicillin and Cotrimoxazole. Escherichia coli showed 40.0% susceptibility to Ampicillin, Chloramphenicol and Cotrimoxazole; 20.0% susceptibility to Tetracycline and 80.0% susceptible to Gentamicin and Cefuroxime. Coagulase negative Staphylococci was susceptible to Gentamicin (72.0%) but Coagulase positive Staphylococci showed intermediate sensitivity to Gentamicin (42.9%). Conclusion Coagulase Negative, Coagulase Positive Staphylococci, Salmonella and Klebsiella were the aetiological agents of bloodstream infection among children at TTH. While gram-positive and gram-negative bacteria showed low susceptibility to Ampicillin, Tetracycline and Cotrimoxazole, the GNR were susceptible to Gentamicin and third-generation cephalosporins. PMID:23419199
Khan, Farhan Ahmad; Singh, Vinod Kumar; Sharma, Sanjeev; Singh, Preeti
Introduction: As we know, some of the species of animals are endangered, as there is an increase in their declining rate and a decrease in their survival rate. The same is true for the antibiotics also, as there is a rise in the antimicrobial resistance and a decline in the development of new antibiotics. Antimicrobial Resistance (AMR) has become a major obstacle in the way of the treatment of infectious diseases worldwide. Therefore, to fight against AMR, antibiotic utilisation studies are being carried out. Therefore, with the same perspective, this prospective study was done to evaluate the current usage of the anti-microbial agents in medicine department of a teaching hospital in northern India. Methods: This was a prospective study which was done for a period of three months from Nov 2012 – Jan 2013. The prescriptions and the patient records are reviewed and analysed. The rationality of the drug usage was also evaluated by analysing the drug prescriptions. Results: Out of the 494 drugs which were prescribed to 180 patients, 291 were antibiotics. The most commonly used AMAs were the ?-lactams (penicillins and cephalosporins) –n = 102, followed by the quinolones –n = 93, Nitroimidazoles –n = 43, aminoglycosides –n = 35 and the macrolides –n = 18. The most common indication for the antimicrobial therapy was infection. According to the evaluation, the use of the antimicrobial therapy was found to be rational in 77.77 per cent patients. The average number of antibacterial agents which were prescribed per patient per course was found to be 1.61 and the average numbers of drugs which were prescribed per patient were 2.74.The average cost per prescription per day was Rs.115 and the average antibiotic cost per encounter was Rs. 85. Conclusion: Antibiotic resistance is increasing at an alarming rate due to the irrational prescribing habits of physicians, leading to increasing morbidity, mortality and treatment costs. Therefore, the medical professionals as well as government personnel who are related to the health sector, need to understand that antibiotics are precious and finite resources. The remedy of this situation requires that regular educational awareness programmes should be conducted in hospitals at a regular basis. PMID:23998062
Akpan-Idiok, Paulina Ackley; Anarado, Agnes Nonye
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
Altenburg, J; Wortel, K; van der Werf, T S; Boersma, W G
This review article describes the epidemiology, clinical presentation, diagnostic workup and treatment options in adult non-cystic fibrosis (non-CF) bronchiectasis (widening of mainly small and medium-sized bronchi as seen on chest computed tomography (CT) scan). We illustrate evidence from the literature with our own data retrieved from chart review, involving 236 adult patients with recurrent lower respiratory tract infections and high-resolution CT-proven non-CF bronchiectasis, who visited the outpatient clinic for respiratory diseases of a large Dutch teaching hospital between 2000 and 2010. Non-CF bronchiectasis can be described as a final common pathway of a vicious cycle of excessive bronchial inflammation, bacterial colonisation and infection. Non-CF bronchiectasis may arise from several causes, headed by infection and immunodeficiency, and is clinically characterised by a chronic, productive cough and infectious exacerbations. Once non-CF bronchiectasis is diagnosed using high-resolution CT scanning, a protocol-driven work-up to identify the underlying cause is recommended. Non-medicinal treatment options are primarily directed at clearance of bronchial secretions, which can further be improved by inhalation of hyperosmolar agents. Antibiotic treatment of exacerbations is a cornerstone medicinal treatment in bronchiectasis management. Patients with frequent exacerbations can be considered for long-term low-dose macrolide treatment, supported by robust evidence. Inhaled antibiotics might be beneficial in selected patients colonised with Pseudomonas aeruginosa. Important developments in the last decade include the introduction of international guidelines and the proposal for a validated scoring system for disease severity. Bronchiectasis patients are encountered by physicians in diverse medical professions and the disease itself is still underdiagnosed. The authors aim to increase awareness of the condition and provide practical tools for diagnosis and treatment. PMID:25968285
Obi, Okey Francis; Ugwuishiwu, Boniface O; Adeboye, Busayo S
In developed countries, large amount of anthropometric data are available for reference purposes; however, anthropometric data of Nigerian populace are lacking. As a result, most agricultural machines and equipment used are designed using anthropometric data from other populations of the world. A total of 377 rural agricultural workers within the age limit of 18-45 years, who are involved in different agricultural activities, were selected from six rural agriculture-based communities in Enugu state. Thirty-six anthropometric body dimensions were measured including age and body weight. A comparison between the male and female data indicated that data obtained from male agricultural workers were higher than that obtained from their female counterparts in all body dimensions except chest (bust) depth, abdominal breadth and hip breadth (sitting). In terms of design parameters, it was observed that the data from Nigerian agricultural workers were different from that obtained from agricultural workers in north-eastern India. Practitioner Summary. Anthropometric data of Nigeria populace are lacking. As a result, most agricultural machines and equipment used are designed using anthropometric data from other populations of the world. It was observed that the data from Nigerian agricultural workers were different from that obtained from agricultural workers in north-eastern India. PMID:25588899
Igwe, O; Omonona, O V; Onwuka, O S; Nnebedum, O D
This study investigated the impacts of asbestos wastes on soils in Emene-Enugu, southeastern Nigeria, generated by the activities of a major asbestos products manufacturing company in southeastern Nigeria. The methods of investigation included vertical electrical sounding (VES), 2-D horizontal resistivity profiling (HRP), induced polarization (IP) survey, chemical analysis of plant tissues and standard penetration tests of soil samples. The 2-D HRP and IP identified six closed waste pits alongside the two active pits. The VES revealed four geoelectrical layers in the area: from bottom to top; the inferred lithologies included dark shale, clay, gravel and recent sands. The geochemical data results revealed that Cd concentration of the soils of the waste pits is above the contaminated land exposure assessment soil guideline value for residential and allotment land uses. The geochemical pollution indices classified the soils as "unpolluted" to "extremely polluted". Bioconcentration factor of Pb in plant tissues was found to be above recommended limits of 0.045. The geotechnical parameters indices revealed that the soils varied from "very soft" to "stiff" and "very loose" to "medium". Soils of the active pits have very low strength and bearing capacity while closed pits have high strength and bearing capacity. It may be safe, therefore, to conclude that as the wastes are completely turned into soils, they will assume geotechnical properties similar to those of natural soils. PMID:25098901
Omonona, O V; Onwuka, O S; Okogbue, C O
Groundwater quality of Enugu metropolis comprising Achara Layout, Abakpa, and Emene settlement areas has been studied and characterized using multivariate statistical techniques. Three principal components (PCs) which explain 77.93 and 88.17% were extracted at Achara Layout and Abakpa, respectively, while two PCs which explain 83.13% were extracted at Emene. PC 1 of all the three areas reflects weathering of the host rock minerals and constitutes the dominant controlling process for all the areas. PC 2 of the three areas and PC 3 of Achara Layout and Abakpa can be attributed to both weathering/leaching of feldspathic minerals of host rocks (giving rise to alkaline earth metals in the groundwater) and anthropogenic activities. Cluster analysis defined groups of groundwater samples with similar hydrochemical characteristics. Two groups in Achara Layout and Emene fell into the high pollution loading class, while only one group in Abakpa fell into this class. The variation in the groundwater quality within each of the three areas may be explained in terms of groundwater flow directions, land use, and well depths. Discriminant analysis showed that the discriminating parameters of the groundwater quality of Achara Layout, Abakpa, and Emene are total dissolved solids, Na and Mg, and Cl, respectively. This study has revealed that the groundwater quality of the areas is controlled by both geogenic and anthropogenic processes and activities. The generated groundwater quality spatial variation models for each area will serve as a tool in the planning and development of groundwater in that region. PMID:24037228
Ogbu, Innocent S I; Echebiri, Vitalis C
Water samples from 20 artesian wells, chosen by the multistage sampling procedure from 5 zones in the city of Enugu, Southeast Nigeria, were analyzed by the disulfonic acid method in duplicate for the presence of nitrate (NO3) and nitrite (NO2). The zonal mean values for NO3 were 0.45 mmol/l, 0.46 mmol/l, 0.55 mmol/l, 0.59 mmol/l, and 0.65 mmol/l (mean = 0.54 mmol/l), and for NO2 the values were 0.34 mmol/l, 0.32 mmol/l, 0.21 mmol/l, 0.14 mmol/l, and 0.20 mmol/l (mean = 0.24 mmol/l), respectively. The mean values were reciprocally related (r = -.7356, p = 0.0002), indicating fecal contamination of well water. There were no significant differences between the mean values and the sum of the NO3 and NO2 values of the samples (p > 0.05), indicating uniform nitrogen content in the region. The mean value for NO3 (0.54 mmol/l) was below the guideline values set by the World Health Organization, but the mean NO2 concentration of 0.24 mmol/l was much higher (290%) than what is considered safe for humans. PMID:15369277
Dasgupta, Sugata; Das, Soumi; Chawan, Neeraj S.; Hazra, Avijit
Background: The increased morbidity and mortality associated with nosocomial infections in the intensive care unit (ICU) is a matter of serious concern today. Aims: To determine the incidence of nosocomial infections acquired in the ICU, their risk factors, the causative pathogens and the outcome in a tertiary care teaching hospital. Materials and Methods: This was a prospective observational study conducted in a 12 bedded combined medical and surgical ICU of a medical college hospital. The study group comprised 242 patients admitted for more than 48 h in the ICU. Data were collected regarding severity of the illness, primary reason for ICU admission, presence of risk factors, presence of infection, infecting agent, length of ICU and hospital stay, and survival status and logistic regression analysis was done. Results: The nosocomial infection rate was 11.98% (95% confidence interval 7.89–16.07%). Pneumonia was the most frequently detected infection (62.07%), followed by urinary tract infections and central venous catheter associated bloodstream infections. Prior antimicrobial therapy, urinary catheterization and length of ICU stay were found to be statistically significant risk factors associated with nosocomial infection. Nosocomial infection resulted in a statistically significant increase in length of ICU and hospital stay, but not in mortality. Conclusion: Nosocomial infections increase morbidity of hospitalized patients. These findings can be utilized for planning nosocomial infection surveillance program in our setting. PMID:25624645
Improvement in efficiency of healthcare in the United States is an urgent issue. Information technology is seen as one of key solutions to improve efficiency. As such, hospitals in the United States are rapidly adopting ...
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
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
Aij, Kjeld Harald; Simons, Frederique Elisabeth; Widdershoven, Guy A M; Visse, Merel
Objectives To date, experiences of leaders in the implementation of Lean after a Lean Training Programme have not been systematically investigated within teaching hospitals. Existing studies have identified barriers and facilitators only from an improvement programme perspective and have not considered the experiences of leaders themselves. This study aims to bridge this gap. Design Semistructured, indepth interviews. Setting One of largest teaching hospitals in the Netherlands. Participants 31 medical, surgical and nursing professionals with an average of 19.2?years of supervisory experience. All professionals were appointed to a Lean Training Programme and were directly involved in the implementation of Lean. Results The evidence obtained in this study shows that, from the perspectives of participants, leadership management support, a continuous learning environment and cross-departmental cooperation play a significant role in successful Lean implementation. The results suggest that a Lean Training Programme contributed to positive outcomes in personal and professional skills that were evident during the first 4?months after programme completion. Conclusions Implementing Lean in a teaching hospital setting is a challenge because of the ambiguous and complex environment of a highly professionalised organisation. The study found that leadership management support and a continuous learning environment are important facilitators of Lean implementation. To increase the successful outcomes of leadership actions, training should be supplemented with actions to remove perceived barriers. This requires the involvement of all professionals, the crossing of departmental boundaries and a focus on meaning-making processes rather than simply ‘implementing’ facts. Therefore, this research suggests that programme participants, such as staff members and leaders, can mutually explore the meanings of Lean thinking and working for their own contexts. By entering this shared learning process (eg, learning on the job) the ownership of Lean implementation could also increase. PMID:24171938
Ezenwaji, Emma E.; Anyadike, Raymond N. C.; Igu, Nnaemeka I.
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.
Talati, Shweta; Bhatia, Prateek; Kumar, Ashok; Gupta, A. K.; Ojha, Col. D
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
Chatterjee, Dattatreyo; Sen, Sukanta; Begum, Sabnam Ara; Adhikari, Anjan; Hazra, Avijit; Das, Anup Kumar
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, improved microbiology support and implementation of antibiotic policy can help to promote rational use of antimicrobial agents. PMID:25821321
Background Hospitals have a role to play in supporting, protecting and promoting breastfeeding. The aim of this study was to describe hospital breastfeeding policy and practices and breastfeeding rates among mothers attending General Paediatric Outpatient Clinic at a tertiary hospital in Lagos, Nigeria. Methods This was a cross-sectional study involving paediatric nurses and doctors, as well as the mothers who brought their child to the General Paediatric Outpatient Clinic. Two sets of questionnaires, different in content, were administered to doctors and nurses, and to mothers of children aged 6-24 months, to assess hospital policy and breastfeeding rates, respectively. Stepwise multiple logistic regression analysis was used to examine factors associated with duration of breastfeeding. Results Although the hospital had a written breastfeeding policy copies of the policy were not clearly displayed in any of the units in the Paediatric department. Almost half the staff (48%; 60/125) were not aware of the policy. The hospital had no breastfeeding support group. Nearly three quarters (92/125) of the staff had received lactation management training. 36% (112/311) of mothers exclusively breastfed for six months, 42% (129/311) had stopped breastfeeding at the time of the survey. 67% (207/311) of babies were given infant formula, 85% (175/207) before 6 months. Women who had antenatal care in private hospitals and were Christian were more likely to breastfeed exclusively for 6 months. Low maternal education was the only factor associated with breastfeeding longer than 12 months. Conclusion Breastfeeding practices and policy implementation at this outpatient clinic were suboptimal. We have identified a need for interventions to increase knowledge of the benefits of breastfeeding and to provide support for its longer term duration. We suggest that BFHI be considered across all facilities concerned with infant and early child health to disseminate appropriate information and promote an increase in exclusive breastfeeding for six months as well as the duration of breastfeeding. PMID:25018776
Isfahani, Haleh Mousavi; Aryankhesal, Aidin; Haghani, Hamid
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' performance evaluation form. PMID:25716403
Teaching Hospital and Other Issues Related to Graduate Medical Education. Hearing before the Subcommittee on Health of the Committee on Ways and Means. House of Representatives, One Hundred Fourth Congress, Second Session (June 11, 1196).
Congress of the U.S., Washington, DC. House Committee on Ways and Means.
This document reports testimony presented on Medicare financing of graduate medical education, as proposed by the Balanced Budget Act of 1995. Witnesses included: (1) Timothy M. Golddfarb, Director, Healthcare Systems (Oregon), who noted the importance of graduate medical education funding to teaching hospitals; (2) Leo P. Brideau of Strong…
Sellappans, Renukha; Lai, Pauline Siew Mei; Ng, Chirk Jenn
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
Wang, Bob Z; Chan, Elsie; Vajpayee, Rasik B
Background The purpose was to determine preoperative indications, intraoperative procedures, and outcomes of capsular tension ring (CTR) insertion during cataract surgery. Methods A review of all patients undergoing cataract surgery with insertion of a CTR between July 2000 and June 2010 was conducted at The Royal Victorian Eye and Ear Hospital, a large tertiary teaching hospital in Victoria, Australia. Information relating to each patient’s demographic details, preoperative assessment, surgical procedure, and postoperative assessment were obtained. Results Eighty-four eyes of 82 patients were included in this study. The main indications for CTR insertion were previous trauma, pseudoexfoliation syndrome, and mature cataracts. Twenty-one eyes (25.0%) did not have any obvious preoperative indication. A posterior capsule tear was the most common intraoperative complication (3.6%). An intraocular lens was successfully implanted in the bag in 72 eyes (85.7%). Postoperatively, the most common complications were a decentered intraocular lens (8.3%) and persistent corneal edema (6.0%). Overall, 61 eyes (72.6%) had better postoperative visual acuity compared with preoperative acuity, with 67 patients (79.8%) achieving vision of 20/40 or better. Conclusion For the majority of cases, CTR use in complex cataract surgeries is associated with improved postoperative outcomes. CTR implantation is most commonly required in patients with known risk factors for zonular instability. PMID:23671385
Wu, Robert C; Lo, Vivian; Morra, Dante; Wong, Brian M; Sargeant, Robert; Locke, Ken; Cavalcanti, Rodrigo; Quan, Sherman D; Rossos, Peter; Tran, Kim; Cheung, Mark
Background Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness. Objectives To describe the effects of different communication interventions and their problems. Design Prospective observational case study using a mixed methods approach of quantitative and qualitative methods. Setting General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals. Participants Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards. Methods Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010. Results We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories. Conclusions Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems. PMID:23355461
Gorios, Carlos; de Souza, Renata Maia; Gerolla, Viviane; Maso, Bruno; Rodrigues, Cintia Leci; Armond, Jane de Eston
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
Zou, Y M; Ma, Y; Liu, J H; Shi, J; Fan, T; Shan, Y Y; Yao, H P; Dong, Y L
The purpose of this investigation was to describe the effect of antibacterial stewardship and evaluate the trends and correlation of antibacterial resistance and usage from 2009 to 2013 in a tertiary-care teaching hospital in northwest China. Antibacterial usage was expressed as defined daily doses per 100 patients per day (DDDs/100 PDs). Hospital-wide population-level data and time series analysis were used to evaluate the trends and determine associations between antibacterial exposure and acquisition of resistance. Yearly consumption of overall antibacterials significantly decreased from 66.54 to 28.08 DDDs/100 PDs (??=?-10.504, p?0.01). The resistant rates of the five most frequently isolated species (including Escherichia coli, Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae) significantly decreased or remained stable, and none of them showed a statistically significant upward trend. The medical quality indicators got better or remained stable. Autoregressive integrated moving average (ARIMA) models demonstrated that the monthly resistance rate of P. aeruginosa to imipenem was strongly correlated with antipseudomonal carbapenems usage (??=?34.94, p?0.001), as did the correlation of P. aeruginosa to meropenem with antipseudomonal third-generation cephalosporins usage (??=?32.76, p?0.01) and K. pneumoniae to amikacin with aminoglycosides usage (??=?22.01, p?0.001). The decreased antibacterial use paralleled the improved bacterial resistance without deteriorating medical quality indicators during antimicrobial stewardship. It also suggests that optimum antibiotic use is necessary to alleviate the threat posed by resistant microorganisms at the hospital level. PMID:25487131
Evans, Melanie; Carlson, Joe; Barr, Paul; Kutscher, Beth; Zigmond, Jessica
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
Koh, Seong Joo; Lee, Jong Hoo
Background/Aims: Nursing home-acquired pneumonia (NHAP) is included under healthcare-associated pneumonia. However, the optimal treatment strategy for NHAP has been controversial in several studies. We evaluated the clinical features of NHAP compared to community-acquired pneumonia (CAP) in elderly patients admitted with pneumonia. Methods: This was a retrospective study in elderly patients aged ? 65 years with NHAP or CAP who were hospitalized at Jeju National University Hospital between January 2012 and April 2013. Results: A total of 209 patients were enrolled, and 58 (27.7%) had NHAP. The patients with NHAP were older, had more frequent central nervous system disorders, and showed worse clinical parameters. Potential drug-resistant pathogens were more frequently detected in the NHAP group (22.4% vs. 9.9%, p = 0.018), and the incidences of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were 8.6% and 10.3%, respectively. In-hospital mortality occurred in 13 patients (22.4%) with NHAP and 17 patients (11.2%) with CAP (p = 0.039). In multivariate analyses, only higher pneumonia severity index (PSI) score was associated with increased mortality (p < 0.001), and the PSI score was higher in the NHAP group than that in the CAP group. Conclusions: Elderly patients admitted with NHAP showed more severe pneumonia at onset, higher rates of potentially drug-resistant pathogens, and worse clinical outcomes than those with CAP. However, higher in-hospital mortality in those with NHAP seemed to be related to the PSI score reflecting host factors and severity of pneumonia rather than the type of pneumonia or the presence of drug-resistant pathogens. PMID:26354058
Bhagavathula, Akshaya Srikanth; Berhanie, Alemayehu; Tigistu, Habtamu; Abraham, Yishak; Getachew, Yosheph; Khan, Tahir Mehmood; Unakal, Chandrashekhar
Objective To determine the prevalence, clinical significance and the associated risk factors of potential drug-drug interactions (DDIs) at internal medicine ward of University of Gondar (UOG) hospital. Method A prospective cross-sectional study was conducted on patients treated in internal medicine ward of UOG hospital from April 29, 2013 to June 2, 2013. Data was collected from medical records and by interviewing the patients face to face. Descriptive analysis was conducted for back ground characteristics and logistic regression was used to determine the associated risk factors. Result In our study, we have identified a total number of 413 potential DDIs and 184 types of interacting combinations with 4.13 potential DDIs per patient. Among 413 potential DDIs most were of moderate interactions 61.2% (n=253) followed by 26% (n=107) of minor interactions and 12.8% (n=53) of major interactions. There was significant association of occurrence of potential DDIs only with taking three or more medications. Conclusion We have recorded a high rate of prevalence of potential DDI in the internal medicine ward of UOG hospital and a high number of clinically significant DDIs which the most prevalent DDI were of moderate severity. Careful selection of drugs and active pharmaceutical care is encouraged in order to avoid negative consequences of these interactions. PMID:25183081
Dubey, Debasmita; Rath, Shakti; Sahu, Mahesh C.; Rout, Subhrajita; Debata, Nagen K.; Padhy, Rabindra N.
