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BACKGROUND: The use of Complementary and Alternative Medicine (CAM) by cancer patients is very common and varies between populations. The referenced English literature has no local study from Africa on this subject. This study was conducted to define the prevalence, pattern of use, and factors influencing the use of CAM by cancer patients at the University of Nigeria TeachingHospital
Objective To determine the prevalence, risk factors, co-morbidities and case fatality rates of Protein Energy Malnutrition (PEM) admissions at the paediatric ward of the University of Nigeria TeachingHospitalEnugu, South-east Nigeria over a 10?year period. Design A retrospective study using case Notes, admission and mortality registers retrieved from the Hospital’s Medical Records Department. Subjects All children aged 0 to 59?months admitted into the hospital on account of PEM between 1996 and 2005. Results A total of 212 children with PEM were admitted during the period under review comprising of 127 (59.9%) males and 85(40.1%) females. The most common age groups with PEM were 6 to 12?months (55.7%) and 13 to 24?months (36.8%). Marasmus (34.9%) was the most common form of PEM noted in this review. Diarrhea and malaria were the most common associated co-morbidities. Majority (64.9%) of the patients were from the lower socio-economic class. The overall case fatality rate was 40.1% which was slightly higher among males (50.9%). Mortality in those with marasmic-kwashiokor and in the unclassified group was 53.3% and 54.5% respectively. Conclusion Most of the admissions and case fatality were noted in those aged 6 to 24?months which coincides with the weaning period. Marasmic-kwashiokor is associated with higher case fatality rate than other forms of PEM. We suggest strengthening of the infant feeding practices by promoting exclusive breastfeeding for the first six months of life, followed by appropriate weaning with continued breast feeding. Under-five children should be screened for PEM at the community level for early diagnosis and prompt management as a way of reducing the high mortality associated with admitted severe cases.
Introduction: The epidemiology and pathology of meningioma in Nigeria are still evolving and little has been published about this tumor in Nigeria, especially in the southeast region. The aim of this paper is to compare the characteristics of intracranial meningioma managed in our center with the pattern reported in the literature worldwide. Materials and Methods: Retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2002 and December 2010 at a Private neurosurgery Hospital in Enugu, Nigeria. We excluded patients whose histology results were inconclusive. Results: Meningiomas constituted 23.8% of all intracranial tumors seen in the period. The male to female ratio was 1:1.1. The peak age range for males and females were in the fifth and sixth decades, respectively. The most common location is the Olfactory groove in 26.5% of patients followed by convexity in 23.5%. Presentation varied with anatomical location of tumor. Patients with olfactory groove meningioma (OGM) mostly presented late with personality changes and evidence of raised ICP. Tuberculum sellar and sphenoid region tumors presented earlier with visual impairment with or without hormonal abnormalities. Seizures occurred in 30.9% of all patients and in 45% of those with convexity meningiomas. Only 57.4% of the patients were managed surgically and there was no gender difference in this group. WHO grade1 tumors were the most common histological types occurring in 84.6%. One patient had atypical meningioma and two had anaplastic tumors. Conclusion: The pattern of meningioma in our area may have geographical differences in location and histology. Childhood meningioma was rare.
Mezue, Wilfred C; Ohaegbulam, Samuel C; Ndubuisi, Chika C; Chikani, Mark C; Achebe, David S
Our objective was to determine the current incidence, clinical pattern, surgical and medical management, maternal morbidity and mortality from tubal pregnancies in Enugu, Nigeria. The records of all patients treated for tubal pregnancy at the University of Nigeria TeachingHospital, Enugu from 1 January 1997 to 31 December 2003 were reviewed. The number of tubal ectopic pregnancies was 136, while the total number of hospital deliveries was 6,003 giving a ratio of 1:44. There were four maternal deaths due to tubal pregnancy, out of a total of 126 maternal deaths that occurred during the same period. Ectopic pregnancy was prevalent in young single women with a previous history of induced abortion and resultant pelvic infection. The most common mode of treatment is salpingectomy. Most gynaecologists are not competent in operative laparoscopy and often do not use medical management of ectopic pregnancy. However, late presentation with haemoperitoneum limits the use of conservative treatment. Maternal morbidity and mortality due to tubal pregnancy is rising in Enugu, Nigeria. Preventive efforts should aim at health education and liberal contraceptive utilisation. Provision of more sophisticated equipment and tests in the management of ectopic pregnancies may in the long term be economically viable. Currently, autotransfusion is under utilised. PMID:16234149
This article explores the potential and the dangers of this novel form of collaboration between academic medicine and the for-profit world. The author focuses on those arrangements--purchases and leasing agreements--by which investor-owned corporations operate, for a profit, hospitals that serve as major medical teaching and research sites. He begins by reviewing how the evolving needs of academic medical centers and
The effect of increasing housestaff experience over the academic year on cost and outcome of inpatient care was studied in teachinghospitals in comparison to those without teaching programs. Records for 240,462 patients with 25 preselected discharge diag...
Using data published annually by the American Hospital Association, the turnover rates of chief executive officers at 800 teaching and 4,700 non-teachinghospitals were compared. Teachinghospital CEOs experienced less turnover than did nonteaching hospital CEOs. The higher-turnover hospitals typically under-perform relative to other hospitals.…
The semen samples of 1,110 (one thousand, one hundred and ten) Igbo males attending infertility clinic, aged between 30-50 years were collected and analyzed. The specimens were collected and analysed in the microbiology laboratory of the University of Nigeria TeachingHospital (UNTH) Enugu, Eastern Nigeria. The standard method of masturbation after 3-5 days of prior abstinence from sex before sample collection was applied. The samples were examined for semen volume and microscopically as a wet preparation for sperm motility, morphology and count. The semen volume result showed that 91.07 % were normal. 6.3% sperm samples were motile. In the sperm count, only 7.3% had normal cells, 62.0% showed abnormal morphology. The aetiology of male infertility in the population studied seems to be related to the sperm count, motility and morphology but not volume. Racial factor seems to play no role and it is important to abstain from sexual intercourse some days before collection of semen for analysis. PMID:17242721
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 teachinghospitals, guidelines are presented which may be utilized to meet the needs of a particular situation. Three broad categories of facilities are…
A study compared two teachinghospitals' costs for educational programs with annual hospital operating expenses, with inflation, and by program. Unit costs were estimated for graduate and undergraduate medical students. Allocated education costs were 13 percent to 14 percent of operating budgets, in line with medical inflation trends. Cost per…
A study is presented of 217 adults referred for psychiatric assessment from the wards of a postgraduate teachinghospital.The pattern of referral and the disproportionate importance of disturbed behaviour amongst referrals from non-medical wards are discussed. The main diagnostic groups, namely, affective disorders, organic states, psychogenic somatic symptoms and attempted suicide, are tabulated and discussed. Complex problems of diagnosis and
Background Urinary tract infection (UTI) is a common cause of childhood morbidity and mortality in the tropics. Children with sickle cell anemia (SCA) may have compromised kidney function arising from repeated vaso-occlusive episodes and recurrent symptomatic or asymptomatic UTI. Objectives This study aims at determining the prevalence of asymptomatic bacteriuria and sensitivity pattern in children with homozygous sickle haemoglobin compared to children with normal haemoglobin. Methods One hundred children with SCA in stable state and 100 children with normal haemoglobin aged 2-12 years were screened for asymptomatic bacteriuria using midstream urine samples. The samples were incubated aerobically at 37°C for 24 hours within one hour of collection. Children whose urine samples yielded significant bacteriuria (?105cfu/ml) on two consecutive cultures were regarded as having asymptomatic bacteriuria. Results Asymptomatic bacteriuria was noted in 6% of children with SCA and occurred more in females than males (F: M = 5:1) when compared to 2% in children with normal haemoglobin. Escherichia coli was the commonest organism isolated (33.3%). All the organisms were resistant to co-trimoxazole and ampicillin while most were sensitive to gentamicin, ceftriaxone and the quinolones. Conclusion The risk of asymptomatic bacteriuria is three times more common in children with sickle cell anemia than in children with normal haemoglobin. It is therefore important to screen SCA patients, especially the females for UTI and should be treated according to the sensitivity result of the cultured organisms.
The authors examined the impact of costs of education on the overall expenses of two major teachinghospitals during a period of rapid growth and change in the Minneapolis and St. Paul, Minnesota, health care environment. By using a retrospective faculty-time study and the two hospitals' estimated costs for education, education costs of each hospital were compared--within and across facilities--with annual hospital operating expenses, with inflation, and by educational program. Unit costs were estimated for undergraduate and graduate medical students. Over the study period, allocated education costs averaged 13-14% of the hospitals' operating budgets. The combined mean allocated cost per medical student and resident was approximately +73,000 in 1983-84. During this period, allocated education costs were in line with medical inflationary trends and did not drive hospital expense increases. These findings suggest that policymakers wishing to restrain the rise in health care costs should look beyond cutting the costs of education programs and find other solutions. PMID:2719790
|A survey conducted by the Department of TeachingHospitals of the Association of American Medical Colleges is reported that shows income, expense, and general operating data for university-owned teachinghospitals. Sixty-one hospitals reported data that were keyed to Medicare cost reports. Self-pay and Medicare maintained their places as leading…
|The funding of postgraduate medical education through the "approved educational activities" of teachinghospitals needs to reevaluated. Since it is considered impossible to separate patient case and educational activities, drawing the line for financial purposes between these activities will be controversial and critical for teachinghospitals.…
The planning and installation of a telemedicine system for communication within a teachinghospital and its academic and hospital units with a capacity for accommodation of up to 400 video-stations is described. The system is intended for improving the communication between patients and health professionals, and between the health professionals themselves. It also provides the basis for improving pre-graduate teaching,
The planning and installation of a telemedicine system for communication within a teachinghospital and its academic and hospital units with a capacity for accommodation of up to 400 video-stations is described. The system is intended for improving the communication between patients and health professionals, and between the health professionals themselves. It also provides the basis for improving pre-graduate teaching,
... Conditions of payment: Assistants at surgery in teachinghospitals. 415.190 ...Conditions of payment: Assistants at surgery in teachinghospitals. (a) Basis...basis for the services of an assistant at surgery in a teachinghospital. This...
... Conditions of payment: Assistants at surgery in teachinghospitals. 415.190 ...Conditions of payment: Assistants at surgery in teachinghospitals. (a) Basis...basis for the services of an assistant at surgery in a teachinghospital. This...
OBJECTIVE Proximal femur fractures cause significant pain and economic cost among pediatric patients. The purposes of this study were (a) to evaluate the distribution by hospital type (teachinghospital vs non-teachinghospital) of U.S. pediatric patients aged 1-20 years who were hospitalized with a closed hip fracture and (b) to discern the mean hospital charge and hospital length of stay after employing propensity score to reduce selec-tion bias. METHODS The 2006 Healthcare Cost and Uti-lization Project (HCUP) Kids’ Inpatient Database (KID) was queried for children aged up to 20 years that had principle diagnosis of hip fracture injury. Hip fractures were defined by International Classifi-cation of Diseases, 9th Revision, Clinical Modifica-tion codes 820.0, 820.2 and 820.8 under Section “Injury and Poisoning (800-999)” with principle internal fixation procedure codes 78.55, 79.15 and 79.35. Patient demographics and hospital status were presented and analyzed. Differences in mean hospital charge and hospital length of stay by hospitalteaching status were assessed via two propensity score based methods. RESULTS In total, 1,827 patients were nation-ally included for analysis: 1,392 (76.2%) were treated at a teachinghospital and 435 (23.8%) were treated at a non-teachinghospital. The average age of the patients was 12.88 years old in teachinghospitals vs 14.33 years old in nonteaching hospitals. The propensity score based ad-justment method showed mean hospital charge was $34,779 in teachinghospitals and $32,891 in the non-teachinghospitals, but these differences were not significant (p=0.2940). Likewise, mean length of hospital stay was 4.1 days in teachinghospitals and 3.89 days in non-teachinghospitals, but these differences were also not significant (p=0.4220). Conclusions Hospitalteaching status did not affect length of stay or total hospital costs in children treated surgically for proximal femur fractures. Future research should be directed at identifying factors associated with variations in hospital charge and length of stay.
Gao, Yubo; Pugely, Andrew; Karam, Matthew; Phisitkul, Phinit; Mendoza, Sergio; Johnston, Richard C.
\\u000a The Enugu USA Medical Mission is a humanitarian year round mission to provide free health care to the people of Enugu State\\u000a of Nigeria who are underserved and less privileged. The purpose of the Enugu USA Medical Mission is to contribute to solutions\\u000a that solve health issues. Toxic chemicals contaminate drinking waters, build up in human organs and bones, and
Godfrey A. Uzochukwu; Mary E. Uzochukwu; Ethelbert Odo
The establishment of a quality assurance program at University Hospital, the primary teaching facility at the University of Arkansas Medical Center, Little Rock, is described. During a 5-month planning effort funded by the Arkansas Regional Medical Progra...
Patients suffering from cancer and human immunodeficiency virus (HIV) disease at a teachinghospital were found to have poorly controlled pain. Many were prescribed inappropriate analgesia. A palliative care service was established to provide symptom control for patients and education for staff. Educational materials were developed, didactic teaching organized, and one-to-one education by case discussion provided to improve patient management.
Regina McQuillan; Ilora Finlay; Cleopatra Branch; Dave Roberts; Mike Spencer
Background: Meningiomas may range on presentation from incidentally identified small lesions to large symptomatic tumors in eloquent areas of the brain. Management options correspondingly vary and include careful observation, surgical excision, and palliative application of very limited therapeutic maneuvers in select cases. This paper discusses the options and difficulties in the management of meningiomas in a developing country. Methods: This study is a retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2006 and September 2011 at Memfys Hospital for Neurosurgery, Enugu. Radiographic diagnosis of meningioma was based on computed tomography (CT) and or magnetic resonance imaging (MRI) criteria in all cases, but only patients who had surgery and a histological diagnosis were analyzed. Results: Seventy-four patients were radiographically diagnosed with intracranial meningioma over the period under review. Fifty-five patients were operated upon and 52 (70.3%) with histological diagnosis of meningioma were further analyzed. Histological diagnosis was complete in 42 (56.8%) patients and in 10 (13.5%) patients the subtype of meningioma was not determined. The male to female ratio was 1:1.08. The peak age range for females was in the 6th decade and for males in the 5th decade. The locations were olfactory groove (26.9%), convexity (21.2%), parasagittal/falx (19.2%), sphenoid ridge (15.4%), tuberculum sellae (7.7%), tentorial (3.8%), and posterior fossa (5.8%). The most common clinical presentation was headaches in 67.3% followed by seizures (40.4%) and visual impairment (38.5%). Histology was benign (World Health Organization [WHO] grade 1) in 39 patients. One patient harbored an atypical and two had anaplastic tumors. Gross total resection of the tumor was achieved in 41 patients. Surgical mortality was 3.9%. Conclusion: Effective management of meningioma depends largely on adequate and complete surgical resection and results in good outcomes. Adequate preoperative assessment, including visual assessment, and hormonal assessment in olfactory groove and sphenoid region meningiomas, is necessary.
Mezue, Wilfred C; Ohaegbulam, Samuel C; Ndubuisi, Chikandu A; Chikani, Mark C.; Achebe, David S
Tel Aviv University uses its associated teachinghospitals for "factory" site visits in occupational health instruction. Medical students visit various departments to observe and evaluate the work environment, later discussing health implications. The visits are well-accepted by students, save time, and contribute to awareness of the hospital…
Background: Despite an expected high prevalence of pregnancy-mask in the Negroid tropical environments, only a few women present to the physicians with this condition in Enugu. It is unclear whether this is due to low prevalence or poor awareness of the condition. Objectives: To determine the prevalence, awareness and treatment of pregnancy-mask among Igbo women in Enugu, Nigeria. Method: The study was a cross-sectional survey of pregnant women in Enugu; South-East Nigeria. The study sample consisted of the first 500 consecutive eligible pregnant women seen at the antenatal clinic of a tertiary health care facility. Socio-demographic data was obtained and the women were examined for site, size and treatments for pregnancy mask. Results: The prevalence of pregnancy-mask was 8.6%. Increasing gestational age was significantly associated with increased prevalence rate (P=0.037). Only 11.6% of those who had pregnancy-mask knew that it was related to pregnancy. Among those who had the lesion in the index pregnancy, 46.5% had applied some treatments to the lesion. The commonly used treatments were anti-fungal ointments (45%), bleaching creams (35%), herbal preparations (15%) and sunscreen (5%). Conclusions: It is concluded that pregnancy-mask has low prevalence and poor awareness among the Igbo women in Enugu and is commonly misdiagnosed. Antifungal and bleaching creams are the common treatment while sunscreen is poorly used. Teaching of this condition in pre-service schools is recommended in order to improve its knowledge among health workers thereby improving its awareness and management in the community.
The treatment and disposal of hospital effluent is a major challenge in most developing nations, including Nigeria. This study was aimed at investigating the physio chemical properties of hospital waste water from a University TeachingHospital based in Southern Nigeria. Six sampling points were identified within and outside the premises of the university teachinghospital.The results showed that the values
Behavioral medicine is a relatively new interdisciplinary field which combines biomedical and behavioral science knowledge, and applies them to prevention, diagnosis, treatment and rehabilitation. Behavioral medicine programs provide a valuable service to patients with chronic illness, psychosomatic or functional disorders, treatment noncompliance, and behavioral risk factors. Behavioral medicine faculty are also active in teaching and research on patient behavior, interviewing
Mary Gutmann; Rob Sanson-Fisher; Bruce Christiansen; Barry Blackwell
Toronto General Hospital (Canada) has developed a medical faculty recognition and reward program including a system to collect and evaluate feedback from trainees and administrators, an annual awards event, three categories of hospitalwide award (educational administration, program development, extraordinary contribution), and departmental student…
...services furnished to beneficiaries in teachinghospitals. 415.162 Section...PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings Â§ 415.162...
...services furnished to beneficiaries in teachinghospitals. 415.162 Section...PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings Â§ 415.162...
Background. Little is known of the factors that underlie surgical errors. Incident reporting has been proposed as a method of obtaining information about medical errors to help identify such factors. Methods. Between November 1, 2000, and March 15, 2001, we conducted confidential interviews with randomly selected surgeons from three Massachusetts teachinghospitals to elicit detailed reports on surgical adverse events
Atul A. Gawande; Michael J. Zinner; David M. Studdert; Troyen A. Brennan
|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 teachinghospital model originally developed for medical training. In this model, information security problems from industry and government are solved and abstracted…
A high autopsy rate allows accurate epidemiological studies and quality control of medical care. This study aims to analyze all autopsies performed in a university teachinghospital in Brazil during 52 consecutive wk. The following data were retrieved from individual autopsy records: gender, age, time of death (hr, day, and month), and the main cause of death. There were 1419
A review of 287 patient visits to a teachinghospital polyclinic shows that most patients had multiple problems that required the help of subspecialists. However, the patients' needs for accessibility, comprehensiveness, coordination, and continuity are as great as those of patients receiving primary care. Implications for academic internal…
Describes and analyzes past events and present trends in funding medical education in teachinghospitals. Such support mechanisms as research grants and third-party payments intended for patient care are considered. Also suggests a few general guidelines related to the future funding of academic medicine. (JN)
Psychologists in the 12 medical schools and affiliated teachinghospitals or centres were surveyed to document their roles and functions. There were 82 respondents (86% of those surveyed). The data were analyzed with respect to age, sex, highest degree earned, institutions granting highest degree, year in which highest degree was earned, number of years at present position, membership in psychological
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 teachinghospital model originally developed for medical training. In this model, information security problems from industry and government are solved and abstracted into living-cases used for training and education of university students and
Sanjay Goel; Damira Pon; Peter A. Bloniarz; Robert Bangert-drowns; George Berg; Vince Delio; Laura Iwan; Thomas Hurbanek; Sandoor P. Schuman; Jagdish Gangolly; Adnan Baykal; Jon Hobbs
Introduction: The sources of racial disparity in duration of patients’ visits to emergency departments (EDs) have not been documented well enough for policymakers to distinguish patient-related factors from hospital- or area-related factors. This study explores the racial disparity in duration of routine visits to EDs at teaching and non-teachinghospitals. Methods: We performed retrospective data analyses and multivariate regression analyses to investigate the racial disparity in duration of routine ED visits at teaching and non-teachinghospitals. The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) were used in the analyses. The data include 4.3 million routine ED visits encountered in Arizona, Massachusetts, and Utah during 2008. We computed duration for each visit by taking the difference between admission and discharge times. Results: The mean duration for a routine ED visit was 238 minutes at teachinghospitals and 175 minutes at non-teachinghospitals. There were significant variations in duration of routine ED visits across race groups at teaching and non-teachinghospitals. The risk-adjusted results show that the mean duration of routine ED visits for Black/African American and Asian patients when compared to visits for white patients was shorter by 10.0 and 3.4%, respectively, at teachinghospitals; and longer by 3.6 and 13.8%, respectively, at non-teachinghospitals. Hispanic patients, on average, experienced 8.7% longer ED stays when compared to white patients at non-teachinghospitals. Conclusion: There is significant racial disparity in the duration of routine ED visits, especially in non-teachinghospitals where non-White patients experience longer ED stays compared to white patients. The variation in duration of routine ED visits at teachinghospitals when compared to non-teachinghospitals was smaller across race groups.
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
This study examines the evidence of deteriorating financial status for many of the nation's teachinghospitals, and the continuing underrepresentation of minorities in medicine. The study of teachinghospitals used existing financial data and information on both non-federal and Veterans Administration teachinghospitals. Results suggested the…
The objective of this study was to compare the quality of maternity care in 2 types of government-run hospital in the town of Khorram Abad, Islamic Republic of Iran in 2009: a university-linked teaching and a social security organization non-teachinghospital. A sample of 264 women hospitalized in the delivery and postpartum wards was selected. Data collection was done using interviews with mothers and observation checklists based on Iranian government criteria. The quality of maternity care in the non-teachinghospital was higher than the teachinghospital in terms of facilities, processes of maternal and newborn care and outcomes (mother's satisfaction). In the teachinghospital, the quality of the physical space, the educational level and training of health care personnel and monitoring and evaluation of care quality needed improvement. In both hospitals, meeting women's expectations about the degree of privacy could lead to an increase in the quality of maternity services. PMID:21977565
Moosavisadat, S M; Lamyian, M; Parsap, S; Hajizadeh, E
The study of the pattern of osteoarthritis in different populations may yield valuable aetiological clues and also allow subtypes to be defined. Over one year 252 osteoarthritic joints from 140 patients seen at a West African teachinghospital were prospectively reviewed. The knee was the joint most often affected. Hip and hand disease, as well as Heberden's nodes, were uncommon. Joint disease was predominantly monoarticular; no patient had three or more sites affected.
This research summarizes an analysis of the impact of environment pressures on hospital inefficiency during the period 1990–1999. The panel design included 616 hospitals. Of these, 211 were academic medical centers and 415 were hospitals with smaller teaching programs. The primary sources of data were the American Hospital Association's Annual Survey of Hospitals and Medicare Cost Reports. Hospital inefficiency was
Today’s patients are quickly discharged from hospitals and often continue complex treatments at home. Patient teaching is critical and hospital nurses are encouraged to use “every teachable moment.” This study explored and described the nature of integrating patient teaching into daily patient care and the factors influencing the delivery of teaching. A fieldwork method, conducted over 12 months, used participant-observation
BACKGROUND: The purpose of this study is to establish teachinghospital accreditation standards anew with the hope that Taiwan's teachinghospitals can live up to the expectations of our society and ensure quality teaching. METHODS: The development process lasted two years, 2005-2006, and was separated into three stages. The first stage centered on leadership meetings and consensus building, the second
We sought to compare the outcomes of teaching and community hospitals on long-term outcomes for patients with rectal cancer. All rectal adenocarcinomas treated in Florida from 1994 to 2000 were examined. Overall, 5,925 operative cases were identified. Teachinghospitals treated 12.5% of patients with a larger proportion of regionally advanced, metastatic disease, as well as high-grade tumors. Five- and 10-year overall survival rates at teachinghospitals were 64.8 and 53.9%, compared to 59.1 and 50.5% at community hospitals (P = 0.002). The greatest impact on survival was observed for the highest stage tumors: patients with metastatic rectal adenocarcinoma experienced 5- and 10-year survival rates of 30.5 and 26.6% at teachinghospitals compared to 19.6 and 17.4% at community hospitals (P = 0.009). Multimodality therapy was most frequently administered in teachinghospitals as was low anterior resection. On multivariate analysis, treatment at a teachinghospital was a significant independent predictor of improved survival (hazard ratio = 0.834, P = 0.005). Rectal cancer patients treated at teachinghospitals have significantly better survival than those treated at community-based hospitals. Patients with high-grade tumors or advanced disease should be provided the opportunity to be treated at a teachinghospital. PMID:17876673
Gutierrez, Juan C; Kassira, Noor; Salloum, Rabih M; Franceschi, Dido; Koniaris, Leonidas G
The need to develop nurses as managers and leaders is crucial to the retention of registered nurses at a time of work force shortages and an increasingly aging work force in most Western industrialized countries. This article describes a creative and collaborative educational initiative developed at a large regional teachinghospital in New South Wales, Australia, designed to address this need. Based on a competency assessment process designed around face-to-face education, resource materials, and individualized mentoring from nurse unit managers, the aim of this multifaceted educational program is to develop effective team leaders in the clinical setting as well as a new generation of nursing leaders. PMID:20000267
Mine flooding is a serious problem in the Enugu Coal Mines and has led to the abandonment of two of the four mines. About 1800 m3 of water is pumped out daily from the mines into the nearby streams. The source of this enormous volume of water has been established based on the hydrodynamics and hydrology of the area. It is shown that although two prolific aquifers—an unconfined and a confined system—overlie the mines, the mine water is derived principally from the unconfined aquifer. The pathway of flow is, however, provided by the numerous fractures connecting the two aquifers and the mine tunnel. The major hydrochemical activity resulting in pollution of the mine water occurs within the sumps in the floor of the longwalls. These sumps act as oxidation chambers where groundwater from the fractures is mixed and subsequently reacted with sulfur-rich solutes released by coal mining. Contrary to general belief, the mine drainage has not seriously degraded the chemistry of receiving streams. The pH, electric conductivity and, thus, the dissolved ions were increased less than 10% of the values in the unaffected region.
Objective: This study aims at examining the pattern of psychiatric referrals with particular reference to (1) age and gender (2) source of referrals and (3) diagnosis of referred patients within a teachinghospital Method: Four hundred and twenty seven referrals (n=427) for psychiatric consultation within KKUH were selected prospectively by systematic randomization over a period of one year, and were compared with a general hospital (n=138) and primary health care (n=402) psychiatric referrals to a mental health facility. Results: The age of referred patients across the three settings differed significantly and the male patients were slightly over-represented in the teachinghospital referrals. Pediatric clinics in the teachinghospital constituted significant sources of psychiatric referrals as compared to the general hospitals. Schizophrenic disorders and acute psychoses were significantly less among teachinghospital referred patients, whereas anxiety and mood disorders were much more common among teachinghospital and primary care patients. The number of personality disorders diagnosed in teachinghospital settings was significant. Conclusions: In Saudi Arabia, sources of psychiatric referrals and diagnostic patterns of mental disorders differ across the three levels, and this is comparable to international research on psychiatric referrals. Besides exploring other aspects of referral process, researchers at the three settings should carry out follow-up studies to assess the impact of psychiatric consultations on the global outcome of referred consultees.
As managed care has grown, much concern has been expressed about the potential plight of the nation's 125 academic health centers (AHCs). Less concern has focused on non-AHC teachinghospitals, although most studies of graduate medical education (GME) costs include these hospitals in their estimates. While most studies have found that costs increase positively with various measures of "teaching intensity," some have concluded that hospitals with smaller programs have costs that are the same or less than comparable nonteaching hospitals. However, few studies have tested whether AHCs' cost structures are sufficiently similar to those of other hospitals to reliably include them in the same estimation. This article tests that assumption for Maryland hospitals, finds it violated, and presents results for non-AHC teachinghospitals. The results reveal that, at least in Maryland, even small teaching programs add to hospital costs. PMID:10705699
Objective. To determine the influence of age and parity on the surgical management of uterine fibroids, clinical presentation, presence of pelvic adhesions, cadre of surgeons, and postoperative complications at the Aminu Kano TeachingHospital, Kano, Nigeria. Methods. A retrospective analysis of 105 cases of uterine fibroids that were managed between 1st January 2003 and 31st December 2007. Results. The period prevalence of uterine fibroids was 24.7% of all major gynecological operations. The mean age was 35.8 ± 7.6 and mean parity 4.7 ± 2.8. Abdominal hysterectomy accounted for 58.1% of the cases and myomectomy 41.9%. The odd of using abdominal hysterectomy was about twice that of myomectomy. Pelvic adhesions were found in 67.6% of the cases. Menorrhagia (86.7%) was the commonest symptom, while post operative anemia and pyrexia showed significant association with myomectomy. There was no maternal mortality. Conclusion. Surgical operations for uterine fibroids are safe and common kind of gynecological operations at the Aminu Kano TeachingHospital. Uterine fibroid is associated more with high parity and dominance of abdominal hysterectomy over myomectomy, because early girl marriage is common in our community.
Background The cooperation of patients and their consent to involve medical students in their care is vital to clinical education, but large numbers of students and lack of experience as well as loss of privacy may evoke negative attitudes of patients, which may sometimes adversely affect the clinical teaching environment. This study aimed to explore the attitudes of patients towards medical students at Damascus University hospitals, and to explore the determinants of those attitudes thus discussing possible implications applicable to clinical teaching. Methods This cross-sectional study was conducted at three teachinghospitals affiliated to the Faculty of Medicine at Damascus University. Four hundred patients were interviewed between March and April 2011 by a trained sociologist using a structured questionnaire. Results Of the patients interviewed, 67.8% approved the presence of medical students during the medical consultation and 58.2% of them felt comfortable with the presence of students, especially among patients with better socio-economic characteristics. 81.5% of the patients agreed to be examined by students in the presence of the supervisor, while 40.2% gave agreement even in the absence of the supervisor. Privacy was the most important factor in the patients' reticence towards examination by the students, whilst the relative safety and comfort if a supervisor was available determined patients' agreement. Conclusions The study concluded overall positive attitudes to the medical students' involvement in medical education. However, it is essential that students and clinical supervisors understand and adhere to professional and ethical conduct when involving patients in medical education.
Background Healthcare disparities associated with insurance and socioeconomic status have been well characterized for several malignancies, such as lung cancer. To assess whether there are healthcare disparities in thyroid cancer, this study evaluated the stage on initial presentation of patients with differentiated thyroid cancer (DTC) in a public versus university teachinghospital. Methods A retrospective chart review was performed to identify patients with a new diagnosis of DTC from January 1, 2007, to January 1, 2010, in a large public and adjoining university teachinghospital at a single academic medical center. Medical records were reviewed for demographics, pathology, and American Joint Committee on Cancer tumor–node–metastasis stage at initial presentation. Results There were 49 cases of well-DTC (96% papillary and 4% Hürthle) in the public hospital and 370 cases (95% papillary, 2% Hürthle, and 3% follicular) in the university teachinghospital. Median age (years) at presentation was 50 in the public versus 48 in the university teachinghospital (p=0.39). Ninety-six percent of public hospital patients were from ethnic minorities compared with 16% of university teachinghospital patients (p<0.0001). Only 1 (2%) public hospital patient had private insurance compared with 85% of university teachinghospital patients. Tumor status (p=0.002) and stage (p=0.03) were more advanced and extrathyroidal extension (p=0.02) was more prevalent among public hospital patients compared with university teachinghospital patients. In a multivariable analysis, public hospital, male gender, increasing age, advanced tumor status, and the presence of lymphovascular invasion were the best predictors of more advanced disease stage. Public hospital patients were 3.4 times more likely to present with advanced DTC than university teachinghospital patients of the same age, gender, tumor status, and lymphovascular invasion status (95% confidence interval 1.29–8.95). Conclusions In a public hospital, where the patient population is defined primarily by insurance status, patients were more likely to present with advanced-stage DTC than patients presenting to an adjacent university teachinghospital. These results suggest a disparity in the stage on initial presentation of DTC, possibly resulting in a delayed diagnosis of cancer.
Lim, Irene Isabel Payad; Hochman, Tsivia; Blumberg, Sheila Nafula; Patel, Kepal Narendra; Heller, Keith Stuart
Patients’ rights observance is one of the effective measures of patients’ satisfaction of health care services. We performed this study at the aim of evaluation of nurses’ awareness of patients’ rights in a teachinghospital in Tehran. This cross-sectional study was conducted in 2010. In this study 156 nurses were randomly selected. Two-part questionnaire was used for data collection. The validity and reliability of questionnaire was determined and then it was distributed between subjects. The data were analyzed by SPSS version 15 using descriptive and inferential statistics. Our results showed that %58.33, %39.10 and % 2.56 of nurses have good, medium, and poor levels of awareness respectively. We observed a significant relationship between nurses awareness and work experience (P=0.008) and concurrent work in public and private hospitals (P=0.01). The most of the nurses (%95.51) were aware of “right to privacy protection and ensure confidentiality of information” and the least of them (%33.97) were aware of “right to receiving necessary information about the health care providers, the rate of tariff and insurance coverage”. According to our survey it is concluded that implementation of Patients’ Right Charter in this hospital is accompanied by some limitations which necessitates promotion of the nurses’ awareness about patients’ rights. Taken together in order to enhance nurses’ awareness special measures and strategies should be considered.
Summary About 10% of patients in hospital develop a hospital-acquired infection (HAI); the most commonly affected site is the urinary\\u000a tract. Many studies have examined risk factors for HAI but few have adjusted for confounding and interaction. We performed\\u000a a prospective case-control study on six acute wards of a busy English teachinghospital to assess risk factors for hospital-acquired\\u000a urinary tract
S. E. Nguyen-Van-Tam; J. S. Nguyen-Van-Tam; S. Myint; J. C. G. Pearson
In a series of 3,267 cervical smears examined in Enugu, Nigeria, from 1993 through 2010, there was a single positive case of tuberculosis (TB). It was found in a 55-year-old, Para 7, postmenopausal woman. Treatment for tuberculosis was instituted successfully.
|A national survey of 69 teachinghospitals (principally affiliated community teachinghospitals) found much variation in direct graduate medical education pass-through costs, supported by Medicare. Analysis suggested variations may be a result of the faculty expenses component, economies of scale, and the contribution of volunteers. Tables and…
A national survey of 69 teachinghospitals (principally affiliated community teachinghospitals) found much variation in direct graduate medical education pass-through costs, supported by Medicare. Analysis suggested variations may be a result of the faculty expenses component, economies of scale, and the contribution of volunteers. Tables and…
The primary source of education and training for health professionals has shifted from hospitals to colleges and universities. Two and four year colleges offer an academic milieu but often sacrifice the teaching of practical concerns. The authors propose a reintegration of teaching components within hospitals to improve professional health care…
The authors recently discovered 2 quality and patient safety curricula for internal medicine and general surgery residents in major teachinghospitals: an infrequent formal curriculum developed by the university and a positive informal curriculum found in the teachinghospital. A hidden curriculum was postulated. These data were gathered through applied qualitative research methodology. In this article, curricular characteristics of the
Susan K. Pingleton; David A. Davis; Robert M. Dickler
This report presents the results of an annual survey of housestaff stipends, benefits, and funding for physicians at teachinghospitals in 1992. The data, presented in 48 tables and 4 figures, are based on responses from 325 members of the Council of TeachingHospitals (COTH), an 83 percent response rate to the survey. Chapter I contains stipend…
The Drug-Free Workplace Act of 1988 mandated written drug abuse policies for recipients of certain government grants and contracts. The literature has reported costly side effects of employee drug abuse such as decreased productivity and increased use of health benefits. Furthermore, litigation involving drug abuse policies has been increasingly won by employers. More than 90% of Fortune 1000 companies have adopted formal drug abuse policies. Using content analysis techniques, the current study examined the written substance abuse policies of 30 large American teachinghospitals. Results showed substantial variation in the style and content of the policies. In general, language used in the policies was vague. The study cites the potential use of strategic ambiguity in the development of the policies. PMID:10069139
The study presents the results of analysis of data collected on 120 cocoyam farmers (60 females and 60 males) across the two Agricultural blocks in Enugu North Agricultural Zone using the multi-stage randomized sampling technique. Descriptive statistical tool (percentages) was used in analyzing farmer’s production problems. The survey reviewed that most of the farmers (males and females) encountered problems of
Congenital club foot has been sparsely reported in literature in Nigeria, although it has been reported as the commonest congenital musculoskeletal abnormality. This study enumerates the point prevalence of this disease in a university teachinghospital in Lagos. Better understanding of the epidemiology in our community should improve awareness, and influence management. Between June 2005 and July 2006, 72 consecutive patients with congenital club feet were seen in the orthopaedic clinic of our Hospital. Demographic data, birth weight, family history, birth facility, maternal age and associated congenital anomalies were recorded and analysed using Statistical Programme for Social Sciences (SPSS) version 15. A total of 72 patients were seen, 28 of whom had bilateral club feet resulting in a total of 100 feet. There were 38 males and 34 females. Only 29% presented in the first month of life and 28% in the second month. Maternal ages ranged between 19 and 38 years and no family history of congenital club foot was given,. Babies delivered outside the orthodox medical system (churches, traditional healers, home etc) constituted 28%. The commonest associated congenital anomalies were tibia hemimelia, hydrocephalus, inguinal hernia and umbilical hernia. A default rate of 28% was observed during treatment. Congenital club foot may not be uncommon in Nigeria. Late presentation and high default rate before correction of the deformity were observed. Establishment of special club foot clinics should reduce the default rate. Training of healthcare workers in maternity units as well as Public awareness should encourage early referral to specialists. PMID:20175426
Adewole, O A; Giwa, S O; Kayode, M O; Shoga, M O; Balogun, R A
Trauma is a major problem in both developing and developed countries. World wide road-traffic injuries (RTIs) represent 25% of all trauma deaths. Injuries cause 12% of the global disease burden and are the third commonest cause of death globally. In our own environment, trauma is also important, with RTIs being a leading cause of morbidity and mortality. There is limited data on RTIs in West African countries, and this necessitated our study. We aimed to find common causative factors and proffer solutions. This was a one year prospective study examining all cases of trauma from RTIs seen at the Accident and Emergency Department of the Ebonyi State University TeachingHospital (EBSUTH), Abakaliki, Nigeria. Three hundred and sixty-three patients were studied. There was a male/female ratio of 3.4:1, with the modal age being 25 years. Most injuries involved motorcycles (54%). Passengers from cars and buses were also commonly affected (34.2%). Most of accidents occurred from head-on collisions (38.8%). Soft-tissue injuries and fractures accounted for 83.5% of injuries. The head and neck region was the commonest injury site (41.1%), and the most commonly fractured bones were the tibia and fibula (5.8%). Death occurred in 17 patients (4.7%), and 46 (12.7%) patients discharged themselves against medical advice. Improvements in road safety awareness, proper driver education-especially motorcycle drivers-and proper hospital care are needed in our subregion. PMID:20623283
Madubueze, Christian C; Chukwu, Christian O Onyebuchi; Omoke, Njoku I; Oyakhilome, Odion P; Ozo, Chidi
Staphylococcus aureus isolates (n = 70) from 65 patients (36 canine, 18 equine, 7 bovine, 2 avian, and 2 feline) at seven veterinary teachinghospitals in the United States were studied. The majority of patients (83%) with an S. aureus infection were canine and equine, but this may have reflected a sample bias based on clinic case loads and diagnostic lab submissions at the participating institutions. Fourteen percent of patients with an S. aureus infection were infected with a methicillin-resistant S. aureus (MRSA) isolate. Six of seven institutions had at least one MRSA infection during the study. Pulsed-field gel electrophoresis on 63 of the 70 isolates yielded 58 unique strains of S. aureus. None of the strain types of the MRSA isolates matched each other or the type of any other S. aureus isolate. The proportions of patients infected with an MRSA isolate were not significantly different between institutions or animal species (P ? 0.222). Methicillin-resistant S. aureus isolates in this study seemed to be community acquired rather than hospital acquired.