Objective To investigate the infection of hospital- and community-acquired “erythromycin-induced clindamycin resistant” strains or D-test positives of clinical isolates of Staphylococcus aureus (S. aureus) (with and without methicillin resistance) in a hospital. Methods Strains of S. aureus isolated from clinical specimens were subjected to D-test and antibiotic profiling. Results Of the total 278 isolates, 140 (50.35%) were D-test positives and the rest were D-test negatives. Further, of 140 (100%) positives, 87 (62.14%) and 53 (37.85%) strains were from males and females, respectively. Of 140 (100%) positives, 117 (83.57%) were methicillin resistant S. aureus and 23 (16.42%) were methicillin sensitive S. aureus; of 140 strains, 103 (73.57%) strains from persons with and 37 (26.42%) were without related infections; of 140 strains, 91 (65%) and 49 (35%) were from hospital- and community-acquired samples, respectively. In 140 strains, 118 (84.28%) with comorbidities and 22 (15.71%) without comorbidities cases were recorded; similarly, persons with prior antibiotic uses contributed 108 (77.14%) and without 32 (22.85%) positive strains. These binary data of surveillance were analyzed by a univariate analysis. It was evident that the prior antibiotic uses and comorbidities due to other ailments were the determinative factors in D-test positivity, corroborated by low P values, P=0.001?1 and 0.002?4, respectively. All isolates (278) were resistant to 17 antibiotics of nine groups, in varying degrees; the minimum of 28% resistance for vancomycin and the maximum of 97% resistance for gentamicin were recorded. Further, of 278 strains, only 42 (15.1%) strains were resistant constitutively to both antibiotics, erythromycin resistant and clindamycin resistant, while 45 (16.2%) strains were constitutively sensitive to both antibiotics (erythromycin sensitive and clindamycin sensitive). Further, of the rest 191 (68.7%) strains were with erythromycin resistant and clindamycin resistant, of which only 140 (50.35%) strains were D-test positives, while the rest 51 (18.34%) strains were D-test negatives. Conclusions In view of high prevalence of D-test positive S. aureus strains, and equally high prevalence of multidrug resistant strains both in community and hospital sectors, undertaking of D-test may be routinely conducted for suppurative infections. PMID:23593595
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…
Background Urinary tract infection (UTI) is a common health problem among pregnant women. Proper investigation and prompt treatment are needed to prevent serious life threatening condition and morbidity due to urinary tract infection that can occur in pregnant women. Recent report in Addis Ababa, Ethiopia indicated the prevalence of UTI in pregnant women was 11.6?% and Gram negative bacteria was the predominant isolates and showed multi drug resistance. This study aimed to assess bacterial profile that causes urinary tract infection and their antimicrobial susceptibility pattern among pregnant women visiting antenatal clinic at University of Gondar Teaching Hospital, Northwest Ethiopia. Methods A cross-sectional study was conducted at University of Gondar Teaching Hospital from March 22 to April 30, 2011. Mid stream urine samples were collected and inoculated into Cystine Lactose Electrolyte Deficient medium (CLED). Colony counts yielding bacterial growth of 105/ml of urine or more of pure isolates were regarded as significant bacteriuria for infection. Colony from CLED was sub cultured onto MacConkey agar and blood agar plates. Identification was done using cultural characteristics and a series of biochemical tests. A standard method of agar disc diffusion susceptibility testing method was used to determine susceptibility patterns of the isolates. Results The overall prevalence of UTI in pregnant women was 10.4?%. The predominant bacterial pathogens were Escherichia coli 47.5?% followed by coagulase-negative staphylococci 22.5?%, Staphylococcus aureus 10?%, and Klebsiella pneumoniae 10?%. Gram negative isolates were resulted low susceptibility to co-trimoxazole (51.9?%) and tetracycline (40.7?%) whereas Gram positive showed susceptibility to ceftriaxon (84.6?%) and amoxicillin–clavulanic acid (92.3?%). Multiple drug resistance (resistance to two or more drugs) was observed in 95?% of the isolates. Conclusion Significant bacteriuria was observed in asymptomatic pregnant women. Periodic studies are recommended to check the outcome of asymptomatic bacteriuria and also monitor any changes in the susceptibility patterns of urinary tract pathogens in pregnant women. PMID:22534117
Ezeonu, CT; Uneke, CJ; Ojukwu, JO; Anyanwu, OU; Okike, CO; Ezeanosike, OB; Agumadu, HU
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
Tavakoli-Ardakani, Maria; Eshraghi, Azadeh; Hajhossein Talasaz, Azita; Salamzadeh, Jamshid
Drug Utilization Evaluation (DUE) studies facilitate assessing the appropriateness and rational use of medications.The goal of the present study was to evaluate Amphotericin B usage in neutropenic patients. A prospective DUE study was performed in Hematology-Oncology and Stem Cell Transplantation wards at Taleghani hospital for one-year. National comprehensive cancer network, clinical practice guidelines in oncology, American Hospital Formulary Service and other relevant medical practice and up-to dated articles were used to evaluate whether Amphotericin B is properly used according to the guidelines. All data collected by a pharmacist in daily review using information of physician and nursing records as well as laboratory findings. During the one-year study, 35 patients receiving amphotericin B were evaluated. 29 patients (82.9%) received amphotericin B due to neutropenia and fever and 6 patients had confirmed fungal infections. All of the injectable solutions of amphotericin B were appropriately prepared for intravenous infusion. In addition, for all patients, ordering (indication) of the study drug was in accordance with the guidelines. Twenty-five (71.4%) patients received an appropriate dose according to the guidelines. Duration of treatment was properly selected in 21 (60%) patients. Twenty-two (62.8%) patients developed hypokalemia as the most frequent adverse drug event. Although, preparation and indication of amphotericin B was in compliance with the current guidelines, dosage and duration of treatment were considered to be incoherent with the designed protocol used in this study. We conclude more attention should be paid to dosage and duration of treatment with amphotericin B in order to optimize its administration. PMID:24250436
Grönthal, Thomas; Moodley, Arshnee; Nykäsenoja, Suvi; Junnila, Jouni; Guardabassi, Luca; Thomson, Katariina; Rantala, Merja
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 MRSP. Rigorous control measures were needed to control the outbreak. We recommend the implementation of a search-and-isolate policy to reduce the burden of MRSP. PMID:25333798
Rai, Pranil; Misra, Gorakh
Introduction Prophylactic use of intra-peritoneal drain is commonly practiced by surgeons in the hope of early detection of complication and reducing mortality and morbidity. The aim of the study was to determine evidence based value of prophylactic drainage of peritoneal cavity in cases of secondary peritonitis and resection and anastomosis of small and large bowel. Materials and Methods One hundred and seventy one (171) cases were included in the study from March 2012-May 2013 that underwent laparotomy for peptic ulcer perforation (PUP), simple and complicated acute appendicitis (appendicular perforation with localized/generalized peritonitis), small bowel obstruction (SBO) and sigmoid volvulus, traumatic and non-traumatic perforation of small and large bowel. Appropriate management was done after resuscitation and investigation. After completion of operation peritoneal cavity was either drained or not drained according operator’s preference. They were divided into drain and non-drain groups. Surgical outcome and postoperative complications ?30 days of operation was noted and compared between two groups. Results No significant difference was observed between drained group and non-drained group in terms of age (32.08±15.99 vs. 35.57 ± 16.42 years), Sex (76M: 42F vs. 40M: 13F), weight 50.9 ± 11.75 vs. 48.4 ± 16.1 kg), height (1.6 ± 0.13 vs. 1.5 ± 0.18 Meter), BMI (20 ± 4.7 vs. 20 ± 7.2), ASA score (p= >0.05). However there was significant difference was observed between drained group and non-drained groups in terms of length of hospital stay (9 ± 4 vs 5 ± 3.4 days), operative duration (115.6 ± 41.0 vs. 80 ± 38.1 minutes), infection rates in dirty wound (40.0% vs 12.5%) and overall postoperative complications (35.85% vs16.11%). Conclusion Based on these results, present study suggests that prophylactic drainage of peritoneal cavity after gastrointestinal surgery is not necessary as it does not offer additional benefits for the patients undergoing gut surgery. Moreover, it increases operative duration, length of hospital stay and surgical site infection (SSI). PMID:26557562
Meher, Bikash Ranjan; Joshua, N.; Asha, B.; Mukherji, Deepali
Objectives: Spontaneous reporting of adverse drug reaction (ADR) is the backbone of pharmacovigilance program. Under reporting by prescribers is still exist. This study was done to assess the knowledge, attitude, and practice (KAP) of undergraduate students about pharmacovigilance. Materials and Methods: It was a questionnaire-based cross-sectional study. Study tool was a validated questionnaire containing 21 questions to evaluate KAP of pharmacovigilance among undergraduate medical students in a Tertiary Care Teaching Hospital of South India. Results: All data were analyzed by using Microsoft Excel sheet, Chi-square, and ANOVA. The mean score of final, prefinal, and 2nd year students is respectively (4.76, 5.63, and 4.73) for knowledge, (4.26, 4.95, and 4.53) for attitude and (1.66, 1.55, and 1.28) for the practice. There is a significant difference in mean score between three groups for knowledge and attitude, but not for practice. They have a better attitude, but poor in knowledge and practice regarding pharmacovigilance. Conclusion: Students lack adequate knowledge and skill of reporting ADR, but they have a positive attitude toward pharmacovigilance program. The integration of pharmacovigilance with undergraduate curriculum may help in improving ADR monitoring and reporting.
Bhattacharjee, Shakya; Kaur, Gurpreet
Objective: Poor documentation following lumbar puncture (LP) had always been a matter of concern. This study aimed to investigate the documentation pattern of neurology house officers, registrars (Regs), and specialist Regs following LP in a major teaching hospital. Materials and Methods: Total hundred patient records were examined in the light of a carefully designed proforma containing 15 important indicators of good-quality LP documentation. Result: Mean number of indicators overall documented by doctors was found to be 6.24 ± 3.0037. The mean number of indicators recorded by house officers was 5.11 ± 3.01 and Regs was 7.56 ± 3.28. A total of 33% LPs were performed without a documented consent. Only 36% performers documented the type and size of needle they used during the procedure. Only 46% documents revealed the strength and name of the local anesthetic used. Statistically significant difference between senior house officers and Regs in terms of numbers of indicators documented was noted. Conclusion: The documentation standard among neurology junior doctors remained poor. PMID:24339594
... number of inpatient beds as recorded in SDI Market Profile Database. Teaching hospital : Refers to a hospital ... Information on teaching hospital status is from SDI Market Profile Database. Urban or rural classification of the ...
Jackson, A J; Barnett, E S; Stevens, A B; McClure, M; Patterson, C; McReynolds, M J
In January 1993 the Royal Group of Hospitals Trust, which employs approximately 5000 staff, implemented the Health and Safety (Display Screen Equipment) Northern Ireland Regulations (1992). During 1994 all regular display screen equipment users were offered a vision screening test. In total 571 employees were screened using computerized vision screening software (City Visual Systems Ltd). Risk assessments were completed for 293 display screen work-stations. One hundred and twelve full eye examinations, carried out by optometrists, were performed on those who failed vision screening and on those who specifically requested an optometric assessment. Results indicate that whereas the proportion of users experiencing visual and general symptoms differed markedly from department to department (28-82%), the median number of individuals failing the screening test was 25% (range 9-40%). Those involved in uninterrupted display screen equipment work for prolonged periods reported visual and general work-related symptoms twice as frequently as those who spent less time working with DSE. The outcome of full eye examinations confirmed that less than 5% of display screen users required spectacles solely for display screen use. Work-station analysis indicated that ergonomic problems were common. The authors conclude that the successful management of health risks from display screen equipment requires simultaneous attention to work-place design, working patterns and eye care. PMID:9196660
Ojieabu, Winifred Aitalegbe; Femi-Oyewo, M. N.; Eze, Uchenna I.
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
Pruitt, Liese; Mumuni, Tolulope; Raikhel, Eugene; Ademola, Adeyinka; Ogundiran, Temidayo; Adenipekun, Adeniyi; Morhason-Bello, Imran; Ojengbede, Oladosu A; Olopade, Olufunmilayo I
Globally, breast cancer is the most frequent malignancy in women, and stage at diagnosis is a key determinant of outcome. In low- to middle-income countries, including Nigeria, advanced stage diagnosis and delayed treatment represent a significant problem. That social barriers contribute to delay has been noted in previous research; however, few specific factors have been studied. Using semi-structured interviews, this study identifies social barriers to diagnosis and treatment for patients who presented at University College Hospital Ibadan, Nigeria. Transcripts from the interviews were coded and analysed thematically. Thirty-one patients and five physicians were interviewed. The median age of patients was 51 (range: 28 to above 80), 83% were Christian and 17% were Muslim. Preliminary analysis showed that delays in diagnosis reflected a lack of education as well as the utilisation of non-physician medical services such as pharmacists. Delays in treatment were often due to fear of unanticipated surgery and cost. The majority of women did not know the cause of their breast cancer, but some believed it was caused by a spiritual affliction. This study suggests that further education and awareness of breast cancer for both patients and providers is needed in order to increase early stage diagnosis. PMID:25443995
Background and purpose Surveillance studies evaluating antimicrobial susceptibilities are of great value in preventing the spread of resistant pathogens by elucidating the trend of resistance in commonly used antibiotics and as a consequence providing information for prescribing the most appropriate agent. This study is a longitudinal antimicrobial resistance surveillance study designed to evaluate the trend in antimicrobial resistance to gram negative microorganisms from 2007 to 2010. Method During a four-year period (2007–2010) isolates derived from all patients admitted to infectious diseases ward of Imam Khomeini Hospital, the major referral center for infectious disease in Iran with the highest admission rates, were evaluated. Based on disk diffusion method and zone of inhibition size, the microorganism was regarded as to be sensitive, resistant or has intermediate susceptibility to the antimicrobial agents. Results The widest spread Gram-negative microorganism in all of isolates taken together in our study was E.coli (30%) followed by Stenotrophomonas maltophilia in 28.6% and Enterobacter spp. in 11.9%, respectively. The susceptibility to amikacin, imipenem, piperacillin/tazobactam, and nitrofurantoin was equal or above 50% for all microorganisms over four years. However, the susceptibility to ampicillin, ampicillin/sulbactam, cefotaxim, and ceftriaxone was less than 50% in derived isolates during the study period. Conclusion In conclusion, the finding of the present study revealed that resistance rate to common antimicrobial agents in Iran is growing and isolates were susceptible mostly to broad-spectrum antibiotics including imipenem and piperacillin/tazobactam. PMID:23351308
Carter, Thomas; Conrad, Chris; Wilson, J. Link; Dogbey, Godwin
Objectives. Ultrasound (US) guidance is a safe and effective method for peripheral intravenous (IV) catheter placement. However, no studies have directly compared the success rate of emergency medicine (EM) residents and nurses at using this technique especially in community hospital settings. This prospective “noninferiority” study sought to demonstrate that nursing staff are at least as successful as EM residents at placing US guided IVs. Methods. A group of 5 EM residents and 11 nurse volunteers with at least two years' experience underwent training sessions in hands-on practice and didactic instruction with prospective follow-up. Two failed attempts on a patient using standard approach by an emergency department (ED) nurse were deemed to be “difficult sticks” and randomly assigned to either a nurse or resident, based on the day they presented. Results. A total of 90 attempts, consisting of trials on 90 patients, were recorded with a success rate of 85% and 86% for residents and nurses, respectively. With a p value of .305, there was no statistically significant difference in the success rate between the residents and nurses. Conclusion. Properly trained nursing staff can be as equally successful as EM residents in placing US guided intravenous lines. PMID:26413322
Background Sister Mary Joseph’s nodule is a metastatic tumor deposit in the umbilicus and often represents advanced intra-abdominal malignancy with dismal prognosis. There is a paucity of published data on this subject in our setting. This study was conducted to describe the clinicopathological presentation and treatment outcome of this condition in our environment and highlight challenges associated with the care of these patients, and to proffer solutions for improved outcome. Methods This was a retrospective study of histologically confirmed cases of Sister Mary Joseph’s nodule seen at Bugando Medical Centre between March 2003 and February 2013. Data collected were analyzed using descriptive statistics. Results A total of 34 patients were enrolled in the study. Males outnumbered females by a ratio of 1.4:1. The vast majority of patients (70.6%) presented with large umbilical nodule > 2 cm in size. The stomach (41.1%) was the most common location of the primary tumor. Adenocarcinoma (88.2%) was the most frequent histopathological type. Most of the primary tumors (52.9%) were poorly differentiated. As the disease was advanced and metastatic in all patients, only palliative therapy was offered. Out of 34 patients, 11 patients died in the hospital giving a mortality rate of 32.4%. Patients were followed up for 24 months. At the end of the follow-up period, 14(60.9%) patients were lost to follow-up and the remaining 9 (39.1%) patients died. Patients survived for a median period of 28 weeks (range, 2 to 64 weeks). The nodule recurred in 6 (26.1%) patients after complete excision. Conclusion Sister Mary Joseph’s nodule of the umbilicus is not rare in our environment and often represents manifestation of a variety of advanced intra-abdominal malignancies. The majority of the patients present at a late stage and many with distant metastases. The patient's survival is very short leading to a poor outcome. Early detection of primary cancer at an early stage may improve the prognosis. PMID:23826688
Ravangard, Ramin; Sajjadnia, Zahra; Jafari, Abdosaleh; Shahsavan, Najme; Bahmaie, Jamshid; Bahadori, Mohammadkarim
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, as well as the importance of meeting the employees' needs and expectations based on their characteristics; familiarizing employees with the Islamic work ethic; educating employees on the importance of being considerate towards their colleagues and subordinates in the workplace, and reinforcing this desirable quality; and finally, clarifying the need for changes in the organization for all employees. PMID:25512831
Onoh, Robinson Chukwudi; Eze, Justus Ndulue; Ezeonu, Paul Olisaemeka; Lawani, Lucky Osaheni; Iyoke, Chukwuemeka Anthony; Nkwo, Peter Onubiwe
Background The global rise in cesarean delivery rate has been a major source of public health concern. Aim To appraise the cesarean deliveries and the associated fetal and maternal outcomes. Materials and methods The study was a case series with data collected retrospectively from the records of patients delivered by cesarean section at the Ebonyi State University Teaching Hospital, Abakaliki over a 10-year period, from January 2002 to December 2011. Ethical approval was obtained. Results Of 14,198 deliveries, 2,323/14,198 (16.4%) were by cesarean deliveries. The overall increase of cesarean delivery was 11.1/10 (1.1%) per annum from 184/1,512 (12.2%) in 2002 to 230/986 (23.3%) in 2011. Of 2,097 case folders studied, 1,742/2,097 (83.1%) were delivered at term, and in 1,576/2,097 (75.2%), the cesarean deliveries were emergencies. The common indications for cesarean delivery were previous cesarean scars 417/2,097 (19.9%) and obstructed labor 331/2,097 (15.8%). There were 296 perinatal deaths, giving a perinatal mortality rate of (296/2,197) 134.7/1,000 births. Also, 129/2,097 (6.1%) maternal case fatalities occurred, giving a maternal mortality rate of 908.6/100,000 total births. Hemorrhage 57/129 (44.2%) and sepsis 41/129 (32.6%) were the major causes. Conclusion The study recorded a significant increase in cesarean delivery rate. Previous cesarean scars and obstructed labors were the main indications. Perinatal and maternal case fatalities were huge. Hence, there is need for continued community education for its reduction. PMID:25999769
Echocardiographic reporting system is very poor in Nepal. No long-term feasibility and efficacy data about the echocardiography database with video clips has been studied. Snazzi Movie Studio S4 was used to convert analog video signals into MPEG2 and color photographs were converted into JPEG format for storage and use for the database. All together 2272 patients' echocardiography were performed by one individual prospectively at the Nepal Medical College Teaching Hospital from 10th January 2007 to 9th January 2012. Echocardiographic findings of these patients were evaluated. Mean age +/- SD were 44.4 +/- 28.7 years. Male female ratio was 0.8:1. Brahman/Chhetri were the usual ethnic group to undergo echocardiography (943, 41.5%), followed byjanajati (631, 27.8%) and newar (496, 21.8%). Age group of 60-69 years was the most common echo users (519, 22.8%). Total time for echocardiography/report writing with database compared to non database was 13.9 +/- 2.4 minutes vs. 12.3 +/- 0.8 minutes, p = 0.51. Out of all lesions, valvular lesions were the most common lesions detected (4885, 215%). Mild tricuspid regurgitation (1213, 53.4%) was the most common valvular lesion followed by mild mitral regurgitation (742, 32.7%). Patent foramen ovale was the most common congenital heart disease (32, 45.7%) followed by atrial septal defect (12, 17.1%). About one seventh of the total patients (318, 13.9%) had systolic dysfunction. Out of total chronic cor pulmonale (383, 16.9%), severe Pulmonary arterial dysfulction (PAH) was noted in more than one third of the patients (169, 44.1%). PMID:24047011
Okoduwa, Stanley Irobekhian Reuben; Umar, Ismaila Alhaji; Ibrahim, Sani; Bello, Fatima; Ndidi, Uche Samuel
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 (NGN50,000-NGN100,000 and above NGN100,000) 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
Aminu, M; Gwafan, JZ; Inabo, HI; Oguntayo, AO; Ella, EE; Koledade, AK
Background Human papillomavirus (HPV) is the cause of 90%–95% of squamous cell cancers. Persistent infection with high-risk HPV can lead to development of precancerous lesions of the cervix in 5%–10% of infected women, and can progress to invasive cervical cancer 15–20 years later. This study was conducted to determine the seroprevalence of HPV immunoglobulin G (IgG) antibodies among women of reproductive age attending a reproductive health clinic at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Methods The study was descriptive, cross-sectional, and experimental, combining the use of a structured questionnaire and analysis of serum samples obtained from 350 consecutive consenting women. The serum samples were analyzed for IgG antibodies to HPV by enzyme-linked immunosorbent assay. Results We found a seroprevalence of 42.9% (150/350) for IgG antibodies to HPV in these women. Women aged 45–49 years and those who had their sexual debut aged 20–23 years had the highest HPV seroprevalence, ie, 50% (57/114) and 51.1% (46/90), respectively. Presence of antibodies varied according to sociodemographic factors, but was significantly associated with educational status, tribe, and religion (P<0.05). Human papillomavirus infection was not significantly associated with the reproductive characteristics and sexual behavior of the women. Antibodies to HPV were detected in 50.0% (9/18) of women with a family history of cervical cancer and in 30.8% (4/13) of those with a history or signs of WHIM (warts, hypogammaglobulinemia, immunodeficiency, myelokathexis) syndrome as a genetic disorder (P>0.05). Conclusion Further studies are needed to determine the HPV serotypes and evaluate the risk of natural development of HPV-related malignancies among women in the study area. PMID:24868172
Okafor, CI; Anyaehie, USB; Ofoegbu, EN
Background: Obesity in developing nations is no longer as uncommon as it was thought to be decades ago however paucity of data on the burden of obesity from urban communities was observed by previous workers. Aim: To determine the magnitude of obesity and its relationship to blood pressure among urban adult residents in Enugu metropolis. Subjects and Methods: A cross-sectional community survey of adults who were not known to have diabetes or hypertension by self-report was carried out. Four parts of the metropolis selected by simple random sampling were used and consenting individuals aged 18-70 years were consecutively recruited. Anthropometric measurements were done using standard procedures as specified in the World Health Organization STEPs instrument. Obesity was determined using widely acknowledged body mass index (BMI) ?30 kg/m2. Descriptive and inferential statistical analyses was performed using SPSS with P value set at <0.05. Results: A high prevalence of obesity of 21.2% (95% confidence interval [CI]: 18.3-24.1) was found among the participants with significant female gender preponderance. The burden increased with age with the middle age group highly involved. Attainment of age of 40 years and above had an increased odd of developing obesity (odds ratio = 1.8; 95% CI: 1.3-2.6). There was a relationship between blood pressure and BMI as shown by positive correlation, higher BMI among hypertensive subjects and high burden of elevated blood pressure among obese subjects (91/164; 55.5%). Conclusion: A high magnitude of obesity existed among this apparently healthy unaware adults resident in an urban Nigerian city and obesity is associated with elevation in blood pressure. PMID:25221717
Background In many countries midwives act as the main providers of care for women throughout pregnancy, labour and birth. In our large public teaching hospital in Australia we restructured the way midwifery care is offered and introduced caseload midwifery for one third of women booked at the hospital. We then compared the costs and birth outcomes associated with caseload midwifery compared to the two existing models of care, standard hospital care and private obstetric care. Methods We undertook a cross sectional study examining the risk profile, birth outcomes and cost of care for women booked into one of the three available models of care in a tertiary teaching hospital in Australia between July 1st 2009 December 31st 2010. To control for differences in population or case mix we described the outcomes for a cohort of low risk first time mothers known as the 'standard primipara'. Results Amongst the 1,379 women defined as 'standard primipara' there were significant differences in birth outcome. These first time ‘low risk’ mothers who received caseload care were more likely to have a spontaneous onset of labour and an unassisted vaginal birth 58.5% in MGP compared to 48.2% for Standard hospital care and 30.8% with Private obstetric care (p < 0.001). They were also significantly less likely to have an elective caesarean section 1.6% with MGP versus 5.3% with Standard care and 17.2% with private obstetric care (p < 0.001). From the public hospital perspective, over one financial year the average cost of care for the standard primipara in MGP was $3903.78 per woman. This was $1375.45 less per woman than those receiving Private obstetric care and $1590.91 less than Standard hospital care per woman (p < 0.001). Similar differences in cost were found in favour of MGP for all women in the study who received caseload care. Conclusions Cost reduction appears to be achieved through reorganising the way care is delivered in the public hospital system with the introduction of Midwifery Group Practice or caseload care. The study also highlights the unexplained clinical variation that exists between the three models of care in Australia. PMID:24456576
Korn, James H.