Middleton, John R.; Fales, William H.; Luby, Christopher D.; Oaks, J. Lindsay; Sanchez, Susan; Kinyon, Joann M.; Wu, Ching Ching; Maddox, Carol W.; Welsh, Ronald D.; Hartmann, Faye
A study was undertaken to determine typical concentrations of airborne bacteria and fungi (microflora) in TeachingHospital environment in Benin City in the tropical rainforest environment of Nigeria. Aerial sampling was conducted at various hospital wards each day. The air samples were collected thrice daily. Concentrations of airborne microflora exceeded available local guidelines for indoor quality in the accident and
F. O. Ekhaise; E. E. Isitor; O. Idehen; A. O. Emoghene
Background Attention and interest in the use of Complementary and Alternative Medicine (CAM) has been reawakened globally. Evidence from studies carried out in different parts of the world has established that CAM use is very common and varies among populations. This study investigated the use of CAM among adults in Enugu urban, irrespective of their health status. It provided information on the prevalence of CAM use, forms of CAM remedies used and reasons for utilizing them Methods The study areas were three local government areas in Enugu urban of Enugu State. Cross-sectional survey using questionnaires were administered to randomly selected households. All consenting participants were used for the study Results 732 participants (37.2% males and 62.8% females) were used for the study. Ages ranged from 18 - 65 years. 620 (84.7%) of the adult population have used CAM ranging from one single type to twenty different types while 112 (15.3%) have not used any form of CAM. The most commonly used CAM product was the biological products, followed by prayer/faith healing. Major reasons for using CAM include their natural state and also for health promotion and maintenance. Conclusion There is need for adequate policy formulation and regulation to ensure safety and efficacy of CAM products. Measures to ensure rational use of CAM should be instituted.
Objective To evaluate intravenous proton-pump inhibitor (IV PPI) prescribing in a single academic teachinghospital. Methods A retrospective pilot study of 107 patients in a single United States military teachinghospital was conducted over a 1-month\\u000a period. Clinical data were collected and analyzed for demographic features, prior medication use, admission hemoglobin level,\\u000a service prescribing the IV PPI, indication for IV
Jacob G. Hoover; Annabel L. Schumaker; Kevin J. Franklin
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 teachinghospital 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.
Objective: The purpose of this study was to measure patient health-related quality of life\\/satisfaction with the results of hysterectomy in 2 distinct groups of women. Study Design: A health-related outcomes questionnaire was completed 3 months after hysterectomy by 50 low-income women who underwent operation at a state-supported teachinghospital and by 50 women who underwent operation at a private hospital.
James B. Unger; Gloria Caldito; Joseph Sams; Jack F. Perrone; Edwin Byrd
This study was undertaken to determine the adoption of improved cocoyam production, processing and storage technologies among small-holder cocoyam farmers in Enugu-North Agricultural Zone in Enugu state. A multi-stage random sampling technique was used to select 120 cocoyam farmers disaggregated into 60 males and 60 female in 2008. Adoption scale analysis was employed to analyze the level of adoption of
B. C Okoye; A. C Okoye; M. U Dimelu; C. C Agbaeze; O. N Okoroafor; A. B Amaefula
The Martland Hospital Library converted many of its periodical backfiles to 16 mm microfilm cartridges. Some details of program implementation, user reactions, costs, and problems are discussed. In a teachinghospital library microfilm in cartridge format has been well accepted by patrons, in part because the need to read from a projection screen has been minimized by granting liberal printing privileges.
ISSUE: Knowledge about transmission of microorganisms is important for implementing strategies that avoid dissemination. The objective of this work was to evaluate critical aspects in fulfillment of isolation practices for pathologies transmitted by air and droplets in a teachinghospital with 650 beds.PROJECT: Review of clinical records of patients hospitalized between 1999 and 2000 with diagnosis of lung tuberculosis (TB),
Background: Allergy to natural rubber latex (NRL) has been frequently reported in health care workers. However, there is little published evidence of the outcome of hospital intervention programs to reduce exposure and detect cases of sensitization early. Objective: This study assesses the effects of intervention to reduce NRL allergy in an Ontario teachinghospital with approximately 8000 employees. Methods: A
Susan M. Tarlo; Anthony Easty; Kathleen Eubanks; Craig R. Parsons; Frank Min; Stephen Juvet; Gary M. Liss
Concomitant use of several drugs by ICU( Intensive Care Unit) patients is often unavoidable. In these patients, pharmacokinetic drug interactions are very likely. The current study was designed to evaluate these interactions in patients hospitalized in an ICU of a teachinghospital in Tehran, Iran. A questionnaire was designed and used to collect study data. The study was done in
Retsky KL; Chen K; Zeind J; Frei B. Inhibition; Mohammad Abbasi; Neda Khanzadeh Moqhadam
To optimize appropriate antimicrobial use in a university hospital and identify barriers hampering implementation strategies, physicians were interviewed regarding their opinions on antimicrobial policies. Results indicated that effective strategies should include regular updates of guidelines that incorporate the views of relevant departments and focus on addressing senior staff and residents because residents do not make independent decisions in a teaching-hospital setting.
Rutten, Willem J.M.J.; Gans, Rijk O.B.; Degener, John E.; Haaijer-Ruskamp, Flora M.
This article estimates the magnitude and quality of antibiotic prescribing in Indonesian hospitals and aims to identify demographic, socio-economic, disease-related and healthcare-related determinants of use. An audit on antibiotic use of patients hospitalized for 5 days or more was conducted in two teachinghospitals (A and B) in Java. Data were collected by review of records on the day of
U. Hadi; D. O. Duerink; E. S. Lestari; N. J. Nagelkerke; M. Keuter; D. Huis in’t Veld; E. Suwandojo; E. Rahardjo; P. van den Broek; I. C. J. Gyssens
Discusses the value of training clinical psychologists in consultation-liaison roles for hospital patients in nonpsychiatric wards. Training would involve communication with hospital staff, the medical chart, case presentation, approach to the patient, differential diagnosis, and psychotropic medication. (KC)
A "system dynamics" model was developed by the University of Vermont's Division of Health Sciences and the Medical Center Hospital of Vermont, the division's affiliated hospital, to anticipate the hospital's utilization by patients in order to plan for future medical students and house staff. The model has proven a useful planning tool because of…
This paper examines the initial actions that should take place following the sudden collapse of a patient in a hospital. The current Basic Life Support guidelines are not designed for this situation, yet are commonly taught to hospital staff. An alternative algorithm for Hospital Resuscitation has been developed. Additional factors, such as the recognition of the sick patient and the importance of audit should be included in hospital resuscitation training. A tiered approach to resuscitation training within a hospital should be adopted and national standards developed. PMID:10488941
Background The purpose of this study is to establish teachinghospital accreditation standards anew with the hope that Taiwan's teachinghospitals can live up to the expectations of our society and ensure quality teaching. Methods The development process lasted two years, 2005-2006, and was separated into three stages. The first stage centered on leadership meetings and consensus building, the second on drafting the new standards with expert focus groups, and the third on a pilot study and subsequent revision. Results Our new teachinghospital accreditation standards have six categories and 95 standards as follows: educational resources (20 items), teaching and training plans and outcomes (42 items), research and results (9 items), development of clinical faculty and continuing education (8 items), academic exchanges and community education (8 items), and administration (8 items). Conclusions The new standards have proven feasible and posed reasonable challenges in the pilot study. We hope the new standards will strengthen teaching and research, and improve the quality of hospital services at the same time.
Background A number of studies have documented variation in treatment patterns by treatment setting or by region. In order to better understand how treatment setting might affect survival, we compared the survival outcomes of women with node-negative breast cancer who were initially treated at teachinghospitals with those of women initially treated at community hospitals. Methods We constructed a retrospective cohort consisting of a random sample of 938 cases, initially diagnosed in 1991, drawn from the Ontario Cancer Registry. Exposure was defined by the type of hospital in which the initial breast cancer surgery was performed. Outcomes were ascertained through follow-up of vital statistics. Results The crude 5-year survival rate was 88.7% for women who had their initial surgery in a community hospital and 92.5% for women who had their initial surgery in a teachinghospital. Women in higher income neighbourhoods experienced better survival at 5 years regardless of which type of hospital they were treated in. Multivariate proportional hazards regression modelling demonstrated a 53% relative reduction in risk of death among women with tumours less than or equal to 20 mm in diameter who were treated at a teachinghospital (relative risk [RR] = 0.47, 95% confidence interval [CI] 0.23–0.96), whereas among those with larger tumours there was no demonstrated difference in survival (RR = 1.32, 95% CI 0.73–2.32). Other variables that were significant in the model were age at diagnosis, estrogen receptor status and the use of radiation therapy. Interpretation Women with node-negative breast cancer and tumours less than or equal to 20 mm in diameter who were initially seen at a teachinghospital had significantly better survival than women with similar tumours who were initially seen at a community hospital. Survival among women with larger tumours was not statistically significantly different for the 2 types of hospital.
Objective:Studies suggest that there is a need to improve the way we deliver care at the end of life. Based on recommendations from end-of-life experts, metrics were identified to measure the quality of dying in Dunedin Hospital.Design:A retrospective observational study was performed to assess the care provided to patients who died in the hospital in 2003.Setting:Dunedin Hospital is a 350-bed
In February 2010, NIOSH received a confidential employee HHE request concerning exposure to chemotherapy drugs at a university veterinary teachinghospital (veterinary hospital) in Michigan. Employees were concerned that exposure to chemotherapy drugs may...
This paper describes a house-call protocol used to teach family-practice residents the principles of palliative care. The protocol addresses the needs of cancer patients attending a major teachinghospital. The “eligibility criteria”, “agenda in the home”, “patient and family information sheet”, “features of the therapeutic alliance”, and “bereavement follow-up mini-agenda” provide the resident family physician with a framework. The protocol and concept of “successful death” are illustrated with a case history. (The term `we' in reference to a home visit denotes the author and a resident or a member of the hospital nursing staff.)
This article explores the practice of false patient out-referral by medical students in Iranian teachinghospital 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 teachinghospitals 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
The medical records system of an upcoming teachinghospital in a developing nation was evaluated for its accessibility, completeness, physician satisfaction, presence of any lacunae, suggestion of necessary steps for improvisation and to emphasize the importance of Medical records system in education and research work. The salient aspects of the medical records department were evaluated based on a questionnaire which was evaluated by a team of 40 participants-30 doctors, 5 personnel from Medical Records Department and 5 from staff of Hospital administration. Most of the physicians (65%) were partly satisfied with the existing medical record system. 92.5% were of the opinion that upgradation of the present system is necessary. The need of the hour in the present teachinghospital is the implementation of a hospital-wide patient registration and medical records re-engineering process in the form of electronic medical records system and regular review by the audit commission. PMID:21409398
Kumar, B Deepak; Kumari, C M Vinaya; Sharada, M S; Mangala, M S
In order to demonstrate how DEA modeling can be helpful for hospital performance assessments conducted in compliance with Brazil's TeachingHospital Policy, a case study is presented of 31 general hospitals linked to Federal Universities. It considers data on assistance, teaching and research and the use of the IDEAL (Interactive Data Envelopment Analysis Laboratory) software as a tool for assessing their efficiency. Developed in Brazil, this unique software provides a three-dimensional view of the productivity frontier, for easier exploratory analyses and selection of pertinent variables, with a better understanding of the outputs of the model (multiplier and envelope) for specialists and decision-makers. As an example, a University Hospital benchmark is presented through outputs that take structural and regional input differences into consideration. This modeling also indicates the changes required in the inefficient units (alterations to input and/or /output vectors), setting forth recommendations on public financing based on quality/efficiency. PMID:17680157
Lins, Marcos Estellita; Lobo, Maria Stella de Castro; da Silva, Angela Cristina Moreira; Fiszman, Roberto; Ribeiro, Vagner José de Paula
Odo, B.I., Alaku, S.O. and Omeje, S.I. 2000. Contribution of small ruminants (sheep and goats) to meat supply in Enugu state, Nigeria. J. Appl. Anim. Res., 18: 165–169.The monthly records of various livestock species (cattle, sheep, goat, pig, horse, donkey and dog) slaughtered for meat in Enugu state for a period of 8 years (1988–1995) were used to determine the
\\u000a In the Biomedical Engineering domain, Clinical Engineering has a crucial role requiring specialization and training in the\\u000a clinical setting of hospitals and clinics, to gain real-world experience with respect to safe and effective application of\\u000a biomedical equipment, technologies and systems to result in efficacious and high quality patient care. The academic training\\u000a coupled with internship in a teachinghospital gives
Objective To understand the types of services provided by Iranian clinical pharmacists in nephrology and infectious disease wards,\\u000a the acceptance rate of clinical pharmacy services in these wards by physicians and the clinical significance of these services\\u000a in the main teachinghospital in Iran. Setting: Nephrology and infectious disease departments of a university hospital in\\u000a Iran. Methods During a 12-month
Simin Dashti-Khavidaki; Hossein Khalili; Hadi Hamishekar; Sheida Shahverdi
Unnecessary, excessive and poor injection practices in the South East Asia region (including Nepal) have been observed previously. The authors aim to study prescription of injectable drugs to inpatients in a teachinghospital in Western Nepal. Prescription of injectable drugs (IDs) and intravenous fluids (IVFs) to inpatients discharged from the wards of the Manipal TeachingHospital during 1st January to
Sudesh Gyawali; P Ravi Shankar; Archana Saha; Lalit Mohan
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
Introduction: The Infection Control Unit at our 950-bed (two-site) teaching facility is a member of the National Nosocomial Infection Surveillance (NNIS) system. Targeted surveillance, using NNIS criteria by five infection control practitioners has been performed in surgery and in the medical, surgical, pediatric, and neonatal intensive care units (ICUs).OBJECTIVES: Our comprehensive surveillance program is to monitor high-risk, high-volume surgical procedures;
We compared total charges for obstetric care at a major teachinghospital and faculty group practice with those at 3 nonteaching centers in western Washington. The patients were all enrollees of an employee-based health maintenance organization. Charges were used as a proxy for costs and included all outpatient, inpatient, and physician charges. In the teaching system, patients were cared for by faculty and house staff; in the nonteaching settings, they received care from private physicians. No significant differences in total charges were found between the teaching and the nonteaching settings for all deliveries ($4,652 [N = 90] versus $4,530 [N = 335], P greater than .5). In the teaching setting, vaginal deliveries were slightly more expensive ($4,178 [n = 75] versus $3,768 [n = 250], P = .15), as were cesarean deliveries ($7,024 [n = 15] versus $6,771 [n = 85], P greater than .5). The rate of cesarean deliveries was lower in the teaching setting (17% versus 25%, P = .10), partially accounting for the similarity in total charges. The length of stay was similar in the teachinghospital (3.29 versus 3.14 days, P greater than .5). We conclude that the academic medical center as a total system of care can provide obstetric care as cost-effectively as nonteaching systems under the constraints of prepaid care.
BACKGROUND: Smooth working relationships between nurses and doctors are necessary for efficient health care delivery. However, previous studies have shown that this is often absent with negative impact on the quality of health care delivery. In 2002, we studied factors that affect nurse-doctor working relationships in University TeachingHospitals (UTH) in Southern Nigeria in order to characterize it and identify
Correct placement of the femoral and tibial bone tunnels is decisive for a successful anterior cruciate ligament (ACL) reconstruction. Our method of tunnel placement was evaluated as part of quality control at a teachinghospital. The emphasis was placed mainly on investigating the influence of surgical experience on tunnel placement, and the effect of tunnel position on the clinical outcome.
H. Behrend; G. Stutz; M. A. Kessler; A. Rukavina; K. Giesinger; M. S. Kuster
The changing social milieu has removed the charity patient but not the need for a teaching population. The University Hospital's program is described, in which patients prepaid a fixed, single fee for all obstetrics-related care through the third post partum day. (LBH)
OBJECTIVES: To assess knowledge and attitudes about Emergency Contraception among women of childbearing age in Karachi, Pakistan.METHODS: A questionnaire based survey was conducted on 400 married women, attending the family practice clinics at a teachinghospital in Karachi, Pakistan from July to December 2006. Questionnaire was administered to women at the family practice clinic-seeking level of knowledge of emergency contraception
Farhana Irfan; Syed Irfan Karim; Saman Hashmi; Sajid Ali; Syed Arif Ali
Objective. – To investigate the characteristics of patients managed for spinal tuberculosis at the rheumatology department of the Tours TeachingHospital, France, between 1986 and 2003.Methods. – Retrospective chart review. The incidence, epidemiology, clinical features, imaging study findings, and diagnostic procedures were recorded.Results. – The annual incidence of spinal tuberculosis was stable throughout the study period. There were 24 patients,
A method of comparing the referral of patients by general practitioners to medical outpatients departments at teachinghospitals in Amsterdam and Birmingham was devised. This was applied to 89 referral letters to medical specialists at the Free University Medical School Policlinic in Amsterdam and to 88 referral letters to clinics at Birmingham University Medical School, UK. The standards of referral
This paper examines the impact of a nine-week overseas clinical placement at a Canadian teachinghospital on second-year radiation therapy students from Trinidad and Tobago. The placement allowed the students to accumulate specific technical competencies and experience other aspects of Canadian radiation therapy professionalism such as patient education and assessment, quality assurance and academic activities. The evaluation of the visit
A study of medical college faculty perceptions of the value of two groups of patients admitted to a teachinghospital 15 years apart suggests that changes in patient populations resulting from economic changes may have diminished the educational value of medical inpatients in academic settings. (MSE)
This article presents a collection development tool that identifies a list of key orthopedic journals to retain in print or license electronically in an academic or teachinghospital library. The authors developed an assessment tool comparing five measures of importance and use, including journal impact factor, cited half-life, interlibrary loan lending, electronic archival access, and library usage. This study assists
Tania P. Bardyn; Taryn Resnick; Ross Mazo; Kenneth A. Egol
Historical progression and the development of current teachinghospitals, medical schools and biomedical research originated from the people of many civilizations and cultures. Greeks, Indians, Syriacs, Persians and Jews, assembled first in Gondi-Shapur during the Sasanian empire in Persia, and later in Baghdad during the Golden Age of Islam, ushering the birth of current academic medicine.
A discussion of management issues at teachinghospitals reviews their history and examines specific challenges in this context, including the ill-defined middle management level, the relative roles of the manager and department heads, separation and integration of managerial, academic, and medical responsibilities, and financing from more than one…
The use of case incidents has been found to be an effective tool for teaching business concepts to senior hospitality students. With proper classroom manage ment, the case incident can be useful in two ways—as an introduction to a specific topic or theme and as a \\
Historical progression and the development of current teachinghospitals, medical schools and biomedical research originated from the people of many civilizations and cultures. Greeks, Indians, Syriacs, Persians and Jews, assembled first in Gondi-Shapur during the Sasanian empire in Persia, and later in Baghdad during the Golden Age of Islam, ushering the birth of current academic medicine. PMID:21233794
Registered nurses form the largest group of professional healthcare providers in any Nigerian teachinghospital. Despite their population size in clinical care, lesser attention has been paid to their library and information needs in medical librarianship literature, compared to extensive research works targeted at satisfying the information needs of physicians and medical students. This study aimed to determine the reading
BACKGROUND: Spontaneous adverse drug reaction (ADR) reporting is the cornerstone of pharmacovigilance. ADR reporting with Yellow Cards has tremendously improved pharmacovigilance of drugs in many developed countries and its use is advocated by the World Health Organization (WHO). This study was aimed at investigating the knowledge and attitude of doctors in a teachinghospital in Lagos, Nigeria on spontaneous ADR
Objective: The main goal of this study was to assess differences in the vaginal flora of pregnant women and provide a detailed evaluation of vaginal swabs for the presence of group B streptococcus (GBS) and other organisms in three teachinghospitals in Shiraz, southwest of Iran. Subjects and Methods: In a cross-sectional study from April 2006 to March 2007, 310
Parvin Hassanzadeh; Mohammad Motamedifar; Maral Namdari Gharaghani
Objective: To review 10 years' experience of obstetric hysterectomy in a university teachinghospital. Study Design: A retrospective study of all cases of caesarean or postpartum hysterectomy between 1984–1994. Demographic data and clinical details including indications for operation, nature of surgical management and complications were analysed. Results: The incidence of obstetric hysterectomy was 1 in 1420 deliveries. Overall, 0.32% of
A six year retrospective survey of enterococcal urinary tract infections in hospital inpatients is reported. During the study period there was an increase in the proportion of significant cultures that yielded enterococci. These organisms were more frequently isolated from catheter specimens than midstream specimens of urine and from surgical than from medical wards.
|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)|
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)
Academic health centers (AHCs) have higher costs per case and also lower margins than either other teachinghospitals or community hospitals. The differences in margins stem mostly from differences in the intensity with which similar patients are treated, as well as hospitals' ability to generate revenue to cover the costs of that greater in- tensity, rather than graduate medical education
We determined the prevalence of adverse drug events (ADEs) in a general teachinghospital in Rabat, Morocco. We performed a 5-day cross-sectional study of hospital departments recruiting inpatients and outpatients. Among the 1390 patients surveyed, 59 (4.2%) experienced at least 1 ADE and for 20 patients (1.4%) the ADE was responsible for hospitalization or prolongation of hospitalization. The ADE was classified as serious in 28 patients. Of the total of 76 ADEs, 10 (13.2%) were categorized as preventable; 6 of these occurred during the treatment monitoring phase. Patients who experienced an ADE were more likely to be women, to be younger (< 30 years) and to be hospitalized in medical departments. PMID:20214128
Serum tumor markers may be requested inappropriately by clinicians. In this retrospective study, we aimed to investigate the\\u000a appropriateness of TM requests in our hospital. Patients in the study were identified from the TM requests for 3 months between\\u000a June–August 2004, using the laboratory database. A total of 2249 patients (1351 men, 898 women) were included in the study\\u000a and
Gülsen Yilmaz; Fatma Meriç Yilmaz; Mehmet Senes; Dogan Yucel
OBJECTIVES:To estimate the incidence, indications, risk factors, and complications associated with emergency peripartum hysterectomy at a community-based academic medical center.METHODS:We analyzed retrospectively 47 of 48 cases of emergency peripartum hysterectomy performed at Winthrop-University Hospital from 1991 to 1997. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment less than 24 hours after delivery. Fisher exact
Elana S Kastner; Reinaldo Figueroa; David Garry; Dev Maulik
Teachinghospitals (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 teachinghospitals 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 teachinghospitals 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
Background The prevalence of heart failure is 3 to 20 per 1,000 population, but may exceed 100 per 1,000 in the over 65 age group. Some\\u000a 1–2% of the total healthcare budget is consumed in the management of heart failure.\\u000a \\u000a \\u000a \\u000a Aim As hospital costs account for approximately 70% of this expenditure we determined the cost of treating heart failure in an\\u000a Irish
St Vincent's Hospital Melbourne cautiously prescribes thalidomide as a treatment for recalcitrant dermatoses. The guidelines used for prescribing and monitoring thalidomide for dermatological conditions at this institution are presented. Fourteen patients were treated with thalidomide (11 women, three men) over a 5-year period. The diagnoses of patients treated were actinic prurigo, prurigo nodularis, lupus erythematosus and Behçet's syndrome. A clinical improvement was noted in 10 patients (71.4%) prescribed thalidomide. Cessation of thalidomide treatment occurred in seven patients (50%) because of adverse effects. Of the patients with adverse effects, four developed abnormal nerve conduction studies and three developed intolerable adverse events (such as dizziness and vomiting). Adverse effects from thalidomide treatment are common but, through vigilant treatment planning, patient education and regular monitoring, the risk of permanent peripheral neuropathy and teratogenicity from thalidomide toxicity can be minimized. PMID:12423435
Crouch, Rohan B; Foley, Peter A; Ng, Jonathan C H; Baker, Christopher S
Despite many medical advances, burns continue to remain a challenging problem due to the lack of infrastructure and trained professionals as well as the increased cost of treatment, all of which have an impact on the outcome. There is very little information on the pattern of outcomes among burn patients in relation to clinical aspects in India. Hence, the present study was undertaken in a burns unit to determine selected epidemiological variables, assess the clinical aspects (etiology, extent and anatomical location) and first aid measures adopted and finally to analyse the outcomes in cases of burn injuries. In addition, we have sought to suggest measures to remove myths about pre-hospital burn treatment and provide recommendations to healthcare professionals.
Shanmugakrishnan, R. Raja; Narayanan, V.; Thirumalaikolundusubramanian, P.
Aims and objectives: The aim of this study was to investigate the type of tooth usually associated with extraction due to caries or periodontal disease and its relation to age at which these were lost, among patients attending dental surgery outpatient clinic, Dhulikhel Hospital, Kathmandu University TeachingHospital (KUTH). Materials and methods: A total no of 626 patients (male-299 and
Key roles in teaching evidence-based practice (EBP) are of interest to many hospital and academic librarians. This article describes how three academic librarians, in collaboration with the academic medical center's EBP Nursing Council, developed a seminar consisting of three credit hours of instruction in the basics of evidence-based practice. The seminar consists of three core elements: basic principles of EBP and finding literature, clinical experience and integration of knowledge into the hospital setting, and patient education and participation. Emphasis is placed upon analysis of the literature, institutional models of practice change, and the importance of patient roles in guideline development. PMID:23394424
The task of scheduling medical staff for evening rounds in the Clinical Teaching Unit of the Ottawa Hospital is a long complicated task due to its complexity. Three main classifications of staff, combined with various rotations, skill sets, clinical teams and vacation periods have combined to create a difficult scheduling problem. As there were no commercial packages available to solve this particular task, a study was made of heuristic scheduling and optimization techniques and a program based on a variation of the tabu search heuristic was written and tested. This system is being used to schedule medical staff at the Ottawa Hospital.
Objective: To study the medication errors leading to noncompliance in a tertiary care teachinghospital. 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.
The Grace Hospital Surgical Services redesign project began in December 1995 and concluded in November 1996. It was led by the Chief of Surgery, the Surgical/Anesthesia Services Director, and the Associate Director of Critical Care/Trauma. The project was undertaken in order to radically redesign the delivery of surgical services in the Detroit Medical Center (DMC) Northwest Region. It encompassed the Grace Hospital Main Operating Room (10 operating theatres) and Post-Anesthesia Recovery Unit, and a satellite Ambulatory Surgery Center in Southfield, Michigan. The four areas of focus were materials management, case scheduling, patient flow/staffing, and business planning. The guiding objectives of the project were to improve upon the quality of surgical services for patients and physicians, to substantially reduce costs, and to increase case volume. Because the Grace Surgical Services redesign project was conducted in a markedly open communicative, and inclusive fashion and drew participation from a broad range of medical professionals, support staff, and management, it created positive ripple effects across the institution by raising staff cost-consciousness, satisfaction, and morale. Other important accomplishments of the project included: Introduction of block scheduling in the ORs, which improved room utilization and turnaround efficiencies, and greatly smoothed the boarding process for physicians. Centralization of all surgical boarding, upgrading of computer equipment to implement "one call" surgery scheduling, and enlarging the capacity for archiving, managing and retrieving OR data. Installation of a 23-hour, overnight recovery unit and provision of physician assistants at the Ambulatory Surgery Center, opening the doors to an expanded number of surgical procedures, and enabling higher quality care for patients. Reduction of FTE positions by 27 percent at the Ambulatory Surgery Center. This yielded a total cost reduction of +1.5 million per annum in the annual budget of +10.3 million; Recruited 10 new podiatrists and increased the volume of cases brought to Northwest Region facilities by surgical specialists. This added 100 cases in 1996, and is projected to add 500 cases in 1997. A 14.5 percent reduction in the cost of operating the Surgical Services was achieved. This was accompanied by enhanced staff morale, physician satisfaction and a higher quality of patient care. PMID:10172985
In order to evaluate pain perception among parturients in Enugu, South-east Nigeria, a cross-sectional questionnaire study of parturients who delivered vaginally in four health institutions in Enugu from 2 December 2005 to 21 January 2006 was administered. Data analysis was by means of percentages, means +/- SD, correlation coefficients, t-tests, chi2-tests, one-way ANOVA and other inferential statistics using the statistical package SPSS for MS Windows at the 95% confidence level. A total of 250 questionnaires were distributed, out of which 181 were correctly filled and returned for a response rate of 72.4%. On a scale of 0 to 10, with 0 representing no pain and 10 representing maximal pain, the mean intensity of pain recorded by the respondents was 7.7 +/- 2.8. A total of 40 (22.1%) parturients received some pain relieving drug during their labour while 141 (77.9%) did not. Of the 40 women who received intra-partum analgesia, three women received pethidine, 17 (42.5%) received pentazocine, while 20 (50%) did not know the analgesic they received. Of the 141 respondents who did not receive intra-partum analgesia, 79 (56.0%) would have liked to have receive analgesia, while 62 (44.0%) would not. Of the 92 women who had their backs rubbed by companions during labour, 67 (72.8%) reported that this practice was helpful in relieving their labour pains, while 25 (27.2%) did not find it helpful. Of the 141 women who had a companion, 103 (73.0%) reported that this was helpful in relieving labour pains, while 38 (27.0%) reported no benefit. Antenatal care, place of residence, ethnicity, religion, marital status, occupational level, receiving intra-partum analgesia, type of analgesia received, having a companion during labour or receiving lectures on labour pains during the antenatal period had no significant impact on pain perception by the respondents (p > 0.05 for each of these variables). There was no significant correlation between pain scores and the respondents' ages and gestational age at delivery (p > 0.05). However, there was a significant positive correlation between the parturients' pain scores and their educational levels (r = 0.18, p = 0.018) and a significant negative correlation between pain scores and parity (r = -0.23, p = 0.009), with primigravidae having the highest perceived mean pain score compared with multiparas and grandmultiparas (7.5 +/- 2.3 vs 6.6 +/- 2.5 vs 6.3 +/- 2.1, p = 0.048). Additionally, those parturients who had their backs rubbed by a companion had a significantly higher mean perceived pain score than their counterparts whose backs were not rubbed (8.4 +/- 2.4 vs 6.8 +/- 2.9, p = 0.000). Parturients whose labours were either induced or augmented had a significantly higher perceived mean pain score than those who had spontaneous labour (8.9 +/- 2.5 vs 7.1 +/- 2.8, p = 0.001). It was concluded that parturients in Enugu, Eastern Nigeria, perceive labour as a very painful process with only a minority of them receiving any form of intra-partum analgesia. There is thus a large unmet need for pain relief among the parturients. Obstetric analgesia as is currently practiced in developed countries is long overdue in Nigeria. PMID:17896256
Onah, H E; Obi, S N; Oguanuo, T C; Ezike, H A; Ogbuokiri, C M; Ezugworie, J O
In a private university teachinghospital in Pakistan, a study using grounded theory design was conducted among new nursing graduates to elicit their transitional experiences from a student to a staff nurse role. Four major themes emerged highlighting the core category of "sailing forward": stepping into the new role, initial adjustment, support systems, and resolution phase. A substantive theory on role transition was the outcome. PMID:21788737
ObjectiveThe study investigated the extent of breast feeding among nursing mothers whose infants or children were receiving specialist attention in various child care units of Lagos University TeachingHospital in Nigeria.Methods100 nursing mothers aged 21 years and above completed a self-administered questionnaire. Their occupations were: Civil servant, Doctor, Pharmacist, Nurse, Lawyer, Private sector employee, Trader and others. Demographic data and
OBJECTIVES:To assess the completeness of gastrointestinal (GI) inpatient consultations at an academic teachinghospital.METHODS:We conducted a prospective, cross-sectional study of 278 inpatient GI consultation requests evaluated from 1 July 2005 to 31 May 2007. A questionnaire assessing multiple aspects of the requesting health-care providers' knowledge and documentation of patient information was completed by first-year GI fellows. Completeness of the consultation
Lukejohn W Day; John P Cello; Erin Madden; Mark Segal
Objective: To obtain information on the prescribing patterns of fluoroquinolones among hospitalized patients, other antibiotics and drugs co-prescribed, calculate fluoroquinolone utilization using defined daily dose (DDD), calculate mean cost of drugs and detail the sensitivity patterns of isolated microorganisms. Methods: The study was carried out over a five-month period (1st November 2003 to 31st March 2004) at the Manipal Teaching
P. Ravi Shankar; Dinesh K. Upadhyay; Arun K. Dubey; Archana C. Saha
Objectives: To investigate the pattern of systemic antiinfective use in Bouali teachinghospital (BH) within a standardized methodology. Methods: To perform a standardized and repeatable study, the Anatomic-Therapeutic-Chemical classification and defined daily dose (ATC\\/DDD) methodology was used for the first time in Iran. The number of systemic antiinfectives (J class) prescribed for inpatients over a period of 6 months was
There is an inherent tension between the training needs of inexperienced clinicians and the safety of the patients for whom they are responsible. Our society has accepted this tension as a necessary trade-off to maintain a competent workforce of physicians year after year. However, recent trends in medical education have diminished resident autonomy in favor of the safety of current patients. One dramatic example is the rapid increase in the number of academic ICUs that provide coverage by attending physicians at all hours. The potential benefits of this staffing model have strong face validity: improved quality and efficiency from the constant involvement of experienced intensivists, increased family and staff satisfaction from the immediate availability of attending physicians, and reduced burn-out among intensivists from reduced on-call responsibilities. Thus, many hospitals have moved toward 24-h coverage by attending intensivist physicians without evidence that these benefits actually accrue and perhaps without full consideration of possible unintended consequences. In this article, we discuss the potential benefits and risks of nocturnal intensivist staffing, considering the needs of current and future patients. Furthermore, we suggest that there remains sufficient uncertainty about these benefits and risks that it is both necessary and ethical to study the effects in earnest.
Treatment of hypertension among hospitalized patients represents an opportunity to improve blood pressure recognition and treatment. To address this issue, we examined patterns of antihypertensive medication prescribing among 5,668 hypertensive inpatients. Outcomes were treatment with any antihypertensive medication and treatment with first line therapy, defined as ACE inhibitor, beta blocker, thiazide diuretic, or calcium channel blocker. Logistic regression models adjusting for age, sex, race, length of stay (LOS), service line, and co-morbidity were used for all comparisons. The multivariate-adjusted odds ratios for treatment were higher for men (1.4, p<0.001), older patients (2.5 for age >80 vs. 1.0 for age < 40, p<0.001), non-white race (1.2 vs. 1.0 for white race, p<0.004), and generalist service line (1.4 vs. 1.0 for all other services, p<0.001). Multivariate-adjusted odds ratios for receiving first-line agents were higher for older patients and generalist service line. Among surgical patients, receipt of medical consultation was only marginally associated with higher odds of antihypertensive or first-line treatment after adjustment for relevant clinical variables. Demographic factors and service line appear to play a major role in determining the likelihood of inpatients hypertension treatment. Understanding and addressing these disparities has the potential to incrementally improve hypertension control rates in the population.