Teaching should be honored as teaching and not as scholarship. Instead of redefining scholarship to include teaching, the task force has redefined teaching as scholarship in the generally accepted, "publish-or-perish" sense. (Author/SLD)
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
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. Resistance to oxacillin and imipenem was higher as well. Comparing device use, DA-HAI rates, and bacterial resistance for the primary isolated bacteria indicated a direct association between urinary catheter use and the rates of CAUTI. PMID:26027477
Iyoke, CA; Ezugwu, FO; Lawani, OL; Ugwu, GO; Ajah, LO; Mba, SG
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 these students may need to focus on increasing the content and adequacy of contraceptive information held by people through regular health worker-led, on-campus workshops. PMID:25114515
Ibe, Ogochukwu; Onwujekwe, Obinna; Uzochukwu, Benjamin; Ajuba, Miriam; Okonkwo, Paul
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 caregivers was US$3.5. Conclusion Onchocerciasis still constitutes considerable economic burden on patients due to the high cost of treatment and productivity loss. Prioritizing domestic resource allocation for the treatment of onchocerciasis is important for significant and sustained reduction in the burden of the disease. In addition, focused health promotion interventions such as health education campaigns should be scaled up in onchocerciasis-endemic communities. PMID:26618633
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
Hospitality Management Hospitality/Foodservice: TBD Food Science: TBD Recreation/Tourism: TBD Culinary Arts/Hospitality NTT: TBD SFBS Sustainable Food & Bioenergy Systems Faculty: Alison Harmon & Campus Restaurant Managed By: Gallatin College Program Director/ Hospitality Management Instructor
Liddicoat, Anthony J., Ed.; Crozet, Chantal, Ed.
Essays and research reports on the relationship between teaching second languages and teaching culture include: "Teaching Culture as an Integrated Part of Language Teaching: An Introduction" (Chantal Crozet, Anthony J. Liddicoat); "Primary Socialization and Cultural Factors in Second Language Learning: Wending Our Way through Semi-Charted…
Bodina, Annalisa; Brizzolara, Antonella; Vadruccio, Gianluca; Castaldi, Silvana
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
Failure of hospital employees to comply with smoke-free policy is associated with nicotine dependence and motives for smoking: a descriptive cross-sectional study at a teaching hospital in the United Kingdom
Parks, Tom; Wilson, Clare V. R.; Turner, Kenrick; Chin, Joel W. E.
Wilson, Kenrick Turner and Joel WE Chin Address: University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, CB0 2SP, UK Email: Tom Parks* - email@example.com; Clare VR Wilson - firstname.lastname@example.org; Kenrick Turner... Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 9 (page number not for citation purposes...
The Introduction of a Diagnostic Decision Support System (DXplain™) into the workflow of a teaching hospital service can decrease the cost of service for diagnostically challenging Diagnostic Related Groups (DRG)s
Elkin, Peter L.; Liebow, Mark; Bauer, Brent A.; Chaliki, Swarna; Wahner-Roedler, Dietlind; Bundrick, John; Lee, Mark; Brown, Steven H.; Froehling, David; Bailey, Kent; Famiglietti, Kathleen; Kim, Richard; Hoffer, Ed; Feldman, Mitchell; Barnett, G. Octo
Background In an era of short inpatient stays, residents may overlook relevant elements of the differential diagnosis as they try to evaluate and treat patients. However, if a resident’s first principal diagnosis is wrong, the patient’s appropriate evaluation and treatment may take longer, cost more, and lead to worse outcomes. A diagnostic decision support system may lead to the generation of a broader differential diagnosis that more often includes the correct diagnosis, permitting a shorter, more effective, and less costly hospital stay. Methods We provided residents on General Medicine services access to DXplain, an established computer-based diagnostic decision support system, for 6 months. We compared charges and cost of service for diagnostically challenging cases seen during the fourth through sixth month of access to DXplain (intervention period) to control cases seen in the six months before the system was made available. Results 564 cases were identified as diagnostically challenging by our criteria during the intervention period along with 1173 cases during the control period. Total charges were $1281 lower (P=.006), Medicare Part A charges $1032 lower (p=.006) and cost of service $990 lower (P=.001) per admission in the intervention cases than in control cases. Conclusions Using DXplain on all diagnostically challenging cases might save our medical center over $2,000,000 a year on the General Medicine Services alone. Using clinical diagnostic decision support systems may improve quality and decrease cost substantially at teaching hospitals. PMID:20951080
Liddicoat, Anthony J., Ed.; Crozet, Chantal, Ed.
This collection of papers examines what it means to teach culture as an integrated part of language from both the language learner's and the language teacher's perspectives. The 11 papers include the following: "Teaching Cultures as an Integrated Part of Language: Implications for the Aims, Approaches and Pedagogies of Language Teaching" (Chantal…
Odetunde, Odutola Israel; Odetunde, Oluwatoyin Arinola; Neboh, Emeka Ernest; Okafor, Henrietta Uche; Njeze, Ngozi Rosemary; Azubuike, Jonathan Chukwuemeka
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 m 3 . 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
Utom, Ahamefula U.; Odoh, Benard I.; Egboka, Boniface C. E.
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.
Brooks, G R; Jones, V G
OBJECTIVE: To address two questions: What are the characteristics of hospitals that affect the likelihood of their being involved in a merger? What characteristics of particular pairs of hospitals affect the likelihood of the pair engaging in a merger? DATA SOURCES/STUDY SETTING: Hospitals in the 12 county region surrounding the San Francisco Bay during the period 1983 to 1992 were the focus of the study. Data were drawn from secondary sources, including the Lexis/Nexis database, the American Hospital Association, and the Office of Statewide Health Planning and Development of the State of California. STUDY DESIGN: Seventeen hospital mergers during the study period were identified. A random sample of pairs of hospitals that did not merge was drawn to establish a statistically efficient control set. Models constructed from hypotheses regarding hospital and market characteristics believed to be related to merger likelihood were tested using logistic regression analysis. DATA COLLECTION: See Data Sources/Study Setting. PRINCIPAL FINDINGS: The analysis shows that the likelihood of a merger between a particular pair of hospitals is positively related to the degree of market overlap that exists between them. Furthermore, market overlap and performance difference interact in their effect on merger likelihood. In an analysis of individual hospitals, conditions of rivalry, hospital market share, and hospital size were not found to influence the likelihood that a hospital will engage in a merger. CONCLUSIONS: Mergers between hospitals are not driven directly by considerations of market power or efficiency as much as by the existence of specific merger opportunities in the hospitals' local markets. Market overlap is a condition that enables a merger to occur, but other factors, such as the relative performance levels of the hospitals in question and their ownership and teaching status, also play a role in influencing the likelihood that a merger will in fact take place. PMID:9018212
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Patten, C S
Bridging patient/"customer" issues and business aspects can be aided through developing a specific nursing basis for hospitality. The ancient practice of hospitality has evolved into three distinct levels: public, personal and therapeutic. Understanding these levels is helpful in integrating various dimensions of guest relations programs in hospitals into a more comprehensive vision. Hospitality issues must become a greater part of today's nursing management. PMID:8134046
Liu, Hsiu-Chu; Li, Hsing; Chang, Hsin-Fei; Lu, Mei-Rou; Chen, Feng-Chuan
Learning from the experience of another medical center in Taiwan, Kaohsiung Municipal Kai-Suan Psychiatric Hospital has changed the nursing informatics system step by step in the past year and a half . We considered ethics in the original idea of implementing barcodes on the test tube labels to process the identification of the psychiatric patients. The main aims of this project are to maintain the confidential information and to transport the sample effectively. The primary nurses had been using different work sheets for this project to ensure the acceptance of the new barcode system. In the past two years the errors in the blood testing process were as high as 11,000 in 14,000 events per year, resulting in wastage of resources. The actions taken by the nurses and the new barcode system implementation can improve the clinical nursing care quality, safety of the patients, and efficiency, while decreasing the cost due to the human error. PMID:26262221
Prevedello, Luciano M; Andriole, Katherine P; Khorasani, Ryan Roobian Ramin
The RSNA Medical Imaging Resource Center (MIRC) software is an open-source program that allows users to identify, index, and retrieve images, teaching files, and other radiologic data that share a common underlying structure. The software is being continually improved as new challenges and different needs become apparent. Although version T30 is easily installed on a stand-alone computer, its implementation at healthcare enterprises with complex network architecture may be challenging with respect to security because users cannot log on by using a standard enterprise-wide authentication protocol. Instead, authentication takes place through the local MIRC database, creating security concerns and potential organizational problems. In this setting, the Lightweight Directory Access Protocol (LDAP) can be used to provide a single sign-on environment and increase authentication security. A commercial directory service using LDAP has been successfully integrated with MIRC in a large multifacility enterprise to provide single sign-on capability compatible with the institutional networking policies for password security. PMID:19605651
Comparisons of Clinical Outcomes and Prognoses in Patients With Gastroesophageal Junction Adenocarcinoma, by Transthoracic and Transabdominal Hiatal Approaches: A Teaching Hospital Retrospective Cohort Study.
Zhou, Jinzhe; Wang, Hao; Niu, Zhaojian; Chen, Dong; Wang, Dongsheng; Lv, Liang; Li, Yu; Zhang, Jian; Cao, Shougen; Shen, Yi; Zhou, Yanbing
To compare the clinical outcomes and prognoses in patients with gastroesophageal junction adenocarcinoma (Siewert type II/III), by transthoracic and transabdominal hiatal approaches.Siewert II/III gastroesophageal junction adenocarcinomas patients (334 cases) underwent different surgical procedures at the Affiliated Hospital of Qingdao University from July 2007 to July 2012 and were analyzed retrospectively. In total, 140 patients underwent surgery by the transthoracic approach, and 194 patients underwent the transabdominal hiatal approach mainly with radical total and proximal gastrectomy (D2). All patients were followed up by telephone review or by outpatient reexamination until July 2013. The surgically related and clinical outcomes were compared using the ? test, t test, Fisher exact test, or nonparametric rank sum test according to different data. The survival curve was drawn by the Kaplan-Meier method and survival analysis used Cox regression analysis.The operative time, length of resected esophagus, number of lymph nodes harvested, postoperative pain scores, postoperative hospital stay, time of antibiotics use, postoperative morbidity, and costs for the transabdominal surgery group were better than that of the transthoracic group. The overall 5-year survival rate was 35.3% and 40.3%, respectively, in the transthoracic and transabdominal surgery groups, and differences were not statistically significant (x?=?2.311, P?>?0.05). The hazard ratio of death for the transthoracic compared with the transabdominal approach was 1.27 (0.93-1.72, P?>?0.05). According to tumor node metastasis (TNM) staging, stratification analysis showed that stage III patient overall survival rates were 25.7% and 37.2%, respectively. The differences were statistically significant (x?=?4.127, P?0.05). In uni- and multivariate Cox regression analysis, the hazard ratio for the transabdominal versus the transthoracic approach was 0.66 (0 43 to 0.99, P?0.05) and 1.47 (1.05-2.06, P?0.05), respectively.There were no significant differences of 5-year overall survival in TNM stage I and II of the Siewert II/III adenocarcinoma patients, but improved survival of TNM stage III patients undergoing transabdominal hiatal compared with transthoracic total radical and proximal gastrectomy. The short-term clinical outcomes improved with the transabdominal hiatial surgery group. PMID:26683954
Improvement in medication adherence and self-management of diabetes with a clinical pharmacy program: a randomized controlled trial in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital
Cani, Catarina Gomes; da Silva Girão Lopes, Laura; Queiroz, Márcia; Nery, Márcia
OBJECTIVE: To evaluate the impact of a clinical pharmacy program on health outcomes in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital in Brazil. METHOD: A randomized controlled trial with a 6-month follow-up period was performed in 70 adults, aged 45 years or older, with type 2 diabetes who were taking insulin and who had an HbA1c level ?8%. Patients in the control group (CG) (n?=?36) received standard care, patients in the intervention group (IG) (n?=?34) received an individualized pharmacotherapeutic care plan and diabetes education. The primary outcome measure was change in HbA1c. Secondary outcomes included diabetes and medication knowledge, adherence to medication, insulin injection and home blood glucose monitoring techniques and diabetes-related quality of life. Outcomes were evaluated at baseline and 6 months using questionnaires. RESULTS: Diabetes knowledge, medication knowledge, adherence to medication and correct insulin injection and home blood glucose monitoring techniques significantly improved in the intervention group but remained unchanged in the control group. At the end of the study, mean HbA1c values in the control group remained unchanged but were significantly reduced in the intervention group. Diabetes-related quality of life significantly improved in the intervention group but worsened significantly in the control group. CONCLUSION: The program improved health outcomes and resulted in better glycemic control in patients with type 2 diabetes undergoing insulin therapy. PMID:25789518
Moosavian, Mojtaba; Rahimzadeh, Mohammad
Background and Objectives: Carbapenem resistant Pseudomonas aeruginosa is a serious cause of nosocomial infections. The main purpose of the study is to determine the prevalence rate of imipenem resistant Pseudomonas aeruginosa carrying metallo-ß-lactamase (MBL) genes. Material and Methods: 236 Pseudomonas aeruginosa isolates were collected from teaching hospitals of Ahvaz University of Medical Sciences during a period of 9 months in 2012. These strains were identified using conventional microbiological tests. The susceptibility of isolates to antibiotics were assessed using disk diffusion test. The IMP-EDTA combination disk phenotypic test was performed for detection of MBL producing strains. Finally, polymerase chain reaction (PCR) was performed to detect MBL genes, blaIMP-1, blaVIM-2 and blaSPM-1 in imipenem resistant strains. Results: Out of 236 examined isolates, 122 isolates (51.4%) were resistant to imipenem. The IMP-EDTA combination test showed that among 122 imipenem resistant strains, 110 strains (90%) were phenotipically MBL producers. Additionally, the results of PCR method showed that 2 strains (1.6%) and 67strains (55%) of imipenem resistant Pseudomonas aeruginosa isolates contained blaVIM-2 and blaIMP-1 genes respectively. No SPM-1gene was found in the examined samples. Conclusion: Resistance of P. aeruginosa isolates to imipenem due to MBL enzymes is increasing in Ahavaz. Because of clinical significance of this kind of resistance, rapid detection of MBL producing strains and followed by appropriate treatment is necessary to prevent the spreading of these organisms.
Cheng, Anita; Jose, JoAnn; Larsen-Reindorf, Roderick; Small, Christina; Nde, Helen; Dugas, Lara; Ehrhardt, Stephan; Nelson, Kenrad; Ezeanolue, Eche; Layden, Jennifer
Hepatitis B virus (HBV) infection is a major global health problem, with sub-Saharan Africa (SSA), including West Africa, bearing a large proportion of cases. Mother-to-child and early childhood horizontal transmission, the most common mechanisms of disease spread in West Africa, lead to a high rate of chronic infection. Although these transmission mechanisms are preventable through vaccine and hepatitis B immunoglobulin, they are not routinely used due to limited resources. Antiviral therapy in pregnant women who are HBV positive is another option to reduce transmission. We conducted a survey study of pregnant women and clinicians at a teaching hospital in West Africa to determine the knowledge base about HBV and willingness to implement measures to reduce HBV transmission. Pregnant women had limited knowledge about HBV and the common transmission mechanisms. Clinicians identified cost and time as the major barriers to implementation of HBV prevention measures. Both pregnant women and clinicians were largely willing to implement and use measures, including antivirals, to help reduce HBV transmission. PMID:26566533
Cheng, Anita; Jose, JoAnn; Larsen-Reindorf, Roderick; Small, Christina; Nde, Helen; Dugas, Lara; Ehrhardt, Stephan; Nelson, Kenrad; Ezeanolue, Eche; Layden, Jennifer
Hepatitis B virus (HBV) infection is a major global health problem, with sub-Saharan Africa (SSA), including West Africa, bearing a large proportion of cases. Mother-to-child and early childhood horizontal transmission, the most common mechanisms of disease spread in West Africa, lead to a high rate of chronic infection. Although these transmission mechanisms are preventable through vaccine and hepatitis B immunoglobulin, they are not routinely used due to limited resources. Antiviral therapy in pregnant women who are HBV positive is another option to reduce transmission. We conducted a survey study of pregnant women and clinicians at a teaching hospital in West Africa to determine the knowledge base about HBV and willingness to implement measures to reduce HBV transmission. Pregnant women had limited knowledge about HBV and the common transmission mechanisms. Clinicians identified cost and time as the major barriers to implementation of HBV prevention measures. Both pregnant women and clinicians were largely willing to implement and use measures, including antivirals, to help reduce HBV transmission. PMID:26566533
Dunowska, Magdalena; Morley, Paul S; Hyatt, Doreene R
The objective of the study was to determine the disinfection efficacy of aerosolizing (cold fogging) Virkon S on survival of Stahpylococcus aureus and Salmonella enterica on different surfaces. Two experiments were conducted in different locations. Salmonella enterica and S. aureus were grown in broth culture and then seeded into pre-marked areas in each location and allowed to dry. Virkon S (1%) was aerosolized into the rooms (approximately 1L of per 30 m(3)). Samples were collected pre- and post-fogging for quantitative cultures to evaluate the efficacy of aerial disinfection. The reduction of S. enterica or S. aureus counts ranged from 3.40 to 0.95 log(10) (Salmonella) or 4.92 to 0.02 log(10) (Staphylococcus). The greatest reduction was evident in samples collected from non-porous horizontal surfaces, which were not obstructed from the air flow. These results indicate that fogging with Virkon S could be beneficial in routine disinfection of pre-cleaned surfaces. The benefits of routine use of cold fogging with Virkon S in veterinary hospital settings would include its wide-range antimicrobial action and minimal working-men power required to disinfect large areas. Also, fogging would potentially minimize microbial contamination in the hard to reach areas. PMID:15708826
Bach, Matthias; Geisel, Tabea; Martin, Julia; Schulze, Bettina; Schaefer, Roland; Virgin, Garth; Stein, Juergen
Current iron supplementation practice in geriatric patients is erratic and lacks evidence-based recommendations. Despite potential benefits in this population, intravenous iron supplementation is often withheld due to concerns regarding pharmacy expense, perceived safety issues, and doubts regarding efficacy in elderly patients. This retrospective, observational cohort study aimed to evaluate the safety and efficacy of intravenous ferric carboxymaltose (FCM, Ferinject) in patients aged >75 years with iron deficiency anaemia (IDA). Within a twelve-month data extraction period, the charts of 405 hospitalised patients aged 65–101 years were retrospectively analysed for IDA, defined according to WHO criteria for anaemia (haemoglobin: <13.0?g/dL (m)/<12.0?g/dL (f)) in conjunction with transferrin saturation <20%. Of 128 IDA patients screened, 51 (39.8%) received intravenous iron. 38 patient charts were analysed. Mean cumulative dose of intravenous FCM was 784.4 ± 271.7?mg iron (1–3 infusions). 18 patients (47%) fulfilled treatment response criteria (?1.0?g/dL increase in haemoglobin between baseline and hospital discharge). AEs were mild/moderate, most commonly transient increases of liver enzymes (n = 5/13.2%). AE incidence was comparable with that observed in patients <75 years. No serious AEs were observed. Ferric carboxymaltose was well tolerated and effective for correction of Hb levels and iron stores in this cohort of IDA patients aged over 75 years. PMID:26236500
Willemsen, Ina; Oome, Stijn; Verhulst, Carlo; Pettersson, Annika; Verduin, Kees; Kluytmans, Jan
This paper describes the trends in prevalence of ESBL producing Enterobacteriaceae (ESBL-E) and ESBL genes, measured in five consecutive yearly Point Prevalence Surveys (PPS). All patients present in the hospital and in a day-care clinic (including patients on dialysis) on the day of the survey, were screened for perianal ESBL-E carriage. Perianal swabs were taken and cultured using an enrichment broth and a selective agar plate. Both phenotypic and genotypic methods were used to detect the production of ESBL, presence of ESBL-genes and clonal relatedness. Out of 2,695 patients, 135 (5.0%) were tested ESBL-E positive. The overall ESBL-E prevalence was stable over the years. Overall 5.2% of all ESBL-E were acquired by nosocomial transmission. A relative decrease of CTX-M-1-1-like ESBL genes (from 44 to 25%, p = 0.026) was observed, possibly related to the strong (>60%) decrease in antibiotic use in livestock in our country during the same period. PMID:26528549
Ibe, Nnenne I.; Iroegbu, Christian U.