This study discusses the problem of surgery cancellation on the economic-financial perspective. It was carried out in the Surgical Center Unit of a school hospital with the objective to identify and analyze the direct costs (human resources, medications and materials) and the opportunity costs that result from the cancellation of elective surgeries. Data were collected during three consecutive months through institutional documents and a form elaborated by the researchers. Only 58 (23.3%) of the 249 cancelled scheduled surgeries represented costs for the institution. The cancellations direct total cost was R$ 1.713.66 (average cost per patient R$ 29.54); distributed as follows: expenses with consumption materials R$ 333.05; sterilization process R$201.22; medications R$149.77 and human resources R$1,029.62. The human resources costs represented the greatest percentile in relation to the total cost (60.40%). It was observed that most of the cancellations could be partially avoided. Planning on management; redesigning work processes, training the staff and making early clinical evaluation can be strategies to minimize this occurrence. PMID:18157457
Perroca, Márcia Galan; Jericó, Marli de Carvalho; Facundin, Solange Diná
Continuing education for hospital staff nurses is a concern worldwide. Current research shows that continuing education among nurses can positively affect patient outcomes (O'Brien, T., Freemantle, N., Oxman, A, et al., 2002. Interactive continuing education workshops or conferences can improve professional practice and patient outcomes. Journal of Evidence Based Nursing. 26 (5)). Seeing a need for improved patient outcomes among hospitals in Ecuador, we conducted a teaching the teacher program to assist nurse managers to carry-out continuing education in their hospital system. This teaching the teacher program was established through the collaboration between one College of Nursing in Utah, USA and a large healthcare system in Guayaquil, Ecuador. The collaboration has been ongoing for five years, 2003 to present. Initial projects included classes for the nursing staff including technical skills, life-saving techniques, and nursing process and assessment. Collaborators from the US and Ecuador believed that in order to maximize the improvement of nursing care in the hospital system it was necessary to turn attention on the nurse managers and not just the staff nurses. This would allow for meaningful ongoing learning beyond the one-time classroom setting. Continuing education is not common in Ecuadorian hospitals as it is in the United States. The purpose of this paper is to describe the project and provide initial evaluative data on the response to the curriculum; including evidence of managers using the teaching principles they were taught. The underlying aim of the project was to achieve a sustainable impact by teaching the leaders of each unit how to be more effective teachers. In May 2007, a two-day "teaching the teacher" workshop was developed with the needs of the managers in mind. The participants in the course included the chief nursing officer and leaders of various units of the hospital. In May 2008 a follow-up class was taught, along with an evaluation by a verbal and written survey with open ended questions and an observation of an actual class being taught by the participants. PMID:19059007
OBJECTIVE: To document the geographic variations in the rates of 10 common surgical procedures in Quebec and to examine the relation between surgical rates and level of access to teachinghospitals. DESIGN: Population-based rates standardized for age and sex were calculated from 1985-88 data from MED-ECHO (the provincial hospital discharge database) for each of the 32 community health districts (départements de santé communautaire [DSCs]) in Quebec. Variation across DSCs was analysed with the use of the ratio of the highest to the lowest rate, the coefficient of variation and the systematic component of variation. On the basis of an urbanization index designed by Statistics Canada, DSCs were classified as having a low, medium, high or very high level of access to teachinghospitals. PATIENTS: All Quebec residents except those whose DSC of residence could not be traced (accounting for no more than 1.7% of patients for any study procedure) and aboriginal people from northern Quebec. SURGICAL PROCEDURES STUDIED: Appendectomy, cesarean section, cholecystectomy, coronary artery bypass grafting (CABG), hysterectomy, inguinal hernia repair, prostatectomy, tonsillectomy with or without adenoidectomy, total hip replacement and varicose vein stripping. RESULTS: There was considerable systematic variation in the surgical rates for all 10 procedures. Cesarean section, the rates of which varied the least, still exhibited almost a twofold variation between the highest and lowest rates. The rates of tonsillectomy varied the most, by a factor of more than five. With a few exceptions there was relatively little relation between the rates of the procedures within the DSCs. The rates of appendectomy, cholecystectomy, hysterectomy and tonsillectomy tended to be lower in the DSCs containing teachinghospitals, whereas the reverse was true for CABG. For the other procedures the relation between the rates and the level of access to teachinghospitals was nonsignificant. CONCLUSIONS: The overall consistency of the observed variations with those of previous studies invites a closer look at the practice patterns and the scientific basis of the clinical decisions associated with procedures showing high variations in rates. The lack of a systematic relation between the surgical rates and the level of access to teachinghospitals challenges the belief that remote regions are underserved with respect to the procedures studied.
OBJECTIVES Several studies have evaluated whether evidence-based medicine (EBM) training courses can improve skills such as literature searching and critical appraisal but to date, few data exist on whether teaching EBM skills and providing evidence-based resources result in change in behavior or clinical outcomes. This study was conducted to evaluate whether a multifaceted EBM intervention consisting of teaching EBM skills and provision of electronic evidence resources changed clinical practice. DESIGN Before/after study. SETTING The medical inpatient units at a district general hospital. PARTICIPANTS Thirty-five attending physicians and 12 medicine residents. INTERVENTION A multicomponent EBM intervention was provided including an EBM training course of seven 1-hour sessions, an EBM syllabus and textbook, and provision of evidence-based resources on the hospital network. MEASUREMENTS AND MAIN RESULTS The primary outcome of the study was the quality of evidence in support of therapies initiated for the primary diagnoses in 483 consecutive patients admitted during the month before and the month after the intervention. Patients admitted after implementation of the EBM intervention were significantly more likely to receive therapies proven to be beneficial in randomized controlled trials (62% vs 49%; P = .016). Of these trial-proven therapies, those offered after the EBM intervention were significantly more likely to be based on high-quality randomized controlled trials (95% vs 87%; P = .023). CONCLUSIONS A multifaceted intervention designed to teach and support EBM significantly improved evidence-based practice patterns in a district general hospital.
Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. Methods This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Results Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6%) was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9%) was most frequently disagreed. In the event of a medical error, majority (67.7%) were ready to disclose their error to the patient. The most common perceived reason for not disclosing the error was threat of a claim or assault (90.9%). Majority (68.3%) believed that malpractice had a negative effect on reputation. Only 13(4.1%) had received at least one legal claim for damages. Only about three-fourths (75.5%) had the habit of frequently obtaining informed consent from the patients. 83(26.0%) expressed reluctance in accepting a case that was deemed to be difficult. Financial gains and liabilities were responsible for biased approach in 8.5% and 12.2% of the respondents respectively. Conclusion There is a dire need of programs aimed at increasing awareness among practicing surgeons in our setup. Proactive measures are required for the formulation of an efficient system of litigation. Physician accountability will not only arouse a greater sense of responsibility in them, but will also augment the confidence placed by patients on the healthcare system.
CONTEXT: Issues of cost and quality are gaining importance in the delivery of medical care, and whether quality of care is better in teaching vs nonteaching hospitals is an essential question in this current national debate.\\u000aOBJECTIVE: To examine the association of hospitalteaching status with quality of care and mortality for fee-for-service Medicare patients with acute myocardial infarction (AMI).
Jeroan J. Allison; Catarina I. Kiefe; Norman W. Weissman; Sharina D. Person; Matthew Rousculp; John G. Canto; Sejong Bae; O. Dale Williams; Robert Farmer; Robert M. Centor
Objectives: The purpose of this study was to examine physician bias when patients present with cardiovascular disease in a teaching hos- pital that treats a majority of African American patients. Physician bias was deemed to occur when cardiovascular disease patients did not receive an invasive procedure when needed. Methods: The hospital in the study was a teaching facility in southeastern
James Gerard Caillier; Sandra C. Brown; Sharon Parsons; Phillip J. Ardoin; Peter Cruise
The war injuries of 361 patients admitted to Mubarak Al-Kabeer TeachingHospital, during the Gulf War are reported. More abdominal and chest injuries were seen in this series in comparison with other conflicts owing to the short evacuation time. Of the injuries, 54% were caused by gunshots, 34% were fragment injuries and 5.5% were glass and stab injuries. Civilians accounted for 50% of the injured. Wound infection rate was 7%, average hospital stay was 8.8 days and hospital mortality was 5.5%. We advocate radical wound excision, exploration of penetrating wounds of neck and abdomen, and mainly conservative management of chest injuries that do not involve the mediastinum.
Behbehani, A.; Abu-Zidan, F.; Hasaniya, N.; Merei, J.
Background: Iron deficiency has been described as the world most common nutritional deficiency and the commonest cause of nutritional anemia in infancy and childhood. The deleterious behavioral and cognitive deficit associated with iron-deficiency anemia could be irreversible. Therefore, the latter should be prevented by early detection of iron deficiency in the non-anemic groups. Aim: To determine the prevalence of iron deficiency in the non-anemic under-five children and to document its variation among the age classes of these children. Subjects and Methods: Under-five children presenting at a tertiary hospital were consecutively enrolled, Serum ferritin levels of the subjects were used to assess the iron status and serum ferrritin level of less than 12 ng/ml was considered as iron deficiency. Data were analyzed using SPSS version 15.0. Chi-square tests were employed as necessary for test of significance in each of the characteristics of the population at P ? 0.05. Results: A total of 178 non anemic under-five children were studied, their mean hematocrit and serum ferrritin values were 35.5 (2.8%) and 54.9 (76.1) ng/ml respectively. Forty-nine (27.5% [49/178]) of the study population was iron deficient and there was no significant difference in the prevalence of iron deficiency among the age classes (P = 0.75). Conclusion: This study has documented a high prevalence of iron deficiency in non-anemic under-five children presenting at the outpatient department and emergency room of a tertiary health facility in Enugu. All the age classes were relatively affected. A further research into the causes of iron deficiency in this age group is recommended.
Bacteraemia is an important cause of morbidity and mortality in the intensive care unit. In this study the distribution of organisms causing bacteraemic episodes in patients in the adult intensive care unit of a large teachinghospital was determined. Particular emphasis was placed on the type of organisms isolated from community- and hospital-acquired bacteraemia, the suspected source of infection, the
M. Crowe; P. Ispahani; H. Humphreys; T. Kelley; R. Winter
Background The optimal structure of an internal medicine ward team at a teachinghospital is unknown. We hypothesized that increasing the ratio of attendings to housestaff would result in an enhanced perceived educational experience for residents. Methods Harbor-UCLA Medical Center (HUMC) is a tertiary care, public hospital in Los Angeles County. Standard ward teams at HUMC, with a housestaff?attending ratio of 5?1, were split by adding one attending and then dividing the teams into two experimental teams containing ratios of 3?1 and 2?1. Web-based Likert satisfaction surveys were completed by housestaff and attending physicians on the experimental and control teams at the end of their rotations, and objective healthcare outcomes (e.g., length of stay, hospital readmission, mortality) were compared. Results Nine hundred and ninety patients were admitted to the standard control teams and 184 were admitted to the experimental teams (81 to the one-intern team and 103 to the two-intern team). Patients admitted to the experimental and control teams had similar age and disease severity. Residents and attending physicians consistently indicated that the quality of the educational experience, time spent teaching, time devoted to patient care, and quality of life were superior on the experimental teams. Objective healthcare outcomes did not differ between experimental and control teams. Conclusions Altering internal medicine ward team structure to reduce the ratio of housestaff to attending physicians improved the perceived educational experience without altering objective healthcare outcomes.
ABSTRACT Objectives: To evaluate risk factors, management, maternal and fetal outcomes of ruptured uterus at Women and Children TeachingHospital Bannu, Pakistan. Study design: The prospective observational study was designed from January 2009 to December 2009. A total 64 patients were found with ruptured uterus evaluated in Women and Children TeachingHospital Bannu, Pakistan. The aim of the study was to evaluate risk factors, management, maternal and fetal outcomes. Results: Frequency of ruptured uterus in hospital was found in 9/ 1000 deliveries, higher than most other studies. Amongst etiological factors the most important were great multiparity 27 (42.2%), injudicious use of Oxytocin 33 (51.6%), obstructed labour 8 (12.5%) and previous caesarean section 12 (18.8%). Of the total number of patients, 49 (76.6%) underwent abdominal hysterectomy (either subtotal or total), 3.1% of them needed bladder repair and 15.6% underwent repair of uterus. 5 (7.8%) died either due to irreversible shock or disseminated intravascular coagulation, 4% of patients had incontinence of urine, 53 (82.8%) of cases delivered dead babies and 9 (14.1%) had severe birth asphyxia needing neonatal intensive care. Conclusion: Uterine rupture is amongst the preventable obstetric complication that carries severe risks both to the mother as to the baby. Health education of people, training and supervision of health personal may reduce incidence especially in remote areas.
QAZI, Qudsia; AKHTAR, Zubaida; KHAN, Kamran; KHAN, Amer Hayat
|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…
|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…
The status of solid waste management in a city is often considered an index for assessing governance. In cities of the developing world, the informal sector plays an important role in the management of solid waste. This paper examines the position of the informal recycling sector in the planning and reform of solid waste management in the city of Enugu,
SUMMARY The socio-demographic and clinical characteristics of one hundred consecutive referrals from emergency O.P.D. of a teaching general hospital were studied. The referral rate was 5.4%. The source, reason and purpose of the referrals were studied. Half of the patients had presented with somatic symptoms. Altered sensorium, suicidal attempt and excitements together constituted one third of all emergency referrals. The diagnosis of neurosis was given in half of the patients and one third of all patients were labelled as suffering from hysterical neurosis. The nature of the presenting complaints and psychiatric diagnoses were comparable to that of the other studies.
A family physician was appointed director of the Adolescent and Youth Medicine Service at the Montreal Children's Hospital. He was assigned a leadership role in the adolescent outpatient clinics and the adolescent inpatient ward. As team leader, he coordinates the work of allied health professionals and provides personal ongoing care to patients, fostering a comprehensive care approach in service, teaching and in links with the community. There are of course certain conceptual and practical problems in the situation of a primary care physician in a tertiary care setting; university departments of family medicine must face the challenge of altering consultants' thinking about their role.
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 TeachingHospitals, one of a series of Trusts whose approach to organizational effectiveness was closely examined. PMID:10848174
Pantoea agglomerans is an environmental organism which may seldom cause opportunistic infections. Here we report on a 6 case outbreak in a teachinghospital. Within three months . agglomerans was isolated from blood cultures of 5 patients from oncology and 1 patient from ICU departments. P. agglomerans was in pure culture in 5 cases, while in the last one Rahnella aquatilis and Candida famata were also isolated. Therefore, P. agglomerans is able to produce nosocomial infections in patients with primary pathology often associated with immune suppression. PMID:19382678
Liberto, Maria Carla; Matera, Giovanni; Puccio, Rossana; Lo Russo, Teresa; Colosimo, Elena; Focà, Emanuele
This is an exploratory, descriptive and quantitative study, based on the following categories: work process, workloads and fatigue in a teachinghospital in Curitiba in the southern region of Brazil. The article characterizes the load and stress experienced in a university hospital, based on a previous study entitled "System for monitoring the health of nursing workers" (SIMOSTE). The results show that females were the most affected (85.9%) and the most affected professionals were nursing assistants (53.1%). The highest number of sick leaves was due to diseases of the osteoarticular system (25.2%) and the most significant loads were mechanical and physiological with 33.06% each. These results may support intervention strategies in the policies directed toward the workers' health to ensure a better quality of life and consequently improve the quality of care provided to the user. PMID:23781725
Background: Bacillus subtilis are opportunistic, spore forming bacteria, common soil inhabitants. A resistant spore allows bacteria to endure extreme conditions of heat and desiccation in the environments promotes their survival in many instances, even in environments like hospitals. Objectives: This paper purposes to find out the incidence of Bacillus subtilis from various sources at Azadi TeachingHospital in Duhok city, Iraq. The susceptibility test and resistotyping (antibiotypes) profile of isolates were also studied. Methods: During a period of eight months between Januarys to April, 2011, a total of 128 samples were collected from various sources and locations at Azadi TeachingHospital in Duhok city. A sterile cotton swabs were used to collect the samples and analyzed by plating on Blood agar, Chocolate agar and MacConkey agar followed by the identification of the isolates based on their cultural characteristics and their reactions in standard biochemical tests. All the isolates were tested for antimicrobial susceptibility by the disk diffusion technique according to the Clinical and Laboratory Standards Institute guidelines on Muller Hinton Agar. Results: Out of the 128 collected samples, 84 samples yielded bacterial growth, of them 31(24.2%) were Bacillus subtilis. Moreover, other bacterial groups were also isolated and identified. The results showed that the occurrence of Bacillus subtilis was higher than the other groups of bacteria. The susceptibility test of Bacillus subtilis isolates; the organism exhibited high susceptibility rate to gentamicin (96.7%) and ciprofloxacin (93.5%) While, cefotaxime (19.3%) and ampicillin (16.2%) demonstrated the lowest percentage of susceptibility rate. Resistotyping (antibiotypes) profiles of Bacillus subtilis isolates were determined. Out of 31 isolates, 22 of them were multiple resistant and belonged to 3 resistotype patterns; resistotype 1 was predominant among isolates. Conclusion: This study shows that there is an increased rate of incidence of Bacillus subtilis in hospital environments in study area and some of these isolates were multi-drug resistant and showed different resistotyping profiles.
Background The purpose of this study was to determine the etiology and epidemiologic characteristics of sudden death at Ladoke Akintola University of Technology (LAUTECH) TeachingHospital, South West Nigeria. Methods This was a retrospective descriptive study of all cases of natural unexpected death, either occurring out of hospital or less than 24 hours after admission to LAUTECH TeachingHospital, over a nine-year period from January 2003 to December 2011. Data were generated from information in the case notes and autopsy reports for these cases. Results Sudden death accounted for 29 (4.0%) of 718 adult medical deaths and 1.0% of all adult medical admissions. Out-of-hospital deaths occurred in 72.4% of cases. The mean age of the patients was 46.8 ± 11.5 (range 25–74) years. The male to female ratio was 6.25:1. Cardiovascular disease were the most common cause of death (51.7%), followed by respiratory disease (20.7%), pulmonary thromboembolism (10.4%), central nervous system disease (13.8%), gastrointestinal disorders (13.8%), severe chemical/drug poisoning (13.8%), and combined cardiovascular and central nervous system disease (13.8%). Hypertension-related causes were responsible for 14/29 (48.3%) of the sudden deaths. Hypertensive heart disease accounted for 86.7% of the cardiovascular deaths, hypertensive heart failure accounted for 73.3%, whilst all heart failure cases accounted for 80.0%. Left ventricular hypertrophy was present in 69.2% of the patients with hypertensive heart disease. Moderate to severe atheromatous changes occurred in the aorta in 38.5% of patients aged ?50 years. No case of myocardial infarction was found. Conclusion Hypertensive heart disease and hypertension-related disorders are the most common causes of sudden death in South West Nigeria, so effective public health strategies should be channeled towards prevention, detection, and treatment of hypertension.
Objective To characterise the prescription of non-formulary drugs to children and neonates at a Brazilian teachinghospital and identify adverse drug reactions (ADRs), drug interactions, and prescription of potentially hazardous medicines. Methods A prospective exploratory study was carried out between January and May 2011 at the general paediatric wards and paediatric oncology, paediatric intensive care, and neonatal care units of the study hospital. Non-formulary drugs were categorised as approved, off-label, or not approved for use in children according to Brazilian compendia. Electronic health records were actively searched for ADRs and the possibility of moderate to severe interactions between non-formulary drugs and other medicines was determined with the Micromedex® database. Results Overall, 109 children or neonates received non-formulary drugs. Of these drugs, 54% were approved for use in children, 12.2% were used off-label, and 33.8% were not approved for use in children. Non-formulary drugs accounted for 13.4% of total prescriptions; 5.3% of drugs had a potential for interactions and five were possibly associated with ADRs. Conclusions Prescription of non-formulary drugs not approved for use in children was common at the study hospital. Studies such as this provide information on the use of medicines for special indications and permit assessment of the relevance of hospital formularies for the paediatric population.
Tramontina, Mariana Y.; Heineck, Isabela; Dos Santos, Luciana
Patients care involves all the activities that are carried out before, during and after radiological diagnostic procedures. The successful application of medical knowledge depends on what patients think and feel about the medical personnel and the hospital. From the clinical experience, patients usually reacts to some factors that creates problems in the radiology units such as delay, neglect, use of harsh words, unnecessary repeats and preferential treatment. The study was aimed at evaluating patients care in radio diagnosis department of Tribhuvan University TeachingHospital (TUTH), Kathmandu, Nepal. A cross sectional study was conducted from May to June, 2012 in TUTH, Kathmandu, Nepal. Semi structured both open and closed ended questionnaires were administered among 287 conscious patients who were agreed to participate in the study. A total 287 patients were enrolled in the study. Out of them, 165 (57.49%) patients perceived that instruction was adequate before and after the examination; 219 (76.30%) patients were satisfied with the services rendered in the hospital; 174 (60.62%) patients perceived that privacy was adequate but 229 (79.9%) and 145 (50.5%) perceived that waiting areas and social aspects of patients care were suboptimal and in adequate. This can be improved by hospital management system. PMID:23671964
Objective. To describe the characteristics and interventions to control a large epidemiological Influenza A Outbreak. Methods. During the months of February to April 2006, a large outbreak of Influenza A was detected, which affected Health Care Workers and hospitalized patients in a large teachingHospital in Guatemala City. Interventions to interrupt transmission were implemented and included barrier methods (N95 masks, respiratory isolation measures, etc.) and enhanced hand hygiene, vaccination of healthy Health Care Workers (HCW), restrictions for patient visits. Results. From February to April 2006, 59 hospitalized patients diagnosed with Influenza A. 19 AIDS patients (mortality: 71%) and 5/40 (12.5%) in other diseases: cancer (3), severe cardiac failure (1) and severe malnutrition (1). The attack rate at day 20 in doctors and medical students was 21% while in other HCW it was 10.5%. Within 3 weeks of the beginning of the plan, deaths were stopped and no more cases in HCW were detected after 3 additional weeks. Conclusion. A rapid, comprehensive plan for the control of nosocomial epidemic Influenza A outbreaks is essential to limit severe morbidity and mortality in hospitals who attend large immunocompromised populations, including AIDS patients. HCW regular vaccinations programs are mandatory. PMID:24052881
Surveying pressure ulcer (PU) prevalence is a common practice in some western countries and has served as a tool to improve prevention policies and procedures. Although attention on PU prevention has increased in China, no PU prevalence baseline information is available to help guide care. To obtain this baseline information, a cross-sectional descriptive study was conducted in a 3,000-bed teachinghospital in Wuhan. On the morning of the study, trained clinicians audited the total hospital patient population (61 nursing units, 2,913 inpatients) using the PU survey tool designed by National Database of Nursing Quality Indicators. The majority of the patients (1,648, 56.6) were male, average patient age was 43.91 (+/-21.20) years, range 1 to 94 years. The overall PU prevalence rate was 1.8% (52 patients/79 ulcers). The hospital-acquired prevalence rate was 1.54% (0.82% when Stage I ulcers were excluded). Prevalence rates were highest in the ICU (45.5%) and most ulcers (53.2%) were located in the sacral-coccyx area. The results of this study suggest that overall PU prevalence rates are low compared to data from other countries. Differences in patient acuity, average patient length-of-stay, and prevention practices may explain these observations. The results of this study can guide hospital prevention efforts and serve as a benchmark for PU prevalence studies in China. PMID:20200444
Objective. To describe the characteristics and interventions to control a large epidemiological Influenza A Outbreak. Methods. During the months of February to April 2006, a large outbreak of Influenza A was detected, which affected Health Care Workers and hospitalized patients in a large teachingHospital in Guatemala City. Interventions to interrupt transmission were implemented and included barrier methods (N95 masks, respiratory isolation measures, etc.) and enhanced hand hygiene, vaccination of healthy Health Care Workers (HCW), restrictions for patient visits. Results. From February to April 2006, 59 hospitalized patients diagnosed with Influenza A. 19 AIDS patients (mortality: 71%) and 5/40 (12.5%) in other diseases: cancer (3), severe cardiac failure (1) and severe malnutrition (1). The attack rate at day 20 in doctors and medical students was 21% while in other HCW it was 10.5%. Within 3 weeks of the beginning of the plan, deaths were stopped and no more cases in HCW were detected after 3 additional weeks. Conclusion. A rapid, comprehensive plan for the control of nosocomial epidemic Influenza A outbreaks is essential to limit severe morbidity and mortality in hospitals who attend large immunocompromised populations, including AIDS patients. HCW regular vaccinations programs are mandatory.
This research assessed the reported incidence, causes and reporting of medication errors in intensive care units (ICUs) and wards of Jordanian teachinghospitals. There are few studies about medication errors in Jordan. This survey was conducted in 2010 using a convenience sample of 212 nurses from four teachinghospitals. The response rate was 70.6% (212/300). The mean of the reported incidence of medication errors for the whole sample was 35%; 36.4% in ICUs and 33.8% in wards. An inaccurate rate of total parenteral nutrition (TPN) was the scenario most commonly classified as a drug error; for this nurses would notify the physician, and complete an incident report. Poor quality or damaged medication labels were the most commonly reported causes of errors. Nurses failed to report medication errors because they were afraid that they might be subjected to disciplinary actions. There were some significant differences between ICUs and wards in assessment of clinical scenarios, causes of medication errors as well as their reporting. Reporting of medication errors should be encouraged. Immediate interventions should be initiated by all healthcare professionals in all clinical settings, especially in wards. PMID:22800388
Abstract This research assessed the reported incidence, causes and reporting of medication errors in Intensive Care Units (ICUs) and wards of Jordanian teachinghospitals. There are few studies about medication errors in Jordan. This survey was conducted in 2010 using a convenience sample of 212 nurses from four teachinghospitals. The response rate was 70.6% (212/300). The mean of the reported incidence of medication errors for the whole sample was 35%; 36.4% in ICUs and 33.8% in wards. An inaccurate rate of Total Parenteral Nutrition (TPN) was the scenario most commonly classified as a drug error; for this nurses would notify the physician, and complete an incident report. Poor quality or damaged medication labels were the most commonly reported causes of errors. Nurses failed to report medication errors because they were afraid that they might be subjected to disciplinary actions. There were some significant differences between ICUs and wards in assessment of clinical scenarios, causes of medication errors as well as their reporting. Reporting of medication errors should be encouraged. Immediate interventions should be initiated by all healthcare professionals in all clinical settings, especially in wards. PMID:22551274
BACKGROUND Delays in the care of hospitalized patients may lead to increased length of stay, iatrogenic complications, and costs. No study has characterized delays among general medicine inpatients in the current prospective payment era of care. OBJECTIVE To quantify and characterize delays in care which prolong hospitalizations for general medicine inpatients. DESIGN Prospective survey of senior residents. SETTING Urban tertiary care university-affiliated teachinghospital. PARTICIPANTS Sixteen senior residents were surveyed regarding 2,831 patient-days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data were collected on 97.6% (2,762) of patient-days eligible for evaluation. Three hundred seventy-three patient-days (13.5% of all hospital days) were judged unnecessary for acute inpatient care, and occurred because of delays in needed services. Sixty-three percent of these unnecessary days were due to nonmedical service delays and 37% were due to medical service delays. The vast majority of nonmedical service delays (84%) were due to difficulty finding a bed in a skilled nursing facility. Medical service delays were most often due to postponement of procedures (54%) and diagnostic test performance (21%) or interpretation (10%), and were significantly more common on weekend days (relative risk [RR], 1.49; P=.02). Indeed, nearly one fourth of unnecessary patient-days (24% overall, 88 patient-days) involved an inability to access medical services on a weekend day (Saturday or Sunday). CONCLUSIONS At our institution, a substantial number of hospital days were judged unnecessary for acute inpatient care and were attributable to delays in medical and nonmedical services. Future work is needed to develop and investigate measures to decrease delays.
At the 125 U.S. medical schools and their affiliated teachinghospitals, 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 teachinghospitals 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 teachinghospitals) 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
Background Spontaneous adverse drug reaction (ADR) reporting is the cornerstone of pharmacovigilance. ADR reporting with Yellow Cards has tremendously improved pharmacovigilance of drugs in many developed countries and its use is advocated by the World Health Organization (WHO). This study was aimed at investigating the knowledge and attitude of doctors in a teachinghospital in Lagos, Nigeria on spontaneous ADR reporting and to suggest possible ways of improving this method of reporting. Methods A total of 120 doctors working at the Lagos State University TeachingHospital (LASUTH), in Nigeria were evaluated with a questionnaire for their knowledge and attitudes to ADR reporting. The questionnaire sought the demographics of the doctors, their knowledge and attitudes to ADR reporting, the factors that they perceived may influence ADR reporting, and their levels of education and training on ADR reporting. Provision was also made for suggestions on the possible ways to improve ADR reporting. Results The response rate was 82.5%. A majority of the respondents (89, 89.9%) considered doctors as the most qualified health professionals to report ADRs. Forty (40.4%) of the respondents knew about the existence of National Pharmacovigilance Centre (NPC) in Nigeria. Thirty-two (32.3%) respondents were aware of the Yellow Card reporting scheme but only two had ever reported ADRs to the NPC. About half (48.5%) of the respondents felt that all serious ADRs could be identified after drug marketing. There was a significant difference between the proportion of respondents who felt that ADR reporting should be either compulsory or voluntary (?2 = 38.9, P < 0.001). ADR reporting was encouraged if the reaction was serious (77, 77.8%) and unusual (70, 70.7%). Education and training was the most recognised means of improving ADR reporting. Conclusion The knowledge of ADRs and how to report them are inadequate among doctors working in a teachinghospital in Lagos, Nigeria. More awareness should be created on the Yellow Card reporting scheme. Continuous medical education, training and integration of ADR reporting into the clinical activities of the doctors would likely improve reporting.
Introduction: The proportion of the elderly population in Nepal, though low, is steadily increasing. Studies on drug utilisation among geriatric patients in Western Nepal, a region with the highest proportion of the elderly in all of Nepal, are lacking. The present study was carried out at the Manipal TeachingHospital, a 700-bed teachinghospital in Pokhara, Western Nepal. Methods: The
Objective: To determine the drug utilization pattern of antihyperglycemic agents (AHA) in a tertiary care teachinghospital. Materials and Methods: This was a prospective observational study. All the relevant data were collected and drug utilization pattern of AHA was determined. Direct cost associated with the use of antihyperglycemic medicines was calculated and consumption of the antihyperglycemic medicines was measured as defined daily dose (DDD)/100 bed-days. The adverse drug reactions (ADRs) related to anti-diabetic medicines were monitored. Statistical Analysis Used: Chi square test (?2), mean±standard deviation. Results: During the study period, 350 patients diagnosed as diabetes mellitus (DM) were admitted. Insulin was prescribed as monotherapy to 81% and to 52% patients during hospital stay and discharge, respectively. Increase in utilization of insulin was recorded in majority of the patients due to presence of co-morbid conditions or resistance to oral hypoglycemic drugs. Use of insulin at the time of discharge decreased significantly (P<0.05) by 29%. Among the oral AHA, combination of glimepiride with metformin was more prevalent during hospital stay and at the time of discharge monotherapy of metformin followed by glimepiride was more prevalent. During hospital stay, cost of AHA was found to be Rs. 95.27 ± 119.03. The total antihyperglycemic drug consumption in the medicine ward during study period was 13.42 DDD/100 bed-days. Fifty ADRs were reported and descriptions of ADRs were found to be only hypoglycemia. Conclusion: The study exhibited a significant increase in the utilization of two drug combination therapies and monotherapy of oral AHA and decrease in the utilization of insulin at the time of discharge.
Abdi, Sayed Aliul Hasan; Churi, Shobha; Kumar, Y.S. Ravi
The clinical, anaesthetic and surgical records of 142 bitches admitted into the primary care clinic at the Small Animal Hospital, University of Liverpool, between January 2002 and August 2004 for routine ovariohysterectomy by final-year students were analysed for complications during and after the surgery. The time taken to perform the surgical procedure was recorded, to allow assessment of the time involved in one-to-one surgical teaching during live-recovery surgeries of client-owned pets. The types of complications were similar to those reported in earlier studies: nine bitches suffered haemorrhage of the ovarian arteries during surgery, and there were four cases of haemorrhage after surgery, 12 cases of wound inflammation and four other types of complication. The rates of intraoperative, postoperative and total complications were 6.3, 14.1 and 20.6 per cent, respectively. PMID:16377787
Forty-two interns and residents on the staff of a community teachinghospital were questioned to assess their understanding of blood gas abnormalities. Misunderstandings were such that 24% of the residents and interns might have given inadequate care had their interpretations dictated practice. Few therapeutic misadventures in fact occurred, largely because of supervision. Even without supervision, it is unlikely that much harm would have come about, partly because pattern recognition and rules of thumb provided adequate guidance and partly because no notice was taken of the results of the blood gas analysis anyway. Those who wish to promote rational practice should direct their educational efforts to improved understanding of the mechanisms of hypoxaemia and of the chemical, physiological and pathophysiological interactions of PCO2, bicarbonate and pH in the various acid-base disorders. PMID:553656
Powles, A C; Morse, J L; Pugsley, S O; Campbell, E J
After graduation at Trinity College Dublin in 1814 Archibald Billing, who was born in County Dublin, settled in London. His Dublin MD (1818) was incorporated at Oxford and he taught at the London Hospital where, when appointed Senior Physician in 1822, he introduced teaching at the patients' bedsides. He ceased to lecture in 1836 when he was invited to become a member of the Senate of the University of London. He published papers on a variety of clinical subjects but is remembered for First Principles of Medicine (1831) that went through six editions. His friends among the operatic artists included Niccolo Paganini, and The Science of Jems, Jewels, Coins and Medals (1867) was the work of a connoisseur. He lived in retirement for many years before he died at the age of 90 at 34 Park Lane, London, on 2 September 1881. PMID:21350071
Concerns about whether the junior doctor changeover in the UK is associated with an increased risk of death have been reawakened by a retrospective study (Jen et al, 2009). Examination of overall mortality data has consistently failed to demonstrate any increase in mortality during the changeover. However, regional and national trends may mask this increase, so a study was undertaken to compare mortality in a busy London teachinghospital with regional and national trends. No evidence of an increase in mortality in August was found for any of the time periods examined, even after comparison with regional and national trends. The authors conclude that examination of overall mortality data is a blunt and impractical instrument for settling the question of whether an increase in morbidity and mortality occurs. Preventable morbidity and mortality should be audited. PMID:23665787
Objective: To identify patient, institutional, and physician characteristics that predict failure to attend scheduled mammography appointments.\\u000a \\u000a \\u000a Design: Retrospective chart review.\\u000a \\u000a \\u000a \\u000a \\u000a Setting: Medicine clinic at an urban public teachinghospital.\\u000a \\u000a \\u000a \\u000a \\u000a Patients: All 907 women aged 40 years and more scheduled for mammography from March 1990 to June 1991.\\u000a \\u000a \\u000a \\u000a \\u000a Measurements and main results: The main outcome measure was whether a woman kept
Karen L. Margolis; Nicole Lurie; Paul G. McGovern; Jonathan S. Slater
This study describes the profile of 100 cases of diabetic ketoacidosis (DKA) at a teachinghospital in 1 Benghazi, Libyan Arab Jamahiriya. DKA was more frequent in young women with type 1 diabetes and mostly due to preventable causes, e.g., disrupted insulin treatment and/or infection. DKA also occurred in type 2 diabetics, with a higher mortality rate, as they were older patients with co-morbidity. Polyurea, fatigue, abdominal pain and vomiting were the most common clinical features, while coma was rarer. A high number of cases were first presentations of type 1 diabetes; hence this diagnosis should be considered in all patients with acute abdomen or decreased level of consciousness. The reasons for high mortality rate in this study (10%) were multifactorial. PMID:20795443
Racial and ethnic disparities in health care continue to be a major impediment to improving the health of many communities in the United States. Efforts must be directed at the multiple social, economic, and historic determinants of health disparities. In addition, health care providers must be aware of these determinants and must have the tools to address them in their individual relationships with patients. This article describes a partnership that arose out of the mutual recognition by a community organization and public hospital of the need to (a) teach physicians how to recognize the root causes of health disparities, (b) improve their cross-cultural understanding and communication, and (c) enhance their awareness of the capacity of community resources to positively impact their patients' lives.
Jacobs, Elizabeth A.; Kohrman, Claire; Lemon, Maurice; Vickers, Dennis L.
Nasal, axillary and rectal swabs were collected from 193 dogs admitted to the Ontario Veterinary College Veterinary TeachingHospital. Enrichment culture was performed and coagulase positive staphylococci were identified via standard methods. Methicillin-resistant Staphylococcus pseudintermedius was isolated from 4/193 (2.1%) dogs, and methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus schleiferi subsp. coagulans were each isolated from 1/193 (0.5%) dogs. Methicillin-resistant Staphylococcus intermedius was not identified. All S. pseudintermedius isolates were unrelated on pulsed-field gel electrophoresis. Evaluation of the epidemiology of methicillin-resistant staphylococcal colonization is necessary to understand the apparent emergence of these strains and to develop appropriate control strategies. PMID:17643874
A cross sectional descriptive study of awareness and practice of family planning methods among 200 women of reproductive age attending gynecology out patient department (GOPD) of Nepal Medical College TeachingHospital from 14 th May 2008 to 14 th July, 2008 was carried out. Most of the respondents (93.0%) were aware of at least one of family planning methods out
The creation of Faculty of Pharmacy at the University of Ibadan led to the downsizing as well as the relocation of more than 80% of pharmacy books and journals from the medical library to the main campus about 15 km away from the teachinghospital\\/College of Medicine library, where the books were initially housed. This study revealed the hardship and
BACKGROUND: Tuberculosis (TB) is an established occupational disease affecting health care workers (HCWs). Determining the risk of TB among HCWs is important to enable authorites to take preventative measures in health care facilities and protect HCWs. This study was designed to assess the incidence of TB in a teachinghospital in Istanbul, Turkey. This study is retrospective study of health
Caglar Cuhadaroglu; Mustafa Erelel; Levent Tabak; Zeki Kilicaslan
The Queen's Medical Center is a 540 bed tertiary care facility in Honolulu. It is a major teachinghospital of the University of Hawaii, a major trauma facility and cares for approximately 27% of all statewide medical\\/surgical admissions. In 1997, an internal group having clinical, managerial and technical skills began to evaluate commercial products appropriate to our needs. We quickly
Psychologists in medical schools, teachinghospitals, and academic medical centers are comparatively small in number, and are often undervalued and denied full practice privileges. As a profession, psychologists must therefore adapt to the realities of a physician-driven, physician-controlled environment. Psychologists’ adaptation to academic medical settings has been considered from several vantage points. An overlooked aspect of adaptation is psychologists’ knowledge
Tuberculosis is a common problem in developing countries including Nepal. Data regarding the safety profile of anti tubercular drugs is lacking in Nepal. The present study analyzed the pattern of ADRs caused by the antitubercular drugs. Inpatient files of all the TB patients who received treatment at the Manipal TeachingHospital, Pokhara, Nepal during the period from 1st January 2001
During a 13-month period, 11 equine patients visiting a veterinary teachinghospital for various diagnostic and surgical procedures developed postprocedural infections from which methicillin (oxacillin)-resistant Staphylococcus aureus (MRSA) strains were isolated. The S. aureus isolates were identified by conventional methods that included Gram staining, tests for colonial morphology, tests for clumping factor, and tests for coagulase and urease activities and
JENNIFER C. SEGUIN; ROBERT D. WALKER; JOHN P. CARON; WESLEY E. KLOOS; CAROL G. GEORGE; RICHARD J. HOLLIS; RONALD N. JONES; MICHAEL A. PFALLER
Background Unsafe health care provision is a main cause of increased mortality rate amongst hospitalized patients all over the world. A system approach to medical error and its reduction is crucial that is defined by clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury. The aim of this study was to develop and implement a risk management system in a large teachinghospital in Iran, especially of the basis of WHO guidelines and patient safety context. Methods WHO draft guideline and patient safety reports from different countries were reviewed for defining acceptable framework of risk management system. Also current situation of mentioned hospital in safety matter and dimensions of patient safety culture was evaluated using HSOPSC questionnaire of AHRQ. With adjustment of guidelines and hospital status, the conceptual framework was developed and next it was validated in expert panel. The members of expert panel were selected according to their role and functions and also their experiences in risk management and patient safety issues. The validated framework consisted of designating a leader and coordinator core, defining communications, and preparing the infrastructure for patient safety education and culture-building. That was developed on the basis of some values and commitments and included reactive and proactive approaches. Results The findings of reporting activities demonstrated that at least 3.6 percent of hospitalized patients have experienced adverse events and 5.3 percent of all deaths in the hospital related with patient safety problems. Beside the average score of 12 dimensions of patient safety culture was 46.2 percent that was considerably low. The “non-punitive responses to error” had lowest positive score with 21.2 percent. Conclusion It is of paramount importance for all health organizations to lay necessary foundations in order to identify safety risks and improve the quality of care. Inadequate participation of staff in education, reporting and analyzing, underreporting and uselessness of aggregated data, limitation of human and financial resources, punitive directions and management challenges for solutions were the main executive problems which could affect the effectiveness of system.
Background: Intestinal helminthiasis is common in our environment and antihelminthic drugs are specie specific. Thus, need to identify and characterize the species cannot be overemphasized. Objective: To determine the prevalence of Ascaris Lumbricoides in Enugu Metropolis. Methods: A cross-sectional survey of 361 subjects in Enugu metropolis was carried out in this study. A single stool sample was collected for examination from the subjects, using appropriately labelled clean specimen containers. The prevalence of Ascaris Lumbricodes was determined using the kato-katz method. Data was obtained using questionnaires which were administered by the researchers to mothers and extended family members living in the same household. Results: Out of the 361 single stool samples collected, from the subjects (made up of 154 samples from mothers, 156 samples from children, and 51 samples from extended family members), 69 subjects (made up of 30 mothers, 27 children and 12 extended family members) were infected with Ascaris lumbricoides, giving an overall prevalence of 19.1%. Prevalence among the mothers, children and extended family members were 19.5%, 17.3% and 23.5% respectively. Conclusion: There is a high prevalence of intestinal Ascaris lumbricoides among subjects living in Enugu metropolis. Attention should be given by the government to periodically carry out mass deworming exercise among households involving mothers, children and extended family members and indeed the whole members of each household.
This study sought to examine the safety of percutaneous coronary intervention (PCI) before and during de novo establishment of a transradial (TR) program at a teachinghospital. TR access remains underused in the United States, where cardiology fellowship programs continue to produce cardiologists with little TR experience. Establishment of TR programs at teachinghospitals may affect PCI safety. Starting in July 2009 a TR program was established at a teachinghospital. PCI-related data for academic years 2008 to 2009 (Y1) and 2009 to 2010 (Y2) were prospectively collected and retrospectively analyzed. Of 1,366 PCIs performed over 2 years, 0.1% in Y1 and 28.7% in Y2 were performed by TR access. No major complications were identified in 194 consecutive patients undergoing TR PCI, and combined bleeding and vascular complication rates were lower in Y2 versus Y1 (0.7% vs 2.0%, p = 0.05). Patients treated in Y2 versus Y1 and by TR versus transfemoral approach required slightly more fluoroscopy but similar contrast volumes and had similar procedural durations, lengths of stay, and predischarge mortality rates. PCI success rates were 97% in Y1, 97% in Y2, and 98% in TR cases. TR PCIs were performed by 13 cardiology fellows and 9 attending physicians, none of whom routinely performed TR PCI previously. In conclusion, de novo establishment of a TR program improved PCI safety at a teachinghospital. TR programs are likely to improve PCI safety at other teachinghospitals and should be established in all cardiology fellowship training programs. PMID:22245405
Leonardi, Robert A; Townsend, Jacob C; Bonnema, D Dirk; Patel, Chetan A; Gibbons, Michael T; Todoran, Thomas M; Nielsen, Christopher D; Powers, Eric R; Steinberg, Daniel H
A significant number of Brazilian gestational-age women are still not tested for HIV, representing a high risk of transmission to their newborns. The current study sought to identify the number of pregnant women with no previous testing or undocumented for HIV referred to the Gynecology and Obstetrics Department of a Regional TeachingHospital and included diagnosis of HIV infection determined by a rapid test and perinatal transmission in pregnancy. Medical records of all pregnant women admitted to hospital from January 2001 to December 2005 were reviewed. Pregnant women without HIV results were submitted to a rapid HIV test. Those who tested positive were further tested by ELISA and confirmed by indirect immunofluorescence assay (IIA) or Western blot (WB). The viral load from babies born to HIV-infected mothers was assessed by bDNA. Of the 16,424 pregnant women analyzed (6.6%), 1,089 were undocumented for HIV. Eleven women were positive in rapid testing and 10 were confirmed by ELISA, IIA or WB, with 0.9% seropositivity. Mother/infant pairs received zidovudine monotherapy prophylaxis and infant viral load was lower than 50 copies/mL. A higher number of pregnant women previously tested for HIV during antenatal care was verified, compared to that obtained nationwide. PMID:19893980
Prestes-Carneiro, Luiz Euribel; Miguel, Nadia Araújo; Ascêncio, Eloah Lopes; Amâncio, Marisa; Alcântara, Vera Lúcia Maria; Portelinha-Filho, José Alexandre
Objective.?To identify factors associated with hand hygiene compliance during a multiyear period of intervention. Design.?Observational study. Setting.?A 719-bed tertiary care teachinghospital. Participants.?Nursing, physician, technical, and support staff. Methods.?Light-duty staff performed hand hygiene observations during the period July 2008-December 2012. Infection control implemented hospital-wide hand hygiene initiatives, including education modules; posters and table tents; feedback to units, medical directors and the executive board; and an increased number of automated alcohol hand hygiene product dispensers. Results.?There were 161,526 unique observations; overall compliance was 83%. Significant differences in compliance were observed between physician staff (78%) and support staff (69%) compared with nursing staff (84%). Pediatric units (84%) and intensive care units (84%) had higher compliance than did medical (82%) and surgical units (81%). These findings persisted in the controlled multivariate model for noncompliance. Additional factors found to be significant in the model included greater compliance when healthcare workers were leaving patient rooms, when the patient was under contact precautions, and during the evening shift. The overall rate of compliance increased from 60% in the first year of observation to a peak of 96% in the fourth year, and it decreased to 89% in the final year, with significant improvements occurring in each of the 4 professional categories. Conclusions.?A multipronged hand hygiene initiative is effective in increasing compliance rates among all categories of hospital workers. We identified a variety of factors associated with increased compliance. Additionally, we note the importance of continuous interventions in maintaining high compliance rates. PMID:24113597
Kowitt, Benjamin; Jefferson, Julie; Mermel, Leonard A
The Generic BSC Nursing four years degree program is a great achievement of Pakistan Nursing Council (PNC). It was developed in collaboration with HEC (Higher Education Commission). There is an unprecedented shortage of nurse educators in the country. The course entitled NU361: Teaching and Learning: Principles and Practices, forms the foundation for educating students about teaching theory, principles and practices.
Purpose: To determine the prevalence and pattern of leukemic ophthalmopathy among adults at the University of Nigeria TeachingHospital (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.
An investigation was carried out during October 2005–September 2006 to determine the prevalence of bloodstream infections in patients attending the outpatient department of the HIV/AIDS clinic at the Lagos University TeachingHospital in Nigeria. Two hundred and one patients—86 males and 115 females—aged 14-65 years were recruited for the study. Serological diagnosis was carried out on them to confirm their HIV status. Their CD4 counts were done using the micromagnetic bead method. Twenty mL of venous blood sample collected from each patient was inoculated into a pair of Oxoid Signal blood culture bottles for 2-14 days. Thereafter, 0.1 mL of the sample was plated in duplicates on MacConkey, blood and chocolate agar media and incubated at 37 °C for 18-24 hours. The CD4+ counts were generally low as 67% of 140 patients sampled had <200 cells/?L of blood. Twenty-six bacterial isolates were obtained from the blood samples and comprised 15 (58%) coagulase-negative staphylococci as follows: Staphylococcus epidermidis (7), S. cohnii cohnii (1), S. cohnii urealyticum (2), S. chromogenes (1), S. warneri (2), S. scuri (1), and S. xylosus (1). Others were 6 (23%) Gram-negative non-typhoid Salmonella spp., S. Typhimurium (4), S. Enteritidis (2); Pseudomonas fluorescens (1), Escherichia coli (1), Ochrobactrum anthropi (1), Moraxella sp. (1), and Chryseobacterium meningosepticum. Results of antimicrobial susceptibility tests showed that coagulase-negative staphylococci had good sensitivities to vancomycin and most other antibiotics screened but were resistant mainly to ampicilin and tetracycline. The Gram-negative organisms isolated also showed resistance to ampicillin, tetracycline, chloramphenicol, and septrin. This study demonstrates that co-agulase-negative staphylococci and non-typhoidal Salmonellae are the most common aetiological agents of bacteraemia among HIV-infected adults attending the Lagos University TeachingHospital, Nigeria. The organisms were resistant to older-generation antibiotics often prescribed in this environment but were sensitive to vancomycin, cefotaxime, cefuroxime, and other new-generation antibiotics.
Background: As focus has shifted from the healthcare providers to the healthcare consumers; patient satisfaction is being increasingly used worldwide for the assessment of quality of services provided by healthcare institutions. To understand patient satisfaction, “patient’s perception” of care must first be understood. Of all the healthcare workers nurses spend maximum time with the patients. Therefore, the nurse is in a unique position to influence and promote effective consumer relationships. Though patient satisfaction surveys with nursing care are routinely conducted in the developed world to monitor and improve the quality of care, the same is not true for the developing world especially in the Indian subcontinent. Objective: To conduct a study of patient’s perception of nursing care in a large teachinghospital. Methods: A prospective study spread over a period of one year was carried out. Sample size consisted of seven percent of patients each admitted as emergency and routine. All the randomly selected patients were administered questionnaires, thus obtaining a sample size of 2600. Of these 2500 questionnaires were usable for data analysis (valid response rate of 81.6%). Results: The results of the study revealed a relatively higher percentage of patients with poor perception regarding ‘explanation and information’, and ‘caring attitude’ aspects of nursing care (31.6% and 11.5% respectively). However more than 95% patients had good perception of ‘responsiveness’, ‘availability’ and ‘ward organization’ capability of the nurse. Conclusion: Patient satisfaction surveys should become a regular outcome monitoring feature in all the hospitals. Also In-service training programs for nurses, with special emphasis on communication are need of the hour and should become a regular exercise.
Samina, Mufti; GJ, Qadri; Tabish, SA; Samiya, Mufti; Riyaz, R
A case-control study was undertaken to identify and quantify antimicrobial and nonantimicrobial drug risk factors associated with a sustained outbreak of Clostridium difficile diarrhea on two medical (teaching and nonteaching) units and an oncology unit. In total, 80 cases associated with an endemic clone of toxigenic C difficile were compared with controls. Eighty controls were selected from a group of 290 controls randomly chosen from the outbreak period. The controls were matched to cases according to age, admitting diagnosis and unit of admission. Seventy (88%) patients in the case group received at least one antibiotic before diarrhea, compared with 37 (46%) patients in the control group. Major risk factors implicated in the development of C difficile diarrhea in hospitalized patients were the following antimicrobial agents: ceftazidime (adjusted odds ratio [aor]=26.01, 95% ci 5.67 to 119.19, P=0.0001); cefuroxime (aor=5.17, ci 1.86 to 14.36, P=0.005); ciprofloxacin (aor=3.81, ci 1.05 to 13.79, P=0.04); and clindamycin (aor=15.16, ci 2.93 to 78.44, P=0.004). This is the first time that the use of ciprofloxacin has been linked to the development of C difficile diarrhea. Use of gastrointestinal drugs (ranitidine, famotidine, cimetidine, omeprazole and sucralfate) was also an added risk (aor=3.20, ci 1.39 to 7.34, P=0.01); however, antineoplastic therapy was not significant (P<0.53). Recognition of the specific high risk drugs may spur more restricted use of these agents, which may help in controlling C difficile diarrhea in hospitalized patients. PMID:22346513
Nath, S K; Salama, S; Persaud, D; Thornley, J H; Smith, I; Foster, G; Rotstein, C
Information on the use of drugs during pregnancy is scarce and rather anecdotal. Careful consideration of the benefit to the mother and the risk to the fetus is required when prescribing drugs during pregnancy. The aim of this study was to gain knowledge on this issue in western Nepal. 2156 prescriptions of pregnant women were collected at random from the antenatal care (ANC) in obstetrics out-patient department (OPD) at Manipal TeachingHospital (MTH), Nepal and analyzed for this study. The mean maternal age and hemoglobin concentration were 25 years and 12.21 g/dl, respectively. Twenty-three percent women attended obstetric OPD due to maternal disorders other than routine ANC (77%). Problem oriented drug use was due to nausea/vomiting (4.7%), dyspepsia (3.1%), and per vaginal spotting/bleeding (3.4%), mainly. Most of the women got 2-3 drugs and commonly included nutritional supplementation and tetanus toxoid. The average number of drugs/prescription was 2.00, 15.37% and 64.8% drugs were prescribed by generic name and as fixed dose combinations, respectively. The most commonly prescribed drugs were nutritional supplements like iron, folate, calcium, vitamins (72.8%), followed by tetanus toxoid (12.4%), gastrointestinals (5%), antimicrobials (4.6%), etc. Though, the selection of drugs was rational in most of the cases, some anomalies were observed and discussed with the clinicians. Our data reflect the general extent and prescribing pattern for those Nepalese pregnant women attending hospital in western Nepal. PMID:12733475
Any suboptimum treatment in the management of patients can lead to medication errors (MEs) that may increase morbidity and mortality in hospitalized individuals. By establishing well-designed patient care activities within the managed care setting, clinical pharmacists can cooperate with other health care professionals to provide quality care and maximize safety. The aim of this study was to evaluate the frequency and prevention of MEs by clinical pharmacists. This was a cross-sectional interventional study conducted in internal wards of a teachinghospital during a two-month period. During this period, patient records, and physician orders were reviewed by clinical pharmacists. Any prescription error identified was documented. Incorrect drug selection, dose, dosage form, frequency, or route of administration all were considered as medication errors. Then, the clinical pharmacist discuss about findings with the clinical fellows to change faulty orders. The frequency and types of MEs in different wards that were detected and prevented by clinical pharmacists was documented. During the study period, in 132 patients, 262 errors were detected (1.98 per each). Wrong frequency 71 (27%), forget to order 37 (14.1%), wrong selection 33 (12.5%), drug interactions 26 (9.9%), forget to discontinue 25 (9.5%) and inappropriate dose adjustment in renal impairment 25 (9.5%) were the most types of errors. Cardiovascular medications were the class with the highest detected errors (31.6%) followed by gastrointestinal agents (15.6%). Medication errors are common problems in medical wards that their frequency can be restricted by the intervention of clinical pharmacists. PMID:23945894
Objectives: Adverse drug reactions (ADRs) to psychotropic agents are common and can lead to noncompliance or even discontinuation of therapy. There is paucity of such data in the Indian context. We deemed it worthwhile to assess the suspected ADR profile of psychotropic drugs in an ambulatory setting in a public teachinghospital in Kolkata. Materials and Methods: A longitudinal observational study was conducted in the outpatient department (OPD) of the concerned psychiatry unit. Twenty consecutive patients per day, irrespective of their psychiatric diagnosis, were screened for suspected ADRs, 2 days in a week, over 15 months. Adverse event history, medication history and other relevant details were captured in a format as adopted in the Indian National Pharmacovigilance Programme. Causality was assessed by criteria of World Health Organization-Uppsala Monitoring Center (WHO-UPC). Results: We screened 2000 patients (68.69% males, median age 34.4 years), of whom 429 were suspected of having at least one ADR; 84 cases had insufficient evidence about causality (WHO-UMC causality status “unlikely”) and were excluded from further analysis. Thus, 17.25% (95% confidence interval: 15.59-18.91%) of our study population reported ADRs with at least “possible” causality. Of 352 events recorded, 327 (92.90%) were “probable” and the rest “possible”. None was labeled “certain” as rechallenge was not performed. Patients received a median of 3.2 psychotropic drugs each. Thirty-three different kinds of ADRs were noted, including tremor (19.60%), weight gain (15.34%) and constipation (14.49%). Among the incriminated drugs, antipsychotics represented the majority (57.10%), with olanzapine topping the list. Conclusions: This study offers a representative profile of ADRs to be expected in psychiatry out-patients in an Indian public hospital. Establishment of a psychotropic drug ADR database can be a worthy long-term goal in the Indian context.
Background: Hypertension in Nigeria is a widespread problem of immense social and economic importance because of its high prevalence and the severity of its complications. Aim: To define the morbidity and mortality pattern of hypertension at the University of Port Harcourt TeachingHospital (UPTH). Method: Records of all patients admitted to the medical wards of the UPTH over a 5-year period with essential hypertension or any of its complications were retrieved from the ward and medical records and reviewed. Result: A total of 780 hypertensive patients were reviewed, constituting 28.2% of all medical admissions. Only 424 (15.2%) had complete records and were analyzed. Record keeping was poor. There were 173 (41%) males and 251 (59%) females with a male to female ratio of 1:1.5. The ages ranged from 18 years to 100 years with a mean of 56.5 ± 16.2. Stroke was responsible for 169 (39.9%) hypertensive complications. Heart failure occurred in 97 (22%) cases while renal failure and encephalopathy accounted for 40 (9.4%) and 7 (1.7%) hypertensive complications respectively. There were 99 deaths out of which 51 (51.5%) were due to stroke, 14 (14.12%) were due to heart failure, and 12 (12.1%) were due to renal failure. Conclusion: The contribution of systemic hypertension to the morbidity and mortality of adults at UPTH is quite significant.
Background Abdominal surgical site infections are among the most common complications of inpatient admissions and have serious consequences for outcomes and costs. Different risk factors may be involved, including age, sex, nutrition and immunity, prophylactic antibiotics, operation type and duration, type of shaving, and secondary infections. This study aimed to determine the risk factors affecting abdominal surgical site infections and their incidence at Imam Khomeini, a major referral teachinghospital in Iran. Methods Patients (n = 802) who had undergone abdominal surgery were studied and the relationships among variables were analyzed by Student's t and Chi-square tests. The subjects were followed for 30 days and by a 20-item questionnaire. Data were collected through pre- and post-operative examinations and telephone follow-ups. Results Of the 802 patients, 139 suffered from SSI (17.4%). In 40.8% of the cases, the wound was dirty infected. The average age for the patients was 46.7 years. The operations were elective in 75.7% of the cases and 24.7% were urgent. The average duration of the operation was 2.24 hours, the average duration of pre-operative hospital stay 4.31 days and the average length of (pre- and post-operation) hospital stay 11.2 days. Three quarters of the cases were shaved 12 hours before the operation. The increased operation time, increased bed stay, electivity of the operation, septicity of the wound, type of incision, the administration of prophylactic antibiotic, type of operation, background disease, and the increased time lapse between shaving and operation all significantly associated with SSI with a p-value less than 0.001. Conclusion In view of the high rate of SSI reported here (17.4% compared with the 14% quoted in literature), this study suggests that by reducing the average operation time to less than 2 hours, the average preoperative stay to 4 days and the overall stay to less than 11 days, and approximating the timing of shaving to the operation and substituting cefazolin for cefaluthin when prophylactic antibiotic is to be administered, the SSI may be reduced to a more acceptable level.
Razavi, Seyd Mansour; Ibrahimpoor, Mohammad; Sabouri Kashani, Ahmad; Jafarian, Ali
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 TeachingHospital, 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
Objectives: To evaluate potential changes of infective endocarditis (IE) in patients treated in a Finnish teachinghospital during the past 25 years. Patients: 326 episodes of IE in 303 patients treated during 1980-2004 were evaluated for clinical characteristics and their changes over time. Results: The mean age of the patients increased with time (from 47.2 to 54.5 years, p =
M Heiro; H Helenius; S Makila; U Hohenthal; T Savunen; E Engblom; J Nikoskelainen; P Kotilainen
From February 1999 to January 2000, a control programme to prevent the spread multi-resistant bacteria (MRB) was implemented in a French teachinghospital. This programme focused on methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae producing extended-spectrum ?-lactamases (ESBL), and was based on the application of barrier precautions (washing hands with antiseptic soaps, wearing disposable gloves and gowns, identifying MRB carriers). No
M Eveillard; F Eb; B Tramier; J. L Schmit; F.-X Lescure; M Biendo; B Canarelli; F Daoudi; G Laurans; F Rousseau; D Thomas
Background: The national policy on malaria control recommends use of intermittent preventive treatment with sulfadoxine/pyrimethamine (IPT-SP) for chemoprophylaxis against malaria in pregnancy; and use of quinine and arthemisinin-based combination therapy (ACT) for acute treatment of malaria in the first, and second/third trimesters, respectively. In Nigeria, a large proportion of pregnant women are seen by the general practitioners (GPs). Objective: To determine the pattern of anti-malaria prescription in pregnancy among GPs in Enugu state, and access the level of conformity with the national policy on malaria control. Materials and Methods: Questionnaires were administered to a cross-section of 147 GPs that attended the 2010 Enugu state branch of the Nigeria Medical Association Scientific Conference/Annual General Meeting/Election. Results: The mean age of the GPs was 37 ± 3.6 (range 27-70) years. Quinine was the commonly (45.6% (n = 67)) prescribed anti-malaria drug in the first trimester while in the second/third trimester ACT was commonly (48.3% (n = 71)) prescribed. Seventy-six (51.7%) practitioners prescribed IPT-SP for chemoprophylaxis against malaria while the rest (48.3%) prescribed other drugs. GPs who obtained MBBS qualification less than or equal to 5 years prior to the survey were more likely to comply with the national policy on malaria control in their prescriptions (P < 0.05). Conclusion: The pattern of anti-malaria prescription among GPs in Enugu state is varied, and conformed poorly to the evidence-based national policy on malaria control. There is need for continuing professional development to keep the GPs abreast with current trends in malaria treatment during pregnancy.
Ugwu, Emmanuel Onyebuchi; Iferikigwe, E. S.; Obi, S. N.; Ugwu, A. O.; Agu, P. U.; Okezie, O. A.
|This report evaluates the Department of Health and Human Services PATH (Physicians at TeachingHospitals) initiative involving audits of Medicare billing processes and procedures. The PATH audits resulted from concerns that medical records did not adequately document the direct involvement of teaching physicians in services provided by resident…
General Accounting Office, Washington, DC. Health, Education, and Human Services Div.
This report evaluates the Department of Health and Human Services PATH (Physicians at TeachingHospitals) initiative involving audits of Medicare billing processes and procedures. The PATH audits resulted from concerns that medical records did not adequately document the direct involvement of teaching physicians in services provided by resident…
General Accounting Office, Washington, DC. Health, Education, and Human Services Div.
The objective of this study was to determine the waiting time to conception among a sample of pregnant Igbo women resident in an urban area of South-east Nigeria. This was a cross-sectional questionnaire study of antenatal clinic attendees at four major health institutions within Enugu, South-eastern Nigeria. The time to conception showed a pattern closer to that of the USA than that of the UK and is consistent with high fertility previously recorded in the Igbo population. We conclude that the data will be useful in counselling women who present with difficulty in conception. PMID:19603320
This work presents the ground-base measurement of aerodynamic diameter of atmospheric Aerosols captured in Nsukka, Enugu State during the harmattan period of February to nonharmattan period of April 2004. Addition of harmful substances such as aerosols to the atmosphere results in pollution of the environment, bad effects on human health, and quality of life. These effects are quantified when the aerodynamic diameter is determined. A comprehensive research has been carried out on the particle sizes of the captured aerosols in Nsukka Environ. Power-law and Statistical models were employed in the analysis and some control strategies were considered.
Since 1986 medical students at the University Children's Hospital Essen are trained as peers in a two week intensive course in order to teach basic paediatric examination techniques to younger students. Student peers are employed by the University for one year. Emphasis of the peer teaching program is laid on the mediation of affective and sensomotorical skills e.g. get into contact with parents and children, as well as manual paediatric examination techniques. The aim of this study is to analyse whether student peers are able to impart specific paediatric examination skills as good as an experienced senior paediatric lecturer. 123 students were randomly assigned to a group with either a senior lecturer or a student peer teacher. Following one-hour teaching-sessions in small groups students had to demonstrate the learned skills in a 10 minute modified OSCE. In comparison to a control group consisting of 23 students who never examined a child before, both groups achieved a significantly better result. Medical students taught by student peers almost reached the same examination result as the group taught by paediatric teachers (21,7±4,1 vs. 22,6±3,6 of 36 points, p=0,203). Especially the part of the OSCE where exclusively practical skills where examined revealed no difference between the two groups (7,44±2,15 vs. 7,97±1,87 of a maximum of 16 points, p=0,154). The majority of students (77%) evaluated peer teaching as stimulating and helpful. The results of this quantitative teaching study reveal that peer teaching of selected skills can be a useful addition to classical paediatric teaching classes. PMID:23737922
Büscher, Rainer; Weber, Dominik; Büscher, Anja; Hölscher, Maite; Pohlhuis, Sandra; Groes, Bernhard; Hoyer, Peter F
BACKGROUND Improving hospital discharge has become a national priority for teachinghospitals, yet little is known about physician perspectives on factors limiting the quality of discharge care. OBJECTIVES To describe the discharge process from the perspective of housestaff physicians, and to generate hypotheses about quality-limiting factors and key strategies for improvement. METHODS Qualitative study with in-depth, in-person interviews with a diverse sample of 29 internal medicine housestaff, in 2010–2011, at 2 separate internal medicine training programs, including 7 different hospitals. We used the constant comparative method of qualitative analysis to explore the experiences and perceptions of factors affecting the quality of discharge care. RESULTS We identified 5 unifying themes describing factors perceived to limit the quality of discharge care: (1) competing priorities in the discharge process; (2) inadequate coordination within multidisciplinary discharge teams; (3) lack of standardization in discharge procedures; (4) poor patient and family communication; and (5) lack of postdischarge feedback and clinical responsibility. CONCLUSIONS Quality-limiting factors described by housestaff identified key processes for intervention. Establishment of clear standards for discharge procedures, including interdisciplinary teamwork, patient communication, and postdischarge continuity of care, may improve the quality of discharge care by housestaff at teachinghospitals.
Greysen, S. Ryan; Schiliro, Danise; Horwitz, Leora I.; Curry, Leslie; Bradley, Elizabeth H.
Introduction It is unknown whether the reported short-term reduction in cardiac arrests associated with the introduction of the medical emergency team (MET) system can be sustained. Method We conducted a prospective, controlled before-and-after examination of the effect of a MET system on the long-term incidence of cardiac arrests. We included consecutive patients admitted during three study periods: before the introduction of the MET; during the education phase preceding the implementation of the MET; and a period of four years from the implementation of the MET system. Cardiac arrests were identified from a log book of cardiac arrest calls and cross-referenced with case report forms and the intensive care unit admissions database. We measured the number of hospital admissions and MET reviews during each period, performed multivariate logistic regression analysis to identify predictors of mortality following cardiac arrest and studied the correlation between the rate of MET calls with the rate of cardiac arrests. Results Before the introduction of the MET system there were 66 cardiac arrests and 16,246 admissions (4.06 cardiac arrests per 1,000 admissions). During the education period, the incidence of cardiac arrests decreased to 2.45 per 1,000 admissions (odds ratio (OR) for cardiac arrest 0.60; 95% confidence interval (CI) 0.43–0.86; p = 0.004). After the implementation of the MET system, the incidence of cardiac arrests further decreased to 1.90 per 1,000 admissions (OR for cardiac arrest 0.47; 95% CI 0.35–0.62; p < 0.0001). There was an inverse correlation between the number of MET calls in each calendar year and the number of cardiac arrests for the same year (r2 = 0.84; p = 0.01), with 17 MET calls being associated with one less cardiac arrest. Male gender (OR 2.88; 95% CI 1.34–6.19) and an initial rhythm of either asystole (OR 7.58; 95% CI 3.15–18.25; p < 0.0001) or pulseless electrical activity (OR 4.09; 95% CI 1.59–10.51; p = 0.003) predicted an increased risk of death. Conclusion Introduction of a MET system into a teachinghospital was associated with a sustained and progressive reduction in cardiac arrests over a four year period. Our findings show sustainability and suggest that, for every 17 MET calls, one cardiac arrest might be prevented.
Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi (previously called Rickettsia tsutsugamushi). The severity of this disease varies from only mild symptoms to death, and its manifestations are nonspecific. Therefore, clinicians may not correctly diagnose scrub typhus early enough for successful treatment. Reports of infections in travelers returning from Asia to their home countries are increasingly common. Thus, it is important that even clinicians in nonepidemic regions be alert for this disease. Here we describe the epidemiological aspects and clinical manifestations of scrub typhus encountered at a teachinghospital in Penghu, Taiwan, over the past 5 years. A total of 126 patients were confirmed to be positive for scrub typhus at the hospital from 2006 to 2010. All cases were confirmed by the Centers for Disease Control and Prevention or its contract laboratory through pathogen isolation and an indirect immunofluorescence assay. Medical records of these patients were reviewed, and demographic and clinical characteristics, laboratory data, seasonal data, geographic distribution, complications, and outcome were analyzed. The incidence of scrub typhus peaked in individuals aged 0-10 and 51-60 years, with the highest incidence among those ?10 years of age. No significant difference was noted between sexes. Fever was the most common symptom (93.6%), followed by chills (23.8%), cough (18.3%), and headache (14.3%). Eschars were observed in 78 (61.9%) patients, with the axilla being the most frequent site (n=17; 21.8%). Most patients were retirees (n=63; 50%), followed by students (n=16; 12.7%). Patients were more likely to live in rural areas than urban areas. Scrub typhus was epidemic in the spring (April to June) and fall (October to December) in a bimodal distribution similar to that observed in Japan. Leukocytosis was not common, but most patients had abnormal C-reactive protein levels, thrombocytopenia, and elevated liver function test results. Residents of Penghu, particularly Makung City and Husi Township, as well as travelers to the region during the spring and fall seasons should be educated about the signs and symptoms of scrub typhus. All physicians who come into contact with individuals residing in or traveling to or from epidemic regions should remain alert about the manifestations of this disease. PMID:23421889
OBJECTIVE: To determine the effect of a preprinted perioperative antimicrobial prophylaxis order form on the appropriateness, standardization and cost of surgical prophylaxis. DESIGN: A pre- and postintervention prospective study with evaluation of drug acquisition costs in selected surgical procedures. SETTING: A 420-bed teachinghospital in the Hamilton-Wentworth region. PATIENTS: A three-month survey of 901 consecutive patients followed by a two-month trial period of 725 consecutive patients undergoing general surgery, orthopedic and urological procedures. INTERVENTION: A perioperative antimicrobial prophylaxis order form was developed based on guidelines from the literature and input from physician and nursing staff. The form was introduced through educational inservices and put into operation. MEASUREMENT: The measurement of antimicrobial perioperative prophylaxis appropriateness and drug acquisition costs were assessed pre- and postintroduction of the order form. Subsequently, prescriber compliance and satisfaction with the program were also evaluated. RESULTS: Appropriateness of perioperative antimicrobial surgical prophylaxis was increased from 36% in the baseline period to 79% in the trial period (P<0.0001). A reduction of $440.71 ($23.20/procedure) in drug acquisition costs was observed for 19 matched hip and knee prosthetic surgical procedures between the baseline and trial periods. In addition, compliance with the perioperative order form rose steadily during the trial period. Physician prescribers reported that the form was used, and was appropriate and user-friendly but that it did not influence their prescribing habits. Nurses responded that the form was helpful and improved the timing of prophylaxis. CONCLUSIONS: The perioperative antimicrobial prophylaxis order form standardized antimicrobial administration time and resulted in an increase in appropriateness. A reduction in antimicrobial costs for surgical procedures was realized. This quality improvement project has enhanced the quality of patient care.
Objective: Magnesium level is known to decline during pregnancy. A suggested role for magnesium deficiency in conditions like pre-eclampsia and pre-term birth has prompted studies with conflicting evidence. The primary objective of this study was to determine the prevalence of hypomagnesemia in pregnancy, while the secondary objectives attempted to define maternal and fetal outcome due to hypomagnesemia. Subjects and Methods: A pilot study was performed to determine the mean serum magnesium level for the population of female patients attending the University of Benin TeachingHospital. The result of the pregnant population in the pilot study was used as a reference for hypomagnesemia in this study. Thereafter, a prospective cohort study of antenatal women recruited in the second trimester and followed-up till delivery and 1 week post-partum was done. Serum magnesium estimates were done with samples collected at recruitment and delivery. The magnesium levels determined at recruitment were used to divide the subjects into two groups of hypomagnesemic and normomagnesemic patients. Their sociodemographic and clinical characteristics were used to generate a database for analysis. Results: The prevalence of magnesium deficiency was 16.25%. Hypomagnesemia was significantly correlated with the occurrence of pre-eclampsia ( P = 0.011), leg cramps ( P = 0.000) and pre-term birth ( P = 0.030). A logistic regression analysis showed that hypomagnesemia had an Odds ratio of 22 for pre-eclampsia. There was no maternal mortality or early neonatal death. Conclusion: Pre-eclampsia and pre-term birth are associated with hypomagnesemia in pregnancy; hence, magnesium supplementation or magnesium-rich diet consisting of green leafy vegetables, soy milk and legumes may improve outcome. PMID:23974737
AIM: To assess the role of a quality assurance programme in improving the service provided by a surgical pathology department. METHODS: A continuous internal quality assurance study of the activities of an anatomical pathology department in an Australian teachinghospital was undertaken over a five year period. This addressed all steps involved in the production of a surgical pathology report. These were addressed in an open forum which included technical, scientific, clerical, and medical staff. Minor errors not needing immediate action were discussed and incorporated into laboratory practice. For major discrepancies with potential implications for patient management supplementary reports were issued and the relevant clinician informed of the outcome. RESULTS: Comprehensive peer review of 8.9% of the total workload of the department (3530 cases) and all the frozen sections (916 cases) over a period of five years, beginning in 1991, led to comments on some aspects of the original report by the reviewer in 19.6% of the cases. The great majority of the comments were minor, concerning issues related to the microscopic findings (4%), macroscopic description (3.1%), clerical aspects (3%), typographical errors (3%), coding errors (2.7%), technical errors including poor sections and incorrect labelling (1.7%), inadequate clinical history (1.2%), and incomplete or incomprehensible diagrams (0.9%). In two cases (0.05%) the original report did not state proximity of the tumour to surgical margins and in three of the frozen sections (0.3%) the original diagnosis was incorrect. However, in these cases the frozen section assessment did not alter the overall management of the cases. CONCLUSIONS: This study highlights the importance of a review system in detecting errors in surgical pathology reporting. Recognition of the fact that surgical pathology is not infallible has improved the end product. It has also minimised interobserver variability in the department, resulting in a uniform approach among the pathologists to macroscopic description, specimen sampling, special stains, and histological reporting.