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
Upadhyay, Saloni; Chufal, Sanjay Singh; Hasan, Yuman; Tayal, Ishwer
Backround: ABO and Rhesus (Rh) blood group antigens are hereditary characters and are useful in population genetic studies, in resolving medico-legal issues and more importantly for the immunologic safety of blood during transfusion. Aims: This study is aimed to determine the distribution pattern of the ABO and Rh blood groups among blood donors in Kumaon region of Uttarakhand and compare it with other data from similar studies within the India and all over the world. Design: It is a retrospective study carried out at blood bank of Shushila Tewari Hospital of Government Medical College, Haldwani from January 2012 to December 2013. Materials and Methods: The study was conducted on 12,701 blood donors. ABO and Rh typing was done using slide agglutination method with antisera ABO and Rh (Tulip diagnostics ltd). Doubtful cases were confirmed by tube agglutination method and reverse grouping using known pooled A and B cells. The age group and sex of donors, frequency of ABO and Rh blood groups were reported in simple percentages. Results: The predominant donors belonged to age group between 18-35years (84.28%). Male donors were more than female donors, ratio being 352:1. Replacement donors (99.71%) were much more than voluntary donors (0.91%). The most common blood group was B (32.07%) and least common being AB (10.53%). Blood group ‘O’ and ‘A’ had same frequency. The prevalence of Rhesus positive and negative distribution in the studied population was 94.49% and 5.51% respectively. Blood group frequency with respect to ABO and Rhesus positive was found to be shown by formula B> O>A >AB. The frequency for ABO and Rhesus negative was given by the formula B>A>O>AB. Conclusion: Knowledge of frequencies of the different blood groups is very important for blood banks and transfusion service policies that could contribute significantly to the National Health System. PMID:25653957
Background Typhoid intestinal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in these patients in resource limited countries is still very poor. This study was to review our experiences on the surgical management of typhoid intestinal perforation and to determine the prognostic factors for mortality in our local setting. Methods This was a combined retrospective and prospective study of patients who were operated for typhoid intestinal perforation at Bugando Medical Centre between August 2006 and September 2011. Data collected were analyzed using SPSS computer software version 15. Results A total of 104 patients were studied representing 8.7% of typhoid fever cases. Males were affected twice more than the females (2.6:1). Their ages ranged from 8 to 76 years with a median age of 18.5 years. The peak age incidence was in the 11-20 years age group. Fever and abdominal pain were the most common presenting symptoms and majority of the patients (80.8%) perforated between within 14 days of illness. Chest and abdominal radiographs revealed pneumoperitonium in 74.7% of cases. Ultrasound showed free peritoneal collection in 85.7% of cases. Nine (10.2%) patients were HIV positive with a median CD4+ count of 261 cells/?l. The perforation-surgery interval was more than 72 hours in 90(86.5%) patients. The majority of patients (84.6%) had single perforations and ileum was the most common part of the bowel affected occurring in 86.2% of cases. Simple closure of the perforations was the most commonly performed procedure accounting for 78.8% of cases. Postoperative complication rate was 39.4% and surgical site infection was the most frequent complication in 55.5% of cases. Mortality rate was 23.1% and it was statistically significantly associated with delayed presentation, inadequate antibiotic treatment prior to admission, shock on admission, HIV positivity, low CD4 count (< 200 cells/?l), high ASA classes (III-V), delayed operation, multiple perforations, severe peritoneal contamination and presence of postoperative complications (P < 0.001). The median overall length of hospital stay was 28 days. Conclusion Typhoid intestinal perforation is still endemic in our setting and carries high morbidity and mortality. This study has attempted to determine the factors that statistically influence mortality in typhoid perforation in our environment. Appropriate measures focusing at these factors are vital in order to deliver optimal care for these patients in this region. PMID:22401289
Background Trochanteric fractures are common fractures in the elderly. Due to characteristic demographic changes, the incidence of these injuries is rapidly increasing. Treatment of these fractures is associated with high rates of complications. In addition, the long-term results remain poor, with high morbidity, declines in function, and high mortality. Therefore, in this study, complication rates and patients’ outcomes were evaluated after fixation of geriatric trochanteric fractures using the Gamma3™ nail. Methods Patients aged 60 years old or older, with pertrochanteric and subtrochanteric femoral fractures, were included. Patients with polytrauma or pathological fractures were excluded. Age, sex, and fracture type were collected on admission. In addition, data were recorded concerning the surgeon (resident vs. consultant), time of operation, and local or systemic perioperative complications. Complications were also collected at the 6- and 12-month follow-ups after trauma. Barthel Index, IADL, and EQ-5D measurements were evaluated retrospectively on admission, as well as at discharge and during the follow-up. Results Ninety patients were prospectively included between April 2009 and September 2010. The patients’ average age was 81 years old, and their average ASA score was 3. The incision/suture time was 53 min (95% CI 46–60 min). Hospital mortality was 4%, and overall mortality was 22% at the 12-month follow-up. Eight local complications occurred (4 haematomas, 1 deep infection, 1 cutting out, 1 irritation of the iliotibial tract, 1 periosteosynthetic fracture). The incidence of relevant systemic complications was 6%. Forty-two percent of the patients were operated on by residents in training, without significant differences in duration of surgery, complication rate, or mortality rate. The Barthel Index (82 to 71, p < .001), IADL (4.5 to 4.3, p = .0195) and EQ-5-D (0.75 to 0.66, p = .068) values did not reach pre-fracture levels during the follow-up period of 12 months. Conclusion The results showed a relatively low complication rate using the Gamma3™ nail, even if the nailing was performed by residents in training. The high mortality, declines in function, and low quality of life could probably be attributed to pre-existing conditions, such as physical status. In summary, the Gamma3™ nail seems to be a useful implant for the nailing of trochanteric fractures, although further studies are necessary comparing different currently available devices. PMID:23176260
Posteraro, Brunella; Spanu, Teresa; Fiori, Barbara; De Maio, Flavio; De Carolis, Elena; Giaquinto, Alessia; Prete, Valentina; De Angelis, Giulia; Torelli, Riccardo; D'Inzeo, Tiziana; Vella, Antonietta; De Luca, Alessio; Tumbarello, Mario; Ricciardi, Walter
Sensititre YeastOne (SYO) is an affordable alternative to the Clinical and Laboratory Standards Institute (CLSI) reference method for antifungal susceptibility testing. In this study, the MICs of yeast isolates from 1,214 bloodstream infection episodes, generated by SYO during hospital laboratory activity (January 2005 to December 2013), were reanalyzed using current CLSI clinical breakpoints/epidemiological cutoff values to assign susceptibility (or the wild-type [WT] phenotype) to systemic antifungal agents. Excluding Candida albicans (57.4% of all isolates [n = 1,250]), the most predominant species were Candida parapsilosis complex (20.9%), Candida tropicalis (8.2%), Candida glabrata (6.4%), Candida guilliermondii (1.6%), and Candida krusei (1.3%). Among the non-Candida species (1.9%), 7 were Cryptococcus neoformans and 17 were other species, mainly Rhodotorula species. Over 97% of Candida isolates were susceptible (WT phenotype) to amphotericin B and flucytosine. Rates of susceptibility (WT phenotype) to fluconazole, itraconazole, and voriconazole were 98.7% in C. albicans, 92.3% in the C. parapsilosis complex, 96.1% in C. tropicalis, 92.5% in C. glabrata, 100% in C. guilliermondii, and 100% (excluding fluconazole) in C. krusei. The fluconazole-resistant isolates consisted of 6 C. parapsilosis complex isolates, 3 C. glabrata isolates, 2 C. albicans isolates, 2 C. tropicalis isolates, and 1 Candida lusitaniae isolate. Of the non-Candida isolates, 2 C. neoformans isolates had the non-WT phenotype for susceptibility to fluconazole, whereas Rhodotorula isolates had elevated azole MICs. Overall, 99.7% to 99.8% of Candida isolates were susceptible (WT phenotype) to echinocandins, but 3 isolates were nonsusceptible (either intermediate or resistant) to caspofungin (C. albicans, C. guilliermondii, and C. krusei), anidulafungin (C. albicans and C. guilliermondii), and micafungin (C. albicans). However, when the intrinsically resistant non-Candida isolates were included, the rate of echinocandin nonsusceptibility reached 1.8%. In summary, the SYO method proved to be able to detect yeast species showing antifungal resistance or reduced susceptibility. PMID:25896705
Davis, James E., Ed.
This issue of "Focus: Teaching English in Southeastern Ohio" contains articles about teaching Shakespeare, student summaries of a Shakespeare conference held at Ohio University-Zanesville in April 1976, and suggested projects for teaching poetry writing. It also contains lists of materials and articles related to the teaching of Shakespeare, and…
Gives practical hints for teaching pronunciation with special attention to accent: 1. Teaching of pronunciation should take place in a "meaningful context." 2. Mimicry drills form the basis for teaching pronunciation. 3. Discrimination drills are a prerequisite for successful teaching of pronunciation. 4. Speaking in chorus is a useful method for…
there appears to be a substantial difference in terms of EHRs implementation and adoption among hospitals with different organizational characteristics and by end-users in different job categories, little has been studied about the relationship between EHR...
Smith, Dean G; Clement, Jan P
It remains an open question whether hospital spending on fundraising efforts to garner philanthropy is a good use of funds. Research and industry reports provide conflicting results. We describe the accounting and data challenges in analysis of hospital philanthropy, which include measurement of donations, measurement of fundraising expenses, and finding the relationships among organizations where these cash flows occur. With these challenges, finding conflicting results is not a surprise. PMID:23614267
Page 27 DESCRIPTION OF HOSPITALS IN THE GREATER HARTFORD AREA Connecticut Children's Medical Center's hospital serving as the primary teaching hospital for the University of Connecticut School of Medicine's Hospitals" rankings. The history of Connecticut Children's spans more than 100 years. Founded as a 10-bed
Quality of Artemisinin-Based Combination Formulations for Malaria Treatment: Prevalence and Risk Factors for Poor Quality Medicines in Public Facilities and Private Sector Drug Outlets in Enugu, Nigeria
Kaur, Harparkash; Allan, Elizabeth Louise; Mamadu, Ibrahim; Hall, Zoe; Ibe, Ogochukwu; El Sherbiny, Mohamed; van Wyk, Albert; Yeung, Shunmay; Swamidoss, Isabel; Green, Michael D.; Dwivedi, Prabha; Culzoni, Maria Julia; Clarke, Siân; Schellenberg, David; Fernández, Facundo M.; Onwujekwe, Obinna
Background Artemisinin-based combination therapies are recommended by the World Health Organisation (WHO) as first-line treatment for Plasmodium falciparum malaria, yet medication must be of good quality for efficacious treatment. A recent meta-analysis reported 35% (796/2,296) of antimalarial drug samples from 21 Sub-Saharan African countries, purchased from outlets predominantly using convenience sampling, failed chemical content analysis. We used three sampling strategies to purchase artemisinin-containing antimalarials (ACAs) in Enugu metropolis, Nigeria, and compared the resulting quality estimates. Methods ACAs were purchased using three sampling approaches - convenience, mystery clients and overt, within a defined area and sampling frame in Enugu metropolis. The active pharmaceutical ingredients were assessed using high-performance liquid chromatography and confirmed by mass spectrometry at three independent laboratories. Results were expressed as percentage of APIs stated on the packaging and used to categorise each sample as acceptable quality, substandard, degraded, or falsified. Results Content analysis of 3024 samples purchased from 421 outlets using convenience (n=200), mystery (n=1,919) and overt (n=905) approaches, showed overall 90.8% ACAs to be of acceptable quality, 6.8% substandard, 1.3% degraded and 1.2% falsified. Convenience sampling yielded a significantly higher prevalence of poor quality ACAs, but was not evident by the mystery and overt sampling strategies both of which yielded results that were comparable between each other. Artesunate (n=135; 4 falsified) and dihydroartemisinin (n=14) monotherapy tablets, not recommended by WHO, were also identified. Conclusion Randomised sampling identified fewer falsified ACAs than previously reported by convenience approaches. Our findings emphasise the need for specific consideration to be given to sampling frame and sampling approach if representative information on drug quality is to be obtained. PMID:26018221
Sloan, F A
This study presents descriptive information on several dimensions of the internal organization of hospitals, with particular emphasis on medical staff, using data from two unique national surveys. Three alternative theories of hospital behavior by economists are described and evaluated with these data. The study also shows how standard bed size, teaching, and ownership categories relate to important features of hospital organization. In this way, understanding of these standard "control" variables is enhanced. For example, systematic organizational differences between proprietary and other hospitals are reported, holding bed size and teaching status constant. No single theory of hospital behavior emerges as dominant. The tables demonstrate the diversity of hospitals and the likelihood that no single model can adequately describe the behavior of all hospitals. PMID:7204062
The teaching of collective risks to paramedical staff is a difficult exercise. To make the training more concrete, the team from the emergency care training centre at Rouen university hospital has adopted an innovative pedagogical approach. Based on a multi-casualty disaster scenario and using model figures, the training invites participants to take part in role plays. PMID:26144514
Herman, M J
This article summarizes key areas of focus for the analysis of risk in the hospital segment of the health care industry. The article is written from a commercial bank lending perspective. Both for-profit (C-corporations) and 501 (c)(3) not-for-profit segments are addressed. PMID:9612734
College of the Canyons, Valencia, CA.
A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…
Fluellen, Jerry E., Jr.
Power Teaching weaves four factors into a seamless whole: standards, teaching thinking, research based strategies, and critical inquiry. As a prototype in its first year of development with an urban fifth grade class, the power teaching model connects selected district standards, thinking routines from Harvard University Project Zero Research…
Choate, G M; Walker, W R; Unger, M
Recently available figures for 1982 and 1983 show that Catholic hospitals as a whole attained positive ratios of net income to fund balances and that these gains exceeded inflation in both years. The financial picture varies, however, when data for specific categories of Catholic hospitals are examined. For example, smaller hospitals relied more on borrowed funds to finance assets and generate profits, and for many of them these profits still did not exceed the 1983 inflation rate. Hospitals particularly vulnerable to diagnosis-related group payment--that is, teaching hospitals, hospitals with negative operating income, and hospitals adding beds--possessed less liquidity than Catholic hospitals aggregately. Hospitals in each of these categories experienced less-than-average basic profitability as well. PMID:10275109
Leung, Peggy; Lo, Terence
This paper focuses on English language teaching for the hospitality industry in Hong Kong, presenting a brief statement on the concept of transfer and its relevance to teaching English as a Foreign Language (EFL) for the world of work. The observable changes in the nature of language in the world of work in a service-oriented economy are…
Chang, C F; Tuckman, H P
Each year Medicare-participant hospitals submit a cost report to the Health Care Financing Administration (HCFA) to settle their reimbursement claims. These reports are subject to audit, and a decision by HCFA to audit can be costly to the auditee. This article uses data from 6,270 cost reports filed in 1986 to explore the factors related to the probability of an audit. Logistic regression equations are estimated to examine how hospital characteristics influence the chance of audit. The results suggest that audit probability can be predicted with reasonable accuracy by a hospital's bed size, ownership type, teaching status, function, proportion of Medicare inpatient days, and geographic location. PMID:10130611
Fenstermacher, Gary D.; Osguthorpe, Richard D.; Sanger, Matthew N.
In this article, the authors introduce what they believe is an important distinction between teaching morality and teaching morally. In P-12 schools, the moral education debate often focuses on character education programs or other moral curricula. Such programs and curricula are championed as a means of teaching morality and transmitting moral…
Heath, Daniel E.; Hoy, Mary; Rathman, James F.; Rohdieck, Stephanie
The Chemical and Biomolecular Engineering Department at The Ohio State University in collaboration with the University Center for the Advancement of Teaching developed the Chemical Engineering Mentored Teaching Experience. The Mentored Teaching Experience is an elective for Ph.D. students interested in pursuing faculty careers. Participants are…
Rosko, M D; Carpenter, C E
The practice of cost shifting has stirred interest in hospital pricing policy. This study examined the determinants of the markup ratio, a summary measure of the hospital's pricing policy, in Pennsylvania acute care hospitals. The results indicate that severity of illness and the proportion of revenue earned from Medicare and Medicaid were the most important factors influencing markups. Other significant factors included extensive teaching activities and county per capita income. PMID:10132098
Oliver, Douglas L.
Adult Partial Hospitalization Program JOHN DEMPSEY HOSPITAL CONTACT US For further information.uchc.edu. The Adult Partial Hospitalization Program is available Monday through Friday from 9 a.m. to 2:05 p.m. OUR LOCATION AND DIRECTIONS The Adult Partial Hospitalization Program is located on the 5th floor of the John
Wolfe, Patrick J.
Fall 2014 Harvard University Certificate of Distinction in Teaching (for outstanding teaching Harvard University Certificate of Distinction in Teaching (for outstanding teaching fellows, teaching Harvard University Certificate of Distinction in Teaching (for outstanding teaching fellows, teaching
Belsheim, David J.; And Others
Forty hospital pharmacists participated in a 2 week pilot of a postgraduate clinical pharmacy clerkship, using different hospital services as teaching sites at the University of Illinois and Cook County hospitals in Chicago. The clerkship experience broadened participants' conceptions of the depth and scope of the clinical pharmacist's role.…
Day, Richard R.
"Teaching Reading" uncovers the interactive processes that happen when people learn to read and translates them into a comprehensive easy-to-follow guide on how to teach reading. Richard Day's revelations on the nature of reading, reading strategies, reading fluency, reading comprehension, and reading objectives make fascinating…
Middleton, Kathleen, Ed.
Ideas to aid the classroom teacher include integration of emphasis on reading into health education; definitions pertinent to contemporary health education; teaching students to read food labels; identification of implications of scientific advances such as test tube reproduction; and a card game to teach food groups to middle school children.…
Crawford, William J.
Grammar is a component in all language skills: reading, writing, speaking, and listening. Teachers need to know rules of grammar (teacher knowledge) as well as techniques that help students use grammar effectively and effortlessly (teaching knowledge). Using reflective practice to help teachers become comfortable with teaching grammar, this…
Bunyan, L. W.
The purpose of this study was to review current developments in team teaching and to assess its potential in the Calgary, Alberta, schools. An investigation into team teaching situations in schools in the eastern half of the United States and Canada revealed characteristics common to successful programs (e.g., charismatic leadership and innovative…
I consider mathematics to be one of the most challenging subjects to teach, ... I had the opportunity of teaching in high school, where I learned that it is possible to ... mind and drop anxiety by 45%, so I decided to introduce five minutes of ...
Safstrom, Carl Anders
Discusses some conditions for understanding teaching as an act of responsibility towards others, rather than as an instrumental act identified through epistemology. Argues that in order to make teaching an ethical relationship between individuals, teachers must give up their position on the safe side of knowledge and participate in the risk…
Cunningham, David C.
A study was designed to evaluate the effectiveness of principals in structuring teaching teams; to assess background and personality characteristics appearing essential to successful individual and team performance; and to select personality factor scores which would predict individual and team success. Subjects were 31 teaching teams (99…
General Hospital #12;2015 Daniel D. Federman Teaching Awards Nominees Susan Frankl, M.D. Medicine Beth and Women's Hospital James Heckman, M.D. Medicine Beth Israel Deaconess Medical Center Susan Herman, M Israel Deaconess Medical Center #12;2015 Daniel D. Federman Teaching Awards Nominees Randall King, M
Shuman, R. Baird
Content area teachers at the secondary level should teach students specific techniques for handling the reading materials in their disciplines. This paper points out the need for administrators to overcome attitudinal barriers of content teachers with regard to teaching reading skills and shows how compulsory attendance laws have led to the…
Burns, Johnna N.
Purpose, Scope, and Method of Study: Hospital school teachers are a unique population of educators highly qualified and experienced in teaching students who are facing health crises. The purpose of this phenomenological study was to describe the lived experience of teaching seriously ill students in the hospital school setting. The study was…
Sadat, Somayeh; Abouee-Mehrizi, Hossein; Carter, Michael W
In this paper, we consider two hospitals with different perceived quality of care competing to capture a fraction of the total market demand. Patients select the hospital that provides the highest utility, which is a function of price and the patient's perceived quality of life during their life expectancy. We consider a market with a single class of patients and show that depending on the market demand and perceived quality of care of the hospitals, patients may enjoy a positive utility. Moreover, hospitals share the market demand based on their perceived quality of care and capacity. We also show that in a monopoly market (a market with a single hospital) the optimal demand captured by the hospital is independent of the perceived quality of care. We investigate the effects of different parameters including the market demand, hospitals' capacities, and perceived quality of care on the fraction of the demand that each hospital captures using some numerical examples. PMID:25711185
Maxwell, Bruce D.
HOSPITALITY APPROVAL FORM DATE: __________________________ PERMISSION IS REQUESTED TO USE __ASMSU ___________________________________ DATE ______________ (Valid for FUNDS 426XXX through 429999 and 4WXXXX) *****THE HOSPITALITY APPROVAL refreshments or meals served during seminars, workshops, professional meetings, or conferences. Hospitality
Maxwell, Bruce D.
HOSPITALITY APPROVAL FORM DATE: __________________________ PERMISSION IS REQUESTED TO USE ___________________________________ DATE ______________ (Valid for FUNDS 426XXX through 429999 and 4WXXXX) *****THE HOSPITALITY APPROVAL refreshments or meals served during seminars, workshops, professional meetings, or conferences. Hospitality
Shepard, D S
A preliminary model is developed for estimating the extent of savings, if any, likely to result from discontinuing a specific inpatient service. By examining the sources of referral to the discontinued service, the model estimates potential demand and how cases will be redistributed among remaining hospitals. This redistribution determines average cost per day in hospitals that receive these cases, relative to average cost per day of the discontinued service. The outflow rate, which measures the proportion of cases not absorbed in other acute care hospitals, is estimated as 30 percent for the average discontinuation. The marginal cost ratio, which relates marginal costs of cases absorbed in surrounding hospitals to the average costs in those hospitals, is estimated as 87 percent in the base case. The model was applied to the discontinuation of all inpatient services in the 75-bed Chelsea Memorial Hospital, near Boston, Massachusetts, using 1976 data. As the precise value of key parameters is uncertain, sensitivity analysis was used to explore a range of values. The most likely result is a small increase ($120,000) in the area's annual inpatient hospital costs, because many patients are referred to more costly teaching hospitals. A similar situation may arise with other urban closures. For service discontinuations to generate savings, recipient hospitals must be low in costs, the outflow rate must be large, and the marginal cost ratio must be low. PMID:6668181
Goes, J B; Zhan, C
STUDY QUESTION. This study investigated the longitudinal relations between hospital financial performance outcomes and three hospital-physician integration strategies: physician involvement in hospital governance, hospital ownership by physicians, and the integration of hospital-physician financial relationships. DATA SOURCES AND STUDY SETTING. Using secondary data from the State of California, integration strategies in approximately 300 California short-term acute care hospitals were tracked over a ten-year period (1981-1990). STUDY DESIGN. The study used an archival design. Hospital performance was measured on three dimensions: operational profitability, occupancy, and costs. Thirteen control variables were used in the analyses: market competition, affluence, and rurality; hospital ownership; teaching costs and intensity; multihospital system membership; hospital size; outpatient service mix; patient volume case mix; Medicare and Medicaid intensity; and managed care intensity. DATA COLLECTION/EXTRACTION. Financial and utilization data were obtained from the State of California, which requires annual hospital reports. A series of longitudinal regressions tested the hypotheses. PRINCIPAL FINDINGS. Considerable variation was found in the popularity of the three strategies and their ability to predict hospital performance outcomes. Physician involvement in hospital governance increased modestly from 1981-1990, while ownership and financial integration declined significantly. Physician governance was associated with greater occupancy and higher operating margins, while financial integration was related to lower hospital operating costs. Direct physician ownership, particularly in small hospitals, was associated with lower operating margins and higher costs. Subsample analyses indicate that implementation of the Medicare prospective payment system in 1983 had a major impact on these relationships, especially on the benefits of financial integration. CONCLUSIONS. The findings support the validity of hospital-physician financial integration efforts, and to a lesser extent the involvement of physicians in hospital governance. The results lend considerably less support for strategies built around direct physician ownership in hospitals, particularly since PPS implementation. RELEVANCE/IMPACT. These findings challenge prior studies that found few financial benefits to hospital-physician integration prior to PPS implementation in 1983. The results imply that financial benefits of integration may take several years after implementation to emerge, are most salient in a managed care or managed competition environment, and vary by hospital size and multihospital system membership. PMID:7591779
Sutters, C A
This paper describes the management of a hospital formulary that is operated by voluntary co-operation of prescribes. The organizational and philosophical factors associated with the formulary management system in a major teaching hospital environment are discussed. A combination of educative, re-educative, persuasive and facilitative strategies is used to influence prescribing behaviour. Both passive and active methods, including face-to-face intervention methods are practised. The formulary is reinforced with an extensive pharmacy monitoring operation which stimulates facilitative dialogue between pharmacists and prescribers and encourages medical self-audit and peer review. Evidence of compliance with recommended policies, and consequent control of drug expenditure are presented. PMID:2318917
Howard, Jeff W.
that you know each member. Teaching Techniques Several teaching techniques are available: lecture, illus- trated talk, discussion, question and answer, demonstra- tion, work session or practical exercise, experimentation, tours and home visits..., and exhibits. Experience in the use of these techniques comes only with practice. 1. Lecture For this technique, the teacher usually speaks to groups from prepared notes without visual aids or opportunity for group questions. This method is useful when new...
Wojtecki, Cindy A.; Wade, Michael J.; Pato, Michele T.
Objective: The authors discuss teaching clinicians about research by generating projects from clinical practice, expertise, and interest. Method: Classes were co-taught by the hospital biostatistician and clinical nurse specialist in consultation with one of the authors. Hospital clinicians were taught how to initiate and design their study as a…
This literature review examines the effects of hospitalization on the young child and suggests ways in which parents and hospital personnel can protect children from the potentially harmful emotional and intellectual effects of hospitalization. The history of attitudes toward the hospitalization of children is discussed. Children's emotional…
Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid
Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…
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The National Hospital Discharge Survey (NHDS), which has been conducted annually since 1965, collects data from a sample of approximately 270,000 inpatient records acquired from a national sample of about 500 hospitals. Only hospitals with an average length of stay of fewer than 30 days for all patients, general hospitals, or children's general hospitals are included in the survey. Information collected includes diagnoses, surgical and nonsurgical procedures, prescription and over-the-counter drugs, immunizations, allergy shots, anesthetics, and dietary supplements.
The marketing challenge for rehabilitation centers lies in teaching patients and referring physicians about what rehab is. Siskin Hospital for Physical Rehabilitation has just started a Web site that aims to meet the challenge. PMID:10167486
Cleopas, A; Kolly, V; Bovier, P; Garnerin, P; Perneger, T
Objective: To evaluate whether hospitalised patients would agree to wear an identification bracelet and whether patient acceptability is improved by more detailed explanations or by using a code instead of a name on the bracelet. Design: Patient survey that tested two variables in a randomised factorial design. Explanations about identification bracelets were given (a) with or without examples of situations where patient identification may be important, and (b) with the patient name or an anonymous code appearing on the bracelet. Setting: Swiss teaching hospital where wearing of identification bracelets was not systematic. Participants: Adult patients discharged from hospital (n = 1411). Main outcome measures: Patients' responses to the questions: (a) should the hospital introduce a compulsory identification bracelet? and (b) would the patient agree to wear such a bracelet? Results: Globally, 83.9% of patients thought that the hospital should introduce bracelets and 90.2% stated that they would agree to wear one. Providing examples increased support for both the hospital policy (87.9% v 79.2%, p<0.001) and personal acceptance (92.2% v 88.1%, p = 0.015). Whether or not the bracelet carried the patient's name or an anonymous code did not influence patient choice. Conclusions: The majority of patients were in favour of wearing an identification bracelet during their hospital stay. This proportion increased significantly when an explanation based on examples of the consequences of incorrect patient identification had been provided. PMID:15465937
Speranzo, A J
The effect of hospital reimbursement systems on the financial management of hospitals is briefly discussed, and the organization of hospital financial operations is reviewed. The implementation of Medicare prospective pricing will change the way in which hospital finances are managed. Health-care managers will be concerned with the profitability of product lines, or diagnosis-related groups, in future strategic planning efforts. The hospital's finance department consists of several traditional areas that exist in almost all financial organizations. The functions and interactions of these various areas are discussed in light of previous and current hospital reimbursement strategies. Staffing of the finance department and the duties of the hospital's chief financial officer are also described. The prospective pricing system of hospital reimbursement and increasing pressure from the business community to stem the rising costs of health care will produce changes in the medical and financial operations of the hospital industry over the next decade. PMID:6375357
Barnet, Richard J.