Since there is no detailed hospital based incident reporting system, this study was designed to evaluate the medication errors associated with infusion pumps in intensive care unit (ICU). The investigation was conducted in a Teachinghospital in the form of a prospective, observational study. A sample size of 43 doses administered to ICU patients was chosen to enable reliable estimate
Fanak Fahimi; Mohammad Sistanizad; Ramin Abrishami; Shadi Baniasadi
Background Parents and Health Care Workers have traditionally attributed a variety of symptoms to teething in young children. Some of these symptoms may however connote underlying serious medical condition in a child. There is little evidence to support these beliefs despite their implications on management of a symptomatic teething child. This study therefore seeks determine the beliefs and problems mothers associate with teething in Enugu, South-east Nigeria. Findings A cross-sectional survey involving sixty mothers presenting at a Children's clinic in Enugu metropolis using questionnaire. More than 90% of the respondents thought that babies can experience medical problems as a result of teething. The commonest medical problems perceived to be associated with teething were fever (71.7%), loose stools (58.3%) and vomiting (35%). Conclusion Mothers still associate a variety of symptoms of childhood illnesses to teething and this association is not evidence based and could lead to delayed interventions, increased morbidity and mortality of children. It is important therefore that mothers and health workers caring for young children are educated on the need to seek prompt medical attentions in a symptomatic child.
Background A retrospective utilization study was performed to evaluate utilization patterns for enteral nutrition in a university teachinghospital. Methods Enteral nutrition was divided into three types according to the nitrogen source, ie, total protein type [Nutrison Fibre®, Fresubin Energy Fibre®, Fresubin®, Supportan® (a special immunonutrition for cancer patients or patients with increased demands for omega-3 fatty acids), Fresubin Diabetes® (a diabetes-specific formula), Ensure®]; short peptide type (Peptison®); and amino acid type (Vivonex®). A pharmacoeconomic analysis was done based on defined daily dose methodology. Results Among hospitalized patients taking enteral nutrition, 34.8% received enteral nutrition alone, 30% concomitantly received parenteral nutrition, and 35.2% received enteral nutrition after parenteral nutrition. Combined use of the different formulas was observed in almost all hospitalized patients receiving enteral nutrition. In total, 61.5% of patients received triple therapy with Nutrison Fibre, Fresubin Diabetes, and Supportan. Number of defined daily doses (total dose consumed/defined daily dose, also called DDDs) of formulas in descending order were as follows: Nutrison Fibre, Fresubin Energy Fibre, Fresubin Diabetes > Supportan > Peptison, Ensure > Vivonex, Fresubin. The ratio of the cumulative DDDs for the three types of enteral nutrition was 35:2.8:1 (total protein type to short peptide type to amino acid type). Off-label use of Fresubin Diabetes was also observed, with most of this formula being prescribed for patients with stress hyperglycemia. Only 2.1% of cancer patients received Supportan. There were 35 cases of near misses in dispensing look-alike or sound-alike enteral nutrition formulas, and one adverse drug reaction in an elderly malnourished patient who did not receive vitamin K1-enriched enteral nutrition during treatment with cefoperazone. After 4 months of the trial intervention, off-label use of Fresubin Diabetes was no longer endorsed by the Drug and Therapeutics Committee for nondiabetic patients, and the proportion of this formula prescribed for patients with stress hyperglycemia decreased by 20%, with a 10-fold increase in the amount of Supportan prescribed for cancer patients. Near misses in dispensing look-alike or sound-alike enteral nutrition were successfully abolished, and no severe coagulation disorders occurred after prophylactic administration of vitamin K1-enriched enteral nutrition in elderly malnourished patients receiving cefoperazone. Conclusion This utilization study indicates that continuous quality improvement is necessary and that a Drug and Therapeutics Committee can play an important role in promoting rational and safe use of enteral nutrition. Appropriateness of this therapy still needs to be improved, especially in addressing the issues of non-evidence-based combined use of multiple enteral nutrition formulas, the relatively high rate of concomitant use of enteral and parenteral nutrition, off-label use of diabetes-specific Fresubin Diabetes, insufficient use of Supportan in cancer patients, and unnecessary use of Supportan in intensive care patients not suffering from cancer.
The "teach-back" process is a comprehensive, interdisciplinary, evidence-based strategy which can empower nursing staff to verify understanding, correct inaccurate information, and reinforce medication teaching and new home care skills with patients and families. The Evidence-Based Practice Fellows at Children's Hospital of Wisconsin designed and implemented an educational intervention for nurses on "teach-back" which encouraged nurses to check for patients' and caregivers' understanding of discharge instructions prior to discharge. Pre and post survey data collected from nurses specifically demonstrated the positive effect "teach-back" could have on preventing medication errors while also simultaneously identifying areas for further study. PMID:23220377
Kornburger, Cheryl; Gibson, Cori; Sadowski, Sandra; Maletta, Kristyn; Klingbeil, Carol
Background: The safety and protection of patients and health care workers is of paramount importance in dentistry, and this includes students in training who provide clinical care. Given the nature of dental care, adverse incidents can and do occur, exposing health care workers to body fluids and putting them at risk of infection, including contracting a blood-borne virus. The aim of this research was to analyze trends in the volume, rate, nature, management, and outcome of adverse incidents reported at one dental teachinghospital from 2005 to 2010. Methods: Descriptive analysis of trends in the volume, rate, nature, management, and outcome of adverse incidents reported at one dental teachinghospital over a six-year period was undertaken in relation to the level of outpatient and day surgery activity. Results: In total, 287 incidents were reported over a six-year period, which amounted to 0.039% of outpatient or day surgery appointments. Nearly three quarters of all the incidents (n = 208, 72%) took place during treatment or whilst clearing away after the appointment. The most frequent incidents were associated with administration of local anesthetic (n = 63, 22%), followed by burs used in dental hand pieces (n = 51, 18%). Conclusion: This research confirms that adverse incidents are a feature of dental hospitals and reports the common sources. The importance of accurate and consistent reporting of data to ensure that these issues are monitored to inform action and reduce risks to staff, students, and patients are highlighted.
ObjectiveTo determine the availability of computerized physician order entry (CPOE) and electronic medical record (EMR) systems in teaching and general hospitals in the Republic of Korea.DesignA combined mail and telephone survey of 283 hospitals.MeasurementsThe surveys assessed the availability of CPOE and EMRs in the hospitals, as well as inducement, participation, and saturation regarding CPOE use by physicians.ResultsA total of 122
Rae Woong Park; Seung Soo Shin; Young In Choi; Jae Ouk Ahn; Sung Chul Hwang
Objective: To find out if there was a difference between hospital consultants, all trained in acute general medicine, in length of stay (LOS), re-admission rates, resource utilisation, and diagnostic coding, among patients admitted as emergencies to St James' Hospital (SJH) Dublin. Methods: A retrospective analysis was performed of data on discharges from hospital, recorded in the hospital in-patient enquiry (HIPE) system, relating to 9204 episodes among 6968 emergency medical patients admitted to SJH between 1 January 2002 and 31 October 2003. For comparative analysis, four physician groups were defined consisting of gastroenterology (GI, n = 4), respiratory (n = 3), general internal medicine (GIM, n = 2), or specialty (n = 5). Results: GIM consultants had the shortest LOS (median 5 days); GIM and respiratory consultants were less likely to have long stay patients (> 30 days, p<0.0001). Patients re-admitted under the same consultant had a longer LOS than those re-admitted under a different consultant (p<0.0001). Endoscopy and GI radiology investigations were used most by GI consultants, computed tomography of the thorax by respiratory, ECHO by respiratory and specialty, and computed tomography of brain by GIM and specialty consultants. GI diagnostic codings were more frequent with GI consultants (p<0.0001), respiratory diagnoses and malignancy with respiratory (p<0.0001 for both), diabetes and hypertension with specialty (p = 0.0017), and heart failure more with GIM consultants (p = 0.001). Conclusions: This study found that the HIPE database was very powerful in predicting differences between hospital consultants in LOS, re-admission rates, resource utilisation, and disease coding. It would be of interest to examine the extent to which protocols and guidelines could reduce such variations.
Moloney, E; Smith, D; Bennett, K; O'Riordan, D; Silke, B
Study objective: To describe the experience of croup at Princess Margaret Hospital for Children (PMH), the only tertiary pediatric hospital in Western Australia, from 1980 through 1995 with reference to the introduction of routine steroid treatment in the ICU in 1989, in the general hospital wards from 1989 through 1993, and in the emergency department observation ward in 1993. Methods:
Aim: To determine the types of functional disabilities in adult and paediatric burns survivors, with specific emphasis on potential risk and socio-economic factors of burn disabilities present in Ghana. Patients and Methods: The descriptive study was carried out in Komfo Anokye TeachingHospital, Kumasi, Ghana from May 2011 to April 2012. Burn survivors who came for follow-up visits after been discharged home and had functional disability were the participants of the study. They were physically examined and interviewed using a pre-tested questionnaire after their informed consent/or that of their parents (in the cases of paediatrics burns survivors) was sought. Results: A total of 70 participants consented for the study. Their ages ranged from 8/12 – 78 years, with a mean age of 12±1.7 years. Majority (60.0%, N=42) of the participants had third degree burns. The nature of disabilities of participants were mostly scar contractures (42.9%, N=30) of which 36.7% (N=11) had impeded arm elevation; 23.3% (N=7) could not fold the palm or move the digits. From the multiple regression analysis risk factors for burn victim to have disability were paediatric age (OR=11.1, P=0.043), third degree of burn (OR=6.2, P=0.001) and anatomical part affected (OR=18.3, P=0.031). Socio-economic factors that affected burn disability victims were nuclear family compensation (OR=4.2, P=0.021), community mockery/stigmatization (OR=0.1, P=0.052) and caretakers time and finance (OR=5.2, P=0.033). Conclusion: The commonest functional disabilities recorded were scar contractions of the axilla region which had impeded the ability of the patients to lift the arm. Risk factors for burns disability included childhood age, third degree of burn incurred and anatomical part affected. Social factors influencing the lives of burn survivors with disability were good family and negative community interactions. Significant economical factors recorded were caretakers’ time and financial constrains.
BACKGROUND: Management of burns patients before May 2009 was very difficult at the Komfo Anokye TeachingHospital (KATH). AIM: To compile burns patients' information in the new Burns Intensive Care Unit (BICU), analyze it and draw comparisons to information from the old BICU at KATH. METHODS: This retrospective study involves data from May 2007 to April 2009 (Group 1 -old BICU) and May 2009 to April 2011 (Group 2 -new BICU). The parameters of burn patients recorded included: record of admission, gender, age, aetiology of injury, Total Burns Surface Area (TBSA), the patients' treatment regime and record of discharge/death. This information was analyzed with SPSS version 18.0. RESULTS: The total number of patients in the study was 511; Group 1 constituted 47.36% (n=242) patients; males (n=307, 61%) outnumbering females (n=204, 39%). The overall mean, median and interquartile range (IQR) ages of the patients were 12.4±2; 9.5 and 18.0 years respectively. The main aetiology of burns in Group 1 was flame burns (n=115, 47.5%) and for Group 2 was scald (n=151, 56.1%). The median TBSA recorded for Groups 1 and 2 were 32% and 41% respectively. A mortality rate of 19.1% (n=46) and 12.7% (n=34) were recorded for Groups 1 and 2 respectively which was statistically significant (p<0.05). We found no differences for age and TBSA (P=0.7168 and P=0.8020 respectively). A Chi Square analysis for gender and aetiology of burn revealed no significant difference between Groups 1 and 2. A risk factor analysis for mortality within the Groups (using multiple regression analysis) identified only aetiology of burn in Group 1 to be a factor (P=0.044). CONCLUSION: This comparative study reveals that a significant difference in mortality was recorded for both groups. The mortality difference does not appear to be due to socio-demographic features. This study may demonstrate that modernized and advanced equipment with the adequate personnel play an essential role in burn management in low income countries such as Ghana. PMID:23623216
Purpose We conducted a prospective survey of 2?663 surgical patients in a Japanese teachinghospital to look for any risk factors\\u000a predisposing to surgical site infection (SSI) other than the National Nosocomial Infection Surveillance (NNIS) System risk\\u000a indices; namely, performance status, operative time, wound classification, and endoscopic use.\\u000a \\u000a \\u000a \\u000a Methods Our Infection Control Team recorded data for 5 years using the Japanese SSI
Among 15 174 non-duplicated Enterobacteriaceae isolates, the prevalence of carbapenem-nonsusceptible Enterobacteriaceae (CNSE) was about 2.5% at a teachinghospital in Taiwan during 2010. Among 117 available isolates of CNSE, 8.6% carried genes encoding carbapenemases. Tigecycline and colistin were the most active agents against carbapenemase-producing and non-producing isolates. Patients infected with CNSE had an all-cause in-hospital mortality of 37.3%, and mortality was similar for infections from carbapenemase producers and non-producers (14-day mortality rates: 22.2% and 21.5%; 30-day mortality rates: 22.2% and 32.3%, respectively). Continuous surveillance of CNSE is recommended in Taiwan. PMID:24016614
We studied a sample of 302 inpatients from all medical and surgical wards of Westmead Hospital. Twenty-six per cent of patients (47% of men and 4% of women) were identified as past or current "at-risk" drinkers. Current drinkers preponderantly were male and were more likely to be admitted to hospital with trauma. Apart from trauma, alcohol-related disease was not diagnosed commonly, and most drinkers were admitted to hospital with diagnoses that were not related clearly to alcohol abuse. Hospital medical staff members appeared reluctant to address alcohol abuse; a low rate of alcohol problems was identified, and alcohol-related diseases appeared to be underdiagnosed. PMID:2902509
Hand washing is widely accepted as the cornerstone of infection control in the intensive care unit (ICU). Nosocomial infections are frequently viewed as indicating poor compliance with hand washing guidelines. To determine the hand hygiene (HH) compliance rate among healthcare workers (HCWs) and its effect on the nosocomial infection rates in the ICU of our hospital, we conducted an interventional study. The study spanned a period of 7 months (February 2011-August 2011) and consisted of education about HH indications and techniques, workplace reminder posters, focused group sessions, and feedback on the HH compliance and infection rates. The WHO HH observation protocol was used both before and after a hospital-wide HH campaign directed at all staff members, particularly those in the ICU. Compliance was measured by direct observation of the HCWs, using observation record forms in a patient-directed manner, with no more than two patients observed simultaneously. The overall HH compliance rate was calculated by dividing the number of HH actions by the total number of HH opportunities. The nosocomial infection rates for the pre- and post-interventional periods were also compared to establish the effect of the intervention on rate of infections acquired within the unit. The overall rate of HH compliance by all the HCWs increased from 42.9% pre-intervention to 61.4% post-intervention, P<0.001. Individually, the compliance was highest among the nurses, 49.9 vs. 82.5%, respectively (P<0.001) and lowest among the doctors, 38.6 vs. 43.2%, respectively (P=0.24). The effect of the increase in the HH compliance rate on the nosocomial infection rate was remarkable. There were significant reductions in the following: the rate of overall health care-associated infections/1000 patient-days, which fell from 37.2 pre-intervention to 15.1 post-intervention (P<0.001); the rate of bloodstream infections, which fell from 18.6 to 3.4/1000 central-line-days (P<0.001); and the rate of lower respiratory tract infections, which fell from 17.6 to 5.2/1000 ventilator-days (P<0.001). Similarly, there were significant reductions in the isolation rates of 4 major hospital pathogens (P<0.001 and P=0.03). These findings suggest that although cross-infection in the ICU is a complex process, its frequency can be affected by meticulous adherence to hand hygiene recommendations. PMID:23290090
Salama, Mona F; Jamal, Wafaa Y; Mousa, Haifa Al; Al-Abdulghani, Khaled A; Rotimi, Vincent O
INTRODUCTION: Hospital medical emergency teams (METs) have been implemented to reduce cardiac arrests and hospital mortality. The timing and system factors associated with their activation are poorly understood. We sought to determine the circadian pattern of MET activation and to relate it to nursing and medical activities. METHOD: We conducted a retrospective observational study of the time of activation for
Daryl Jones; Samantha Bates; Stephen Warrillow; Helen Opdam; Donna Goldsmith; Geoff Gutteridge; Rinaldo Bellomo
This study examined the level of patient satisfaction and nursing staff work satisfaction at an urban public hospital in the Southwestern United States. The primary objectives of this study were to determine: (1) the level of overall patient satisfaction and satisfaction with specific dimensions of hospital care; (2) the differences in patient satisfaction according to demographic characteristics (age, gender, ethnicity,
BACKGROUNDIn the past 10 years, medication errors have come to be recognised as an important cause of iatrogenic disease in hospital patients.AIMSTo determine the incidence and type of medication errors in a large UK paediatric hospital over a five year period, and to ascertain whether any error prevention programmes had influenced error occurrence.METHODSRetrospective review of medication errors documented in standard
Results—31 of 38 (82%) hospitals reported outbreaks of nosocomial infection during the 5 years prior to the interview, 17 (45%) reported > 1 outbreak, 22 (58%) had restricted patient admissions to aid mitigation, and 12 (32%) had completely closed sections of the facility to control disease spread. Nineteen (50%) hospitals reported that zoonotic infections had oc- curred during the 2
Katharine M. Benedict; Paul S. Morley; David C. Van Metre
Unnecessary, excessive and poor injection practices in the South East Asia region (including Nepal) have been observed previously. The authors aim to study prescription of injectable drugs to inpatients in a teachinghospital in Western Nepal. Prescription of injectable drugs (IDs) and intravenous fluids (IVFs) to inpatients discharged from the wards of the Manipal TeachingHospital during 1st January to 30th June 2006 was studied. The mean number of drugs, IDs and IVFs administered, median cost of drugs and of IDs/IVFs per prescription calculated. Comparison of ID/IVF use in the four major hospital departments (Medicine, Obstetrics and Gynecology, Pediatrics and Surgery) was done. The administration of IDs/IVFs and injectable antimicrobials were measured in Defined Daily Dose (DDD)/100 bed-days and of Intravenous fluid in Liters (L)/100 bed-days. Of the 1131 patients discharged, 938 (82.94%) patients received one or more IDs/IVFs. The mean number of drugs, IDs and IVFs prescribed were 8.75, 4.72 and 1.42. Median cost of drugs and IDs/IVFs per prescription were 8.26US$ and 5.12US$ respectively. IDs/IVFs accounted for 81.37% of total drug cost. The most commonly used ID, injectable antimicrobial and IVF were Diclofenac (19.3 DDD/100 bed-days), Metronidazole (7.68 DDD/100 bed-days) and Dextrose normal saline (8.56 L/100 bed-days), respectively. The total IVF consumption was 24.25 L/100 bed-days. Significant differences between departments were observed (p<0.05). In conclusion, the use of IDs/IVFs was higher compared to other studies. Interventions to improve IDs/IVFs prescribing practices may be required.
Gyawali, Sudesh; Shankar, P Ravi; Saha, Archana; Mohan, Lalit
OBJECTIVE: Maxillary sinusitis is a frequent ear-nose-throat (ENT) infection. The purpose of this study was to determine the prevalence of maxillary sinusitis in the ENT department of a teachinghospital in Cotonou, Benin, and to report the clinical findings, together with the results of complementary examinations and treatment outcomes. PATIENTS AND METHODS: This was a retrospective descriptive analysis of patients seen at our hospital from January 1, 2004 to December 31, 2008 for maxillary sinusitis. RESULTS: Over the 5-year study period, 1752 cases of maxillary sinusitis were treated in the ENT department of the teachinghospital, which works out to 350 or 351 cases per year. The overall prevalence was 19.3%. There were 759 patients (83.1%) aged 16-50years, and 984 patients (56.2%) were men. Factors favoring maxillary sinusitis were: dry season with dust (n=1051 patients, 60%); and atmospheric pollution (87.6%). Maxillary sinusitis was acute for 528 patients (30.1%) and chronic for 1224 patients (69.9%). A rhinogenic cause was identified for 960 patients (54.8%), an allergic cause for 668 patients (38.1%) and a dental cause for 96 patients (55.5%). In cases of chronic sinusitis, the infection was predominantly staphylococcal (29.3%) and pneumococcal (21.9%). Basically, medical treatment was given by combining local treatments for rhinopharyngeal disinfection or vasoconstriction. In cases with a dental origin, dental care was also delivered. For allergy-related sinusitis, nasal sprays with corticosteroids and antihistamine agents were prescribed. Outcomes were favorable for 89.7% of patients. PMID:23747145
Aim To monitor the adverse drug reactions (ADRs) caused by antihypertensive medicines prescribed in a university teachinghospital. Methods The present work was an open, non-comparative, observational study conducted on hypertensive patients attending the Medicine OPD of Majeedia Hospital, Jamia Hamdard, New Delhi, India by conducting patient interviews and recording the data on ADR monitoring form as recommended by Central Drugs Standard Control Organization (CDSCO), Government of India. Results A total of 21 adverse drug reactions were observed in 192 hypertensive patients. Incidence of adverse drug reactions was found to be higher in patients more than 40?years in age, and females experienced more ADRs (n = 14, 7.29%) than males, 7 (3.64%). Combination therapy was associated with more number of adverse drug reactions (66.7%) as against monotherapy (33.3%). Calcium channel blockers were found to be the most frequently associated drugs with adverse drug reactions (n = 7), followed by diuretics (n = 5), and ?-blockers (n = 4). Among individual drugs, amlodipine was found to be the commonest drug associated with adverse drug reactions (n = 7), followed by torasemide (n = 3). Adverse drug reactions associated with central nervous system were found to be the most frequent (42.8%) followed by musculo-skeletal complaints (23.8%) and gastro-intestinal disorders (14.3%). Conclusions The present pharmacovigilance study represents the adverse drug reaction profile of the antihypertensive medicines prescribed in our university teachinghospital. The above findings would be useful for physicians in rational prescribing. Calcium channel blockers were found to be the most frequently associated drugs with adverse drug reactions.
Unnecessary, excessive and poor injection practices in the South East Asia region (including Nepal) have been observed previously. The authors aim to study prescription of injectable drugs to inpatients in a teachinghospital in Western Nepal. Prescription of injectable drugs (IDs) and intravenous fluids (IVFs) to inpatients discharged from the wards of the Manipal TeachingHospital during 1st January to 30th June 2006 was studied. The mean number of drugs, IDs and IVFs administered, median cost of drugs and of IDs/IVFs per prescription calculated. Comparison of ID/IVF use in the four major hospital departments (Medicine, Obstetrics and Gynecology, Pediatrics and Surgery) was done. The administration of IDs/IVFs and injectable antimicrobials were measured in Defined Daily Dose (DDD)/100 bed-days and of Intravenous fluid in Liters (L)/100 bed-days. Of the 1131 patients discharged, 938 (82.94%) patients received one or more IDs/IVFs. The mean number of drugs, IDs and IVFs prescribed were 8.75, 4.72 and 1.42. Median cost of drugs and IDs/IVFs per prescription were 8.26US$ and 5.12US$ respectively. IDs/IVFs accounted for 81.37% of total drug cost. The most commonly used ID, injectable antimicrobial and IVF were Diclofenac (19.3 DDD/100 bed-days), Metronidazole (7.68 DDD/100 bed-days) and Dextrose normal saline (8.56 L/100 bed-days), respectively. The total IVF consumption was 24.25 L/100 bed-days. Significant differences between departments were observed (p<0.05). In conclusion, the use of IDs/IVFs was higher compared to other studies. Interventions to improve IDs/IVFs prescribing practices may be required. PMID:19753281
Gyawali, Sudesh; Shankar, P Ravi; Saha, Archana; Mohan, Lalit
The goal of this study was to examine the adult surgical emergencies seen at the Nnamdi Azikiwe University TeachingHospital (NAUTH), Nnewi, with a view to proffering preventive solutions where appropriate and improving outcome. From the register of patients seen at the Casualty department and from the operations register in the main operation room of NAUTH, names and hospital numbers of adult patients treated as emergencies over a 5-year period, from 7 September 1998 to 6 September 2003, were obtained. The hospital folders were then retrieved from the Records Department. From each folder, the following details about each patient were extracted: age, sex, diagnosis at presentation, causative factors, treatment given, and outcome. A total of 902 adult patients were treated during the period. The commonest emergency operation was appendectomy for acute appendicitis in 139 patients (97 women and 42 men), followed closely by road traffic accidents (RTAs) involving 137 patients (103 men and 34 women). Gunshot injuries, which resulted mainly from armed robbery attacks, accounted for 127 cases. More men (113) sustained gunshot injuries than women (14). Of the 92 cases of acute intestinal obstruction seen, 62 occurred in women and 30 in men. Some 126 men presented with acute urinary retention, and two others presented with priapism. Governments at various levels should provide modern diagnostic tools for the accurate preoperative diagnosis of surgical emergencies in hospitals. Governments should also inculcate strict discipline into drivers using the highways, particularly in relation to abuse of alcohol and drugs. Good roads and adequate security should be provided for the people. The need for Pre-Hospital Care for the efficient evacuation of accident victims is emphasized. These measures will help to improve the management and outcome of surgical emergencies, and decrease the number of surgical emergencies resulting from RTAs and gunshot wounds. PMID:15880283
Chianakwana, Gabriel U; Ihegihu, Chima C; Okafor, Pius I S; Anyanwu, Stanley N C; Mbonu, Okechukwu O
Background Diabetes mellitus is becoming one of the major causes of premature adult mortality in developing countries. However, there is a very little documentation of the morbidity trend in such countries. Objective To assess the ten-year trend of diabetes mellitus at Gondar University Teaching Referral Hospital, northwest Ethiopia. Methods A hospital-based retrospective record review was done at the main referral hospital in northwest Ethiopia. Data were obtained from medical records of all registered diabetic patients in the Diabetic Follow up Clinic between 2000 and 2009. An Extended Mantel-Haenzel chi-square test for the linear trend was used to examine the trend over time. Result Out of the total 354,524 patients who visited the Outpatient Department of the hospital during the study period, 1553 (4.4/1000) were diabetes patients, of which 50.1% was type 1 and 49.9% type 2 diabetes mellitus. The average increase in the proportion of both Type 1 and Type 2 diabetes mellitus cases between 2000 and 2009 was 125%. The mean (±SD) age for Type 1 diabetes mellitus was 29.1 (±12), and 53.5 (±12) for Type 2 diabetes. Overall 42.5% of the diabetes mellitus patients were female and 31.7% were rural residents. The mean body mass index for both type of diabetes mellitus increased from 15.9 to 18.3 kg for type 1 and from 23.8 to 24.6 for type 2 between 2000 and 2009, respectively. Conclusion The number of diabetes mellitus cases seen at Gondar Referral Hospital is rising steadily. A comprehensive diabetes prevention, treatment, and care program is needed to improve the quality of life of the increasing diabetes mellitus cases in Ethiopia.
Objective: This study in a tertiary care teaching center with 361 beds was conducted to assess use, misuse, and abuse of antibiotics.Materials and Methods: Every day of the study, a computer program was used to compile a list of patients' bedside records. On a specific day, the bedside charts of selected patients were reviewed to determine whether: (1) a justification
Yamileth Mora; María L. Avila-Agüero; María A. Umaña; Ana L. Jiménez; María M. París; Idis Faingezicht
The study used the log-linear model derived from the Cobb-Douglas functional form for explaining determinants of productivity among male and female cocoyam farmers in Nsukka Agricultural Zone of Enugu State. The study involved a multi-stage random sampling technique of 120 farmers, consisting of 60 males and 60 females. For the male farmers, the coefficients for capital, cocoyam setts, labour and
B. C Okoye; A. C Okoye; G. N Asumugha; M. U Dimelu; A. E Agwu; C. C Agbaeze
Two hundred and forty blood samples were collected from children, women, and men in urban areas of Enugu State, Nigeria. The samples were analyzed for lead by atomic absorption spectrophotometry. Results show the range and % detectable values were 3.9–88.1 ?g\\/dl and 97.92%, respectively. The sample population was classified according to age groups (?12, 13–25, and >25 years), sex, occupationally
Background Teaching sessions for medical students during ward rounds are an essential component of bedside teaching, providing students with the opportunity to regard patients as actual people, and to observe their physical conditions directly, allowing a better understanding of illnesses to be developed. We aim to explore medical students’ perceptions regarding medical and surgical ward rounds within the Faculty of Medicine at Kuwait University, and to evaluate whether this teaching activity is meeting the expectation of learners. Methods A pretested questionnaire was used to collect data from 141 medical students during the 2012–2013 academic year. They were asked to provide their current and expected ratings about competencies that were supposed to be gained during ward rounds, on a scale from 1 (lowest) to 5 (highest). Mean scores were calculated, and the Student t-test was used to compare results. P < 0.05 was the cut-off level for significance. Results Only 17 students (12.1%) declined to participate in the study. The students’ current competency scores (for competencies taught within both disciplines – medical and surgical) were significantly lower than the scores indicating students’ expectations (P < 0.001). The best-taught competency was bedside examination, in both medical (mean: 3.45) and surgical (mean: 3.05) ward rounds. However, medical ward rounds were better than surgical rounds in covering some competencies, especially the teaching of professional attitude and approach towards patients (P < 0.001). Conclusion Both medical and surgical ward rounds were deficient in meeting the students’ expectations. Medical educators should utilize the available literature to improve the bedside teaching experience for their students.
Panipenem/betamipron (PAPM/BP) may be highly effective for life-threatening Streptococcus pneumoniae infection. However, the efficacy of PAPM/BP for S. pneumoniae infections has not been compared with that of other antimicrobial agents. We retrospectively compared PAPM/BP with other carbapenems for treatment of life-threatening infections in newly hospitalized adults with pneumococcal bacteremia. Clinical information for cases of pneumococcal bacteremia was collected from three teachinghospitals in Japan from January 2003 to December 2010. In total, 17 patients who received PAPM/BP therapy and 34 treated with other carbapenems (27 with meropenem, 4 with imipenem/cilastatin, and 3 with biapenem) were identified. The mean age (71 vs. 70 years old), sex distribution (women, 29 vs. 21 %), Charlson comorbidity index (CCI) (1.5 vs. 1.6), and rates of septic shock (29 vs. 38 %), and meningitis (5.9 vs. 8.8 %) did not differ significantly between the two groups. The inpatient mortality rates were lower in the PAPM/BP group (12 vs. 44 %, p = 0.03). Multiple logistic regression analysis adjusted for age, sex, CCI, and severe sepsis/septic shock showed that use of other carbapenems was associated with higher in-hospital mortality, with an odds ratio of 6.922 (95 % CI, 1.171-40.92) compared to PAPM/BP therapy. Initial PAPM/BP therapy might have a therapeutic advantage over other carbapenems in treatment of severe Streptococcus pneumoniae infections. PMID:23203218
Teleoperated surgical robots could provide a genuine breakthrough in laparoscopy and it is for this reason that the development\\u000a of robot-assisted laparoscopy is one of the priorities of the Strasbourg University Hospitals’ strategic plan. The hospitals\\u000a purchased a da Vinci S® robot in June 2006 and Strasbourg has, in IRCAD, one of the few robotic surgery training centres in the
N. Sananès; O. Garbin; M. Hummel; C. Youssef; R. Vizitiu; D. Lemaho; D. Rottenberg; P. Diemunsch; A. Wattiez
Problem statement: Antimicrobial resistance is a worrisome situation in hospitals around the world and the misuse of certain classes of anti microbials has contributed for this situation. Approach: We performed a prospective surveillance study on t he incidence of multi-drug resistant bacteria before (phase 1) and after (phase 2) the introduction of a 4th-generation cephalosporin in a non-teachinghospital. Results:
Between January 2002 and June 2007, uropathogens were isolated from 473 of 1557 canine urine samples submitted to Prairie Diagnostic Services from the Western College of Veterinary Medicine Veterinary TeachingHospital. Culture and susceptibility results were analyzed, retrospectively, to estimate the prevalence of common bacterial uropathogens in dogs with urinary tract infections and to identify changes in antimicrobial resistance. The most common pathogens identified were Escherichia coli, Staphylococcus intermedius, Enterococcus spp., and Proteus spp. Antimicrobial resistance increased during the study period, particularly among recurrent E. coli isolates. Using the formula to help select rational antimicrobial therapy (FRAT), bacterial isolates were most likely to be susceptible to gentamicin, fluoroquinolones, amoxicillin-clavulanic acid, and groups 4 and 5 (third generation) cephalosporins.
Ball, Katherine R.; Rubin, Joseph E.; Chirino-Trejo, M.; Dowling, Patricia M.
Background Maternal mortality is high the world over, especially in sub-Saharan Africa, including Nigeria. Nigeria has consistently demonstrated one of the most abysmally poor reproductive health indices in the world, maternal mortality inclusive. This is a sad reminder that, unless things are better organized, Southeast Nigeria, which Nnamdi Azikiwe University TeachingHospital (NAUTH) represents, may not join other parts of the world in attaining Millennium Development Goal 5 to improve maternal health in 2015. Objectives This study was conducted to assess NAUTH’S progress in achieving a 75% reduction in the maternal mortality ratio (MMR) and to identify the major causes of maternal mortality. Materials and methods This was a 10-year retrospective study, conducted between January 1, 2003 and December 31, 2012 at Nnamdi Azikiwe University TeachingHospital, Nnewi, Southeast Nigeria. Results During the study period, there were 8,022 live births and 103 maternal deaths, giving an MMR of 1,284/100,000 live births. The MMR was 1,709 in 2003, reducing to 1,115 in 2012. This is to say that there was a 24.86% reduction over 10 years, hence, in 15 years, the reduction should be 37%. This extrapolated reduction over 15 years is about 38% less than the target of 75% reduction. The major direct causes of maternal mortality in this study were: pre-eclampsia/eclampsia (27%), hemorrhage (22%), and sepsis (12%). The indirect causes were: anemia, anesthesia, and HIV encephalopathy. Most of the maternal deaths occurred in unbooked patients (98%) and within the first 48 hours of admission (76%). Conclusion MMRs in NAUTH are still very high and the rate of reduction is very slow. At this rate, it will take this health facility 30 years, instead of 15 years, to achieve a 75% reduction in maternal mortality.
Introduction: Review of opioid prescriptions in a hospital provides valuable information to health care professionals which may contribute to proper pain management; opioid utilization studies may help uncover factors that can be improved for better prescribing. To evaluate the use of opioid analgesics in a university hospital, a review of opioids prescribed in hospitalized patients was developed. Methods: Information was obtained from the pharmacy database and medical records. The study period was 1 month. Results: Medical records of 1156 patients admitted in July 2009 were analyzed. The most widely prescribed opioid was tramadol; the preferred administration route was intravenous; the main indication was severe pain; and major prescribers were from surgical departments. Discussion: Underutilization of potent opioids for acute and chronic pain seems to occur. Conclusion: Most prescribers prefer weak opioids, given intravenously to treat acute and chronic pain, while some patients may benefit from the prescription of more potent opioids.
Antiseptics have a major role against the infections and their prevention. The good management of antiseptics allows the reduction of antibiotics use and thus the emergence of resistant bacterial strains. The evaluation of the antibacterial activity of three antiseptics (povidone iodine [PVPI], iodized alcohol and alcohol 70 degrees) used at HMIMV and taken from pharmacy was based on AFNOR method NF T 72-150. The analysis of their chemical properties were done by standardized methods (manganimetry, Bunsen's method, test to determine sodium thiosulfate levels [or sodium thiosulfate test] and Guy Lussac alcoholmeter). Our results were compared with those obtained in another two university hospitals of Rabat: Hospital of Speciality and Ibn Sina. The frequencies of resistant bacterial strains were respectively 4.6%, 30.7% and 15.4% to PVPI, alcohol iodized and alcohol 70 degrees . Our results have shown that the PVPI is the best antiseptic in our hospital. PMID:20650737
The CIPP model of evaluation was used through its Context, Input, Process and Product elements, to evaluate the process of introducing a quality development program established in a nursing department within a teaching referral hospital in Amman, Jordan. The evaluation was intended to test whether the development program had achieved its overall goals: Management within a static state of nursing
The hospital as an institution is both a place where ailing people seek and receive care and a common pathway for.the clinical education of medical students, nurses-and virtually the whole spectrum of health professionals. It provides continuing education for the practicing physician and increasingly serves the function of an institution of higher learning for whole neighborhoods, communities, and regions. This
Jesus J. Pena; Melvin Cohen; Bernard Rosen; James E. Ramseur; Daniel Donohue
OBJECTIVE: To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates. DESIGN: A 1-day point-prevalence study. SETTING: A total of 19 intensive care units at the Hospital das Clínicas - University of São Paulo, School of Medicine
Carlos Toufen Junior; André Luiz Dresler Hovnanian; Suelene Aires Franca; Carlos Roberto Ribeiro Carvalho
The rapid growth in internationalisation of education has led to the point where Australia has become a world leader in transnational education. Simultaneously, the provision of hospitality and tourism management education has developed rapidly from its inception in 1974 with numbers of international students rising steadily. Although robust research into the international student experience has been conducted, the impact of
Background: The outbreak of severe acute respiratory syndrome (SARS) in Toronto, which began on Mar. 7, 2003, resulted in extraordinary public health and infection control measures. We aimed to describe the psychological and occupational im- pact of this event within a large hospital in the first 4 weeks of the outbreak and the subsequent administrative and mental health response. Methods:
Robert Maunder; Jonathan Hunter; Leslie Vincent; Jocelyn Bennett; Nathalie Peladeau; Molyn Leszcz; Joel Sadavoy; Lieve M. Verhaeghe; Rosalie Steinberg; Tony Mazzulli
Background A gap exists between the best evidence and practice with regards to surgical site infection (SSI) prevention. Awareness of evidence is the first step in knowledge translation. Methods A web-based survey was distributed to 59 general surgeons and 68 residents at University of Toronto teachinghospitals. Five domains pertaining to SSI prevention with questions addressing knowledge of prevention strategies, efficacy of antibiotics, strategies for changing practice and barriers to implementation of SSI prevention strategies were investigated. Results Seventy-six individuals (60%) responded. More than 90% of respondents stated there was evidence for antibiotic prophylaxis and perioperative normothermia and reported use of these strategies. There was a discrepancy in the perceived evidence for and the self-reported use of perioperative hyperoxia, omission of hair removal and bowel preparation. Eighty-three percent of respondents felt that consulting published guidelines is important in making decisions regarding antibiotics. There was also a discrepancy between what respondents felt were important strategies to ensure timely administration of antibiotics and what strategies were in place. Checklists, standardized orders, protocols and formal surveillance programs were rated most highly by 75%–90% of respondents, but less than 50% stated that these strategies were in place at their institutions. Conclusion Broad-reaching initiatives that increase surgeon and trainee awareness and implementation of multifaceted hospital strategies that engage residents and attending surgeons are needed to change practice.