Information about nuclear weapons and their effects must be taught without imparting hopelessness and despair. Suggestions for teaching about the arms race from an historical perspective and about alternative security systems--international law, conventional weapons, nonviolent resistance--are given. (PP)
Burbules, Nicholas C.
This essay reflects upon certain aspects of Wittgenstein's own practices as a teacher. "Doing" philosophy always took priority for Wittgenstein, whether this was in oral or written form: it was important to show the deep puzzles in our language (and our culture and thinking) as a step toward dissolving them. In this respect, one can teach only as…
New York State Education Dept., Albany. Bureau of Secondary Curriculum Development.
Intended primarily for use by instrumental music teachers who do not have a major concentration in strings, this guide provides pertinent basic resources, materials, teaching--learning expectation, and a general overall guide to achievement levels at various stages of development. Discussions are presented of Choosing the Proper Method Book,…
Communication: Journalism Education Today, 1998
Outlines nine objectives students should be able to accomplish after completing the activities in the unit on typography presented in the previous articles in this journal. Offers eight tips for teaching typography. Includes a short list of books about typography and a list of seven organizations. (SR)
Shea, Mary Ann, Ed.
This collection of lectures includes the following contributions from faculty at the University of Colorado at Boulder: (1) "Aloof Professors and Shy Students" (Patricia Nelson Limerick); (2) "Teaching the Thundering Herd: Surviving in a Large Classroom" (Charles R. Middleton); (3) "The Scientist as a Story Teller" (R. Igor Gamow); (4) "Active…
Waters, John K.
It has been 41 years since the late Wisconsin Senator Gaylord Nelson launched the first nationwide grassroots demonstration on behalf of the environment, known as Earth Day. The event was a national "teach-in" about environmental causes, and it is widely considered the spark that ignited the modern environmental education movement. Within months,…
Harper, G. H.
Argues that the meaning of the word "symbiosis" be standardized and that it should be used in a broad sense. Also criticizes the orthodox teaching of general principles in this subject and recommends that priority be given to continuity, intimacy, and associated adaptations, rather than to the harm/benefit relationship. (Author/JN)
O'Neill, Kevin C.
An approach to teaching Nathalie Sarrault's "Tropismes" in second-, third-, and fourth-year French class is outlined. The technique begins with analysis of elements of the tropism, establishing patterns, and requiring students to write a companion tropism to one of the author's. (MSE)
This article describes an approach to teaching the basic skills of tennis to students in grades 4 and 5. It relates a five-lesson unit suitable to a near-weekly class schedule. The author found it effective when seeing his students as infrequently as once every four days for fifty minutes.
Wu, Ziqi; Robson, Stephani; Hollis, Brooke
In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority. PMID:23424818
Fleming, Daniel; Lovat, Terence
The article is a response to this journal's call for papers on metaphors for teaching, and also draws from a previous publication in which Kent Eilers developed a methodology for teaching global theologies. In this methodology, the ultimate goal was the development of "hermeneutical dispositions of empathy, hospitality, and receptivity toward…
Believing that a course in the novel ought to include the making of prose as well as its analysis, a college English instructor altered his teaching strategy by treating both the novel author and his students as writers. Prior to studying a particular novel, the instructor gave students an assignment that would involve a particular literary…
Culliton, Barbara J.
Although faculty opposition stopped the sale of Harvard's McLean Hospital to the Hospital Corporation of America (HCA), a partnership remains a possibility. Issues related to the proposed sale as well as those affecting hospital economics are considered. Proposed terms of the sale are included. (JN)
MANNY, ELSIE S.; ROGERS, CHARLES E.
MODERN ADVANCEMENTS IN MEDICAL SCIENCE HAVE PRECIPITATED THE NEED FOR ADEQUATE UP-TO-DATE HOSPITAL FACILITIES REASONABLY CLOSE TO ALL PEOPLE. RURAL COMMUNITIES HAVE UTILIZED FEDERAL AID, STATE AID, ASSISTANCE FROM FOUNDATIONS, CIVIC BONDS, AND VOLUNTEER CONTRIBUTIONS AND DRIVES TO ERECT AND EQUIP HOSPITALS. HOSPITAL CARE FOR RURAL PEOPLE USUALLY…
MENU HOSPITALITY AT BIRKBECK, UNIVERSITY OF LONDON 2014-15 EXTERNALPROVIDED BY #12;WELCOME to cancel this request with the supplier without cost. Any items used to serve hospitality that are damaged for hospitality is supplied in re- usable bottles. A charge of £5.00 will be levied to the booking
Maxwell, Bruce D.
HOSPITALITY APPROVAL FORM DATE: __________________________ PERMISSION IS REQUESTED TO USE HOSPITALITY APPROVAL FORM MUST BE APPROVED PRIOR TO THE DATE OF THE EVENT. NOTE: ALL EXPENSES MUST MEET, or conferences. Hospitality Form required for food over $30.00. (Account Code 62809) _____ Entertainment: Costs
2. View northwest of main hospital building complex, hospital building (Building 90), administration and clinical hospital building (Building 88), and hospital building (Building 91) - National Home for Disabled Volunteer Soldiers Western Branch, 4101 South Fourth Street, Leavenworth, Leavenworth County, KS
Ferguson, Jane; Alpert, Joel J.
A survey of U.S. pediatric training programs to determine the role of rules in the hospital admission of pediatric patients is reported. The results support the hypothesis that rules are a widely used teaching tool. The rules relate to such factors as fevers, age, specific diseases, administrative concerns, head traumas, and poisonings. (JMD)
This booklet is part of a series of activity booklets designed to increase the child's awareness of careers. It also provides reinforcement activities of the basic skills. In this particular booklet children in grades K-2 are introduced to careers in the field of hospitality and recreation. The subjects of the teaching sections are children's…
Fiedler, Phyllis E.; And Others
This study focuses on reducing the hostility of hospitalized adolescent and young adult psychiatric patients through assertive training techniques designed to teach appropriate responses to interpersonal conflict. It was predicted that, after treatment, the assertive group would show greater assertiveness, less hostility, and a more positive…
Yano, Eiji; And Others
This survey of 67 university and 172 nonuniversity teaching hospitals in Japan found that many of the residents, especially in the university hospitals, received no experience in basic clinical skills during their 2-year residencies. Possible explanations for this lack are offered, and the need for improved training in basic clinical skills is…
Baro, Emmanuel E.; Ebhomeya, Loveth
Purpose: The purpose of this paper is to identify the information needs of nurses in two hospitals in Nigeria and the ways in which they went about attempting to meet those needs. Design/methodology/approach: The study is a descriptive survey of nurses at the Federal Medical Center (FMC), Yenagoa, and Niger Delta University Teaching Hospital…
... get started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Steps to Choosing a Hospital Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . 7–9 Hospital Quality Quick Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 A ... a Hospital 7 Steps to Choosing a Hospital Checklist STEP 1: Learn about the care you need ...
Griffis, Heather M; Kilaru, Austin S; Werner, Rachel M; Asch, David A; Hershey, John C; Hill, Shawndra; Ha, Yoonhee P; Sellers, Allison; Mahoney, Kevin
Background Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health. Objective The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics. Methods We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews. Results Adoption of social media varied across hospitals with 94.41% (3351/3371) having a Facebook page and 50.82% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts. Conclusions Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the quality of hospital care and services. PMID:25431831
LANGUAGE ARTS ! Teaching Materials! !!! ! 1. PROGRAMS OF STUDY ! ! ! ! ! ! ! ! ! !Language Arts by the English Language Arts Council.! !! 2. LEARNING & TEACHING RESOURCES ! ! Online Learning and Teaching Resources: ! Illustrative Examples for English Language Arts: Kindergarten to Grade 9 -- provides practical
Coe, Taylor M.; Wilson, Samuel E.; Chang, David C.
Background This study aimed to determine whether hospitals with higher historical mortality rates are independently associated with worse patient outcomes. Methods Observational study of in-hospital mortality in open AAA repair, AVR, and CABG in a California in-patient database. Hospitals’ annual historical mortality rates between 1998 and 2010 were calculated based on three years of data prior to each year. Results were adjusted for race, sex, age, hospital teaching status, admission year, insurance status, Charlson comorbidity index. Results Hospitals were divided into quartiles based on historical mortality rates. For AAA, the odds ratio (OR) for in-hospital mortality for hospitals within the highest quartile of prior mortality was 1.30 compared to the lowest quartile (95%CI:1.03–1.63). For AVR, the OR was 1.41 for the 3rd quartile (95%CI:1.15–1.73) and 1.54 for the highest quartile (95%CI:1.27–1.87). For CABG, the OR was 1.33 for the 3rd (95%CI:1.2–1.49) and 1.58 for the highest (95%CI:1.41–1.76). Conclusion Patients presenting to hospitals with high historical mortality rates have a 30%–60% increased mortality risk compared to patients presenting to hospitals with low historical mortality rates. PMID:26026336
Engbers, Rik; Fluit, Cornelia R M G; Bolhuis, Sanneke; Sluiter, Roderick; Stuyt, Paul M J; Laan, Roland F J M
Policy initiatives that aim to elevate the position of medical teaching to that of medical research could influence the satisfaction of three basic psychological needs related to motivation for medical teaching. To explore relations between the satisfaction of three basic psychological needs towards medical teaching and two policy initiatives for medical teaching: (Junior) Principal Lecturer positions [(J)PL positions] and Subsidized Innovation and Research Projects in Medical Education (SIRPMEs). An online questionnaire was used to collect data about medical teaching in the setting of a university hospital. We adapted the Work-related Basic Need Satisfaction scale (Van den Broeck et al. in J Occup Organ Psychol, 83(4):981-1002, 2010), in order to measure feelings of autonomy, competence, and relatedness in teaching. We examined the relations between (J)PL positions and SIRPMEs and the satisfaction of three basic psychological needs. A total of 767 medical teachers participated. The initiatives appear to be related to different beneficial outcomes in terms of feelings of autonomy, competence, and relatedness in medical teaching. Either a (J)PL position is obtained by teachers who feel competent and related towards medical teaching, or obtaining a (J)PL position makes teachers feel more competent and related towards teaching, or these relations could be interacting. Also, either a SIRPME is obtained by teachers who feel competent and autonomous towards medical teaching, or obtaining a SIRPME makes teachers feel more competent and autonomous towards teaching, or these relations could be interacting. Additional research needs to scrutinize the causal or interacting relations further and to determine optimal conditions for these policy initiatives more specifically. Implications for future research are discussed. PMID:25503924
Mamishi, Setareh; Pourakbari, Babak; Teymuri, Mostafa; Babamahmoodi, Abdolreza; Mahmoudi, Shima
Nosocomial, or hospital-acquired, infections are considered the most common complications affecting hospitalized patients. According to results obtained from studies conducted in the Children Medical Center Hospital, a teaching children's hospital and a tertiary care referral unit in Tehran, Iran, improvements in infection control practices in our hospital seem necessary. The aim of this study was to identify risk management and review potential hospital hazards that may pose a threat to the health as well as safety and welfare of patients in an Iranian referral hospital. Barriers to compliance and poor design of facilities, impractical guidelines and policies, lack of a framework for risk management, failure to apply behavioral-change theory, and insufficient obligation and enforcement by infection control personnel highlight the need of management systems in infection control in our hospital. In addition, surveillance and early reporting of infections, evaluation of risk-based interventions, and production of evidence-based guidelines in our country are recommended. PMID:25379367
40 University Hospital Kobe University Hospital began as Kobe Hospital which first opened its doors in 1869. In 1944, Kobe Hospital became known as the Prefectural Kobe Hospital, affiliated with the Prefectural Medical College. In 1967, it was renamed once again as Kobe University Hospital, becoming
If you would like to contribute a teaching note for any of these sections please contact email@example.com Contents: LET'S INVESTIGATE: Bows and arrows STARTING OUT: A late start ON THE MAP: A South African school making a world of difference TECHNICAL TRIMMINGS: May the force be with you an easily constructed force sensor Modelling Ultrasound A-scanning with the Pico Technology ADC-200 Virtual Instrument PHYSICS ON A SHOESTRING: Sugar cube radioactivity models CURIOSITY: Euler's disk MY WAY: Why heavy things don't fall faster
Riguzzi, Christine; Hern, H. Gene; Vahidnia, Farnaz; Herring, Andrew; Alter, Harrison
Introduction There has been concern of increased emergency department (ED) length of stay (LOS) during the months when new residents are orienting to their roles. This so-called “July Effect” has long been thought to increase LOS, and potentially contribute to hospital overcrowding and increased waiting time for patients. The objective of this study is to determine if the average ED LOS at the beginning of the hospital academic year differs for teaching hospitals with residents in the ED, when compared to other months of the year, and as compared to non-teaching hospitals without residents. Methods We performed a retrospective analysis of a nationally representative sample of 283,621 ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS), from 2001 to 2008. We stratified the sample by proportion of visits seen by a resident, and compared July to the rest of the year, July to June, and July and August to the remainder of the year. We compared LOS for teaching hospitals to non-teaching hospitals. We used bivariate statistics, and multivariable regression modeling to adjust for covariates. Results Our findings show that at teaching hospitals with residents, there is no significant difference in mean LOS for the month of July (275 minutes) versus the rest of the year (259 min), July and August versus the rest of the year, or July versus June. Non-teaching hospital control samples yielded similar results with no significant difference in LOS for the same time periods. There was a significant difference found in mean LOS at teaching hospitals (260 minutes) as compared to non-teaching hospitals (185 minutes) throughout the year (p<0.0001). Conclusion Teaching hospitals with residents in the ED have slower throughput of patients, no matter what time of year. Thus, the “July Effect” does not appear to a factor in ED LOS. This has implications as overcrowding and patient boarding become more of a concern in our increasingly busy EDs. These results question the need for additional staffing early in the academic year. Teaching hospitals may already institute more robust staffing during this time, preventing any significant increase in LOS. Multiple factors contribute to long stays in the ED. While patients seen by residents stay longer in the ED, there is little variability throughout the academic year. PMID:24578770
...exception for services furnished in hospital outpatient and certain other ambulatory settings), 415.176 (concerning renal dialysis services), and 415.184 (concerning psychiatric services), the medical records must document the teaching...
...exception for services furnished in hospital outpatient and certain other ambulatory settings), 415.176 (concerning renal dialysis services), and 415.184 (concerning psychiatric services), the medical records must document the teaching...
...exception for services furnished in hospital outpatient and certain other ambulatory settings), 415.176 (concerning renal dialysis services), and 415.184 (concerning psychiatric services), the medical records must document the teaching...
Altaf, Mohammed; Zubedi, Ayesha Mubeen; Nazneen, Fareesa; Kareemulla, Shaik; Ali, Syed Amir; Aleemuddin, N. M.; Hannan Hazari, Md. Abdul
Background: This study aims at simplifying the practical patient management and offers some general indications for pharmacotherapeutic choice by the implementation of (Global Initiative for Chronic Lung Disease) guidelines. This study was designed to evaluate the clinical and economic consequences of salmeterol/fluticasone (SF), formoterol/budesonide (FB), and formoterol/fluticasone (FF) in severe and very severe chronic obstructive pulmonary disease (COPD) patients. Objectives: The aim was to find out the most cost-effective drug combination between the three combinations (SF/FB/FF) in COPD patients. Materials and Methods: A prospective observational comparative study (cost-effectiveness analysis), in which 90 severe (30 ? forced expiratory volume in 1 s [FEV1] <50% predicted) and very severe (FEV1 < 30% predicted) COPD patients (outpatients/inpatients) who are prescribed with any one of the following combinations (SF/FB/FF) were selected. In our study, we have divided 90 COPD patients into three groups (Group I, Group II, and Group III) each group consisting of 30 patients. Group I was prescribed with medication SF, Group II with medication FB, and Group III with medication FF. We used five different parameters such as spirometry test (mean FEV1 initial and final visit), number of symptom-free days (SFDs), number of moderate and severe exacerbations, Number of days of hospitalization and direct, indirect, and total cost to assess the cost-effectiveness of SF/FB/FF. Comparison of cost and effects was done during the period of 6 months of using SF/FB/FF. Results: The average FEV1 for Group I, Group II, and Group III subjects at initial visit was 33.47%, 33.73%, and 33.20% and was increased to 36.60%, 35.8%, and 33.4%, respectively. A 3% increment in FEV1 was reported for Group I subjects (SF) and was highly significant statistically (t = ?8.833, P = 0.000) at 95% CI. For Group II subjects (FB), a 2% increment in FEV1 was reported and was highly significant statistically (t = ?9.001, P = 0.000) at 95% CI. For Group III (FF) subjects 0.2% increment in FEV1. The overall mean total cost for Group I, Group II, and Group III subjects during the 6 months period was found to be Rs. 29,725/-, Rs. 32,602/- and Rs. 37,155/-. Incremental cost-effectiveness of FB versus SF was Rs. 37,781/- per avoided exacerbation and Rs. 661/-per SFD. Conclusion: This study highlights the favorable therapeutic performance of combined inhaled bronchodilators and corticosteroids (SF/FB/FF), thus suggesting that healthcare costs would be also affected positively. Results from our study showed that SF and FB were the most effective strategies in the treatment of COPD, with a slight clinical superiority of SF. The FF strategy was not much effective (i.e. associated with fewer outcomes and higher costs). PMID:26229751
Introducing the article, the author emphasizes the importance of preschool and school instruction of the hospitalized children. Although this education and instruction programme differs in many particularities from that in normal schools, it should adhere to the same principles regarding the content and organization of the educational process and promote collaboration between the teaching staff in regular schools and teachers in hospitals. "Play therapy' is only one of the aspects of this activity and it is our task as pediatricians to provide a satisfactory number of full-time preschool and school teachers on the ward. Good planning in this field is of utmost importance. Suitable facilities for playing and learning are necessary, as well as toys, books and other possibilities for handcraft skills. Appropriate staff rooms should be provided for the hospital teaching staff. Today, the idea of hospital education and instruction programme is accepted and teachers and preschool teachers already work in some pediatric hospitals. Our task is, however, that kindergarten and school find their place in each children's hospital. This should also be enacted by law. PMID:7208075
Timmons, Suzanne; Manning, Edmund; Barrett, Aoife; Brady, Noeleen M.; Browne, Vanessa; O’Shea, Emma; Molloy, David William; O'Regan, Niamh A.; Trawley, Steven; Cahill, Suzanne; O'Sullivan, Kathleen; Woods, Noel; Meagher, David; Ni Chorcorain, Aoife M.; Linehan, John G.
Background: previous studies have indicated a prevalence of dementia in older admissions of ?42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups. Objective: to determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland. Methods: six hundred and six patients aged ?70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for delirium and depression, and assessed for co-morbidity, functional ability and nutritional status. Results: of 598 older patients admitted to acute hospitals, 25% overall had dementia; with 29% in public hospitals. Prevalence varied between hospitals (P < 0.001); most common in rural hospitals and acute medical admissions. Only 35.6% of patients with dementia had a previous diagnosis. Patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status (P < 0.001). Delirium was commonly superimposed on dementia (57%) on admission. Conclusion: dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available. Most dementia is not previously diagnosed, emphasising the necessity for cognitive assessment in older people on presentation to hospital. PMID:26420638
Levine, Sarah L., Ed.; McVay, Scott, Ed.
This book, celebrating teachers and teaching, contains the artistry and wisdom of 42 teachers who have remained passionate about classroom teaching for many years. Chapter 1, "Beginnings," includes "The First Day of School" (Richard A. Lawson), "Sustaining the Wonder of Teaching" and "Harvest Home," (Bettye T. Spinner), "The Call to Teach,"…
Inglis, James; And Others
The four articles in this issue deal with the teaching of literature. In "Why I Teach Literature," James Inglis suggests that the teaching of literature through the concept of a tripartite dialogue (teacher, students, writer) is necessary for understanding the living and creative aspects of literature. John O'Neill, in "Why I Teach Poetry,"…
Lang, James M.
In this article, the author contemplates two books dealing with developing a teaching persona. These books are Elaine Showalter's "Teaching Literature" and Jay Parini's "The Art of Teaching". Showalter and Parini present very different perspectives on the issue. Showalter addresses it in a section called "Personae: The Teaching Self," in which she…
Texas Tech Univ., Lubbock. Home Economics Curriculum Center.
This reference book provides information needed by employees in hospitality services occupations. It includes 29 chapters that cover the following topics: the hospitality services industry; professional ethics; organization and management structures; safety practices and emergency procedures; technology; property maintenance and repair; purchasing…
Facilities Manager Food & Beverage Manager Food/Restaurant Critic Hotel Supplier Golf/Country Club ManagerA major is Hospitality Management leads to endless possibilities for travel, adventure, advancement, and networking opportunities. The Hospitality Management program prepare, students to handle multiple facets
Prynne, T. A.
Designed for both hospital personnel interested in television and audiovisual personnel entering the medical field, this handbook is a verbal and pictorial survey of what is being done with TV within the medical profession. After an introduction which answers technical questions about medical TV posed during the American Hospital Association's…
California State Dept. of Education, Sacramento. Bureau of Homemaking Education.
This curriculum guide on the hospitality occupations was developed to help secondary and postsecondary home economics teachers prepare individuals for entry-level jobs in the hospitality industry. The content is in seven sections. The first section presents organizational charts of a medium-size hotel, food and beverage division, housekeeping and…
The Northern Arizona Hospitality Education Program is an exemplary three-year project designed to help students, mainly Indian, obtain job skills and attitudes necessary for successful employment in the hospitality industry. Nine high schools from Apache, Coconino, and Navajo Counties participated in the project. Objectives included providing an…
An increasing number of hospitals are undertaking external revenue-generating activities to supplement their shrinking budgets. Written at the request of Leadership, this article outlines an example of a successful catering service -- a money-generating business that more Canadian hospitals could profitably consider. PMID:10127850
Krishnamurthy, K.; Venugopal, D.; Alimchandani, A.K.
This review traces the history of the mental hospital movement, initially on the world stage, and later in India, in relation to advances in psychiatric care. Mental hospitals have played a significant role in the evolution of psychiatry to its present status The earliest hospital in India were established during the British colonial rule. They served as a means to isolate mentally ill persons from the societal mainstream and provide treatments that were in vogue at the time. Following India's independence, there has been a trend towards establishing general hospital psychiatry units and deinstitutionalization, while at the same time improving conditions in the existing mental hospitals. Since 1947, a series of workshops of superintendents was conducted to review the prevailing situations in mental hospitals and to propose recommendations to improve the same. Implementation of the Mental Health Act, 1987, and grovernmental focus upon mental hospital reform have paved way for a more specific and futuristic role for mental hospitals in planning psychiatric services for the new millenium, especially for severe mental illnesses. PMID:21407925
Compares stewardship and hospitality as they relate to the biosphere. Traces the origin of the word "hospitality," discusses cultural traditions of hospitality, and applies the concept of hospitality to the natural world. Considers forms of symbiosis in nature: commensals, mutualism, and parasitism. Hospitality promotes respect, humility, and…
Bernet, Patrick Michael; Rosko, Michael D; Valdmanis, Vivian G
U.S. Hospitals rely heavily on debt financing to fund major capital investments. Hospital efficiency is at least partly determined by the amount and quality of plant and equipment it uses. As such, a hospital's access to debt and credit rating may be related to its efficiency. This study explores this relationship using a broad sample of hospitals and associated bond issuance histories. Employing stochastic frontier analysis (SFA), we measure cost inefficiency to gauge the impact of debt issuance and debt rating. We find that hospitals with recent bond issues were less inefficient. Although we do not find a perfectly linear relationship between debt rating and inefficiency, we have evidence that hints at such a relation. Finally, we find an increase in inefficiency in the years following bond issues, consistent with the possibility of a debt death spiral. PMID:21110482
Noor, Sufian K.; Elmadhoun, Wadie M.; Bushara, Sarra O.; Ahmed, Mohamed H.