Eskicioglu, Cagla; Gagliardi, Anna R.; Fenech, Darlene S.; Forbes, Shawn S.; McKenzie, Marg; McLeod, Robin S.; Nathens, Avery B.
Background: Inappropriate or excessive use of topical corticosteroids can lead to cutaneous and systemic adverse effects which occur more commonly with the use of very potent steroids. Monitoring and analysis of the prescription practices of topical steroids can help to achieve rational prescription of these drugs. Aim: The present study was carried out to study and analyze the pattern of prescribing topical corticosteroids among outpatients attending the dermatology clinic in a rural tertiary care and teachinghospital, Ambajogai, Maharashtra. Materials and Methods: A cross-sectional descriptive study was conducted for a duration of two months from August 2011 to September 2011, and 500 prescriptions were randomly collected from the dermatology pharmacy and analyzed. Results: About 66% of the prescriptions contained four to five drugs per prescription. Topical steroids were given in 28.4% of all the prescriptions. In almost all the prescriptions, strength, quantity of the steroid to be used, frequency, site, and duration of application was not mentioned. The chief complaints and diagnoses were not mentioned in about 85% of the prescriptions for topical corticosteroids. About 94.36% of the prescriptions contained very potent steroids. Conclusion: Inadequate prescribing information is a clear characteristic of the dermatological prescriptions containing topical corticosteroids. Doctors should be educated about the importance of giving patients sufficient information regarding the use of steroids. There is a need to revise hospital formulary where low-potency steroids can also be included along with potent ones so that the latter can be avoided in conditions where they are unnecessary.
Rathod, Suvarna S; Motghare, Vijay M; Deshmukh, Vinod S; Deshpande, Rushikesh P; Bhamare, Chetanraj G; Patil, Jyoti R
Background and Introduction: Depression is a prevalent mental disorder and the 4(th) leading cause of disability in the world as per the World Health Organization (WHO). The adverse Drug Reactions (ADRs) to antidepressants are common and they can lead to a non compliance or even a discontinuation of the therapy. This study entitled us to monitor the ADR profile of the antidepressants in a tertiary care teachinghospital. Patients and Methods: A longitudinal, observational study was conducted in the Outpatients Department of Psychiatry in S.C.B. Medical College and Hospital l in collaboration with the I.M.S and SUM Hospital. A total of 160 cases were studied for ADRs by using a predesigned CDSCO form. The patients who were on TCAs, SSRIs and newer antidepressants (SNRIs/NDRIs) were assessed by doing physical examinations, neurological examinations and relevant lab tests. The causalities were assessed by the criteria of the WHO-UMC. The analysis of ADRs was done by using the Chi square test. Results: Among the 160 patients who took antidepressants, 26.87% reported ADRs, with at least one possible causality.None were labeled as certain, as a rechallenge was not performed.ADRs were mostly observed in polytherapy (14.37%) and with antidepressants like TCAs (58.84%). Conclusions: Agitation, anxiety and insomnia were the common ADRs which were associated with the use of antidepressants. This study offers a representative profile of the ADRs which can be expected in the Psychiatry Outpatients Department and due care must be taken to avoid these ADRs. PMID:23905119
Background and Introduction: Depression is a prevalent mental disorder and the 4th leading cause of disability in the world as per the World Health Organization (WHO). The adverse Drug Reactions (ADRs) to antidepressants are common and they can lead to a non compliance or even a discontinuation of the therapy. This study entitled us to monitor the ADR profile of the antidepressants in a tertiary care teachinghospital. Patients and Methods: A longitudinal, observational study was conducted in the Outpatients Department of Psychiatry in S.C.B. Medical College and Hospital l in collaboration with the I.M.S and SUM Hospital. A total of 160 cases were studied for ADRs by using a predesigned CDSCO form. The patients who were on TCAs, SSRIs and newer antidepressants (SNRIs/NDRIs) were assessed by doing physical examinations, neurological examinations and relevant lab tests. The causalities were assessed by the criteria of the WHO-UMC. The analysis of ADRs was done by using the Chi square test. Results: Among the 160 patients who took antidepressants, 26.87% reported ADRs, with at least one possible causality.None were labeled as certain, as a rechallenge was not performed.ADRs were mostly observed in polytherapy (14.37%) and with antidepressants like TCAs (58.84%). Conclusions: Agitation, anxiety and insomnia were the common ADRs which were associated with the use of antidepressants. This study offers a representative profile of the ADRs which can be expected in the Psychiatry Outpatients Department and due care must be taken to avoid these ADRs.
Objective-To assess antimicrobial resistance among bacteria isolated from dogs and cats admitted to a veterinary teachinghospital (VTH), determine the incidence of acquisition of and frequency of persistent colonization by antimicrobial-resistant organisms among these animals, and identify risk factors associated with these variables. Design-Prospective longitudinal study. Animals-622 dogs and 92 cats admitted to a VTH and expected to stay ? 48 hours. Procedures-Samples were collected with rectal and nasal or oropharyngeal swabs at admission and discharge. Isolates of enterococci, staphylococci, and Escherichia coli were tested for antimicrobial resistance via microbroth dilution methods. A subset of isolates was analyzed with pulsed-field gel electrophoresis and multilocus sequence typing. Significant trends in proportions of organisms with antimicrobial resistance over the 3-year study period were assessed. Results-The proportion of staphylococci with antimicrobial resistance increased, whereas the proportion of E coli with resistance decreased, over time; resistance among enterococci was more variable. For 506 dogs with paired admission and discharge samples, multidrug-resistant (MDR) E coli was acquired by 40 (8%) and methicillin-resistant Staphylococcus aureus (MRSA) was acquired by 7 (1.4%); hospitalization for > 3 days was significantly associated with both variables. Most (5/7 isolates) acquired MRSA was of sequence type (ST) 5. Conclusions and Clinical Relevance-Extended hospitalization was associated with increased risk of acquiring MDR E coli or MRSA, although few animals acquired MRSA. It is unclear whether associations were confounded by illness severity or use of infection control measures. Additionally, MRSA of ST5, which has been associated with small animal medicine, was the most commonly acquired MRSA in this study. PMID:24050566
Hamilton, Elizabeth; Kruger, John M; Schall, William; Beal, Matthew; Manning, Shannon D; Kaneene, John B
This study aimed to apply the WHO surgical safety checklist in the surgical specialties of a university hospital and to evaluate the opinion of the team regarding the influence of its application on the safety of the surgical process and on the interpersonal communication of the team. It is a descriptive, analytical qualitative field study conducted in the surgical center of a university hospital Data were collected by applying the checklist in a total of 30 surgeries. The researcher conducted its application in three phases, and then members of the surgical team were invited to voluntarily participate in the study, signifying their agreement to participate by signing an informed consent form and answering guiding questions. Bardin's Content Analysis Method was used to organize and analyze the data. The subjects did not notice any changes in their interpersonal communication when using the checklist; however, they gave suggestions and reported that its use provided greater safety to the procedure. PMID:23781726
Pancieri, Ana Paula; Santos, Bruna Pegorer; de Avila, Marla Andréia Garcia; Braga, Eliana Mara
Background and Purpose: To characterize the clinical and microbiological features of tuberculous arthritis and to clarify the factors affecting treatment outcome. Methods: We retrospectively reviewed 51 adult patients with a diagnosis of tuberculous arthritis at Chang Gung Memorial Hospital-Linkou over a 14-year period. Results: There were 35 males and 16 females with a mean age of 58.9 years (range, 32
Because of their typically small in-house computer and network staff, non-university hospitals often hesitate to consider\\u000a picture archiving and communication system (PACS) as a solution to the very demanding financial, clinical, and technological\\u000a needs of today’s Radiology Department. This article presents the experiences of the 3-year process for the design and implementation\\u000a of the Radiology Electronic Imaging Network (REIN) in
Manuel Arreola; Harvey L. Neiman; Amy Sugarman; Larry Laurenti; Ron Forys
Background The outbreak of severe acute respiratory syndrome (SARS) in Toronto, which began on Mar. 7, 2003, resulted in extraordinary public health and infection control measures. We aimed to describe the psychological and occupational impact of this event within a large hospital in the first 4 weeks of the outbreak and the subsequent administrative and mental health response. Methods Two principal authors met with core team members and mental health care providers at Mount Sinai Hospital, Toronto, to compile retrospectively descriptions of the experiences of staff and patients based on informal observation. All authors reviewed and analyzed the descriptions in an iterative process between Apr. 3 and Apr. 13, 2003. Results In a 4-week period, 19 individuals developed SARS, including 11 health care workers. The hospital's response included establishing a leadership command team and a SARS isolation unit, implementing mental health support interventions for patients and staff, overcoming problems with logistics and communication, and overcoming resistance to directives. Patients with SARS reported fear, loneliness, boredom and anger, and they worried about the effects of quarantine and contagion on family members and friends. They experienced anxiety about fever and the effects of insomnia. Staff were adversely affected by fear of contagion and of infecting family, friends and colleagues. Caring for health care workers as patients and colleagues was emotionally difficult. Uncertainty and stigmatization were prominent themes for both staff and patients. Interpretation The hospital's response required clear communication, sensitivity to individual responses to stress, collaboration between disciplines, authoritative leadership and provision of relevant support. The emotional and behavioural reactions of patients and staff are understood to be a normal, adaptive response to stress in the face of an overwhelming event.
A high incidence of oropharyngeal dysphagia (OD) in acute-care settings has been reported; however, no data on its management\\u000a are found in the literature. Here we report the experience with rehabilitative management of OD in a large Italian hospital.\\u000a The characteristics of inpatients with OD during 2004 have been studied prospectively. For each patient, demographic data,\\u000a the department referring the
Antonio Schindler; Elena Vincon; Elena Grosso; Anna Maria Miletto; Rosalba Di Rosa; Oskar Schindler
Abstract Concurrent to reports of zoonotic and nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in veterinary settings, recent evidence indicates that the environment in veterinary hospitals may be a potential source of MRSA. The present report is a cross-sectional study to determine the prevalence of MRSA on specific human and animal contact surfaces at a large veterinary hospital during a nonoutbreak period. A total of 156 samples were collected using Swiffers® or premoistened swabs from the small animal, equine, and food animal sections. MRSA was isolated and identified by pre-enrichment culture and standard microbiology procedures, including growth on Mueller-Hinton agar supplemented with NaCl and oxacillin, and by detection of the mecA gene. Staphylococcal chromosome cassette mec (SCCmec) typing and pulsed-field gel electrophoresis profile were also determined. MRSA was detected in 12% (19/157) of the hospital environments sampled. The prevalence of MRSA in the small animal, equine, and food animal areas were 16%, 4%, and 0%, respectively. Sixteen of the MRSA isolates from the small animal section were classified as USA100, SCCmec type II, two of which had pulsed-field gel electrophoresis pattern that does not conform to any known type. The one isolate obtained from the equine section was classified as USA500, SCCmec type IV. The molecular epidemiological analysis revealed a very diverse population of MRSA isolates circulating in the hospital; however, in some instances, multiple locations/surfaces, not directly associated, had the same MRSA clone. No significant difference was observed between animal and human contact surfaces in regard to prevalence and type of isolates. Surfaces touched by multiple people (doors) and patients (carts) were frequently contaminated with MRSA. The results from this study indicate that MRSA is present in the environment even during nonoutbreak periods. This study also identified specific surfaces in a veterinary environment that need to be targeted when designing and executing infection control programs.
Johnson, Amanda; Nava-Hoet, Rocio C.; Bateman, Shane; Hillier, Andrew; Dyce, John; Gebreyes, Wondwossen A.; Wittum, Thomas E.
A comparison of mortality and morbidity pattern of hospital admissions of children under 14 years during 1966–68 and 1977–81\\u000a has been made. Annual admission rate has increased from 1515 to 2515, which is in proportion to the population increase of\\u000a 3 lacs from 1966 to 1981. Recently more than 70% were discharged within a week as against 52% during 1966–68,
M. Chansoria; S. Thora; N. V. Patel; B. Mukerjee; D. K. Shrivastava; K. K. Kaul
Context As a patient safety measure, laboratories are required to have a critical values policy by regulatory agencies. Unfortunately, little information is available on repeat critical values for the same analyte(s) on the same patient. Objective To investigate the occurrence and distribution of repeat critical values and the relationship between the frequency of such values and patient outcome to provide information for hospitals on improving reporting policies. Methods Eleven laboratory critical value lists, including chemistry and hematology analytes, were selected from a tertiary hospital in China in the year 2010. The distribution and interval time for each repeat critical value were calculated. Serum potassium and platelet count were used as examples to illustrate the relationship between the frequency of the repeat critical values and patient outcome. Results All test items on the critical value list were prone to the occurrence of repeat critical values. On average, each patient who experienced critical values had 2.10 occurrences. The median interval time for each repeat critical value varied, with most being longer than 8 hours. For those patients who had repeat critical values of serum potassium and platelet count, along with the increased frequency, the patients had a longer hospital stay and a generally worse outcome. Conclusions Patient can have a number of repeat critical values and the frequency of these values is closely related to patient outcome. A careful evaluation is warranted if a laboratory chooses to adopt a policy of not reporting each repeat critical value.
The study compared paper-based and electronic-based medical handover with respect to quality of information transfer during hospital out-of-hours shifts, and analysed the caseload burden of the hospital night team. The participants were 1645 hospital patients transferred from the day team to the out-of-hours team over four months in 2006. Quality of information transfer was determined by clinical data handed over within pre-set fields, and caseload burden by the frequency of tasks required at handover. Handover information fields comprised patient's demographics and location, primary diagnosis, current problem, plan of action and primary care team details. Electronic handover achieved a significantly higher number of completed fields than paper-based handover. Blood collection, checking blood and X-ray results, and adjusting fluid balance and intravenous cannulation account for most of the workload during the nightshift. Electronic handover provides better continuity of care than paper-based handover, and redistribution of tasks during working hours would benefit night staff. PMID:19713394
Raptis, Dimitri A; Fernandes, Carl; Chua, Weiliang; Boulos, Paul B
Background Lower extremity amputation results in significant global morbidity and mortality. Australia appears to have a paucity of studies investigating lower extremity amputation. The primary aim of this retrospective study was to investigate key conditions associated with lower extremity amputations in an Australian population. Secondary objectives were to determine the influence of age and sex on lower extremity amputations, and the reliability of hospital coded amputations. Methods Lower extremity amputation cases performed at the Princess Alexandra Hospital (Brisbane, Australia) between July 2006 and June 2007 were identified through the relevant hospital discharge dataset (n?=?197). All eligible clinical records were interrogated for age, sex, key condition associated with amputation, amputation site, first ever amputation status and the accuracy of the original hospital coding. Exclusion criteria included records unavailable for audit and cases where the key condition was unable to be determined. Chi-squared, t-tests, ANOVA and post hoc tests were used to determine differences between groups. Kappa statistics were used to measure reliability between coded and audited amputations. A minimum significance level of p?0.05 was used throughout. Results One hundred and eighty-six cases were eligible and audited. Overall 69% were male, 56% were first amputations, 54% were major amputations, and mean age was 62?±?16?years. Key conditions associated included type 2 diabetes (53%), peripheral arterial disease (non-diabetes) (18%), trauma (8%), type 1 diabetes (7%) and malignant tumours (5%). Differences in ages at amputation were associated with trauma 36?±?10?years, type 1 diabetes 52?±?12?years and type 2 diabetes 67?±?10?years (p?0.01). Reliability of original hospital coding was high with Kappa values over 0.8 for all variables. Conclusions This study, the first in over 20?years to report on all levels of lower extremity amputations in Australia, found that people undergoing amputation are more likely to be older, male and have diabetes. It is recommended that large prospective studies are implemented and national lower extremity amputation rates are established to address the large preventable burden of lower extremity amputation in Australia.
Virtual slide telepathology is an important potential tool for providing re-review of surgical pathology cases as part of a quality assurance program. The University of Arizona pathology faculty has implemented a quality assurance program between 2 university hospitals located 6 miles apart. The flagship hospital, University Medical Center (UMC), in Tucson, AZ, handles approximately 20 000 surgical pathology specimens per year. University Physicians Healthcare Hospital (UPHH) at Kino Campus has one tenth the volume of surgical pathology cases. Whereas UMC is staffed by 10 surgical pathologists, UPHH is staffed daily by a single part-time pathologist on a rotating basis. To provide same-day quality assurance re-reviews of cases, a DMetrix DX-40 ultrarapid virtual slide scanner (DMetrix, Inc, Tucson, AZ) was installed at the UPHH in 2005. Since then, glass slides of new cases of cancer and other difficult cases have been scanned the same day the slides are produced by the UPHH histology laboratory. The pathologist at UPHH generates a provisional written report based on light microscopic examination of the glass slides. At 2:00 pm each day, completed cases from UPHH are re-reviewed by staff pathologists, pathology residents, and medical students at the UMC using the DMetrix Iris virtual slide viewer. The virtual slides are viewed on a 50-in plasma monitor. Results are communicated with the UPHH laboratory by fax. We have analyzed the results of the first 329 consecutive quality assurance cases. There was complete concordance with the original UPHH diagnosis in 302 (91.8%) cases. There were 5 (1.5%) major discrepancies, which would have resulted in different therapy and/or management, and 10 (3.0%) minor discrepancies. In 6 cases (1.8%), the diagnosis was deferred for examination of the glass slides by the reviewing pathologists at UMC, and the diagnosis of another 6 (1.8%) cases were deferred pending additional testing, usually immunohistochemistry. Thus, the quality assurance program found a small number of significant diagnostic discrepancies. We also found that implementation of a virtual slide telepathology quality assurance service improved the job satisfaction of academic subspecialty pathologists assigned to cover on-site surgical pathology services at a small, affiliated university hospital on a rotating part-time basis. These findings should be applicable to some community hospital group practices as well. PMID:19540562
Graham, Anna R; Bhattacharyya, Achyut K; Scott, Katherine M; Lian, Fangru; Grasso, Lauren L; Richter, Lynne C; Carpenter, John B; Chiang, Sarah; Henderson, Jeffrey T; Lopez, Ana Maria; Barker, Gail P; Weinstein, Ronald S
Background: There is a dearth of studies which are related to consultation-liaison psychiatry in India. The psychiatric referral rates in India are very low, considering the higher rates of psychiatric morbidity in patients who attend various departments of a hospital. Studying the pattern of psychiatric referrals may pave the way for interventions to improve the current scenario. Methods: The study population comprised of all the patients who were referred for psychiatric consultation from other departments (both in-patient and out-patient) of the hospital over a period of two years. Data which was related to socio-demographic profile, source of referral, reason for referral and the psychiatric diagnosis were recorded and analyzed by using descriptive statistical methods. Results: A total of 520 patients were referred for psychiatric consultation, with a referral rate of 0.42%. A majority of the psychiatric referrals (59%) were from the department of medicine and the most common reason for referral was medically unexplained somatic complaints (23.1%), followed closely by anxiety (21%) and abnormal behaviour (13.1%). The most commonly diagnosed psychiatric disorders were neurotic, stress related and somatoform disorders (41.7%) followed by mood disorders (12.9%) and substance use disorders (12.7%). Conclusion: There is a need to encourage multi-disciplinary interaction in the management of patients who attend general hospitals, so as to better identify the psychiatric morbidity. Further studies should focus on interventions that can improve referral rates through early recognition of the common psychiatric conditions, with particular emphasis on sensitizing the general physicians, who are the most common source of psychiatric referrals.
Because of their typically small in-house computer and network staff, non-university hospitals often hesitate to consider picture archiving and communication system (PACS) as a solution to the very demanding financial, clinical, and technological needs of today's Radiology Department. This article presents the experiences of the 3-year process for the design and implementation of the Radiology Electronic Imaging Network (REIN) in the Department of Radiology at The Western Pennsylvania Hospital (WPH). WPH embarked on this project in late 1994 to find a solution to the very pressing demands to reduce operating costs and improve service to primary care clinicians, both on-site and at WPH-affiliated clinics. A five-member committee consisting of in-house medical, administrative, information services, and medical physics staff was formed to design a network that would satisfy specific needs of WPH by using a phased mini-PACS approach and to select the various vendors to implement it. Suppliers for individual mini-PACS were selected to provide modality-specific solutions. For the backbone network, vendors were evaluated based on their technological progress, competence and resources, the commitment of the company to the imaging network business, and their willingness to embark on a mid-sized PACS project such as this. Based on patient volume, workflow patterns, and image quality requirements, the committee produced proposals detailing number and location of workstations, short- and long-term memory requirements, and so on. Computed tomography/magnetic resonance imaging, computer radiography, ultrasound, nuclear medicine, digital fluoroscopy, and angiography mini-PACS have been implemented over the past 2 years, and most of these are already integrated into the main REIN. This article presents detailed information concerning the design, selection and implementation processes, including storage requirement calculations. This indicates that PACS implementation is achievable for community hospitals with small computer, networking, and physics departments. Also presented are recommendations concerning design and vendor selection, that may be helpful for similar institutions. PMID:9268864
Arreola, M; Neiman, H L; Sugarman, A; Laurenti, L; Forys, R
OBJECTIVE: To determine referral rates, to study the nature of consultations with obstetricians, and to examine how both patient and physician characteristics affect referrals. DESIGN: Case series. Retrospective review of hospital records. SETTING: Victoria Hospital, a tertiary care centre affiliated with the University of Western Ontario in London, Ont. PARTICIPANTS: Five hundred forty-two women admitted consecutively for delivery under the care of family physicians from October 1, 1990, to September 31, 1991. OUTCOME MEASURE: The number and types of obstetrical consultations obtained for the study population. RESULTS: Of the 50.7% of cases requiring consultation, half were delivered by obstetricians. The most common reasons for consultation were failure to progress in labour, induction of labour, posterior presentation, fetal distress, and pregnancy-induced hypertension. The most common reasons for obstetricians to attend delivery were to perform forceps rotations and cesarean sections. CONCLUSIONS: Parity and risk classification were the two most important factors for predicting whether consultation would occur. The high rate of consultation in this study might relate to ease of access to consultation in a tertiary care environment. More study is needed to examine the reasons for consultation because it seems that some of the situations for which obstetricians were consulted could have been safely managed by family physicians.
The present study was conducted to assess the epidemiological relation of Staphylococcus aureus isolates from nasal carriers of hospital staff. Nasal swabs were taken from each of 327 personnel. After culturing on blood agar for overnight, probable staphylococcal isolates were identified and subjected to tube coagulase test. After a two-week interval, second nasal swabs were taken from the subjects whose first cultures were positive for S. aureus. Nasal carriage was defined in 58 (17.7%) personnel with positive culture for both sampling time. Antibiogram typing and arbitrarily-primed polymerase chain reaction (AP-PCR) with M13 primer were used for typing of the strains. Antibiotyping distinguished seven types and three subtypes, and 85% of the isolates were clustered in one group. AP-PCR, in contrast, identified 12 distinct patterns with 13 variants. A specific profile was not found among the isolates obtained from the personnel in a particular clinic. These results indicate that antibiotyping has poor discrimination power and heterogeneity among the nasal S. aureus strains in the hospital personnel screened is high. PMID:12437221
Guducuoglu, H; Ayan, M; Durmaz, R; Berktas, M; Bozkurt, H; Bayram, Y
The overall objective of this initiative was to develop a quality improvement (QI) curriculum using Lean methodology for internal medicine residents at Boston Medical Center, a safety net academic hospital. A total of 90 residents and 8 School of Public Health students participated in a series of four, 60- to 90-minute interactive and hands-on QI sessions. Seventeen QI project plans were created and conducted over a 4-month period. The curriculum facilitated internal medicine residents' learning about QI and development of positive attitudes toward QI (assessed using pre- and post-attitude surveys) and exposed them to an interprofessional team structure that duplicates future working relationships. This QI curriculum can be an educational model of how health care trainees can work collaboratively to improve health care quality. PMID:23382452
In Nepal, febrile illness is one of the most common reasons for seeking medical attention, but there is limited information on the frequency of specific etiology of fever. This is a retrospective study. Patients presented with fever admitted in medicine ward and Intensive care unit of KIST Medical College, Imadol, Lalitpur from January 2010 to January 2012 are included in the study. Of the 898 patients enrolled, 23.5% had infective exacerbation of COPD. Enteric fever, urinary tract infection, acute gastroenteritis, tuberculosis and community acquired pneumonia were the cause of fever in 20%, 13%, 10%, 7.3% and 6% cases of respectively. Findings confirm the heavy burden of infection was a cause of fever requiring hospitalization. This highlights the importance of simple diagnostic tests and cost effective treatment required to manage these patients. PMID:24047025
Dhungana, S P; Shrestha, S K; Kashyap, A K; Piryani, R M; Acharya, G P
This study was aimed at contributing to the cost management of the admission process of nursing technicians by mapping and measuring the direct cost of the main activities in this process. The exploratory, retrospective, documental study on the modality of case study was carried out at the Educational Support Service of the University of São Paulo's Hospital Universitário. The admission process was divided into five sub-processes: planning, recruiting, selection, hiring and admission training. Results showed that the direct total cost of the admission process was R$ 6359.90, and that, within the sub-processes, selection was the one that consumed most resources--R$ 3416.40, amounting to 53.72% of the total. Each hired candidate cost R$ 635.99. PMID:17977388
The objective of this research was to assess current patterns of hospital antibiotic prescribing in Northern Ireland and to determine targets for improving the quality of antibiotic prescribing. A point prevalence survey was conducted in four acute teachinghospitals. The most commonly used antibiotics were combinations of penicillins including ?-lactamase inhibitors (33·6%), metronidazole (9·1%), and macrolides (8·1%). The indication for treatment was recorded in 84·3% of the prescribing episodes. A small fraction (3·9%) of the surgical prophylactic antibiotic prescriptions was for >24 h. The results showed that overall 52·4% of the prescribed antibiotics were in compliance with the hospital antibiotic guidelines. The findings identified the following indicators as targets for quality improvement: indication recorded in patient notes, the duration of surgical prophylaxis and compliance with hospital antibiotic guidelines. The results strongly suggest that antibiotic use could be improved by taking steps to address the identified targets for quality improvement. PMID:22115422
Aldeyab, M A; Kearney, M P; McElnay, J C; Magee, F A; Conlon, G; MacIntyre, J; McCullagh, B; Ferguson, C; Friel, A; Gormley, C; McElroy, S; Boyce, T; McCorry, A; Muller, A; Goossens, H; Scott, M G
Background: Wound infections continue to be problematic in clinical practice where empiric treatment of infections is routine. Objectives: A retrospective cross-sectional study to determine the current causative organisms of wound infections and their antibiotic susceptibility patterns in the Niger Delta University TeachingHospital (NDUTH), Okolobiri, Bayelsa State of Nigeria. Methods: Records of wound swabs collected from 101 patients with high suspicion of wound infection were analysed. Smears from the wound swabs were inoculated on appropriate media and cultured. Bacterial colonies were Gram stained and microscopically examined. Biochemical tests were done to identify pathogen species. The Kirby-Bauer disk diffusion method was used for antibiotic testing. Results: Prevalence of wound infection was 86.13% (CI: 79.41–92.85). Most bacteria were Gram negative bacilli with Pseudomonas aeruginosa being the most prevalent pathogen isolated. The bacterial isolates exhibited a high degree of resistance to the antibiotics tested (42.8% to 100% resistance). All isolates were resistant to cloxacillin. Age group and sex did not exert any effect on prevalence, aetiological agent or antimicrobial resistance pattern. Conclusion: We suggest a multidisciplinary approach to wound management, routine microbiological surveillance of wounds, rational drug use and the institution of strong infection control policies.
PURPOSE To determine the level of awareness of mammography and mammographic screening amongst women in Lagos, Nigeria. MATERIALS AND METHODS A structured questionnaire was administered to 555 consecutively recruited women who visited various clinics at the Lagos State University TeachingHospital, Ikeja, between January 2009 and June 2009. RESULTS The mean age of respondents was 38.16 ± 9 years, and the majority (59.6%) had a tertiary education. A family history of breast cancer was present in 33 (6.0%) women, less than 20% of whom had undergone mammography. Only 20% of all subjects were aware of the recommendation that they should receive routine mammography and mammographic screenings on an annual or biannual basis, depending on their age, and of the side effects associated with the procedure. The mass media was women's main source of information regarding these procedures. The majority (67.6%) of participants confirmed that they performed breast self-examinations, though less than 5% of them had had their breasts examined by mammography. CONCLUSION This study revealed a rather low level of awareness about mammography and mammographic screening, indicating the need to educate women about the risk of breast cancer and the importance of screening as a tool for the early detection and treatment of this condition. PMID:20677131
Background: Bloodstream infections are associated with a significant patient morbidity and mortality. The detection of microorganisms in the patients’ blood has a great diagnostic and prognostic significance. The early positive results provide valuable diagnostic information, based on which the appropriate antimicrobial therapy can be initiated. Objective: To know the aetiology of the bloodstream infections in the Kathmandu Medical College, Nepal and the antibiotic sensitivity patterns of the causative organisms. Materials and Methods: The blood specimens which were received from May 2010 to October 2010 in Kathmandu Medical College and TeachingHospital, Kathmandu, Nepal, were processed and all the positive isolates were included in the study. The isolates were identified by the standard laboratory procedures. The antibiotic susceptibility patterns were determined by the modified Kirby Bauer antibiotic sensitivity method. Result: Of the 1089 blood cultures which were received with the suspected cases of blood stream infections, 138 (12.6 %) were bacteriologically positive. Salmonella serotypes were isolated in 42.7% cases of blood stream infections, followed by Klebsiella pneumoniae in 19.5%, Staphylococcus aureus in 15.9% and others in the rest of the cases. All the gram-negative bacilli isolates showed lower degrees of resistance to amikacin and ofloxacin. All the gram positive isolates were sensitive to amikacin, oxacillin and vancomycin. Conclusion: This study stresses on the need for a continued screening and surveillance in the routine blood culture technique for starting with the empiric therapy for blood borne infections.
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 TeachingHospital, 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.
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.
Background: Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our environment. However, its benefit in women aged 40 years and above remains debatable. Materials and Methods: An 11-year prospective study was conducted involving 98 women, aged 40 years and above, who had abdominal myomectomy for the treatment of uterine fibroid at the University of Maiduguri TeachingHospital, Maiduguri. They were followed up regularly for 1–6 years to detect conception, resolution of symptoms and obstetrics performance. Data were analyzed using SPSS version 13. Results: The mean age of the patients was 42.6±2.9 years and 77 (78.6%) of them were nulliparous. Lower abdominal swelling was the commonest clinical presentation and the mean uterine size was 18.6±8.5 weeks. Infertility with uterine fibroids was the indication for myomectomy in majority of the cases [48 (48.9%)], while pregnancy complications accounted for 11.2% (11) of the cases Fertility restoration was 10.4% among the infertile patients. There was complete resolution of symptoms in 35.9% of those who required symptomatic relief, and term pregnancies were recorded in 72.7% of patients with pregnancy complications. Conclusion: Myomectomy is the recommended treatment of uterine fibroids in women aged 40 years and above with infertility and who wish to become pregnant. If there is no need for further fertility preservation, hysterectomy should be offered.
Obed, Jesse Y.; Bako, Babagana; Kadas, Saidu; Usman, Joshua D.; Kullima, Abubakar A.; Moruppa, Joel Y.
To describe the self-reported oral health knowledge, attitudes and oral hygiene habits, among pregnant women receiving antenatal care at the Lagos State University teachingHospital (LASUTH). A cross-sectional questionnaire-based survey was conducted at the LASUTH antenatal clinic during the period January - June 2008. Most of the respondents demonstrated a reasonable level of oral health knowledge and positive attitudes towards oral health. However, there were gaps in the oral health knowledge of the women surveyed. The relationship between the level of oral health knowledge and ethnicity (p=0.856), level of education (p=0.079), age category (p=0.166), and trimester of pregnancy (p=0.219) were not statistically significant. In addition, the women's knowledge and attitude towards oral health was not reflected in their oral hygiene practices. There is a need to provide oral health education for pregnant women during antenatal care in order to highlight the importance of good oral health in achieving good health for both the mother and her baby. PMID:22571100
Records of two veterinary teachinghospitals from January 1, 1976 to June 1, 1982 were searched for diagnoses of stifle lameness. Forty-two records were found and information was recorded regarding signalment, history and clinical presentation. The following abnormalities were associated with stifle lameness: subchondral bone cyst (18 cases), joint instability (15 cases), degenerative joint disease (12 cases), cranial cruciate ligament injury (9 cases), cytological or bacteriological evidence of sepsis (9 cases), collateral ligament injury (3 cases), femorotibial luxation (2 cases) and intra-articular fracture (2 cases). The duration of lameness presentation ranged from 0.3 to 24 weeks and the mean follow-up period was 20.47 ± 11.44 months (three animals were lost to follow-up). Animals (n = 15) with subchondral bone cysts as the sole association with lameness presented at an early age (range — 6 to 18 months) and apparently regardless of treatment, had a good prognosis as determined by 75% (three lost to follow-up) returning to their intended function. Cattle (n = 9) with septic arthritis were presented at an age ranging from two months to seven years and only 22.2% returned to function. Cattle (n = 15) with joint instability presented at an age varying from nine months to 13 years also did poorly as only 26.6% returned to function. ImagesFigure 1.Figure 2.
The goal of every surgery is a successful outcome with the shortest hospital stay. Morbidly obese patients with their myriad of comorbidities have confounded surgeons over the years, usually leading to an increased length of hospital stays after complicated surgeries. Laparoscopic Roux-en-Y gastric bypass (LRYGB) has proven to be an effective treatment for the morbidly obese with a usual length of stay of 3 days. The purpose of this article is to review our experience with 23-hour stays for LRYGB over a 13-month period and to apply a recently published risk score to these patients. A single surgeon performed 173 bariatric surgeries of which 96 were LRYGB, the study group. The demographics of this group found the overwhelming majority were female, white, slightly older than the men but with a somewhat smaller body mass index (BMI). The ethnic breakdown was 67.7 per cent white, 22.9 per cent black, and 9.4 per cent Hispanic. The average for all patients was 41.7 years and the BMI was 49.25 kg/m2. Using the Obesity Surgery Mortality Risk Score, 62.5 per cent of our patients were low risk or Class A, 37.5 per cent intermediate risk or Class B, and none of our patients qualified as high risk or Class C. Our average patient score was 1.3. In terms of length of stay, 91 of the 96 patients (94.8%) were discharged within 23 hours of surgery without mortality or 30-day readmission. The remaining five patients (5.2%) had unexplained, sustained tachycardia and were re-explored on the first postoperative day laparoscopically. Three of these patients had negative explorations. One had a jejunojejunostomy revision and the other was found to have a small bowel injury, which was laparoscopically repaired. All five patients were discharged within the next 23 hours. All patients were discharged on a clear liquid diet and advanced to a regular diet over the next month. No diet intolerance was noted nor were any patients converted to an open operation. In conclusion, we have demonstrated that a comprehensive bariatric program in a small teaching community hospital can successfully perform LRYGB and discharge a high percentage of patients within 23 hours with a very low complication rate. We also believe the Obesity Surgery Mortality Risk Score will help bariatric programs to risk-stratify their patients preoperatively. This will contribute to decision-making and further inform patients of their risk as part of their education preoperatively. PMID:19097539
Fares, Louis G; Reeder, Rachel C; Bock, John; Batezel, Valerie
Background and Aims: The aim of this study was to investigate whether changes can be accomplished rapidly after implementing a fast-track colonic surgery project at a university-affiliated general teachinghospital. Methods: In 2004 and 2005 all colonic surgery patients were recorded for a number of pre-, per- and postoperative care elements. In 2006, during the implementation of a fast-track program,
K. J. C. Jottard; C. van Berlo; L. Jeuken; C. Dejong
This is a retrospective study analysing the reasons behind the observed increasing rate of caesarean section (C/S) over a 10-year period (1990-99) in the obstetric unit of Jordan University Hospital. All the indications of C/S carried out in the unit were analysed. The duration of the study was divided into 2, of 5 years each (1990-94, 1995-99). There was a 6.9% increase in the C/S rate over the second half of the study period. This was statistically significant (P < 0.001). All the indications contributed significantly to rise. Fetal distress had the highest contribution 33.5%, while repeat C/S and malpresentation contributed to 21.5% and 21.3%, respectively. This increase was not associated with a significant change in the perinatal mortality. The rise in the caesarean section rate was higher in primigravida compared with multigravida (10.9% vs 6.2%). Fetal distress has the highest contribution in primigravida. In multigravida, if we exclude repeat caesarean section, the major indications were fetal distress and malpresentation. The percentage of elective and emergency caesarean section was similar in both study periods. The reasons behind the increase C/S rate couldn't be understood. Probably a lower threshold concerning the decision to perform the C/S rather than a change in obstetric management in responsible for this rise. PMID:12745557
INTRODUCTION Being able to communicate effectively with patients is essential not only from a medicolegal standpoint but more importantly from clinical governance perspectives. Issues such as informed consent and patient choice within the NHS are currently being highlighted; for these to be available to patients, their language requirements are paramount. PATIENTS AND METHODS An audit was performed by the Linkworkers office at the Central Manchester & Manchester Children's Hospital NHS (CMMC) Trust on the total number of attendances and refusals per language in the period 1998–2003. RESULTS In the CMMC Trust, Urdu/Punjabi, Bengali, Cantonese, Somali, Arabic and French represent the majority of the workload, comprising almost 80% of cases in 2003. In the same year, an increase in demand for languages of Eastern European countries became evident. Finding interpreters for these languages even via agencies can be extremely difficult. CONCLUSIONS If the current trend continues, requirement for these services will increase exponentially. For this demand to be met adequately these issues must be kept at the forefront of NHS planning.
Khwaja, Nadeem; Sharma, Saroj; Wong, Julian; Murray, David; Ghosh, Jonathan; Murphy, Michael O; Halka, Anastassi T; Walker, Michael G
Burns are a significant health problem in Brazil, but there have been few data collected that could shape treatment and prevention programs. To help overcome that knowledge gap, this study looked at the types of accidents and the characteristics of 138 burn patients admitted into the burn unit of the University of São Paulo Hospital in Ribeirão Preto, state of São Paulo, Brazil, between November, 1991, and December, 1993. Patient charts were reviewed to collect data on age, sex, region of the body affected, burn depth and surface affected, agent causing the burn, and circumstances in which the burn happened. Of the 138 cases, 71% occurred in the home. In 50% of all accidents the victims were children. Boiling water was the agent responsible for 59% of the accidents among children younger than 3 years of age; fuel alcohol used in the home for cooking and other purposes caused 57% of the accidents among children between 7 and 11 years, the most affected pediatric group. Among adults, the group between 20 and 39 years of age was the most affected (23%); 84% of the victims in this age group were male. Seventeen percent of all cases involved adult males at work. Women suffered burns in accidents at home (67%) and in suicide-related events (33%). Seventy-five percent of the suicide cases were women. The strategies to reduce the incidence of burn injuries should aim at eliminating environmental risk factors and implementing educational programs disseminated through radio and television. PMID:9924518
Rossi, L A; Barruffini, R de C; Garcia, T R; Chianca, T C
Aims: To evaluate a systematic approach to the development and implementation of evidence based asthma management guidelines. Methods: Comparative study of children (2–18 years) with acute asthma; a control cohort (cohort 1) was recruited before implementation of the guidelines and two cohorts were recruited after implementation (cohorts 2 and 3). Results: There was no difference in the proportion of patients who reattended in the six months following initial presentation for cohort 1 (21.5%), cohort 2 (27.8%), or cohort 3 (25.4%) and no difference in readmission rates (11.4%, 11.3%, 11.0% respectively). There was no difference in measures of asthma morbidity between the cohorts at 3 and 6 months across three domains: interval symptoms, exercise limitation, and bronchodilator use. Of those who did not have a management plan before presentation, one was provided to 46.9% of cohort 1, 74.8% of cohort 2, and 81.1% of cohort 3. There was no difference comparing cohort 2 or cohort 3 with cohort 1 regarding quality of life for either the subjects or their parents. Conclusions: Implementation of our evidence based guidelines was associated with the improved provision of asthma management plans, but there was no effect on reattendance or readmission to hospital, asthma morbidity, or quality of life. Future efforts to improve asthma management should target specific components of asthma care.
Massie, J; Efron, D; Cerritelli, B; South, M; Powell, C; Haby, M; Gilbert, E; Vidmar, S; Carlin, J; Robertson, C
OBJECTIVE--To investigate outpatients' use of, and satisfaction with social care services in an HIV unit. DESIGN--Survey of patients with HIV infection using self administered questionnaire. SETTING--Outpatient HIV clinics at the Royal Free Hospital, London, March-April 1991. MAIN OUTCOME MEASURES--Patients' social circumstances, use or intended use of social care services and satisfaction with social care services. RESULTS--The greatest demand was for counselling about coping with HIV (38% of respondents), available medical treatment (24%), counselling for the HIV test (33%), psychological support for emotional (24%) or relationship problems (16%), advice about housing (24%) and financial matters (20%). In general, the use of social care services by men and women was similar. Twice as many men, however, sought help with payment of domestic bills, compared with women. Women were more likely to seek advice about financial benefits, obtaining sterile injecting equipment and discuss sleep and relationship problems. Thirty eight percent of patients were unemployed. Overall, 84% thought the service was good or excellent. Although less than 40% of patients currently used any one service, 60% thought they would use these services in the future. CONCLUSION--The greatest demand for social care services was for coping with HIV, housing and financial matters, and HIV test counselling. More than half the patients stated that they would probably need social care services in future.
Bor, R; Elford, J; Murray, D; Salt, H; Tilling, J; Miller, R; Johnson, M
OBJECTIVES: This study was undertaken to characterize the neuroinfection profile in a tertiary neurological ward. INTRODUCTION: Neuroinfection is a worldwide concern and bacterial meningitis, tetanus and cerebral malaria have been reported as the commonest causes in developing countries. METHODS: From 1999 to 2007, all patients admitted to the Neurology Ward of Hospital das Clínicas, S?o Paulo University School of Medicine because of neuroinfection had their medical records reviewed. Age, gender, immunological status, neurological syndrome at presentation, infectious agent and clinical outcome were recorded. RESULTS: Three hundred and seventy four cases of neuroinfectious diseases accounted for 4.2% of ward admissions and the identification of infectious agent was successful in 81% of cases. Mean age was 40.5±13.4 years, 63.8% were male, 19.7% were immunocompromised patients and meningoencephalitis was the most common clinical presentation despite infectious agent. Viruses and bacteria were equally responsible for 29.4% of neuroinfectious diseases; parasitic, fungal and prion infections accounted for 28%, 9.6% and 3.5% respectively. Human immunodeficiency virus (HIV), herpes simplex virus 1 (HSV1), Mycobacterium tuberculosis, Treponema pallidum, Taenia solium, Schistosoma mansoni, Cryptococcus neoformans and Histoplasma capsulatum were the more common infectious pathogens in the patients. Infection mortality rate was 14.2%, of which 62.3% occurred in immunocompetent patients. CONCLUSION: Our institution appeared to share some results with developed and developing countries. Comparison with literature may be considered as quality control to health assistance.
Marchiori, Paulo E; Lino, Angelina M M; Machado, Luis R; Pedalini, Livia M; Boulos, Marcos; Scaff, Milberto
Background This study was carried out in Opi-Agu a tropical semi-urban autonomous community comprising of three villages in Enugu State, Nigeria, between the months of April and June 2010. It was designed to determine the prevalence of Onchocerca volvulus infection and assess the perception of the disease among the inhabitants of this community. Methods A total number of 305 individuals comprising of 148 males and 157 females were examined for various manifestations of onchocerciasis symptoms using rapid epidemiological assessment (REA) method. Results Out of this number, 119 (39.02%) individuals were infected. Prevalence of infection among age groups and villages varied. Age group 41 yr and above had the highest (31.00%) prevalence, while among the villages, Ogbozalla village ranked higher (45.71%) than the other villages. Overall the prevalence of infection among the sexes revealed that males were more infected (43.24%) than the females (35.03%). Lichenified onchodermatitis (LOD) was the most prevalent (35.29%) onchocerciasis symptom among others identified in the area, while leopard skin (LS) had the lowest (20.17%) occurrence and blindness (0.00%) which is the most devastating effect of O. volvulus infection was not observed. Questionnaire responses from 410 individuals revealed that 34.8% respondent from Idi village and 28.1% from Ibeku village believed that O. volvulus infection occurs through poor personal hygiene. Bite of blackfly ranked least (10.6%) among the respondent's knowledge of the causes of onchocerciasis in Opi-Agu community. Conclusion Opi-Agu community members had poor knowledge of onchocerciasis, the vector and of its etiologic organism. There is need for integration of community health education with mass chemotherapy.
Background Periprosthetic joint infections (PJIs) are major complications associated with high costs and substantial morbidity. We sought to evaluate hip and knee arthroplasty infection rates at our hospital, compare them in periods before and after implementation of measures to reduce PJIs (1990–2002 and 2003–2007) and identify associated risk factors. Methods We retrospectively reviewed records of patients who received primary hip or knee total joint prostheses at our centre between Jan. 1, 1990, and Dec. 31, 2007, and were readmitted for the treatment of infection related to their surgery. We also reviewed data from a prospective surveillance protocol of total hip (THA) and knee arthroplasty (TKA) infections that started in November 2005. We ascertained the annual rates of deep, superficial and hematogenous infections. Results During the periods studied, 2403 THAs and 1220 TKAs were performed. For THA, the average rates of deep, superficial and hematogenous infections were 2.0%, 0.8% and 0.3%, respectively. For TKA, the rates were 1.6%, 0.7% and 0.2%, respectively. Of 106 infected joints, 84 (79.2%) presented risk factors for infection. Efforts to reduce the infection rate at our institution began in 2003. We achieved a 44% decrease in the deep infection rate for THA (2.5% v. 1.4%, p = 0.06) and a 45% decrease for TKA (2.0% v. 1.1%, p = 0.20) between the periods studied. Conclusion Knowing the actual infection rate associated with different procedures in specific settings is essential to identify unexpected problems and seek solutions to improve patient care. Although we do not know what specific improvements were successful, we were able to decrease our infection rates to levels comparable to those reported by similar care centres.
Background: The underlying pathological conditions in cardio-thoracic patients, anesthetic and operative interventions often lead to complex physiological interactions that necessitate ICU care. Our objectives were to determine the intensive care unit (ICU) utilization by cardio-thoracic patients in our centre, highlight the common indications for admission; and evaluate the interventions provided in the ICU and the factors that determined outcome. Materials and Methods: The intensive care unit (ICU) records of University College Hospital, Ibadan for a period of 2 years (October 2007 to September 2009) were reviewed. Data of cardio-thoracic patients were extracted and used for analysis. Information obtained included the patient demographics, indications for admission, interventions offered in the ICU and the outcome. Results: A total of 1, 207 patients were managed in the ICU and 206 cardio-thoracic procedures were carried out during the study period. However, only 96 patients were admitted into the ICU following cardio-thoracic procedures, accounting for 7.9% of ICU admissions and 46.6% of cardio-thoracic procedures done within the review period. The mean length of stay and ventilation were 5.71 ± 5.26 and 1.30 ± 2.62 days. The most significant predictor of outcome was endotracheal intubation (P = 0.001) and overall mortality was 15%. Conclusion: There is a high utilization of the ICU by cardio-thoracic patients in our review and post-operative care was the main indication for admission. Some selected cases may be managed in the HDU to reduce the burden on ICU resources. We opine that when endotracheal intubation is to continue in the ICU, a 1:1 patient ratio should be instituted.
Osinaike, Babatunde B; Akinyemi, Oluranti A; Sanusi, Arinola A
Iatrogenic errors producing serious and often preventable injury occur frequently in hospitalized patients, particularly in children. Little is known about the epidemiology of analgesic medication errors in patients being discharged from the hospital. The goal of this study was to describe the epidemiology of controlled substance prescription errors by physicians-in-training for children being discharged from the hospital. We conducted a
Benjamin H. Lee; Christoph U. Lehmann; Eric V. Jackson; Sabine Kost-Byerly; Sharon Rothman; Lori Kozlowski; Marlene R. Miller; Peter J. Pronovost; Myron Yaster
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.
Ezenwaji, Emma E.; Anyadike, Raymond N. C.; Igu, Nnaemeka I.
Background Pharmaceutical drug promotion is a means of informing health professionals about new drugs. The approach is often times unethical and inappropriate and may promote irrational prescribing. Dearth of information on impact of pharmaceutical drug promotion on prescribing behaviour of doctors in developing African countries has necessitated this study. We therefore aimed to determine the sources of drug information for doctors working in a teachinghospital in Nigeria and to assess the self-reported impact of the sources on their prescribing behaviour. Methods A total of 163 doctors working at the University College Hospital (UCH), Ibadan in Nigeria were evaluated with a questionnaire for their demographics and sources of drug information. For doctors who relied on drug promotion, they were asked to self-report and self-rate their opinion on extent of interactions with pharmaceutical companies as well as how such interactions had impacted on their prescribing behaviour. Apart from the demographics, each question was evaluated with a typical five-level Likert item. Data analyses were with simple descriptive statistics. Results Of the 400 doctors working at UCH, only 40.8% participated in the study. Drug information was sourced from colleagues (161, 98.8%), reference books (158, 96.9%), pharmaceutical sales representatives-PSRs (152, 93.2%), promotion materials (151, 92.6%), scientific papers/journals/internet (149, 91.4%), and drug promotion forum/product launches (144, 88.3%). Each source was highly utilized but there was no wide variation in their pattern of use. According to the self-report of over a half of the respondents, PSRs was an accurate and reliable drug information resource; PSRs increased their awareness of the promoted drugs; and their prescribing behaviours were influenced by information from PSRs. Conclusion Respondents tend to rely on a broad range of drug information resources which include potentially inappropriate resources such as PSRs. Since this study was based on self-report, the influence of drug information resources reported by the respondents on their prescribing behaviour may have been underestimated. Measures should be taken to minimize interactions between PSRs and the respondents.
Background: Underreporting of spontaneous adverse drug reaction (ADR) is a threat to pharmacovigilance. Various factors related with the knowledge and attitudes are responsible for underreporting of ADRs. Aims: The study was aimed at investigating the knowledge and attitudes of doctors to ADR reporting. Materials and Methods: It was a questionnaire-based cross-sectional study. One hundred and eight questionnaires were administered to doctors working in a teachinghospital with an ADR monitoring center. Statistical Analysis Used: The descriptive statistics were used for responses to evaluate the knowledge and attitudes toward ADR reporting. Pearson's Chi-square test was used to observe the association of knowledge and attitude with experience and position. Results: The response rate was 62.9%. Spontaneous reporting rate was found to be 19.1%. The major factors found to be responsible for underreporting of ADR include inadequate risk perception about newly marketed drugs (77.9%), fear factor (73.5%), diffidence (67.7%), lack of clarity of information on ADR form about reporting (52.9%), lethargy (42.7%), insufficient training to identify ADRs (41.2%), lack of awareness about existence of pharmacovigilance program (30.9%) and ADR monitoring center in the institute (19.1%), and inadequate risk perception of over-the-counter (OTC) product (20.6%) and herbal medicines (13.2%). Experience and position did not influence the knowledge and attitudes of doctors. Conclusion: The deficiencies in knowledge and attitudes require urgent attention not only to improve the rate of spontaneous reporting, but also for enhanced safety of the patients and society at large.
Khan, Sarfaraz Alam; Goyal, Chhaya; Chandel, Nitibhushansingh; Rafi, Mohammed
Background: Stigma is one of the obstacles in the treatment and regaining the mental health of people with mental illness. The aim was determination of mental illness stigma among nurses in psychiatric wards. This study was conducted in psychiatric wards of teachinghospitals in Tabriz, Urmia, and Ardabil in the north-west of Iran. Materials and Methods: This research is a descriptive analysis study in which 80 nurses participated. A researcher-made questionnaire was used, which measured demographic characteristics and mental illness stigma in the three components of cognitive, emotional, and behavioral. All data were analyzed using SPSS13 software and descriptive and analytical statistics. Results: Majority of nurses (72.5%) had medium level of stigma toward people with mental illness. About half of them (48.8%) had great inclination toward the social isolation of patients. The majority of them (62.5%) had positive emotional responses and 27.5% had stereotypical views. There was a significant correlation between experience of living with and kinship of nurses to person with mental illness, with prejudice toward and discrimination of patients. There was also a significant correlation between interest in the continuation of work in the psychiatric ward and prejudice, and also between educational degree and stereotypical views. Conclusions: The data suggest there is a close correlation between the personal experience of nurses and existence of mental illness stigma among them. Therefore, the implementation of constant educational programs on mental illness for nurses and opportunities for them to have direct contact with treated patients is suggested.
Staphylococcus aureus is an important cause of bloodstream infections worldwide. We examined the prevalence of genes that encode erythromycin ribosome methylase and bacterial toxins in S. aureus collected from bloodstream infections. Sixty different S. aureus isolates were obtained from blood cultures of patients who were admitted to a TeachingHospital in Tianjin from January 2006 to August 2011. The susceptibility of the isolates to 16 antibiotics was tested. Methicillin-resistant S. aureus (MRSA) was identified using the disk diffusion method with cefoxitin. PCR was used to detect genes that encode the staphylococcal enterotoxins, Panton-Valentine leukocidin, toxic shock syndrome toxin 1 and erythromycin ribosome methylase. Molecular analysis of the MRSA strains was done using pulsed-field gel electrophoresis (PFGE) and staphylococcal cassette chromosome mec (SCCmec) typing. The positivity rates of mecA, ermA, ermB, and ermC in the isolates were 13/60, 10/60, 18/60, and 18/60, respectively. Among the 60 isolates, 30 harbored enterotoxin genes, with sea as the most frequent toxin gene (33%), followed by sec (15%), sed (12%), and seb (5%). The see and tst genes were not found in any of the isolates. The pvl gene was detected in four strains. Eleven MRSA isolates were of the SCCmec type III; two MRSA isolates could not be determined through SCCmec typing. PFGE analysis of the 13 MRSA isolates produced 8 distinct pulsotypes. Virulence genes and erythromycin ribosome methylase genes were highly prevalent in these isolates. The PFGE results demonstrated that the MRSA spread through cloning, mainly involving SCCmec type III. PMID:23546946
Wang, L X; Hu, Z D; Hu, Y M; Tian, B; Li, Jing; Wang, F X; Yang, H; Xu, H R; Li, Y C; Li, J
Background: Introduction of the HPV vaccine is a forefront primary prevention method in reducing the incidence of carcinogenic human papillomavirus (HPV) and cervical cancer. The Malaysia government has implemented the National HPV immunisation programme since 2010, supplying HPV vaccine free to targeted 13 year olds. This study aimed to explore the level of knowledge among mothers on cervical cancer, HPV, HPV vaccine and National HPV (NHPV) immunisation programme since its' implementation. It also assessed acceptance of mothers towards HPV vaccine being administered to their daughter, son or themselves. Materials and Methods: A cross sectional study was conducted on 155 respondents using self-administered questionnaires; conducted in December 2012 at the Obstetrics and Gynaecology Clinic in a teachinghospital in Kuala Lumpur. Respondents were selected using a multistage sampling technique. Results: A response rate of 100% was obtained. Overall, 51.0% of mothers had good knowledge, with 55% having good knowledge of cervical cancer, 54.2% for both HPV and the National HPV immunisation programme and 51.0% for the HPV vaccine. Regression analyses showed that ethnicity was associated with knowledge on cervical cancer (p=0.003) while education was associated with knowledge on HPV (p=0.049). Three factors are associated with knowledge of the National HPV immunisation programme; ethnicity (p=0.017), mothers' education (p=0.0005) and number of children (p=0.020). The acceptance of HPV vaccine to be administered among daughter was the highest at 87.1%, followed by for mothers themselves at 73.5%, and the least is for sons 62.6%. Conclusions: This study found that the overall level of knowledge was moderate. Adequate information on cervical cancer, HPV, HPV vaccination and the National HPV immunisation programme should be provided to mothers in order to increase acceptance of the HPV vaccine which can reduce the disease burden in the future. PMID:23803068
Ezat, Sharifa Wan Puteh; Hod, Rozita; Mustafa, Jamsiah; Mohd Dali, Ahmad Zailani Hatta; Sulaiman, Aqmar Suraya; Azman, Azlin
Background Association between psychiatric morbidity and substance abuse among adolescent has been reported. However prevalence and pattern of such dysfunctions are unknown in our environment. Aims To determine the prevalence of psychosocial dysfunction and depressive symptoms among adolescents who abuse substance and also note the influence of socio-demographic factors and type of substance on the pattern of dysfuction. Method A cross-sectional study was carried out among 900 adolescents selected from 29 secondary schools in Enugu metropolis. A multi-stage sampling procedure was used to select the students. The student drug use questionnaire was used to screen respondents for substance abuse. Those who were abusing substance and matched controls (non substance abusers) were assessed for psychiatric symptoms using the 35-item Paediatric Symptom Checklist (PSC) and the Zung Self-rating Depression Scale (SDS). Social classification was done using the parental educational attainment and occupation. Result A total of 290 students were current substance abusers. The substances most commonly abused were alcohol (31.6%), cola nitida (kola nut) (20.7%) and coffee (15.7%). Using the PSC scale, 70 (24.1%) subjects compared to 29 (10.7%) of the controls had scores in the morbidity range of ? 28 for psychosocial dysfuction. This was statistically significant (?2 = 17.57 p = 0.001). Fifty-four subjects (18.6%) had scores in the morbidity range of ? 50 for depressive symptoms using the Zung SDS compared to 21 (7.7%) of controls. This was statistically significant (?2 = 14.43, p = 0.001). Prevalence of dysfunction was not significantly related to age in both subjects and controls (?2 = 4.62, p = 0.010, ?2 = 4.8, p = 0.10 respectively). Also using both scales, there was no significant relationship between psychosocial dysfunction and gender or social class in both subjects and control. The prevalence of dysfuction using both scales was significantly higher in multiple abusers compared to single abusers. Subjects abusing alcohol scored more on both scales compared to those abusing other substances. Conclusion Prevalence of psychosocial dysfunction is higher in adolescents abusing substance compare to controls. The prevalence of psychiatric morbidity was not related to the age, gender or social classes in the study population.We advocate periodic screening of our adolescents for drug abuse regular evaluation of such group for possible psychopathology.
Background The Community Directed Interventions (CDI) strategy has proven effective in increasing access to health services in sedentary populations. It remains to be seen if CDI strategy is feasible among nomads given the dearth of demographic and medical data on the nomads. This study thus characterized the nomadic populations in Enugu State, Nigeria and outlined the potentials of implementing CDI among nomads. Study design and methods This exploratory study adopted qualitative methods. Forty focus group discussions (FGD) were held with members of 10 nomadic camps in 2 LGAs in Enugu State, as well as their host communities. Thirty in-depth interviews (IDIs) were held with leaders of nomadic camps and sedentary populations. Ten IDIs with traditional healers in the nomadic camps and 14 key informant interviews with health workers and programme officers were also conducted. Documents and maps were reviewed to ascertain the grazing routes of the nomads as well as existing health interventions in the area. Results Like sedentary populations, nomads have definable community structures with leaders and followers, which is amenable to implementation of CDI. Nomads move their cattle, in a definite pattern, in search of grass and water. In this movement, the old and vulnerable are left in the camps. The nomads suffer from immunization preventable health problems as their host communities. The priority health problems in relation to CDI include malaria, measles, anemia, and other vaccine preventable infections. However, unlike the sedentary populations, the nomads lack access to health interventions, due to the mutual avoidance between the nomads and the sedentary populations in terms of health services. The later consider the services as mainly theirs. The nomads, however, are desirous of the modern health services and often task themselves to access these modern health services in private for profit health facilities when the need arises. Conclusion Given the definable organizational structure of the nomads in Enugu State and their desire for modern health intervention, it is feasible to test the CDI strategy for equitable healthcare delivery among nomads. They are willing and capable to participate actively in their own health programmes with minimal support from professional health workers.
There are practically no low cost, environmentally friendly options in practice whether incineration, autoclaving, chemical treatment or microwaving (World Health Organisation in Health-care waste management training at national level,  for treatment of health-care waste. In Kenya, incineration is the most popular treatment option for hazardous health-care waste from health-care facilities. It is the choice practiced at both Kenyatta National Hospital, Nairobi and Moi Teaching and Referral Hospital, Eldoret. A study was done on the possible public health risks posed by incineration of the segregated hazardous health-care waste in one of the incinerators in each of the two hospitals. Gaseous emissions were sampled and analyzed for specific gases the equipment was designed and the incinerators Combustion efficiency (CE) established. Combustion temperatures were also recorded. A flue gas analyzer (Model-Testos-350 XL) was used to sample flue gases in an incinerator under study at Kenyatta National Hospital--Nairobi and Moi Teaching and Referral Hospital--Eldoret to assess their incineration efficiency. Flue emissions were sampled when the incinerators were fully operational. However the flue gases sampled in the study, by use of the integrated pump were, oxygen, carbon monoxide, nitrogen dioxide, nitrous oxide, sulphur dioxide and No(x). The incinerator at KNH operated at a mean stack temperature of 746 °C and achieved a CE of 48.1 %. The incinerator at MTRH operated at a mean stack temperature of 811 °C and attained a CE of 60.8 %. The two health-care waste incinerators achieved CE below the specified minimum National limit of 99 %. At the detected stack temperatures, there was a possibility that other than the emissions identified, it was possible that the two incinerators tested released dioxins, furans and antineoplastic (cytotoxic drugs) fumes should the drugs be subjected to incineration in the two units. PMID:22718254
Many hospital antimicrobial stewardship programs restrict the availability of selected drugs by requiring prior approval. Carbapenems may be among the restricted drugs, but it is unclear if hospitals that restrict availability actually use fewer carbapenems than hospitals that do not restrict use. Nor is it clear if restriction is related to resistance. We evaluated the relationship between carbapenem restriction and
Background Corneal lacerations mostly affect younger children, commonly males, who will constitute the majority of the workforce. Clinical outcomes are reviewed and compared so that measures to reduce their occurrence and improve outcome can be proffered. Methods Records of all children between the ages of 1-18?yrs, who presented with penetrating eye injuries at the eye clinic of the University of Port Harcourt teachingHospital, Rivers state, Nigeria between January 2002 and December 2009 were included. Information retrieved -patient’s Bio data, presenting symptoms, presenting visual acuity (VA), source of injury, surgical intervention and outcome using VA. All data analysed with EPI Info version 6 with the aid of a statistician. Results Folders of thirty-six children (36 eyes) between the ages of 0–18?years diagnosed with corneal laceration over a period of 8?years out of 65 cases managed within that period available. Other folders reported as missing. Male female ratio 3:1, the mean age is 8.7?years (SD?±?3.67). Only one presented within 24?hours. Objects causing injury mainly missiles with stones/catapult injuries (n?=?8, 22.2%). Presenting VAs in those that could be measured, ranged from 6/24 to 6/60 (n?=?4, 11%) to no light perception (NLP) (n?=?5, 13.9%). Associated injuries include lid laceration, cataract, vitreous haemorrhage and retinal detachment. Twenty one patients had primary corneal repair (58.3%) carried out within 7?days of presentation. Four had endophthalmitis. After 3?months follow up, VA of 6/60 and better was achieved in 11 of 18 eyes left in follow up (6/60-6/24 in 8 eyes (22.2%), 6/18 and better in 3 eyes (8.3%). Conclusion Most eye injuries in children are preventable. In this study, the prognosis was better in those whose injuries were confined to a peripheral part of the cornea, with no other associated injury, who presented within 5?days and who did not have any intraocular infection at the time of presentation. The importance of health education, adult supervision of play and application of appropriate measures that is necessary for reducing the incidence and severity of trauma is emphasized.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common human enzyme deficiencies in the world. It is particularly common in populations living in malaria-endemic areas, affecting more than 400 million people worldwide. This present study was conducted with the aim of determining the prevalence of G6PD deficiency among children visiting the Emergency Paediatric Unit of Usmanu Danfodiyo University TeachingHospital for pediatric-related care. The study included 118 children, made up of 77 (65.3%) males and 41 (34.7%) females aged ?5 years with mean age of 3.26 ± 1.90 years. Randox G6PD quantitative in vitro test screening was used for the diagnosis of G6PD deficiency. Of the 118 children tested, 17 (14.4%) were G6PD-deficient. Prevalence of G6PD deficiency was concentrated predominantly among male children (22.1%). Male sex was significantly correlated with G6PD deficiency among the children studied (r = 7.85, P = 0.01). The highest prevalence occurred among children in the 2- to 5-year age-group. Of the 17 G6PD-deficient children, twelve (70.2%) were moderately deficient, while five (29.4%) were severely deficient. Blood film from G6PD-deficient children indicated the following morphological changes; Heinz bodies, schistocytes, target cells, nucleated red cells, spherocytes, and polychromasia. This present study has shown a high prevalence of G6PD deficiency among children residing in Sokoto in the northwestern geopolitical zone of Nigeria. The study indicated a male sex bias in the prevalence of G6PD deficiency among the children studied. There is a need for the routine screening of children for G6PD deficiency in our environment, to allow for evidence-based management of these children and to ensure the avoidance of food, drugs, and infective agents that can potentially predispose these children to oxidative stress as well as diseases that deplete micronutrients that protect against oxidative stress. There is need to build capacity in our setting among pediatricians to ensure the effective management of children with G6PD deficiency.
IntroductionThere are scarce descriptions of hospital drug procurement in the primary literature. The aim of this study was to analyse the drug tender led by a clinical pharmacologist in a 1200-bed university hospital in Serbia, a developing country in socio-economic transition, and to give recommendations for future steps in hospital drug policy.Procedure and outcomesDrug tendering was conducted according to the
Dragan R. Milovanovic; Radomir Pavlovic; Miroslav Folic; Slobodan M. Jankovic
Transcranial Doppler ultrasound scan is a noninvasive method of evaluating the major intracranial vessels. It is becoming an important screening tool for predicting high-risk sickle cell patients for developing cerebrovascular disease. This study evaluates the patients' characteristics, common indications, and findings on Doppler ultrasound of the middle cerebral arteries of sickle cell patients performed at Aminu Kano TeachingHospital, Kano, Nigeria.This is a preliminary report of an ongoing review of the transcranial Doppler scans done at Aminu Kano TeachingHospital. The records of all patients, the indications for Doppler examination, and major findings on the middle cerebral arteries were documented.There are 60 patients, consisting of 22 males and 38 females. Their ages ranged from 1.0 to 41.0 years, with mean of 11.58 ± 7.30 years. About a third of the patients were asymptomatic (38.3%). Those with headache constituted 20.0%, whereas those with past cerebral syndrome constituted 8.3%. Other indications include stroke (11.67%) and transient ischemic attack (3.3%).The mean peak systolic velocity of the middle cerebral artery measured 204.8 cm/s (±80 cm/s) and 208.8 (±79 cm/s) on the respective right and left side. This right-to-left difference was statistically significant (P = 0.046). Symptomatic and female patients showed higher mean peak systolic velocity values when compared with males, although the difference was not statistically significant. PMID:23370781
ISSUE: Pneumonia associated to depressed consciousness (NADC) is an important problem in large hospitals. In our hospital it accounts for 21% of the reported pneumonia with a crude mortality of 26.7%, 18.1 extra days stay (observed mainly at internal medicine and neurosurgery departments). The objective of this work is to evaluate the impact of an interventional program in decreasing the
Hospital patients should have access to effective palliative care. In our study, three short-stay beds were re-allocated to specialist palliative care as part of a pilot programme. This paper describes the first 100 admissions of patients with inadequately controlled symptoms or distress. Median pain and distress scores were both seven out of a maximum of 10 (interquartile ranges [IQR] 4-10 and 1-10 respectively), reducing to 3.5 (IQR 1-5) and 0 (0-5) after 48 hours. Median length of stay was five days (IQR 3-10); 77% of patients were discharged: 32% to home, 26% to a hospice or community hospital, 19% to their original ward for treatment and 23% died in the unit. A unit education programme introduced as part of the study attracted 600 staff members. Pain and distress were rapidly improved by brief, intense palliative care in a small onsite facility. The pilot programme also influenced the understanding of palliative care in the hospital, demonstrating what it offered patients, family and staff. It demonstrated effective, concurrent working alongside an active disease-management approach, and encouraged collaborative discussions about the goals of care. PMID:22441056
Paterson, F; Buchanan, D; Macivor, F; Baker, L; Levack, P
BACKGROUND: Pain is under-recognised and undertreated. Although standards now exist for pain management, it is not known if this has improved care of hospitalized children. OBJECTIVES: To benchmark pain prevalence, pain intensity, pain assessment documentation and pharmacological treatment of pain. The aim was to highlight areas of good practice, identify areas for improvement and inform development of hospital standards, education, future audits and the research agenda. METHODS: The present prospective cross-sectional survey of all medical and surgical inpatient units took place on a single day at the Hospital for Sick Children (Toronto, Ontario), a Canadian tertiary and quaternary pediatric hospital. A structured, verbally administered questionnaire was used to obtain information on patient demographics, pain before admission, pain intensity during admission and pain treatment. Charts were reviewed to establish frequency of documented pain assessment, the pain assessment tool used and analgesics given. Subgroup analysis was included for age, sex, visible minority or fluency in English, medical versus surgical services and acute pain service input. RESULTS AND CONCLUSIONS: Two hundred forty-one (83%) of the 290 inpatients or their carergivers were interviewed. It was found that 27% of patients usually had pain before admission, and 77% experienced pain during admission. Of these, 23% had moderate or severe pain at interview and 64% had moderate or severe pain sometime in the previous 24 h. Analgesics were largely intermittent and single-agent, although 90% of patients found these helpful. Fifty-eight per cent of those with pain received analgesics in the preceding 24 h but only 25% received regular analgesia. Only 27% of children had any pain score documented in the preceding 24 h. It was concluded that pain was infrequently assessed, yet occurred commonly across all age groups and services and was often moderate or severe. Although effective, analgesic therapy was largely single-agent and intermittent. Widespread dissemination of results to all professional groups has resulted in the development of a continuous quality assurance program for pain at the Hospital for Sick Children. A re-audit is planned to evaluate changes resulting from the new comprehensive pain strategies.
Taylor, Elsa M; Boyer, Kristina; Campbell, Fiona A
Limited resources and capacity constraints force Ben Taub General Hospital (BTGH) to optimize patient throughput in order to minimize Emergency Center overcrowding and ambulance diversions. The purpose of this study was to identify impeding systematic del...
The objective of the study was to review the implementation of Post Abortion Care and effective linkage to other post abortion services in Ebonyi State University TeachingHospital, Abakaliki, Nigeria. Data on PAC over a five year period (July, 2004 to June, 2009) were analyzed and a standardized questionnaire was administered to 45 direct PAC service providers. Abortion complications constituted 41.4% of all Gynaecological admissions. Maternal mortality from complications of abortion was 11.5% of all the maternal mortality at the centre. Women aged 19 years and less were 37 (7.1%) and single women were 132, constituting 25.3% of all cases. About 31% of the PAC care providers had formal training for the implementation of the PAC services. Fifteen percent of the care givers were satisfied with the linkage between PAC and the Family Planning services. There is poor integration between emergency post abortion care and other reproductive health services in the centre. PMID:22783674
Caring for an individual with a halo vest can be a frustrating and anxiety-provoking experience for healthcare professionals, the patient, and their families. Physicians or trained nurses apply halo vests in various situations in which cervical spine stabilization is required for an extended period. This device can be used as a first-line treatment in the management of nonoperative cervical trauma, that is, fractures, or placed following cervical surgery. Standardizing the application techniques and care associated with the halo vest, pin site care, and day-to-day activities of daily living will increase the comfort and self-confidence of healthcare professionals and the patient and family members in the provision of care. A collaborative approach among three greater Toronto area teachinghospitals aided in the development of standardizing care and patient educational materials for patients with halo vests. PMID:20550077
The purpose of this report is to present the findings of a retrospective study (2008-2009) to determine the seroprevalence of hepatitis B and C virus in blood donors at the Blood Transfusion Center of Military TeachingHospital Mohammed V in Rabat, Morocco. Samples from 19,801 consecutive blood donors were analyzed by the immuno-enzymatic method (Enzyme Linked Immunosorbent Assay, third generation). The overall seroprevalence of HBV and HCV was 0.8% and 0.2% respectively. A total of 98 units were rejected because of elevated alanine transaminase. No case of co-infection was found. From 1991 to 2010, HBV and HCV seropositivity showed a significant declining trend. In spite of the low prevalence observed, this study confirms that the risk of transfusion transmitted infection exists and thus underlines the need to implement preventive strategies to improve blood transfusion safety. PMID:22235634
Background: Quality of life (QOL) assessment in patients on chronic Hemodialysis (HD) or peritoneal dialysis (PD) has rarely been carried out. The aim of this study was to assess the quality of life during hemodialysis and peritoneal dialysis treatment in patients referred to teachinghospitals in Urmia, Iran. Methods: All chronic HD and PD patients in Taleghani and Imam Khomeini TeachingHospitals in Urmia were requested to fill in the validated with a health-related quality-of-life SF36 questionnaire for assessing health status in five dimensions and on a visual analogue scale, allowing computation of a predicted QOL value to be compared. Results: Of the 558 questionnaires distributed to chronic HD patients, 455 were returned (response rate 82%). Fifty out of 64 PD patients (78%) returned the questionnaires. The two groups were similar in age, gender and duration of dialysis treatment. Mean QOL was rated at 60±18 for HD and 61±19 for PD, for a mean predicted QOL value of 62±30 and 58±32, respectively. Results of the five dimensions were similar in both groups, except for a greater restriction in usual activities for PD patients (p= 0.007). The highest scores were recorded for self-care, with 71% HD and 74% PD patients reporting no limitation, and the lowest scores for usual activities, with 14% HD and 23% PD patients reporting severe limitation. Experiencing pain/discomfort (for HD and PD) or anxiety/depression (for PD) had the highest impact on QOL. Conclusion: The results show that QOL on PD was better, but such studies have not been performed in various areas in Iran and the results may be different because of the involvement of many factors such as geographical, socioeconomic and cultural items. More studies are required to verify the value of the SF36 measurements in predicting the clinical condition of patients with ESRD and their outcomes.
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 TeachingHospital, Northwest Ethiopia. Methods A cross-sectional study was conducted at University of Gondar TeachingHospital 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.