Objectives: This study aimed to determine the pattern of hospital admissions and patient outcomes in medical wards at Atbara Teaching Hospital in River Nile State, Sudan. Methods: This retrospective cross-sectional study was conducted from August 2013 to July 2014 and included all patients admitted to medical wards at the Atbara Teaching Hospital during the study period. Morbidity and mortality data was obtained from medical records. Diseases were categorised using the World Health Organization’s International Classification of Diseases (ICD) coding system. Results: A total of 2,614 patient records were analysed. The age group with the highest admissions was the 56–65-year-old age group (19.4%) and the majority of patients were admitted for one week or less (86.4%). Non-communicable diseases constituted 71.8% of all cases. According to ICD classifications, patients were admitted most frequently due to infectious or parasitic diseases (19.7%), followed by diseases of the circulatory (16.4%), digestive (16.4%) and genito-urinary (13.8%) systems. The most common diseases were cardiovascular disease (16.4%), malaria (11.3%), gastritis/peptic ulcer disease (9.8%), urinary tract infections (7.2%) and diabetes mellitus (6.9%). The mortality rate was 4.7%. Conclusion: The burden of non-communicable diseases was found to exceed that of communicable diseases among patients admitted to medical wards at the Atbara Teaching Hospital. PMID:26629380
JOHN DEMPSEY HOSPITAL Chief Executive Officer, John Dempsey Hospital Anne Diamond Executive Vice President for Health Affairs (Interim) Andrew Agwunobi Manager, Hospital Administration (Dual Report, Perfusion Services (John Dempsey Hospital, Waterbury Hospital, St. Mary's Hospital, Connecticut Children
Knight, Lynn V.; Bligh, John
Background: Change is ubiquitous. Current trends in both educational and clinical settings bring new challenges to clinicians and have the potential to threaten the quality of clinical teaching. Objective: To investigate hospital specialists' perceptions of clinical teaching in the context of change. Design: Qualitative study using in-depth…
Shamshuddin, S; Matthews, H R
Widespread adoption of digital imaging in clinical practice and for the image-based examinations of the Royal College of Radiologists has created a desire to provide a digital radiology teaching library in many hospital departments around the UK. This article describes our experience of using OsiriX software in developing digital radiology teaching libraries. PMID:24880758
Massell, Adele P.; Hosek, James R.
The report investigates production and the cost effects of teaching within hospital departments. Models of primary production show that the cost effects of teaching are determined by the salaries paid to students (including residents, interns, medical students, and technical trainees) and physicians, by the levels of student inputs used in…
Taylor, J H; O'Donnell, J W
The city of Burlington, Vermont assessed a $2.83 million property tax against the Medical Center Hospital of Vermont, a not-for-profit teaching hospital. The hospital responded by challenging the action in a civil court suit. The city argued that the hospital had ceased to be a charitable institution as the term was used in state statutes. The Vermont Superior Court found for the hospital, over-turning the assessment by the city and prohibiting collection of the tax. The court held that the hospital retained its charitable nature in spite of changes in the organization and the health care environment. The holding in the case provides one more view in the continuing national debate over the function and future of charitable hospitals. PMID:10286423
Calgary, University of
TOURISM AND HOSPITALITY MANAGEMENT (TOUR) Bachelor of Commerce Degree The tourism industry & conferences, adventure tourism, travel trade, and tourism services. The Tourism and Hospitality concentration and hospitality industry. Graduates acquire knowledge and skills in communication, research, analysis, problem
Kraetschmer, Nancy; Jass, Janak; Woodman, Cheryl; Koo, Irene; Kromm, Seija K.; Deber, Raisa B.
This study aimed to enhance understanding of the dimensions of accountability captured and not captured in acute care hospitals in Ontario, Canada. Based on an Ontario-wide survey and follow-up interviews with three acute care hospitals in the Greater Toronto Area, we found that the two dominant dimensions of hospital accountability being reported are financial and quality performance. These two dimensions drove both internal and external reporting. Hospitals' internal reports typically included performance measures that were required or mandated in external reports. Although respondents saw reporting as a valuable mechanism for hospitals and the health system to monitor and track progress against desired outcomes, multiple challenges with current reporting requirements were communicated, including the following: 58% of survey respondents indicated that performance-reporting resources were insufficient; manual data capture and performance reporting were prevalent, with the majority of hospitals lacking sophisticated tools or technology to effectively capture, analyze and report performance data; hospitals tended to focus on those processes and outcomes with high measurability; and 53% of respondents indicated that valuable cross-system accountability, performance measures or both were not captured by current reporting requirements. PMID:25305387
Aghababian, R; Lewis, C P; Gans, L; Curley, F J
Hospital disaster planning should encompass events that affect the safety of the hospital environment and address those measures that ensure the availability of necessary services. Although most of the emphasis has been placed on general disaster planning, there is little written about disasters occurring within a hospital. In recent years, several incidents at our medical center involving fire, flood, and power failure resulted in a reevaluation of our preparedness to handle such situations. These experiences prompted this discussion and literature review of internal disaster plan because it is likely that at some time an internal emergency may occur. PMID:8161046
McCullough, Cheryll A.; Coombs, Geoffrey W.; Monsen, Tor; Christiansen, Keryn J.
We report the molecular epidemiology of 27 clinical multidrug-resistant Staphylococcus epidermidis (MDRSE) isolates collected between 2003 and 2007 in an Australian teaching hospital. The dominant genotype (sequence type 2 [ST2]) accounted for 85% of the isolates tested and was indistinguishable from an MDRSE genotype identified in European hospitals, which may indicate that highly adaptable health care-associated genotypes of S. epidermidis have emerged and disseminated worldwide in the health care setting. PMID:22442320
Christiana Hospital, Newark, Delaware Helen F. Graham Cancer Center at Christiana Care 4755 Ogletown-Stanton Rd. Newark, DE 19718 (302) 733-1000 www.christianacare.org www.christianacare.org/hfgcc • Robert Laskowski, MD, President and CEO, Christiana
Nosocomial pneumonia; Ventilator-associated pneumonia; Health-care associated pneumonia; HCAP ... Hospital-acquired pneumonia can also be spread by health care workers, who can pass germs from their hands ...
Kauer, R T; Silvers, J B
Hospital managers may find it difficult to admit their investments have been suboptimal, but such investments often lead to poor returns and less future cash. Inappropriate use of free cash flow produces large transaction costs of exit. The relative efficiency of investor-owned and tax-exempt hospitals in the product market for hospital services is examined as the free cash flow theory is used to explore capital-market conditions of hospitals. Hypotheses concerning the current competitive conditions in the industry are set forth, and the implications of free cash flow for risk, capital-market efficiency, and the cost of capital to tax-exempt institution is compared to capital-market norms. PMID:1743965
... Bed? Todd says that there is no standard definition for hospital beds, a fact that consumers shopping ... in retail stores that don’t meet the definition of medical devices under the law, but which ...
As natural resources are decreasing and environmental pollution is increasing, the buildings that play an important role in this problem should be constructed sustainably so their affects are kept to a minimum. Hospitals operate 24 hours a day...
Tarby, W; Hogan, K
Crouse Hospital in Syracuse, New York, is a 612-bed, not-for-profit teaching hospital with 2,500 employees. A close examination of operations at Crouse facilitated the development of a patient education task force that used a comprehensive, multidisciplinary approach to meet the educational needs of both patients and clinicians. The collaborative process involved all hospital departments. Within eighteen months, patient requests for information rose from 3% to 30% of total requests made at the hospital. Requests were made directly to the library or through a member of the health care team. Hospital staff members were surveyed about information needs and availability, and a library work plan was devised, setting standards of service for a multimedia approach. Work redesign improved the library staff's ability to integrate patient education into daily operations. Cost savings were achieved through the elimination of duplicated resources and services throughout the hospital. The management model developed at Crouse was the result of a needs assessment and a multidisciplinary, collaborative process. The model emphasizes communication links among disciplines rather than physical locations. The Crouse experience validates the development of hospital-based consumer health information services. PMID:9160153
others, demonstrates their strength of character and selflessness. This project was not possible without each of you. My boss, Richard Weir, has given me an opportunity to work as a child life specialist with hospitalized children. He has allowed my... talents to find a home at work. I learn invaluable lessons through the families I encounter at the hospital. Thank you for your flexibility as I completed this task alongside my regular job. Janis and Regina allowed me the opportunity to learn about...
Zhao, Lue-Ping; Yu, Guo-Pei; Liu, Hui; Ma, Xie-Min; Wang, Jing; Kong, Gui-Lan; Li, Yi; Ma, Wen; Cui, Yong; Xu, Beibei; Yu, Na; Bao, Xiao-Yuan; Guo, Yu; Wang, Fei; Zhang, Jun; Li, Yan; Xie, Xue-Qin; Jiang, Bao-Guo; Ke, Yang
Background With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. Methods We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS), cost per day (CPD), inpatient mortality rate (IMR), and length of stay (LOS), using a generalized additive model. Findings There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001), from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. Interpretations These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role. However, purely market-oriented health-care reform could also misguide future healthcare reform. PMID:23977243
Sasu, Samuel; Kümmerer, Klaus; Kranert, Martin
The practice of use and disposal of waste from pharmaceuticals compromises the safety of the environment as well as representing a serious health risk, as they may accumulate and stay active for a long time in the aquatic environment. This article therefore presents the outcome of a study on pharmaceutical waste management practices at homes and hospitals in Ghana. The study was conducted at five healthcare institutions randomly selected in Ghana, namely two teaching hospitals (hospital A, hospital B), one regional hospital (hospital C), one district hospital (hospital D) and one quasi-governmental hospital (hospital E). Apart from hospital E which currently has a pharmaceutical waste separation programmr as well as drug return programme called DUMP (Disposal of Unused Medicines Program), all other hospitals visited do not have any separate collection and disposal programme for pharmaceutical waste. A survey was also carried out among the general public, involving the questioning of randomly selected participants in order to investigate the household disposal of unused and expired pharmaceuticals. The results from the survey showed that more than half of the respondents confirmed having unused, left-over or expired medicines at home and over 75% disposed of pharmaceutical waste through the normal waste bins which end up in the landfills or dump sites. PMID:22081380
Hospitals that hire contract service firms to manage one or all aspects of their hospitality service departments increasingly expect those firms to help meet total quality management goals as well as offer the more traditional cost reduction, quality improvement and specialized expertise, finds the 1992 Hospital Contract Services Survey conducted by Hospitals. PMID:1577450
Bronson Methodist Hospital Founded in 1900, today Bronson Methodist Hospital (BMH) is a state provides care in virtually every specialty: cardiology (Heart Hospital at Bronson), general surgical's Hospital at Bronson), and adult critical care services. As a tertiary care center, BMH includes a Level I
Health service accreditation systems have explicit standards for organisation against which the participating hospital assesses itself before a structured visit by outside "surveyors". They submit a written report back to the hospital with commendations and recommendations for development prior to a follow-up survey. Accreditation may be awarded for a fixed term or may be with held by an independent assessment Board if the hospital does not meet a defined threshold of standards. In Europe, some government and medical organisations initially distanced themselves from the pilot hospital wide programmes, arguing that they would cost too much and undermine management, or that they were irrelevant to clinical practice. But gradually it became obvious that accreditation worked for hospitals; purchasers and insurers saw its potential for quality and resource management; and professional bodies recognised the links between clinical training, practice and outcome and the environment in which health care is provided. If nothing else, it offered a multi-professional bridge between the existing numerous fragmented systems such as inspecting (statutory safety), visiting (professional training), and monitoring (service contracts). The introduction of accreditation appears to benefit hospitals in many different countries and health systems and provides a vehicle for integrated quality management which is visible to funding agencies, government and the public. Interest is growing within Europe. PMID:10179643
Flax, Jim; Garrard, Judith
At the University of Minnesota Medical School a course, Introduction to Clinical Medicine, introduces communication skills; develops interview skills consistent with students' personality, their role as medical students, and the patients' needs; assists students in becoming comfortable as medical students in the hospital setting; and teaches them…
Pierre-Marie, Tebeu; Gregory, Halle-Ekane; Maxwell, Da Itambi; Robinson, Enow Mbu; Yvette, Mawamba; Nelson, Fomulu Joseph
More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon. PMID:26401210
Pierre-Marie, Tebeu; Gregory, Halle-Ekane; Maxwell, Da Itambi; Robinson, Enow Mbu; Yvette, Mawamba; Nelson, Fomulu Joseph
More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon. PMID:26401210
Lerner, William D.; And Others
Physicians are likely to encounter a wide gamut of disorders related to drug and alcohol abuse and will need specialized knowledge and skills to treat the affected population effectively. The development and implementation of a program to meet these needs at the Medical College of Virginia is described. (MLW)
Lamers, Karilyn; Janisse, Lisa; Brown, Gail; Butler, Carol; Watson, Barb
For nurses, the stress caused by entering a new place of employment may give rise to insecurity and a lack of confidence. Lack of confidence in one's nursing skills can affect performance and, ultimately, patient care and safety. In healthcare, growing fiscal constraints have resulted in lost resources, and support for new nursing staff is limited by both time and cost considerations. Clinical educators therefore must find innovative ways to provide education and support, including creative learning modalities that facilitate nurses' transition into a new role and work environment. PMID:24860953
Dozier, Cheryl; Garnett, Susan; Tabatabai, Simeen
Conversations are the heart of responsive teaching. By talking with struggling learners, teachers can find out about their interests in order to design effective, personalized instruction; build relationships; work through complexities in teaching and learning; and celebrate successes.
Discusses experiences in teaching high school physics in the Cameroon. Comments on the educational system, the school, instructional strategies, materials/equipment, and the author's personal experiences teaching in this developing country. (JN)
Caraway, James E.
The author discusses other writings on effective college teaching and then presents his list of necessary characteristics for the effective teacher, stressing the interpersonal dimension of the teaching-learning situation. (MF)
Hotelling, Barbara A
Teaching normal-birth Lamaze classes normally involves considering the qualities that make birth normal and structuring classes to embrace those qualities. In this column, teaching strategies are suggested for classes that unfold naturally, free from unnecessary interventions. PMID:19436595
Summarizes arguments for and against teaching ethics within science education, and clarifies what might be the several aims of teaching ethics in science. Discusses how ethics instruction might be incorporated into the science curriculum. (Contains 120 references.) (WRM)
Reflection and collaboration are two activities teachers can use to change and improve their practice. However, finding the time and space to do so can be challenging. The collaborative reflective teaching cycle is a structured activity teachers can use to engage in reflection and collaboration. This article describes how a seventh grade teaching…
Notes that one of the most important contexts for ethical decision-making is the nature and operation of "contemporary capitalisms." Suggests that rather than issuing a call for teaching business ethics, the author emphasizes the need for more ethical business teaching. (SG)
Wimberly, Anne E. Streaty
In this article, the author looks back on her journey of teaching, framing it as a privileged fulfillment of the call as a means of inviting others' reflection on the meanings of the teaching vocation. She builds on this framework with personal stories focused on two aspects of teaching from which she has learned much: the pivotal role of…
Organisation for Economic Cooperation and Development, Paris (France). Centre for Educational Research and Innovation.
This book reports on an international study of quality in teaching in elementary and secondary schools and on policies to promote quality teaching in 11 countries. The study on which the book is based called on case studies by experts from 11 countries on policies to improve the quality of teaching, seminars for teachers to discuss the definition…
Hugerat, Muhamad; Zidani, Saleem; Kurtam, Naji
Discusses the objectives of the science curriculum and the teacher's responsibility of passing through not only the required material, but also skills. Suggests that in order to improve teaching and learning skills, new strategies, such as teaching and learning through research must be utilized. Presents four examples of teaching and learning…
A noted educator reflects on six satisfactions that he experienced during his career in teaching: introducing students to great ideas, getting a foothold on immortality, improvising on the job, enjoying teaching as a meaningful aesthetic experience, sharing your love of what you teach, and knowing you made a difference in a student's life.
... talks about the other changes. If you are teaching certain skills to your patient, check for the patient's mastery ... When teaching a new skill, ask your patient to demonstrate the new skill so you assess understanding and mastery. Use the teach- ...
Educator Bell Hooks acknowledged the fundamental truth that teaching, caring, and transformation are closely linked, that is, that true teaching must be accompanied by a deep level of care in order for learning to take place. No matter how young or old, no matter the subject matter, and no matter where teaching and learning take place--a…
Battro, Antonio M.
Animals cannot teach as humans do. Therefore, we lack the experimental support of animal studies that are so important to understand the evolution of our basic learning skills but are useless to explore the development of the teaching skills, unique to humans. And most important: children teach! We have at least two new challenges in our Mind,…
Masami, Mukai; Yutaka, Ando; Yasuo, Okuda; Naoto, Takahashi; Yoshihisa, Yoda; Hiroshi, Tsuji; Tadashi, Kamada
Our hospital started the charged particle therapy since 1996. New institutions for charged particle therapy are planned in the world. Our hospital are accepting many visitors from those newly planned medical institutions and having many opportunities to provide with the training to them. Based upon our experiences, we have developed the radiation oncology teaching files system for charged particle therapy. We adopted the PowerPoint of Microsoft as a basic framework of our teaching files system. By using our export function of the viewer any physician can create teaching files easily and effectively. Now our teaching file system has 33 cases for clinical and physics contents. We expect that we can improve the safety and accuracy of charged particle therapy by using our teaching files system substantially. PMID:23920759
Gan, V N; Murphy, T V
Before the whole-cell pertussis vaccine was available, Bordetella pertussis infections were an important cause of morbidity and mortality in infants. To determine the extent of continuing morbidity in an era of vaccination, a retrospective review was conducted of the records of neonates and infants hospitalized with pertussis infection at Parkland Memorial Hospital and Children's Medical Center, Dallas, Tex. During the 20 years from 1967 through 1986, 182 patients were younger than 24 months. Among 176 patients whose immunization history was recorded, 89% had received fewer than two doses of pertussis vaccine. The mean hospital stay was 7.4 days (range, 1 to 69 days). A convulsion occurred in 11 patients (6%). Apnea was reported in 45 patients (25%) and observed in the hospital in 26 (14%). Nine patients (5%) received mechanical ventilatory therapy. Intensive care monitoring was required in 18 patients (10%). Three (1.6%) died, all with secondary bacterial pneumonia. This hospital-based population indicates that pertussis continues to be a cause of serious morbidity and mortality in infants. PMID:2403094
Thornton, Alex; McAuliffe, Katherine
Despite the obvious benefits of directed mechanisms that facilitate the efficient transfer of skills, there is little critical evidence for teaching in nonhuman animals. Using observational and experimental data, we show that wild meerkats (Suricata suricatta) teach pups prey-handling skills by providing them with opportunities to interact with live prey. In response to changing pup begging calls, helpers alter their prey-provisioning methods as pups grow older, thus accelerating learning without the use of complex cognition. The lack of evidence for teaching in species other than humans may reflect problems in producing unequivocal support for the occurrence of teaching, rather than the absence of teaching. PMID:16840701
Clarke, G. Grant; Fish, D. G.; Giles, T. J.
A census taken in April 1965 revealed that there were 3162 residents training in Canadian hospitals approved by the Royal College of Physicians and Surgeons of Canada. Thirty-one of the 151 approved hospitals had no residents in training, and another 43 hospitals each having 20 or more residents accounted for 85% of all residents training in Canada. Fifty-seven per cent of the residents in Canada were Canadian citizens, 19% were landed immigrants, and 24% were foreign trainees. Major teaching hospitals contained 65% of all residents; 70% of Canadian graduates and 60% of non-Canadian graduates were training in major teaching hospitals. Hospitals approved for full training in the specialty of the trainee contained 57% of all residents; 64% of Canadian graduates and 48% of foreign graduates were in such hospitals. PMID:5908720
Truesdell, John A., Jr. (John Alan)
The National Institutes of Health (NIH) has been the stalwart of research funding at universities and academic teaching hospitals. However, since the start of the last decade NIH funding has contracted in real terms. ...
Hoppitt, William J E; Brown, Gillian R; Kendal, Rachel; Rendell, Luke; Thornton, Alex; Webster, Mike M; Laland, Kevin N
Many species are known to acquire valuable life skills and information from others, but until recently it was widely believed that animals did not actively facilitate learning in others. Teaching was regarded as a uniquely human faculty. However, recent studies suggest that teaching might be more common in animals than previously thought. Teaching is present in bees, ants, babblers, meerkats and other carnivores but is absent in chimpanzees, a bizarre taxonomic distribution that makes sense if teaching is treated as a form of altruism. Drawing on both mechanistic and functional arguments, we integrate teaching with the broader field of animal social learning, and show how this aids understanding of how and why teaching evolved, and the diversity of teaching mechanisms. PMID:18657877
Williams, C B; Saunders, B P; Bladen, J S
After 17 years of prototyping, a first release version of the St Mark's Hospital teaching simulator is in final preparation. Advances in computer processing power and graphics cards make it possible to achieve real-time processing of colon and endoscope characteristics and a simulated endoscopic view at an acceptable cost. Realistic feel or "force feedback" for all instrument controls and shaft movements is incorporated. To make the simulator more than a "video game", a package of teaching and assessment features is to be incorporated, including interactive animated graphics to explain particular endoscope loops and situations and the variations of colonic anatomy that are typically encountered. Simulation should spare patients from being used for the early phases of training and should speed up and quantify the learning process. Simulators may introduce even experienced endoscopists to some of the advanced options available in current or future endoscopes or accessories, as well as the use of imminent new technology such as the magnetic imaging system. PMID:11085481
Lepczyk, M; Raleigh, E H; Rowley, C
With the increasing cost of health care and the growing constraints made by third party payers, in-hospital time for preoperative teaching is quickly being reduced. Seventy-two patients attended preoperative instruction either as an inpatient the day before surgery or as an outpatient 4-8 days before surgery. Anxiety and knowledge levels were measured before and after class and the evening before surgery. No differences were found between the groups on a measure of anxiety levels. Both groups demonstrated a moderate anxiety level with no significant change over the testing period. Using the knowledge pretest as a covariate, repeated measures analysis of variance suggested the knowledge gained with the class was significantly greater for the outpatient group than the inpatient group (P = 0.018). There was also a significant positive relationship between the knowledge score and knowing someone who had cardiac surgery (t = 2.34, d.f. = 66, P = 0.022). The results suggest that it makes little difference whether patients receive information up to a week before surgery or just the day before; therefore, the more economical preadmission teaching may be the path of choice. PMID:2332553
For the first time, the Centers for Medicare & Medicaid Services is posting Star Ratings, showing patients' perception of care, on the Hospital Compare website. Ratings are based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and include individual scores on 12 composite measures based on the HCAHPS responses as well as state and national averages. A big gap between patients who reported receiving discharge instructions (86%) and those who said they understood what to do at home (52%) indicates that hospitals need to revise their discharge teaching and make sure patients understand their treatment plan. Case managers need to take the time to fully assess all patients--not just those going to post-acute facilities--to find out their living situations, their support systems, and their need for resources after they go home. PMID:26094346
The Teaching Citation Teaching/Professional Development Opportunities For Ph.D. Students_students/degree_requi rements/teaching_requirement Teaching Citation (approved 4/20/2006) · Graduate Schoolwide Language Instruction · New certificates require approval by Graduate Council #12;Teaching Citation
The interior of this masonry-built hospital in Cauquenes, Chile had severe fracturing and partially collapsed interior walls following the M 8.8 earthquake on Feb. 27, 2010. This building will be torn down and replaced with a reinforced concrete building....
Responsible Hospitality (RH)--also called Responsible Beverage Service (RBS)--encompasses a variety of strategies for reducing risks associated with the sale and service of alcoholic beverages. RH programs have three goals: (1) to prevent illegal alcohol service to minors; (2) to reduce the likelihood of drinkers becoming intoxicated; and (3) to…
This two story hospital wing in Cauquenes, Chile suffered severe damage to the wall of the first floor as a result of the M 8.8 earthquake on Feb. 27, 2010. This building must be torn down. All patients were successfully evacuated at 3:34 AM after the earthquake shaking started....
Background Over 12,000 hospital admissions in the UK result from substance misuse, therefore issues surrounding this need to be addressed early on in a doctor’s training to facilitate their interaction with this client group. Currently, undergraduate medical education includes teaching substance misuse issues, yet how this is formally integrated into the curriculum remains unclear. Methods Semi-structured interviews with 17 key members of staff responsible for the whole or part of the undergraduate medical curriculum were conducted to identify the methods used to teach substance misuse. Using a previously devised toolkit, 19 curriculum co-ordinators then mapped the actual teaching sessions that addressed substance misuse learning objectives. Results Substance misuse teaching was delivered primarily in psychiatry modules but learning objectives were also found in other areas such as primary care placements and problem-based learning. On average, 53 teaching sessions per medical school focused on bio-psycho-social models of addiction whereas only 23 sessions per medical school focused on professionalism, fitness to practice and students’ own health in relation to substance misuse. Many sessions addressed specific learning objectives relating to the clinical features of substance dependence whereas few focused on iatrogenic addiction. Conclusions Substance misuse teaching is now inter-disciplinary and the frequent focus on clinical, psychological and social effects of substance misuse emphasises the bio-psycho-social approach underlying clinical practice. Some areas however are not frequently taught in the formal curriculum and these need to be addressed in future changes to medical education. PMID:24533849
Kozhimannil, Katy B.; Arcaya, Mariana C.; Subramanian, S. V.
Background Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. Methods and Findings Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project—a 20% sample of US hospitals—we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. Conclusions Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight the need for more comprehensive or linked data including parity and gestational age as well as examination of other factors—such as hospital policies, practices, and culture—in determining cesarean section use. Please see later in the article for the Editors' Summary PMID:25333943
El-Eid, Ghada R.; Kaddoum, Roland; Tamim, Hani; Hitti, Eveline A.
Abstract Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions. The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process. This is a quantitative pre and post-intervention study. Three hundred and eighty-six bed tertiary care hospital. A series of Six Sigma driven interventions over a 10-month period. The primary outcome was discharge time (time from discharge order to patient leaving the room). Secondary outcome measures included percent of patients whose discharge order was written before noon, percent of patients leaving the room by noon, hospital length of stay (LOS), and LOS of admitted ED patients. Discharge time decreased by 22.7% from 2.2?hours during the preintervention period to 1.7?hours post-intervention (P?0.001). A greater proportion of patients left their room before noon in the postintervention period (P?0.001), though there was no statistical difference in before noon discharge. Hospital LOS dropped from 3.4 to 3.1 days postintervention (P?0.001). ED mean LOS of patients admitted to the hospital was significantly lower in the postintervention period (6.9?±?7.8 vs 5.9?±?7.7?hours; P?0.001). Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific. PMID:25816029
Current concepts in leadership and governance on the level of supervisory board, management and departments are often considered as insufficient to cope with the profound structural change which actually takes place in the German health care system. While vertical and horizontal disconnecting is typical of the professional bureaucracy of hospitals, transition from functional to divisional structure further increases this risk. Accordingly, medical experts are oriented towards their professional peers and patient care on the one side; on the other side the management gets isolated and looses operative and strategic control. Several studies provide evidence for the relevance of role models to serve as agents of change, which are now developed into the concept of "Clinical Governance": evidence-based medicine, guidelines, continuous quality improvement, safety culture, resource accountability and organisational learning. The present situation makes it necessary to extend this conception, which focuses on the departmental level in an organisation with divisional features, to one of "Clinical Corporate Governance". This term, which also includes supervisory structures and the management board and is relevant for the total hospital and company, respectively, is based on the corporate governance concept. Inside the hospital, the management and the heads of the departments have to agree that (1) experts really need to be integrated into the decision process, and that (2) the outcomes of the entire hospital have to be regarded as equal or superior to the aims of a single department. The public image of the hospital should be one of a strong and reliable partner in health care and health care business on a local, regional and national level. Members of the supervisory board should clearly put corporate aspects above political and other implications and pay attention to personal independence from the leaders of the medical departments. PMID:19545081
Kertesz, Joseph W; Delbridge, Emilee J; Felix, Daniel S
Training physicians to effectively assess, diagnose, and treat patients' behavioral health concerns begin in residency. While this training is increasingly more common in outpatient educational settings, there is also a great need to teach physicians to practice behavioral medicine with patients who are hospitalized. However, teaching family medicine resident physicians to understand, value, and practice essential behavioral health knowledge and skills during inpatient rotations can be a challenge for both residents and educators. In this article, we describe three models of inpatient behavioral medicine teaching, each with examples of practical content and teaching methods. We discuss strategies for success and potential barriers to overcome while teaching in the inpatient setting. Helping patients choose to change their health behaviors, which likely contribute in part to the reasons for their hospitalizations in the first place, should begin while patients are still in the hospital. Models of teaching, such as those presented here, can help improve the way we train physicians to address behavioral health needs with hospitalized patients. PMID:25084858
Scott, Ian A; Denaro, Charles P; Bennett, Cameron J; Hickey, Annabel C; Mudge, Alison M; Flores, Judy L; Sanders, Daniela C J; Thiele, Justine M; Wenck, Beres; Bennett, John W; Jones, Mark A
In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital and after-hospital care, patient self-care, and hospital-community integration. A multidisciplinary quality improvement program was designed and instigated in Brisbane in October 2000 involving 250 clinicians at three teaching hospitals, 1080 general practitioners (GPs) from five Divisions of General Practice, 1594 patients with ACS and 904 patients with CHF. Quality improvement interventions were implemented over 17 months after a 6-month baseline period and included: clinical decision support (clinical practice guidelines, reminders, checklists, clinical pathways); educational interventions (seminars, academic detailing); regular performance feedback; patient self-management strategies; and hospital-community integration (discharge referral summaries; community pharmacist liaison; patient prompts to attend GPs). Using a before-after study design to assess program impact, significantly more program patients compared with historical controls received: ACS: Angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering agents at discharge, aspirin and beta-blockers at 3 months after discharge, inpatient cardiac counselling, and referral to outpatient cardiac rehabilitation. CHF: Assessment for reversible precipitants, use of prophylaxis for deep-venous thrombosis, beta-blockers at discharge, ACE inhibitors at 6 months after discharge, imaging of left ventricular function, and optimal management of blood pressure levels. Risk-adjusted mortality rates at 6 and 12 months decreased, respectively, from 9.8% to 7.4% (P = 0.06) and from 13.4% to 10.1% (P = 0.06) for patients with ACS and from 22.8% to 15.2% (P < 0.001) and from 32.8% to 22.4% (P = 0.005) for patients with CHF. Quality improvement programs that feature multifaceted interventions across the continuum of care can change clinical culture, optimise care and improve clinical outcomes. PMID:15139843
Maintains that the teaching/learning styles implicit in Educational Drama offer native education students a teaching/learning methodology which is compatible with a native teaching/learning style. (SR)
Oliver, Douglas L.
UConn Health John Dempsey Hospital Department of Pharmacy (Patient Identification) Pharmacy Note: Initial IV Vancomycin Dosing per Collaborative Practice Protocol Baseline Patient Demographics, Clinical/0000 Page 1 of 2 #12;UConn Health John Dempsey Hospital Department of Pharmacy (Patient Identification
Shahi, Mehraban; Sadoughi, Farahnaz; Ahmadi, Maryam
IT governance is a set of organizational structures ensuring decision-making rights and responsibilities with regard to the organization's IT assets. This qualitative study was carried out to identify the IT governance domains in teaching hospitals affiliated to Iran University of Medical Sciences. There were 10 heads of IT departments and 10 hospital directors. Semi structured interviews used for data collection. To analyze the data content analysis was applied. All the interviewees (100%) believed that decisions upon hospital software needs could be made in a decentralized fashion by the IT department of the university. Most of the interviewees (90%) believed that there were policies for logistics and maintenance of networks, purchase and maintenance, standards and general policies in the direction of the policies of the ministry of health and medical education. About 80% of the interviewees believed that the current emphasis of the hospital's IT unit and the hospital management for outsourcing of services were in the format of specialized contracts and under supervision of the university Statistic and IT department. A hospital strategic committee is an official organizational group consisting of hospital executives, heads of IT and multiple functional areas and business units in a hospital. In this committee, "the head of hospital" acts as the director of IT activities and ensures that IT strategies are alignment with the hospital business strategies. PMID:25948446
Hsia, Renee Y; Akosa Antwi, Yaa; Nath, Julia P
Objectives To determine the variation in charges for 10 common blood tests across California hospitals in 2011, and to analyse the hospital and market-level factors that may explain any observed variation. Design, setting and participants We conducted a cross-sectional analysis of the degree of charge variation between hospitals for 10 common blood tests using charge data reported by all non-federal California hospitals to the California Office of Statewide Health Planning and Development in 2011. Outcome measures Charges for 10 common blood tests at California hospitals during 2011. Results We found that charges for blood tests varied significantly between California hospitals. For example, charges for a lipid panel ranged from US$10 to US$10?169, a thousand-fold difference. Although government hospitals and teaching hospitals were found to charge significantly less than their counterparts for many blood tests, few other hospital characteristics and no market-level predictors significantly predicted charges for blood tests. Our models explained, at most, 21% of the variation between hospitals in charges for the blood test in question. Conclusions These findings demonstrate the seemingly arbitrary nature of the charge setting process, making it difficult for patients to act as true consumers in this era of ‘consumer-directed healthcare.’ PMID:25127708
-Type text/plain; charset=UTF-8 Trade, Law and Development Raj Bhala, Teaching China GATT 1 TRADE L. & DEV. 1 (2009) TEACHING CHINA GATT RAJ BHALA ? ABSTRACT How would China fare in its first WTO case? That question has been... Organization, Annex 1A, Legal Instruments—Results of the Uruguay round, 1867 U.N.T.S. 187, 33 I.L.M. 1153 (1994) Spring, 2009] Teaching China GATT 5 There exists a small, growing cadre of brilliant...
Hammer, Antje; Arah, Onyebuchi A.; DerSarkissian, Maral; Thompson, Caroline A.; Mannion, Russell; Wagner, Cordula; Ommen, Oliver; Sunol, Rosa; Pfaff, Holger
Background Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essential requirements for successful cooperation and coordination within groups. Objectives We assume that social capital within hospital management boards is an important factor in the development of effective organizational systems for overseeing health care quality. We hypothesized that the degree of social capital within the hospital management board is associated with the effectiveness and maturity of the quality management system in European hospitals. Methods We used a mixed-method approach to data collection and measurement in 188 hospitals in 7 European countries. For this analysis, we used responses from hospital managers. To test our hypothesis, we conducted a multilevel linear regression analysis of the association between social capital and the quality management system score at the hospital level, controlling for hospital ownership, teaching status, number of beds, number of board members, organizational culture, and country clustering. Results The average social capital score within a hospital management board was 3.3 (standard deviation: 0.5; range: 1-4) and the average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0-27). Higher social capital was associated with higher quality management system scores (regression coefficient: 1.41; standard error: 0.64, p=0.029). Conclusion The results suggest that a higher degree of social capital exists in hospitals that exhibit higher maturity in their quality management systems. Although uncontrolled confounding and reverse causation cannot be completely ruled out, our new findings, along with the results of previous research, could have important implications for the work of hospital managers and the design and evaluation of hospital quality management systems. PMID:24392027
Texas Tech Univ., Lubbock. Home Economics Curriculum Center.
This student activity book contains pencil-and-paper activities for use in a hospitality services course focusing on the food and lodging segments of the hospitality and tourism industry. The activities are organized into 29 chapters on the following topics: hospitality services industry; professional ethics; organization/management structures in…
A description is provided of a 15-month, in-service nursing education program at Childrens Hospital (Los Angeles, California). The first sections of the paper describe Childrens Hospital and provide a rationale for the hospital-based program. A listing of program goals and objectives is also provided, indicating that the curriculum is designed to…
Johnson, Eric D. M.; Kazmer, Michelle M.
Library scholars and practitioners have frequently reflected on the various factors that in combination make up a hospitable library, but there has been little theoretical synthesis of the notion of the library as a place of hospitality. The hospitality industry provides a rich vein of theoretical material from which to draw definitions of…
St. Jude Children’s Research Hospital was founded in 1962. The Cancer Center received its NCI designation in 1977 and was awarded status as a comprehensive cancer center by NCI in 2008. The hospital’s mission is to advance cures and means of prevention for pediatric catastrophic diseases through research and treatment.
Purpose: The purpose of this paper is to explore current strands in hospitality management education and research, and suggest that future programs should reflect a more social science informed content. Design/methodology/approach: The paper reviews current research in hospitality management education and in the study of hospitality and…
Smith, Deborah C.; Wesley, Ann
Provides a chart comparing state and national objectives. Assesses student understanding of photosynthesis and explains the process of teaching students producer-consumer relationships. (Contains 14 references.) (YDS)
Miami, University of
UNDERGRADUATE METEOROLOGY PROGRAM TEACHING FACULTY Bruce Albrecht, Ph.D. Colorado State University State University Mesoscale and tropical meteorology Teaching Specialty: Survey of Modern Meteorology Amy.D. University of Washington Atmospheric convection and climate Teaching Specialty: Synoptic Meteorology, Physics
Gonsu, Kamga Hortense; Guenou, Etienne; Toukam, Michel; Ndze, Valantine Ngum; Mbakop, Calixte Didier; Tankeu, Dongmo Norbert; Mbopi-Keou, Francois Xavier; Takongmo, Samuel
Introduction Many studies still show significant numbers of surgical patients contracting nosocomial infections each year globally with high morbidity and mortality. The aim of this study was to identify potential bacteria reservoirs that may be responsible for nosocomial infection in surgical services in the Yaoundé University Teaching Hospital (YUTH) and the Central Hospital Yaoundé (CHY). Methods A cross sectional descriptive study was conducted from June to August 2012. Air, water, and surface samples were collected from two surgical services and subjected to standard bacteriological analysis. Results A total of 143 surface samples were collected. Bacteria were isolated in all surfaces except from one trolley sample and a surgical cabinet sample. The predominant species in all services was coagulase negative Staphylococcus (CNS). The average number of colonies was 132. 82CFU/25cm2. The bacteria isolated in the air were similar to those isolated from surfaces. From the 16 water samples cultured, an average of 50.93 CFU/100ml bacteria were isolated. The distribution of isolated species showed a predominance of Burkholderia cepacia. Conclusion These results showed the importance of the hospital environment as a potential reservoir and source of nosocomial infections amongst surgical patient at YUTH and CHY, thus we suggest that Public health policy makers in Cameroon must define, publish guidelines and recommendations for monitoring environmental microbiota in health facilities. PMID:26140067
Deeds, Jacquelyn P.; And Others
With agriculture teaching as its theme, this issue looks at teaching horticulture, team teaching, the ups and downs of teaching, integrating students with disabilities, and why people choose teaching as a career. (JOW)
Dixon, Danny; Vodde, Rich; Freeman, Mary; Higdon, Tami; Mathiesen, Sally G
Employment in a children's hospital of a major medical center can be stressful for healthcare providers, especially when faced with potential losses of pediatric and adolescent patients. Although it seems natural to believe that emotional distress following the death of a patient would be addressed, this is not always the case. The current manuscript presents results of a survey of healthcare providers at Shands Children's Hospital at the University of Florida, a not for profit teaching hospital. Hospital staff (N=94) responded to the survey with a 100% return rate. Responses identified situations considered to be stressful, and described how healthcare providers in this setting dealt with these incidents. Regarding existing hospital resources, respondents reported using multidisciplinary patient care conferences, social workers, and co-workers most often, as sources of support. Respondents also provided a lengthy listing of recommendations for improvement. Addressing the issues presented in this study may result in improved employee retention and lower overall turnover rates. PMID:16048857
Younis, M; Rice, J; Barkoulas, J
In this study, we identify the empirical determinants of hospital profitability, as measured by return on assets, using a comprehensive sample of hospitals from all four U.S. regions over the post-PPS era. We augment previous empirical models of hospital profitability by considering the effects of additional economic and financial variables and the effects of conversion of ownership status. Our empirical findings suggest that the following factors are significant determinants of hospital profitability during the post-PPS era: geographic location, ownership status, teaching status, conversion of ownership status, adjusted number of employees, length of stay, competition, financial indebtedness, bed capacity, and occupancy rate. We also find that a nonlinear relationship characterizes the dependence of hospital profitability on bed capacity and occupancy rate. PMID:11794758
Cromwell, Jerry; Hewes, Helene T.; Kelly, Nancy L.; Franklin, Saul
The annual surveys of the American Hospital Association historically have been the only national source of statistics on hospital structure and performance. Although valuable, this source has not provided the policy or research community with hospital-specific information on revenues, assets, and financial status. Data on these and other variables from heretofore unpublished Medicare cost report data are presented in this article. Hospital expenses, revenues, profits, indebtedness, utilization, investments, and employees are trended over the 1970-81 period by urban-rural location, teaching status, and ownership. It is indicated in these data that a major transformation in the hospital industry has occurred in response to cost-based Medicare-Medicaid and other factors that made acute care essentially unaffordable to the average citizen. The health maintenance organization movement and Medicare's prospective payment system are seen as logical reactions to this transformation. PMID:10312272
Palmer, Janice L.; Lach, Helen W.; McGillick, Janis; Murphy-White, Maggie; Carroll, Maria B.; Armstrong, Johanna L.
Individuals with Alzheimer’s disease and other dementias have 3.2 million hospital stays annually, which is significantly more than older individuals without dementia. Hospitalized patients with dementia are at greater risk of delirium, falls, overwhelming functional decline that may extend the hospital stay, and prolonged and/ or complicated rehabilitation. These risks support the need for staff education on the special care needs of this vulnerable population. In this article we describe a full-day educational program, the Dementia Friendly Hospital Initiative, designed to teach staff how to provide the specialized care required by patients with dementia. Participants (N=355) from five different hospitals, including 221 nurses, completed a pre-test/ post-test evaluation for the program. Changes in participants’ attitudes/ practices, confidence, and knowledge were evaluated. Scores indicated significant improvement on the post-test. The evaluation provides further evidence for recommending dissemination of the DFHI program. PMID:25299008
McCue, Michael J; Thompson, Jon M; Kim, Tae Hyun
The hospital industry has experienced increased consolidation in the past 20 years. Since 2010, in particular, there has been a large rise in the number of hospital acquisitions, and observers have suggested this is due in part to the expected impact of federal healthcare reform legislation. This article reports on a study undertaken to identify the market, management, and financial factors affecting acute care, community hospitals acquired between 2010 and 2012. We identified 77 such hospitals and compared them to other acute care facilities. To assess how different factors were associated with acquisitions, the study used multiple logistic regressions whereby market factors were included first, followed by management and financial factors. Study findings show that acquired hospitals were located in markets with lower rates of preferred provider organization (PPO) penetration compared with nonacquired hospitals. Occupancy rate was found to be inversely related to acquisition rate; however, case-mix index was significantly and positively related to a hospital's being acquired. Financial factors negatively associated with a hospital's being acquired included age of plant and cash flow margin. In contrast to the findings from earlier studies of hospital acquisitions, our results showed that acquired hospitals possessed newer assets. However, similar to the findings of other studies, the cash flow margin of acquired hospitals was lower than that of nonacquired facilities. PMID:26554263
Between 2.2% and 17% of all strokes have symptom onset during hospitalization in a patient originally admitted for another diagnosis or procedure. These in-hospital strokes represent a unique population with different risk factors, more mimics, and substantially worsened outcomes compared to community-onset strokes. The fact that these strokes manifest during the acute care hospitalization, in patients with higher rates of thrombolytic contraindications, creates distinct challenges for treatment. However, the best evidence suggests benefit to treating appropriately selected in-hospital ischemic strokes with thrombolysis. Evidence points toward a “quality gap” for in-hospital stroke with longer in-hospital delays to evaluation and treatment, lower rates of evaluation for etiology, and decreased adherence to consensus quality process measures of care. This quality gap for in-hospital stroke represents a focused opportunity for quality improvement. PMID:26288675
The Singing River Hospital System (SRHS) began in 1931 as Jackson County Hospital. The facility was the first community owned and operated hospital in Mississippi, and had 23 beds. Several additions to the hospital took place until, in 1958, a new 122-bed hospital was built and opened, and renamed Singing River Hospital. In 1968, the hospital system concept was created to include Ocean Springs Hospital in Ocean Springs Mississippi. SRHS has evolved steadily and significantly over the years.
Described is an activity which allows the investigation of human body systems using textbooks to enhance research skills and providing an opportunity for collaboration between pupils. Discussed are the purpose, materials, method, and results of this teaching method. Reported are some of the advantages of using this activity in teaching systems.…
Sebastian, Glenn R.
Ten exercises based on the weather map provided in the national newspaper "U.S.A. Today" are used to teach intermediate grade students about weather. An overview describes the history of "U.S.A. Today," the format of the newspaper's weather map, and the map's suitability for teaching weather concepts. Specific exercises, which are briefly…
Larson, Susan Booth
This teaching guide is comprised of four interdisciplinary units dealing with the expeditions of conquistadors in the New World: (1) "Cortes and the Aztecs: Different Views of the World"; (2) "Pizarro and the Incas: The 'What Ifs?' of History"; (3) "Orellana and the Amazon: Human and Environmental Issues"; and (4) "Teaching Guide for Cabeza de…
What is the meaning of absolute value? And why do teachers teach students how to solve absolute value equations? Absolute value is a concept introduced in first-year algebra and then reinforced in later courses. Various authors have suggested instructional methods for teaching absolute value to high school students (Wei 2005; Stallings-Roberts…
Vaughn, Lisa; Gonzalez Del Rey, Javier; Baker, Raymond
Amidst changes in the health care field with requirements for increased efficiency and limited time for teaching, there is a need for a teaching-learning model which maximizes the learning process and is exciting, fun, and motivating for both teacher and learner. Microburst Teaching and Learning is one strategy for combining various teaching styles and methods in 'bursts' with different learning styles to enhance the learning process.The model accommodates adult learning theory, adult attention span, learner motivation, the variety of learning styles found in learners, and the need for efficiency. Preliminary reactions to the Microburst Model indicate its appeal and motivating nature as a useful teaching-learning model.The next steps are to more critically evaluate the efficacy of the model for a broader range of clinical preceptors and to examine the variety of specific teaching strategies to determine which methods work best in specific settings. Because there are many potential teaching methods and teaching styles from which medical teachers can choose, a companion article outlining these specific methods and styles is currently in preparation.Weanticipate the article's publication within the next year. PMID:11260738
Vaughn, Lisa; del Rey, Javier Gonzalez; Baker, Raymond
Introduces Microburst Teaching and Learning, a strategy for combining various teaching styles and methods in 'bursts' with different learning styles to enhance the learning process. The model accommodates adult learning theory, adult attention span, learner motivation, the variety of learning styles found in learners, and the need for efficiency.…
DeRogatis, Amy; Honerkamp, Kenneth; McDaniel, Justin; Medine, Carolyn; Nyitray, Vivian-Lee; Pearson, Thomas
The editor of "Teaching Theology and Religion" facilitated this reflective conversation with five teachers who have extensive experience and success teaching extremely large classes (150 students or more). In the course of the conversation these professors exchange and analyze the effectiveness of several active learning strategies they…
Cheng, Tina L.; Greenberg, Larrie; Loeser, Helen; Keller, David
Reviews methods of teaching preventive medicine in pediatrics and highlights innovative programs. Methods of teaching prevention in pediatrics include patient interactions, self-directed learning, case-based learning, small-group learning, standardized patients, computer-assisted instruction, the Internet, student-centered learning, and lectures.…
Harding, Delma E.; And Others
The first section of this book discusses modern approaches to teaching biology, including theoretical approaches (such as "teaching form and function together") and the use of educational technology. The second part gives guidelines for planning and stocking science centers and laboratories. The third section deals with the use of materials: use…
Ma Rhea, Zane
This paper reports on research conducted on the impact of Buddhism on teaching, exploring the educational philosophy and approach, the daily practice of teaching, and the challenge of bringing together the mainstream education curriculum with Buddhist worldview in the first school in Australia being guided by Buddhist philosophy. Although there…
Forte, David F.
A brief look at Columbia, Harvard, and Notre Dame law schools shows that the American tradition in teaching natural law has not been strong. The value of teaching natural law is discussed, a separate course or seminar is seen as the most effective option, and a selection of available sources for such a course is appended. (JMD)
Teachers can use "built teaching aids" or elements of the school building itself to expand teaching and enhance learning. Possibilities include bulletin boards, display cases, murals painted by local artists, permanent information panels, interior windows to classrooms, flags, and bas-reliefs on building exteriors. Playground pavement can become a…
Most people think of a teacher leader as someone who takes on additional roles outside the classroom. But in this article, Michelle Collay argues that all effective teaching requires leadership. Using examples from classroom teachers with whom she has worked, Collay describes four dimensions of powerful classroom-based leadership: (1) teaching…
The author of this article, a middle school science teacher, reflects on her teaching profession and how she connected to other teachers which helped fuel her students' love of learning. She describes her traditional teaching practice and the facilities of her school's middle science laboratory facilities. She explains how social media…
It's obvious that technology is reshaping students' reading and writing practices, with or without educators' intervention. The challenge is to teach students to be truly literate in two languages--those of the pre- and post-digital worlds. So how can teachers teach to two literacies at once? They must approach this task with three mind-sets.…
Midlands Technical Coll., Columbia, SC.
In 1987, Midlands Technical College (MTC), in Columbia, South Carolina, initiated a Computer Integrated Manufacturing (CIM) project, the Midlands Teaching Factory, LTD, which integrated various college departments with the goal of manufacturing a high quality, saleable product. The faculty developed a teaching factory model which was designed to…
Bakunas, Boris; Holley, William
Kerr and Zigmond (1986) found that 67 percent of all high school teachers surveyed viewed organizational skills as crucial for student success in school. How can teachers get their students to agree? One way is to teach organizational skills just as they would teach writing or computation skills. Explain and demonstrate what students are to do,…
Ghezzi, Patrick M.
The advantages of emphasizing discrete trials "teaching" over discrete trials "training" are presented first, followed by a discussion of discrete trials as a method of teaching that emerged historically--and as a matter of necessity for difficult learners such as those with autism--from discrete trials as a method for laboratory research. The…
Presents the hypothesis that drama positively affects second language students by providing spontaneity and motivation. To test the hypothesis, the function of drama in language teaching is explored as well as the technique used to teach English through drama. (Author/VWL)
Bakunas, Boris; Holley, William
Advocates teaching students organizational skills that lead to school success. Outlines seven such skills and how to teach them, including such things as bringing necessary supplies to class, organizing handouts and loose-leaf papers, taking and organizing notes, developing and following study plans, and planning and carrying out large projects.…
Greenberg, R.; And Others
The Image Processing for Teaching project provides a powerful medium to excite students about science and mathematics, especially children from minority groups and others whose needs have not been met by traditional teaching. Using professional-quality software on microcomputers, students explore a variety of scientific data sets, including…
Teaching creatively in ESP might in certain cases present some appropriate solutions to the teaching situation and, more importantly, boost students' confidence and motivation towards achieving some of the course objectives. Based on a case study, this paper displays some of the results obtained through a limited scope research conducted with…
Beach, Richard W.; Appleman, Deborah; Hynds, Susan; Wilhelm, Jeffrey
This text for pre-service and in-service English education courses presents current methods of teaching literature to middle and high school students. The methods are based on social constructivist/socio-cultural theories of literacy learning, and incorporate research on literary response conducted by the authors. "Teaching Literature to…
Kenneth E. Brashier, Mark S. Lewine, Alexei V. Filippenko, and Donna C. Boyd were the four professors who won the Professors of the Year for 2006. They were chosen from nearly 300 candidates nominated by their institutions for their "outstanding commitment to teaching undergraduate students and their influence on teaching." The annual competition…
Hoctor, Marge, Ed.
This journal issue gathers together several articles on teaching with technology, with special focus on teaching of gifted students in California. "Computers and Creativity: Tools, Tasks, and Possibilities" (Bernard J. Dodge) discusses how teachers can establish an environment that will nurture creativity through use of computers. "Technology…
Crawford, Michael J.
Presents a rationale for utilizing trivia to teach conversation. Shows how trivia-based materials fit into communicative language teaching approaches and provides examples of trivia-based activities and explains how to use them in the classroom. (Author/VWL)
Marek, Michael W.
This paper is a slightly revised version of a keynote address given at the 2015 National Quemoy University English Conference, Reimagining the Teaching of Language, Literature, and Culture, in Kinmen, Taiwan, on 5 June 2015. The author contends that teaching English as a Foreign Language is changing rapidly, and successful teachers and scholars…
Teaching in Northern Uganda is challenging considering the numerous obstacles and constraints that teachers must face on a daily basis, let alone the fact that they live in a war zone, constantly at risk of cross-fire. In this article, the author shares his experience working in Northern Uganda. He relates the life and teaching experiences of…
Jones, Kevin R.
This news brief presents information on managing substitute teaching. The information is based on issues discussed at a summit meeting which included public school administrators and personnel directors from around the nation. The main topics of concern focused around four core components related to the management of substitute teaching:…
Koran, John J., Jr.
This pamphlet, replacing an earlier edition with the same title, reviews the research related to science instruction in high schools with reference to its implications for teaching. Recommendations for particular teaching methods are made when the evidence is strong, and, where it is weak, implications of the trends discerned are stated, and…
Discusses several practices in teaching physics that are of dubious merit, such as stressing vocabulary and stressing content over process. Suggests several alternate approaches to make physics teaching more interesting. Includes several issues affecting the quality of science education which involve general school policy. (JN)
Chapman, Patricia H., Comp.; And Others
This book contains 172 creative teaching ideas pertaining to various subject areas and aspects of business education. Most of the ideas included are intended for use in secondary and postsecondary classrooms; however, a few are applicable at all grade levels. The teaching ideas are organized according to the following subject areas/topics:…
Murray, John J.
Three game approaches to the teaching of poetry, designed to make the student actively involved with poems are described as "teaching tools." The semantico-dictionary or word-cross game involves programing techniques, logic, and lexicography in poetic analysis. The punched-out poem game involves filling in the blanks of a poem in which all the…
Danielson's Framework for Teaching has provided a common language for discussions of teaching practice for almost 20 years. Many educators love the Framework's comprehensiveness; they find the specific language to be useful as they strive to improve their practice. For other educators, however, the Framework's 22 components and 76 smaller elements…
Richardson, G., Ed.
Key areas of modern language teaching are addressed in 10 articles. In addition to a general overview of methods and aims of foreign language teaching, attention is directed to the audiolingual and audiovisual revolution, language study for the slow-learning child and for the child with above average ability, imaginative learning activities for…
Moseley, Bryan; Dustin, Daniel
In this article, the authors advance a metaphor born of chaos theory that views the college classroom as a complex dynamical system. The authors reason further that "teaching as chaos" provides a more accurate representation of the teaching-learning process than the existing linear scientific metaphors on which traditional learning assessments are…
Harvard Univ., Cambridge, MA. Graduate School of Education.
THIS BIBLIOGRAPHY LISTS MATERIAL ON VARIOUS ASPECTS OF TEACHING. APPROXIMATELY 100 UNANNOTATED REFERENCES ARE PROVIDED FOR DOCUMENTS DATING FROM 1960 TO 1966. BOOKS, JOURNALS, REPORT MATERIALS, AND SOME UNPUBLISHED MANUSCRIPTS ARE LISTED IN SUCH AREAS OF EDUCATION AS HEURISTIC GAMES, TEACHER EVALUATION, CURRICULUMS, TEACHING TECHNIQUES, AND…
Shakhashiri, Bassam Z.
Presents several perspectives on what quality chemistry teaching is, including the need for chemistry educators to communicate the positive contributions of chemistry to society. Describes a hierarchy of teaching/learning activities, characteristics of good teachers, and examples of how to be aware of the learner's perspective. (TW)
Brophy, Jere E.; Evertson, Carolyn M.
Process-product research in which the investigator observes in teachers' classrooms and tries to relate process measures of teaching behavior to product measures of student outcome has face validity appeal and common sense logic. This research approach appears to be the simplest and most direct way to identify teaching behaviors which discriminate…
Economics can be a tough subject, so good teachers find creative ways to teach it. However, only a few economic literacy programs promote "an economic way of thinking" and teach students how to analyze relevant economic problems, says Burton Folsom. Having examined several economic education programs, the author has found that many programs are…
Rosenak's "Teaching Jewish Values" (1986) is perhaps his most accessible book about Jewish education. After diagnosing the "diseases" of Jewish education, he endorses "teaching Jewish values" as the curricular strategy most likely to succeed given the chasm which divides traditional Jewish subject matter and the…
Miller, J. Dale
Supplementary teaching materials for French language programs are presented in this text. Primarily intended for secondary school students, the study contains seven units of material. They include: (1) French gestures, (2) teaching the interrogative pronouns, (3) French cuisine, (4) recreational learning games, (5) French-English cognates, (6)…
Korn, Max, Comp.
The bibliography on precision teaching, issued by Canada's National Institute on Mental Retardation, contains approximately 84 entries alphabetized according to author. The entries, which include books, articles, and dissertations, range over such topics as the use of behavior modification in precision teaching, school-wide implementation of…
... 3,003 Number of Community Hospitals in a System *** 3,144 Number of Community Hospitals in a Network **** 1,582 *Registered hospitals are those hospitals that meet AHA's criteria for registration as a hospital facility. Registered hospitals include AHA ...
Sihuin-Tapia, Elsa Yudy; Gómez-Quispe, Oscar Elisban; Ibáñez-Quispe, Vladimiro
In order to determine the satisfaction of hospitalized patients in the Sub-regional Hospital of Andahuaylas, 175 patients were surveyed using the Servqual multidimensional model. The estimate of variables associated with the satisfaction of the hospitalized patients was performed by using bivariate and multivariate logistic regression analysis. We found 25.0% satisfaction. Lower levels of satisfaction were associated with having a secondary level education (aOR: 0.05; 95% CI: 0.01 to 0.64) and with having been hospitalized in the surgery department (aOR 0.14, CI: 95%: 0.04 to 0.53). It was concluded that there was a low level of satisfaction with the quality of care received by hospitalized patients and this was associated with the level of education and type of hospital department. PMID:26338391
Sloan, F A; Gordon, G S; Cocks, D L
Many hospitals have introduced formularies to reduce hospital pharmacy expense, among other reasons. This study provides empirical evidence of the influence of hospital formulary restrictions on pharmacy charges, all other hospital charges, and on length of stay, using a survey of hospital drug policies and hospital discharge data from Washington State in 1989. Limiting the number of drugs in particular therapeutic categories reduced total charges incurred for gastrointestinal disease and asthma patients, increased total charges for cardiovascular disease patients, and had no effect on charges for infectious diseases patients. Restricting availability of drugs reduced pharmacy charges, but these savings tended to be offset by increases in other charges. Combining the categories, we found that restricting availability of drugs did not affect charges. We conclude that across-the-board restrictions do not result in cost savings, although savings may be realized for particular drug categories. PMID:8412389
de Mello, Rita Mello; Schneider, Jacó Fernando
This study aims to identify the reasons that lead relatives to hospitalize patients in a psychiatric unit of a general hospital. It is a qualitative study based on Alfred Schutz' phenomenological sociology. Fourteen relatives, each with one family member hospitalized, were interviewed from August to October 2009. The guiding question of the phenomenological interview was "What do you expect from psychiatric hospitalization in a general hospital?". Phenomenological sociology was used to understand and interpret the interviews. Statements showed three concrete categories, that lead to the reasons for: treatment guidelines and continuity; prospects for improvement; ideas about normality. This research shows the experiences of relatives, contributing with mental health professionals' reflection about their actions and about the involvement of families in a general hospital's psychiatric unit. PMID:21987981
Kustra, Erika; Doci, Florida; Gillard, Kaitlyn; Hondzel, Catharine Dishke; Goff, Lori; Gabay, Danielle; Meadows, Ken N.; Borin, Paola; Wolf, Peter; Ellis, Donna; Eiliat, Hoda; Grose, Jill; Dawson, Debra L.; Hughes, Sandy
An institutional culture that values teaching is likely to lead to improved student learning. The main focus of this study was to determine faculty, graduate and undergraduate students' perception of the teaching culture at their institution and identify indicators of that teaching culture. Themes included support for teaching development; support…
McHugh, Matthew D.; Kelly, Lesly A.; Smith, Herbert L.; Wu, Evan S.; Vanak, Jill M.; Aiken, Linda H.
Background Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why. Objectives To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations. Method and Study Design Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences. Results Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76–0.98; P = 0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77–1.01; P = 0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes. PMID:24022082
Kotsis, Sandra V.
Background International volunteering missions are becoming an important focus of plastic surgeons in the United States. The purpose of this paper is to describe the teaching of pediatric hand surgery in Vietnam to share the lessons learned from this project. Methods Two medical education trips were conducted to the no. 1 Children’s Hospital in Ho Chi Minh city (Saigon) to teach pediatric hand and burn reconstructive surgery to the surgeons and therapists. This is the main referral children’s hospital for the country, and pediatric hand surgery expertise is not available. Results Structured education programs were conducted over two trips to introduce congenital hand surgery and burn reconstructive procedures using flap techniques. The education programs included lectures and surgical demonstrations of selected procedures. Their proficiency was verified by supervised conduct of these operations. Conclusions A well-conceived medical education program can introduce complex surgical discipline to a country. Through two trips, the surgeons at this referral center will have the capability to take care of many children requiring reconstructive hand surgery. PMID:18780043
Background Research showed that promising approaches such as benchmarking, operations research, lean management and six sigma, could be adopted to improve patient logistics in healthcare. To our knowledge, little research has been conducted to obtain an overview on the use, combination and effects of approaches to improve patient logistics in hospitals. We therefore examined the approaches and tools used to improve patient logistics in Dutch hospitals, the reported effects of these approaches on performance, the applied support structure and the methods used to evaluate the effects. Methods A survey among experts on patient logistics in 94 Dutch hospitals. The survey data were analysed using cross tables. Results Forty-eight percent of all hospitals participated. Ninety-eight percent reported to have used multiple approaches, 39% of them used five or more approaches. Care pathways were the preferred approach by 43% of the hospitals, followed by business process re-engineering and lean six sigma (both 13%). Flowcharts were the most commonly used tool, they were used on a regular basis by 94% of the hospitals. Less than 10% of the hospitals used data envelopment analysis and critical path analysis on a regular basis. Most hospitals (68%) relied on external support for process analyses and education on patient logistics, only 24% had permanent internal training programs on patient logistics. Approximately 50% of the hospitals that evaluated the effects of approaches on efficiency, throughput times and financial results, reported that they had accomplished their goals. Goal accomplishment in general hospitals ranged from 63% to 67%, in academic teaching hospitals from 0% to 50%, and in teaching hospitals from 25% to 44%. More than 86% performed an evaluation, 53% performed a post-intervention measurement. Conclusions Patient logistics appeared to be a rather new subject as most hospitals had not selected a single approach, they relied on external support and they did not have permanent training programs. Hospitals used a combination of approaches and tools, about half of the hospitals reported goal accomplishment and no approach seemed to outperform the others. To make improvement efforts more successful, research should be conducted into the selection and application of approaches, their contingency factors, and goal-setting procedures. PMID:22852880
Thomas, Kali S.; Rahman, Momotazur; Mor, Vincent; Intrator, Orna
Objectives To determine whether the quality of the hospital and of the nursing home (NH) to which a patient was discharged were related to the likelihood of rehospitalization. Study Design Retrospective cohort study of 1,382,477 individual hospitalizations discharged to 15,356 NHs from 3683 hospitals between 2006 and 2008. Methods Data come from Medicare claims and enrollment records, Minimum Data Set, Online Survey Certification and Reporting Dataset, Hospital Compare, and the American Hospital Association Database. Cross-classified random effects models were used to test the association of hospital and NH quality measures and the likelihood of 30-day rehospitalization. Results Patients discharged from higher-quality hospitals (as indicated by higher scores on their accountability process measures and high nurse staffing levels) and patients who received care in higher-quality NHs (as indicated by high nurse staffing levels and lower deficiency scores) were less likely to be rehospitalized within 30 days. Conclusions The passage of the Affordable Care Act changed the accountability of hospitals for patients’ outcomes after discharge. This study highlights the joint accountability of hospitals and NHs for rehospitalization of patients. PMID:25730351
& Sciences delivered brief presentations reflecting on the use of technology in their teaching Sommers (Psychology) The presenter demonstrated how to incorporate multimedia into PowerPoint slides with Images: Using Images in a Multidisciplinary History Course Paula Lupkin (Architecture) and Maggie Garb
Locklin, Reid B.; Tiemeier, Tracy; Vento, Johann M.
Tomoko Masuzawa and a number of other contemporary scholars have recently problematized the categories of "religion" and "world religions" and, in some cases, called for its abandonment altogether as a discipline of scholarly study. In this collaborative essay, we respond to this critique by highlighting three attempts to teach world religions…
May, William F.
A philosophical overview of the place of technology in higher education and especially in teaching is presented. Research can be viewed as the acquisition of knowledge; teaching as its transmission; and service as its application. Technology affects the transmission of knowledge in both the teaching process and the content of teaching. The…
Nikos, Klaoudatos; Stavros, Papastavridis
In this paper, we describe the skeleton of two teaching units, based on a Model for teaching mathematics, Context Orientated Teaching (COT). The first teaching unit concerns the proof of a mathematical proposition, while the second one concerns the solution of an open problem. Both are taught in the 10th grade, under the specific conditions of the…
Koys, Daniel J; Martin, Wm Marty; LaVan, Helen; Katz, Marsha
The authors address the hospital outcomes of patient satisfaction, healthcare quality, and net income per bed. They define union density as the percentage of a hospital's employees who are in unions, healthcare quality as its 30-day acute myocardial infraction (AMI; heart attack) mortality rate, and patient satisfaction as its overall Hospital Consumer Assessment of Healthcare Providers and Systems score. Using a random sample of 84 union and 84 nonunion hospitals from across the United States, multiple regression analyses show that union density is negatively related to patient satisfaction. Union density is not related to healthcare quality as measured by the AMI mortality rate or to net income per bed. This implies that unions per se are not good or bad for hospitals. The authors suggest that it is better for hospital administrators to take a Balanced Scorecard approach and be concerned about employee satisfaction, patient satisfaction, healthcare quality, and net income. PMID:26652043
Andaleeb, S S
This paper examines consumer attitudes toward hospital advertising. The results do not support recent findings in other professional fields that consumers are favorably disposed toward this marketing activity. From a demographic perspective, there were differences in attitudes based on gender, age, and education. Income levels had no significant relationship with attitudes. However, consistent results were found on the relative proportion of consumers who were able to recall hospital advertisements. Mostly, they recalled hospital ads seen on TV and newspapers. PMID:10137174
Merridew, C G
"Those wonderful huts…" (Florence Nightingale). This is the story of the British Civil Hospital, erected in 1855 at Renkioi on the south Dardanelles coast of Turkey. The spectacular hospital was a portable one designed by British engineer IK Brunel. It was his only health-related project, and it was known as a Civil Hospital because its staff were all civilians, despite its patients being military. PMID:25196954
Far, Rafat Mohebbi; Rad, Fatemeh Samiee; Abdolazimi, Zahra; Kohan, Mohamad Mehdi Daneshi
Objective: The purpose of this study was to determine the rate and causes of wastage of blood and blood products (packed red cells, plasma, platelets, and cryoprecipitate) in Qazvin hospitals. Materials and Methods: The study was conducted in all hospitals in Qazvin, including 5 teaching hospitals, 2 social welfare hospitals, 3 private hospitals, 1 charity hospital, and 1 military hospital. This descriptive study was based on available data from hospital blood banks in the province of Qazvin. The research instrument was a 2-part questionnaire. The first part was related to demographic characteristics of hospitals and the second part elicited information about blood and blood component wastage. The collected data were then analyzed using descriptive statistic methods and SPSS 11.5. Results: Blood wastage may occur for a number of reasons, including time expiry, wasted imports, blood medically or surgically ordered but not used, stock time expired, hemolysis, or miscellaneous reasons. Data indicated that approximately 77.9% of wasted pack cell units were wasted for the reason of time expiry. Pack cell wastage in hospitals is reported to range from 1.93% to 30.7%. Wastage at all hospitals averaged 9.8% among 30.913 issued blood products. Overall blood and blood product (packed red cells, plasma, platelets, and cryoprecipitate) wastage was 3048 units and average total wastage per participant hospital for all blood groups was 254 units per year. Conclusion: Blood transfusion is an essential part of patient care. The blood transfusion system has made significant advancements in areas such as donor management, storage of blood, cross-matching, rational use of blood, and distribution. In order to improve the standards of blood banks and the blood transfusion services in Iran, comprehensive standards have been formulated to ensure better quality control in collection, storage, testing, and distribution of blood and its components for the identified major factors affecting blood product wastage. PMID:25035674
Cohen, Susan Phillips
This paper covers the history of teaching pet loss, the skills new veterinarians should know, suggestions for who might teach those skills, and a sample curriculum. In the last 25 years, the veterinary profession has become more aware of the needs of clients who have lost pets and more skilled at meeting those needs. To maximize the ability of practitioners to handle pet loss, veterinary colleges and teaching hospitals can prepare students to do four things: explain a bad medical situation, assess the client, help a client to make a good decision, and support a client through their loss. These skills can and should be taught by a variety of experts, including veterinary faculty and practitioners, mental health professionals, clients, and peers. PMID:19228902
Willcoxson, Lesley; Manning, Mark L.; Johnston, Natasha; Gething, Katrina
Definitions and practical interpretations of the research-teaching nexus are various, but almost invariably the link between teaching and research lies in the direction of transferring research into teaching rather than vice versa. This transfer is achieved by using research to inform teaching and, less frequently, by engaging students in…
Fajardo Dolci, Germán; Aguirre Gas, Héctor G; Robledo Galván, Héctor
Hospital evaluation is a fundamental process to identify medical units' objective compliance, to analyze efficiency of resource use and allocation, institutional values and mission alignment, patient safety and quality standards, contributions to research and medical education, and the degree of coordination among medical units and the health system as a whole. We propose an evaluation system for highly specialized regional hospitals through the monitoring of performance indicators. The following are established as base thematic elements in the construction of indicators: safe facilities and equipment, financial situation, human resources management, policy management, organizational climate, clinical activity, quality and patient safety, continuity of care, patients' and providers' rights and obligations, teaching, research, social responsibility, coordination mechanisms. Monitoring refers to the planned and systematic evaluation of valid and reliable indicators, aimed at identifying problems and opportunity areas. Moreover, evaluation is a powerful tool to strengthen decision-making and accountability in medical units. PMID:22089674
Bayley, T. J.
Trainees and educationalists in general practice have some grounds for suggesting that the hospital component of vocational training should be restructured and teaching improved. However, the implications for other trainees and secondary care have to be considered. Changes that are needed include a curriculum for senior house officers in each specialty; appointment of training consultants with the necessary skills; and a different attitude by everyone towards study leave, including arrangements for funding. The optimum duration of hospital posts for trainees in general practice might be shorter than now, but the effects on others must be considered and competencies guaranteed in a briefer training period. Changes in the regulations for vocational training could help to improve specialist experience if trainees in general practice were allowed to be supernumerary. Alternatively, senior house officer posts for trainees in general practice could be split between secondary and primary care, thus encouraging a broader perspective. PMID:8019224