In this study, the relationship between patients' perceptions of pain control during hospitalization and their overall satisfaction with care was examined. Satisfaction data were collected from the federally mandated Hospital Consumer Assessment of Healthcare Providers and Systems survey for 4349 adult patients admitted to any surgical unit over an 18-month period. Patients' perceptions of pain control and staff's efforts to control pain were associated with their overall satisfaction scores. These perceptions varied widely among services and nursing units. Interestingly, patient satisfaction was more strongly correlated with the perception that caregivers did everything they could to control pain than with pain actually being well controlled. The odds of a patient being satisfied were 4.86 times greater if pain was controlled and 9.92 times greater if the staff performance was appropriate. Hospitals may improve their patients' satisfaction by focusing on improving the culture of pain management. PMID:22345130
Hanna, Marie N; González-Fernández, Marlís; Barrett, Ashlea D; Williams, Kayode A; Pronovost, Peter
Many major teachinghospitals might not be able to offer adequate access to specialty care for uninsured patients. This study found that medical school faculty were more likely to have difficulty obtaining specialty services for uninsured than for privately in- sured patients. These gaps in access were similar in magnitude for public and private insti- tutions. Initial treatment of uninsured
Joel S. Weissman; Ernest Moy; Eric G. Campbell; Manjusha Gokhale; Recai Yucel; Nancyanne Causino; David Blumenthal
The apparent prevalence of endoparasitic infections of cats and dogs presented to the small animal Veterinary Hospital of the University of Pennsylvania was measured between 1984 and 1991. Two thousand feline and 8077 canine fecal samples were examined along with 6830 canine blood samples. The overall mean monthly prevalence of feline infections was 16% for ascarids, 0.9% for hookworms, 4.0%
Objective: To assess the pharmacovigilance awareness among the healthcare professionals in a teachinghospital in Northern India.Material and Methods: A questionnaire which was suitable for assessing the basic Knowledge, Attitude and the Practice (KAP) of pharmacovigilance was designed and distributed among 100 doctors of the Punjab Institute of Medical Sciences (PIMS) Hospital, Jalandhar, Punjab, India.Results: Among the 100 doctors, 61 responded. The data was analyzed by using the SPSS statistical software. Although 77% of the subjects knew the term 'pharmacovigilance', only 59% were aware of the existence of the National Pharmacovigilance Program. 23% volunteered to reports Adverse Drug Reactions (ADRs), but more than 60% doctors did not know how and where to report the ADRs.Conclusion: There is a need for a regular training and the reenforcement for the ADR reporting among the health care personnel. The perception of the reporting process being tedious, the lack of time, a poor knowledge on the reporting mechanism and inadequate expertise seemed to be the main reasons for not reporting the ADRs. A majority of the respondents suggested regular training sessions on a priority basis for the success of the pharmacovigilance program and for the better clinical management of the patients in general. PMID:23449824
Objective: To assess the pharmacovigilance awareness among the healthcare professionals in a teachinghospital in Northern India. Material and Methods: A questionnaire which was suitable for assessing the basic Knowledge, Attitude and the Practice (KAP) of pharmacovigilance was designed and distributed among 100 doctors of the Punjab Institute of Medical Sciences (PIMS) Hospital, Jalandhar, Punjab, India. Results: Among the 100 doctors, 61 responded. The data was analyzed by using the SPSS statistical software. Although 77% of the subjects knew the term ‘pharmacovigilance’, only 59% were aware of the existence of the National Pharmacovigilance Program. 23% volunteered to reports Adverse Drug Reactions (ADRs), but more than 60% doctors did not know how and where to report the ADRs. Conclusion: There is a need for a regular training and the reenforcement for the ADR reporting among the health care personnel. The perception of the reporting process being tedious, the lack of time, a poor knowledge on the reporting mechanism and inadequate expertise seemed to be the main reasons for not reporting the ADRs. A majority of the respondents suggested regular training sessions on a priority basis for the success of the pharmacovigilance program and for the better clinical management of the patients in general.
Objective. We performed a prospective observational audit study to compare neonatal and maternal outcomes of the primary cesarean sections performed in first stage versus second stage of labour. Methods. One thousand three hundred and eighty-nine nullipara women who had undergone cesarean section in a tertiary teachinghospital between February 1, 2009 and January 31, 2010 were included in the study. Primary maternal outcomes of interest were uterine atonia, transfusion requirement, urinary system injury, requirement for hysterectomy, and duration of hospital stay. Results. A total of 1389 women underwent cesarean section at this 12 month time period. Of these 1389 cesarean sections, 1271 were in the first stage of the labour and 171 were in the second stage of the labour. Urinary injuries, transfusion requirement, and uterine atonia hysterectomy were significantly more frequent in women who underwent cesarean section in the second stage of the labour compared to women undergoing cesarean section in the first stage of the labour. Conclusion. Cesarean section in the second stage of the labour is associated with increased maternal and neonatal morbidities. Special attention is required to the patients undergoing cesarean section in the second stage of the labour.
Objective. We performed a prospective observational audit study to compare neonatal and maternal outcomes of the primary cesarean sections performed in first stage versus second stage of labour. Methods. One thousand three hundred and eighty-nine nullipara women who had undergone cesarean section in a tertiary teachinghospital between February 1, 2009 and January 31, 2010 were included in the study. Primary maternal outcomes of interest were uterine atonia, transfusion requirement, urinary system injury, requirement for hysterectomy, and duration of hospital stay. Results. A total of 1389 women underwent cesarean section at this 12 month time period. Of these 1389 cesarean sections, 1271 were in the first stage of the labour and 171 were in the second stage of the labour. Urinary injuries, transfusion requirement, and uterine atonia hysterectomy were significantly more frequent in women who underwent cesarean section in the second stage of the labour compared to women undergoing cesarean section in the first stage of the labour. Conclusion. Cesarean section in the second stage of the labour is associated with increased maternal and neonatal morbidities. Special attention is required to the patients undergoing cesarean section in the second stage of the labour. PMID:21941557
Background: Sex ratio, an important social indicator measuring extent of prevailing equity between males and females in society, is defined as number of females per 1000 males. Changes in sex ratio reflect underlying socioeconomic, cultural patterns of a society. As per 2011 census sex ratio in India is 914/1000 males, which continues to be significantly adverse towards women. Objectives: This study was conducted to assess the knowledge and attitude regarding Prenatal Diagnostic Techniques (PNDT) Act among the pregnant women at a tertiary care teachinghospital in Mumbai. Materials and Methods: A cross-sectional study was carried out in the antenatal ward of Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai during the period of January to April 2008. A total of 143 women were included and a pre-designed and pre-tested questionnaire was used to get information regarding socio-demographic details of the pregnant women. They were asked regarding the knowledge and attitude towards the PNDT Act. Data was analyzed by using Statistical Package of Social Sciences (SPSS) 16.0. Results: In the present study, out of 143 women, 105 (73.5%) knew about sex determination. Even out of those who had heard, the correct knowledge regarding PNDT act was very less. Sonography as a technique for sex determination done at private hospital was known to the majority of women. Conclusion: Education of women about gender equality and recommendations under PNDT act in order to improve declining sex ratio in our country must be done. Wide publicization in the media of the Act must be scaled up.
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
In an epidemiologic and case-control study including 30 case patients over a 3.5-year period in a Taiwanese university hospital, only ?-lactamase inhibitor use and extended-spectrum cephalosporin use were identified as independent risk factors for nosocomial CMY-2-producing Escherichia coli bloodstream infection, and CMY-2 producers were found more prevalent than extended-spectrum ?-lactamase-producing isolates.
OBJECTIVE: The objective of this study was to determine whether Internal Medicine residents would find the use of an expert system (i.e. Clinical Diagnostic Decision Support System) to be a satisfactory experience when used during a clinical rotation in the hospital setting. Resident willingness to use the instrument was considered to be of particular importance because of growing concerns regarding the educational experience of residents in the hospital. Thus, our first goal was to assess resident satisfaction with the tool, prior to widespread implementation. STUDY POPULATION: Residents on the General Medical Hospital Service at St. Mary's Hospital, Rochester, Minnesota STUDY TYPE: Prospective cohort study METHOD: We provided unrestricted access DXplain, a Web-based Clinical Diagnostic Decision Support System, to five general medical teams in St. Mary's Hospital, Rochester, MN. All residents were particularly encouraged to access the system during the evaluation of new admissions. Usage of the system was recorded electronically each time a user logged on. At the conclusion of the 2 month study period, a survey was sent electronically to each of the participating residents. RESULTS: During the study period, a total of 30 residents (G1 =20, G3= 10) rotated on the five medical services. 29/30 residents responded to the survey. 18/29 indicated that they had used the service, while 11/29 stated that they had not accessed the system. The resident's logged on 117 times to enter a case during the study period, with several entering more than one case per logon. The average number of log-ons per user was 2.4/week. Of the 18 who used the system, 15 found it useful (83.3%), 2 were unsure whether it was useful (11.1%), and 1 (5.6%) did not think it was helpful. However, when asked how often the system led the user to consider novel alternative diagnoses 13/18 (72.2%) responded "almost always to frequently" and 5/18 (27.8%) said "occasionally to sometimes". None of the users felt that the system "rarely" or "never" yielded additional diagnostic considerations. Seventeen out of eighteen users (94.4%) thought the system was "easy to use". When asked if they would like to have such a system regularly available 13/18 (72.2%) responded yes, while 4/18 (22.2%) were unsure. One resident said that they would not like to have DXplain available (5.6%). CONCLUSION: We believe the data reflect a significant level of satisfaction with the system among residents. Their recognition that it frequently led them to consider novel diagnoses suggests it had a positive educational impact.
Bauer, Brent A.; Lee, Mark; Bergstrom, Larry; Wahner-Roedler, Dietlind L.; Bundrick, John; Litin, Scott; Hoffer, Edward; Kim, Richard J.; Famiglietti, Kathleen; Barnett, G. Octo; Elkin, Peter L.
Background: The use of moxifloxacin (Avelox) has increased at Vancouver General Hospital since its introduction onto the formulary in 2002. It is unclear, however, whether the use of the drug is optimal according to its indication. Hand-held electronic devices, such as personal digital assistants (PDAs), are novel tools that can be used during routine patient care to collect data for drug use evaluation (DUE) reviews. Objective: We hypothesized that moxifloxacin was over-utilized and that opportunities existed to optimize its use. This study was designed to characterize moxifloxacin use in concordance with evidence-based assessment criteria. The feasibility of using a PDA device as a data-collection tool was also evaluated. Design: An observational DUE was conducted over a 4-week period (from February 17 to March 16, 2007) at Vancouver General Hospital, a 955-bed tertiary care hospital. Inpatients who received at least one dose of moxifloxacin were enrolled. Evidence-based assessment criteria were developed to evaluate the appropriateness of moxifloxacin use, and a PDA database was developed for data collection. The primary endpoint was the proportion of moxifloxacin use for approved first-line indications. Results: A total of 132 patients were included. Eighty-nine patients (67%) received moxifloxacin for first-line indications, including community-acquired pneumonia (57%) and acute exacerbation of chronic bronchitis (10%). Forty-three patients (33%) had alternative indications, primarily hospital-acquired pneumonia (25%). In 129 evaluable patients, approximately half (51%) of the clinical outcomes were successful; 37% were indeterminate; and 12% were failures. General medicine and respiratory service clinicians prescribed moxifloxacin more appropriately compared with surgical service personnel. Most of the pharmacists supported the use of PDAs as DUE data-collection tools. Conclusion: Overall, moxifloxacin utilization at Vancouver General Hospital was appropriate according to evidence-based assessment criteria. Additional opportunities to improve its use exist through health care staff education. PDAs are ideal data-collection tools for DUEs, as they can be conveniently used during routine patient care.
Samilski, Jennifer A. E.; Lau, Tim T. Y.; Elbe, Dean H. T.; Aulakh, Amneet K.; Lun, Eric M. C.
This study examines the relationship between hospital structural characteristics and patient satisfaction with hospital care. Teachinghospitals and private hospitals were expected to receive higher ratings of patient satisfaction than were nonteaching and government-controlled hospitals, because they generally are reputed to be technologically superior. Results show that, in general, most patients are satisfied with their hospital stays, but they are clearly more dissatisfied with their stays in teachinghospitals. Although a number of other correlates of patient satisfaction with the hospital stay are identified, no measure succeeds in reducing to insignificance the strong relationship between teaching status and dissatisfaction. Some suggestions are made as to why teachinghospital receive relatively poor evaluations from their patients.
Background: Psoriasis is a chronic skin disease which has an impact on health-related quality of life (QoL). The psoriasis disability index (PDI) is a simple 15-item questionnaire which is used to assess overall psoriasis disability. Objectives: (1) To assess the health-related QoL among patients with psoriasis, attending dermatology OPD of Medical College Hospital, Kottayam. (2) To find out the association of QoL with age and gender. Materials and Methods: This was a descriptive case series study conducted in Dermatology OPD of Medical College Hospital, Kottayam, Kerala. Psoriasis patients attending the Dermatology OPD of Medical College Hospital for 2 months were assessed. Results: Out of the total 32 patients, 56.2% were males, whose mean age was 45; 72% were married, 47% had education above plus two and were employed. Also, 34% had income above Rs. 3000 per month. Among the PDI subsets, daily activities were affected the most (90.6%), followed by work (84.4%), leisure activities (71.9%), problems with treatment (68.7%) and the least affected was personal relations (62.5%). Overall PDI score (median 14.5, interquartile range 4.5–22) showed that the QoL was affected in 75% of which 9.4% were mild (score < 9), 31.2% were moderate (score 10–18) and 34.4% were severe (score > 18). There was no association between the total PDI score and age or gender. Conclusion: QoL was affected in 75% of psoriasis patients. There was no association between QoL and age or gender.
Manjula, V D; Sreekiran, S; Saril, P Surendran; Sreekanth, M P
The prevalence of latent tuberculosis infection in a cohort of nurses new to a London hospital was 7.6% (13 of 171), using an interferon-gamma (IFN-gamma) release assay, and 16.2% (24 of 148), using the tuberculin skin test. On multivariate analysis, birth in a country with tuberculosis prevalence of more than 40 cases per 100,000 population was associated with positive results of both the IFN-gamma release assay and the tuberculin skin test. PMID:19415970
Khanna, Priya; Nikolayevskyy, Vladyslav; Warburton, Fiona; Dobson, Elek; Drobniewski, Francis
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.
This research is of qualitative nature and it aims at studying nurse's social representations towards nursing and its professional practice and the way they effectively accomplish this practice at Rio de Janeiro Federal University San Francisco de Assisi School Hospital (HESFA/UFRJ). Data were collected from interview, campus observations and documents. Data analysis reveal contradictions and conflicts experienced by nurses in their professional praxis. They are beginning a process of reflection on their professional autonomy: they are sorry for the lack of structure is assisting clients properly; they do believe that researching and political participation are essential for profession development. PMID:9775944
Background: Examining the knowledge, attitude, perceptions and practices (KAP) of the medical students regarding antibiotic resistance (ABR) and use can help us in devising suitable educational interventions for them, tailored according to their earlier held knowledge, beliefs, capabilities and experience. Methods: A cross sectional, questionnaire based survey was conducted among the second year medical students of a teachinghospital, whereby their KAP regarding antibiotic use and resistance was assessed by using a five point Likert scale, whose responses ranged from ‘strongly agree’ to ‘strongly disagree,’ ‘always’ to ‘never and ‘very important’ to ‘unimportant’. The data was analyzed by using simple descriptive statistics. Wherever it was relevant, the Chi-square test was used to determine any significant difference. Results: The response rate was 100 per cent. The number of respondents who agreed that ABR was an important and a serious public health issue in our teachinghospital (n= 66, 68 per cent), was significantly less (p < 0.001) as compared to the number of respondents who agreed that ABR was an important and a serious issue which the country (n = 86, 88.65 per cent) and the world (n = 88, 90.7 per cent) were facing. Only 77.3 per cent (n= 75) of the respondents were aware that bacteria were not responsible for causing colds and flu, while the remaining 22.7 per cent (n = 22) were not knowledgeable about this fact. More than 80 per cent rated the adverse effect profile of the antibiotic and the risk of a superinfection as the important factors which deserved consideration. Cost of the antibiotic was considered to be an important factor deserving consideration by only 56.7 percent (n=55) of the participants. Conclusions: Our survey revealed that most of the students were aware of the antimicrobial resistance and its consequences. The only concern was their casual attitude regarding the antibiotic use. Further educational interventions are necessary to improve their understanding and perceptions on antibiotic resistance, as well as their attitude towards antibiotic use.
Peer review of the quality of care of the medical staff in a healthcare delivery system, properly executed and utilized, can bring about changes that improve the quality and safety of patient care, enhance clinical performance, and augment physician education. Although all healthcare facilities are mandated to conduct peer reviews, the process of how it is conducted, reported, and utilized varies widely. In 2007, our institution, a large public teaching acute care facility, developed and implemented an electronic Medical Staff Peer Review System (MS-PRS) that replaced the existing paper-based system and created a centralized database for all peer review activities. Despite limited resources and mounting known challenges, we have developed and implemented a system that includes 100% mortality reviews, an ongoing random review for reappointment and operative procedures, and morbidity peer reviews. Parallel to the 4-year implementation of the system, we observed a steady, significant downward trend in the medical malpractice claim rate, which can be attributable in part to the implementation of MS-PRS. In this paper, we share our experiences in the development, outcomes, challenges encountered, and lessons learned from MS-PRS and provide our recommendations to similar institutions for the development of such a system. PMID:22646743
Chan, Linda S; Elabiad, Manal; Zheng, Ling; Wagman, Brittany; Low, Garren; Chang, Roger; Testa, Nicholas; Hall, Stephanie L
The Adult Literacy Program at Hawaii State Hospital utilized techniques drawn from the Morningside Model of Generative Instruction. In a study involving psychiatric inpatients, participants were taught reading, mathematics, or both over a 6- to 8-month time span. Using the Woodcock-Johnson Psychoeducational Battery-Revised, it was determined that nearly half of the participants demonstrated academic gains during the study period. Further, a behavioral observation system indicated that participants were on-task 80% of the observation time and staff engaged in positive interactions nearly 20% of the observation time. This study is the first of its kind to document any efficacy for academic instruction with a psychiatric inpatient population. PMID:15690738
Schirmer, Todd N; Meyer, Kim A; Samarasinghe, Roshani
The present study focussed the expectations of 13 nurses from a University hospital regarding to the executive director's managerial style. The Managerial Grid of BLAKE & MOUTON (1987) was used as a theoretical reference and a questionnaire was applied based on the Grid & Leadership in Nursing Instrument elaborated by TREVIZAN (1993). Results evidenced that the most expected style corresponds, considering the Managerial Grid, to "team management", or 9.9. The second style was the "management of men organization", or 5.5. Authors concluded that there are important expectations for these nurses related to a management that enhances values such as trust, respect, commitment, personal investment and team work in order to achieve the organization goals. PMID:11075149
The purpose of this survey was to determine the number of healthcare professionals with knowledge about e-health and how many people would like to use e-health in their practice. A hospital-based cross-sectional study was conducted from September to November 2007 in Rawalpindi Medical College and allied hospitals. E-health survey questionnaires were designed and distributed among healthcare professionals, and their knowledge and attitudes toward e-health were assessed. Of 186 healthcare professionals, 41.4% were doctors, 31.7% were medical students, and 26.9% were nurses. Of this total, 57% had heard of e-health prior to the survey; 28% were of the opinion that healthcare professionals should hear about e-health in medical college; 50.5% believed that e-health services for developing countries were useful in general. According to 40.3%, more information on successful e-health projects would be necessary to introduce e-health services into medical practice. Self-education, and better diagnosis and treatments were the main motivational factors to use e-health. Of those surveyed, 67.2% had access to Internet but most of them had not used an online database for reaching a diagnosis, preferring other doctors as their main source of expert advice. Recommendation by doctors and respected medical experts was considered most important for buying an e-health service. The present study demonstrates a lack of adequate knowledge about e-health among healthcare specialists. However, a majority believed that e-health has a very important role to play in present and future healthcare. PMID:19441953
BACKGROUND: A previous audit performed at a tertiary/quaternary pediatric hospital in Toronto, Ontario, demonstrated suboptimal assessment and treatment of children’s pain. Knowledge translation (KT) initiatives (education, reminders, audit and feedback) were implemented to address identified care gaps; however, the impact is unknown. OBJECTIVES: To determine the impact of KT initiatives on pain outcomes including process outcomes (eg, pain assessment and management practices) and clinical outcomes (eg, pain prevalence and intensity); and to benchmark additional pain practices, particularly opioid administration and painful procedures. METHODS: Medical records at The Hospital for Sick Children (Toronto, Ontario) were reviewed on a single day in September 2007. Pain assessment and management practices, and pain prevalence and intensity in the preceding 24 h were recorded on a standardized data collection form. Where possible, pain outcomes were compared with previous audit results. RESULTS: Records of 265 inpatients were audited. Sixty-three per cent of children underwent a documented pain assessment compared with 27% in an audit conducted previously (P<0.01). Eighty-three per cent of children with documented pain received at least one pain management intervention. Overall, 51% of children received pharmacological therapy, and 15% received either a psychological or physical pain-relieving intervention. Of those assessed, 44% experienced pain in the previous 24 h versus 66% in the previous audit (P<0.01). Fewer children experienced severe pain compared with the first audit (8.7% versus 26.1%; P<0.01). One-third of children received opioids; 19% of these had no recorded pain assessment. Among 131 children who underwent a painful procedure, 21% had a concurrent pain assessment. Painful procedures were accompanied by a pain-relieving intervention in 12.5% of cases. CONCLUSIONS: Following KT initiatives, significant improvements in pain processes (pain assessment documentation and pain management interventions) and clinical outcomes (pain prevalence, pain intensity) were observed. Further improvements are recommended, specifically with respect to procedural pain practices and opioid utilization patterns.
Zhu, Lisa M; Stinson, Jennifer; Palozzi, Lori; Weingarten, Kevin; Hogan, Mary-Ellen; Duong, Silvia; Carbajal, Ricardo; Campbell, Fiona A; Taddio, Anna
Background Due to difficulty in confirming clinical suspicions of malignancy in patients presenting with bone tumours, the cost of surgical biopsies where hospital charges are borne almost entirely by patients, competition with bone setters and healing homes with high rate of loss to follow up; we set out to find if sufficient material could be obtained to arrive at reliable tissue diagnosis in patients with clinical and radiological evidence of bone tumours in our hospitals. Methods After initial clinical and plain radiographic examinations, patients were sent for fine needle aspirations. Aspirations were carried out with size 23G needles of varying lengths with 10 ml syringes in a syringe holder (CAMECO, Sebre Medical, Vellinge, Sweden). The aspirates were air dried, stained by the MGG method and examined microscopically. Histology was performed on patients who had subsequent surgical biopsy. These were then correlated with the cytology reports. Results Out of 96 patients evaluated, [57 males, 39 females, Mean age 31.52 years, Age Range 4–76 years,] material sufficient for diagnosis was obtained in 90 patients. Cytological diagnosis of benign lesions was made in 40 patients and malignant in 47. Of these, 27 were metastases, osteogenic sarcoma 16, giant cell tumour 19, infection 11. Histology was obtained in 41 patients. Correct diagnosis of benignity was made in 17 out of 18 cases, malignancy in 21 out of 22 cases. One non-diagnostic case was malignant. The accuracy of specific cytological diagnosis was 36/41 (87.8%) and incorrect in 5/41 (12.2%). Conclusion We conclude that FNAC can be useful in the pre-operative assessment of bone tumours especially where other diagnostic modalities are unavailable.
Nnodu, Obiageli E; Giwa, SO; Eyesan, Samuel U; Abdulkareem, Fatima B
Background Mammography has been used in developed countries with considerable success but very little is known about this imaging modality in low resource settings. This study examined the level of awareness of mammography and determined factors influencing the level of awareness. Methods We conducted a hospital based cross sectional study to investigate the level of awareness of mammography among 818 randomly selected women attending the General Outpatient clinics (GOP) of the University College Hospital (UCH), Ibadan, Nigeria. Independent predictors of level of awareness of mammography were identified using multiple logistic regression analysis. Results The proportion of women who ever heard of mammography was 5%, and they demonstrated poor knowledge of the procedure. Those with primary or secondary levels of education were about three times less likely to be aware of mammography when compared with those with tertiary level of education (OR?=?0.3, 95% CI, 0.12 – 0.73). Also, participation in community breast cancer prevention activities (OR?=?3.4, 95% CI, 1.39 – 8.36), and previous clinical breast examination (OR?=?2.34, 95% CI, 1.10 – 4.96) independently predicted mammography awareness. Newspapers and magazines appeared to be the most important sources of information about mammography screening. Conclusion The level of awareness of mammography is poor among women attending outpatient clinics in the studied population. Interventions promoting awareness of this screening procedure should give particular attention to the illiterate and older women while clinicians performing breast examinations should utilize the opportunity to inform women about the mammography procedure. Promotion of educational articles on breast cancer and its screening methods via media remains vital for the literate.
Acinetobacter baumannii is an important nosocomial pathogen, especially in immunocomprimised patients and those hospitalized in intensive care units. After the first isolation of A. baumannii strains from the bronchial aspirates of two patients in the intensive care unit (ICU) of our hospital as a pure culture, screening studies were performed to define possible source(s). A. baumannii strains isolated from bronchial aspirates and blood cultures of the patients in ICU were collected as a possible part of the outbreak. A total of 23 screening samples collected from equipment (7), hands (4) and gloves (2) of the staff, and from ten different body regions of the patients in the ICU were cultured. Antimicrobial susceptibility test of the isolates was performed by the standardized disk-diffusion method. All isolates were subtyped by antibiogram, arbitrarily primed polymerase chain reaction (AP-PCR) and pulsed-field gel electrophoresis (PFGE) typing methods. A total of 26 A. baumannii strains including eight clinical and 18 screening isolates were identified. All isolates were susceptible only to meropenem, tobramycin, and imipenem. There was at least a 96% resistance rate to the other antibiotics tested. Antibiogram typing showed that 24 of the 26 isolates were epidemiologically related, two were unique. AP-PCR yielded two types, one of which had 21 isolates, the other had five. PFGE fingerprinting revealed that all isolates were clonally related, including four closely related and 22 indistinguishable strains. Based on the results of PFGE which has been accepted as a reference method it can be concluded that A. baumannii strains isolated from our intensive care unit originated from a single type of strain. PMID:16386018
Nigeria has the highest population of sickle cell anemia (SCA) patients in the whole world. This condition manifests with frequent episodes of aches and pains, recurrent infections, and frequent hospitalization. Prenatal screening is one of the methods of reducing the prevalence of this disease. The study aimed to determine the awareness and acceptability of prenatal screening for SCA among health professionals and students at the Lagos University TeachingHospital. It was a descriptive and cross-sectional study carried out between August and September 2006, involving 403 health professionals and students using structured questionnaires. The study revealed that 91.3% of the respondents had heard about prenatal screening for SCA, whereas 8.7% of the respondents had not. In addition, the majority of the respondents (75.3%) knew that SCA can be prevented by prenatal screening for SCA, whereas 13.7% and 11.3% were not aware or not sure, respectively. Up to 48.2% of the respondents were not aware that prenatal screening for SCA is available in Nigeria with the nurses being the least aware (?=11.9, P=0.00). 42.1% of the respondents will not allow preventive termination of pregnancy if prenatal screening confirms SCA. For those who will not allow preventive termination, up to 79% of them decided on the basis of their religious beliefs. There is a poor level of awareness of the availability of prenatal screening services in Nigeria among health workers in Lagos, and religion is a major factor militating against its acceptability. PMID:22538322
If you would like to contribute a teaching note for any of these sections please contact firstname.lastname@example.org. Contents: LET'S INVESTIGATE: Standing waves on strings MY WAY: Physics slips, trips and falls PHYSICS ON A SHOESTRING The McOhm: using fast food to explain resistance Eggs and a sheet STARTING OUT: After a nervous start, I'm flying ON THE MAP: Christ's Hospital CURIOSITY: The Levitron TECHNICAL TRIMMINGS: Brownian motion smoke cell LET'S INVESTIGATE
This study was a case record review of adult patients with tetanus admitted into Lagos University TeachingHospital between 2000 and 2009. Of 78,009 adults admitted, 190 had tetanus, constituting 0.25% of admission. Mean age was 30.4 ± 13.8 years. Male to female ratio was 3:1. The commonest occupation was commercial motorcyclists. 96% of the patients were unimmunized and 4% that had partial immunization had localized tetanus. Commonest presentation was trismus (83%). Twenty three patients had complications, 30% had autonomic dysfunction. Mean incubation period was 11.4 ± 4.8 days, and mean duration of onset was 72 ± 45.6h. 31 patients died, case fatality rate was 16.3%. Twelve percent of those with long period of onset died while 43% with short period of onset died (P=0.002). Patients with complications (78%) died of tetanus while only 8% of those without complication died (P<0.0001). Case fatality rate is still unacceptably high for a vaccine preventable disease. Attention to primary prevention of people at risk and active surveillance to prevent complications will further reduce mortality. PMID:23069727
Bankole, Idowu A; Danesi, Mustapha A; Ojo, Oluwadamilola O; Okubadejo, Njideka U; Ojini, Frank I
Background: Interventions which were made to promote a better self-management have produced improvements in the glycaemic control in patients with Diabetes mellitus. An improved glycaemic control is known to prevent the long term complications. Method: This study was conducted at the Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, which is a rural tertiary health care centre. 546 patients were included in our study and they were assessed for the glycaemic control (HbA1c), diabetes distress (DDs), and self care activities. Results: Of the total 546 patients, 49% had a poor glycaemic control, as was indicated by HbA1c levels of >7%. The factors which are significantly associated with a poor glycaemic control are age (p=0.03 ), sex (p= 0.0415), literacy (p=0.0422), duration of the disease (p=0.0006), diabetic distress (p=0.0001) and self care activities like diet ( p=0.0001), medication (p=0.0001) and exercise (p=0.0001), whereas there was no significant effect of the BM I (p=0.094) on the glycaemic control. Conclusion: This study revealed the factors that could predict the glycaemic control in the diabetic patients who attended our tertiary care teachinghospital. The barriers that prevent these patients from meeting their goals must be explored, to improve their health outcomes. PMID:23814728
Universal or "broad-range" PCR-based ribosomal DNA (rDNA) was performed on a collection of 58 isolates (n = 30 bacteria + 28 fungi), originating from environmental air from several locations within a busy clinical microbiology laboratory, supporting a university teachinghospital. A total of 10 bacterial genera were identified including both Gram-positive and Gram-negative genera. Gram-positive organisms accounted for 27/30 (90%) of total bacterial species, consisting of seven genera and included (in descending order of frequency) Staphylococcus, Micrococcus, Corynebacterium, Paenibacillus, Arthrobacter, Janibacter and Rothia. Gram-negative organisms were less frequently isolated 3/30 (10%) and comprised three genera, including Moraxella, Psychrobacter and Haloanella. Eight fungal genera were identified among the 28 fungal organisms isolated, including (in descending order of frequency) Cladosporium, Penicillium, Aspergillus, Thanatephorus, Absidia, Eurotium, Paraphaeosphaeria and Tritirachium, with Cladosporium accounting for 10/28 (35.7%) of the total fungal isolates. In conclusion, this study identified the presence of 10 bacterial and eight fungal genera in the air within the laboratory sampled. Although this reflected diversity of the microorganisms present, none of these organisms have been described previously as having an inhalational route of laboratory-acquired infection. Therefore, we believe that the species of organisms identified and the concentration levels of these airborne contaminants determined, do not pose a significant health and safety threat for immunocompotent laboratory personnel and visitors. PMID:20183192
Sera were obtained from 266 mothers of singleton stillborn babies (cases) and 266 mothers of live-born babies (controls), matched for parity, who delivered at the University TeachingHospital, Lusaka, Zambia, between October 1979 and April 1980. Tests were performed on 262 samples from cases and 261 from controls. The microhaemagglutination assay for Treponema pallidum (MHA-TP) was reactive in 54% of cases and 29% of controls; the rapid plasma reagin (RPR) 18-mm circle card test was reactive at a dilution of 1:16 or greater in 29% of cases and in 3.5% of controls. Both these differences are highly significant. Sera from cases and controls were further examined for evidence of cytomegalovirus, human (alpha) herpesvirus, hepatitis B virus, toxoplasma, and plasmodium infections. The only difference between sera from cases and controls was that cytomegalovirus antibody titres ? 1:1024 occurred more often among cases. There was no relationship between antibody titre and birth weight. The results of this study emphasize the importance of screening pregnant women for syphilis. Treatment of those found to be infected should help prevent stillbirths due to syphilis.
Watts, Theresa E.; Larsen, Sandra A.; Brown, Stuart T.
Objectives: The physiological and clinical similarities between asthma and chronic obstructive pulmonary disorder (COPD) make their differentiation difficult. In the present study, we compared reversibility to bronchodilator, immunoglobulin E (IgE), blood eosinophil and neutrophil levels among asthma and COPD patients to differentiate these diseases. Materials and Methods: The study was carried on 20 asthmatics and 29 patients of COPD that reported to the outpatient and inpatient department in University TeachingHospital, Jamia Hamdard, New Delhi, India. The parameters evaluated included pulmonary function (FEV1, FVC, and FEV1/FVC), IgE levels, and eosinophil and neutrophil count. Results: It was observed that reversibility was significantly higher in asthmatic patients, while irreversibility predominates in COPD patients. There was no significant difference in pre- and post-FEV1 and pre- and post-FVC and in their percentage predicted. However the percentage change in FEV1 significantly varies in asthma and COPD patients. No significant changes in neutrophil and eosinophil levels were observed in these patients. The serum IgE levels were found significantly higher in asthmatic patients. Conclusions: We conclude that reversibility in FEV1 levels or percentage change in FEV1 and serum IgE levels are promising lab parameter to distinguish these two conditions. However, further research is required to fully understand the role of neutrophil and eosinophil in the onset and development of asthma and COPD.
Rathod, Virender P. Singh; Kapoor, Prem; Pillai, K. K.; Khanam, Razia
Background: Malaria is a public health problem globally especially in the Sub-Saharan Africa and among the under five children and pregnant women and is associated with a lot of maternal and foetal complications. Objective: The study was on the effect of intermittent preventive treatment of malaria in pregnancy on the prevalence of malaria in pregnancy and the outcome of pregnancy. Materials and Methods: In a descriptive cross-sectional study, a semi-structured questionnaire was administered to women admitted in Ekiti State University TeachingHospital labour ward, Ado-Ekiti. About 4,200 women participated in the study and the inclusion criteria were women who were booked in the hospital, attended at least four antenatal clinic visits, and consented to the study while the exclusion criteria were those who didn't book in the hospital and failed to give their consent. Results: The study revealed that about 75% of the pregnant women studied had access to intermittent preventive treatment of malaria. Among the women attending the antenatal clinic that received sulphadoxine-pyrimethamine (SP), about 78% of them took two doses of SP. The prevalence of clinical malaria was statistically higher in women who did not receive intermittent preventive treatment with SP during pregnancy (44.7% vs. 31.3%, P = 0.0001) and among women who had one dose of the drug instead of two doses (40.0% vs. 28.7%, P = 0.0001). There was no statistical significant difference in the mean age in years (31.53 ± 5.238 vs. 31.07 ± 4.751, P = 0.09 and the gestational age at delivery (38.76 ± 1.784 vs. 38.85 ± 1.459, P = 0.122) between the women who did not receive SP and those who had it. There was a statistical significant difference in the outcome of pregnancy among women who had Intermittent Preventive Treatment in pregnancy (IPTp) and those who did not viz.-a-viz. in the duration of labor (8.6 ± 1.491 vs. 8.7 ± 1.634, P = 0.011) and the birth weight of the babies (3.138 ± 0.402 vs. 3.263 ± 0.398, P = 0.0001). Conclusion: SP is an effective malarial prophylaxis in pregnancy.
Background: In a developing country, infectious disease remains the most important cause of fever, but the noncommunicable diseases, like malignancy, are fast becoming important differential diagnoses. An important clinical problem is the cases labeled as fever of unknown origin (FUO), which often evade diagnosis. Objective: The present study was undertaken to find the cause of FUO in a tertiary care hospital of eastern India. Materials and Methods: This is a prospective study of inpatients, with regard to both clinical signs and investigations. Results: The main diagnosis in the end was tuberculosis, closely followed by hematological malignancy. A substantial number of cases remained undiagnosed despite all investigations. The provisional diagnosis matched with the final in around two thirds of the cases. While for younger patients leukemia was a significant diagnosis, for older ones, extra-pulmonary tuberculosis was a main concern. Interpretation: In India, infectious disease still remains the most important cause of fever. Thus the initial investigations should always include tests for that purpose in a case of FUO. Conclusion: Geographic variations and local infection profiles should always be considered when investigating a case of FUO. However, some of the cases always elude diagnosis, although the patients may respond to empirical therapy.
In order to assess the performance of a surgical pathology laboratory in a university hospital, we have established a comprehensive system of quality audit based on peer review. Each month, 2% of cases received are selected at random and assessed retrospectively by two senior pathologists. The system, which uses semi-quantitative scoring, examines diagnostic accuracy, identifies delay at any stage in the production of reports, evaluates the overall quality of the slides, the presentation of the final report, and the accuracy of the SNOMED coding. Each of these parameters is graded as "satisfactory," "borderline," or "unsatisfactory." In 20 of 518 cases (3.9%) analyzed in 18 months, the microscopic report was unsatisfactory; in six of these cases, the error could have affected patient management. Remediable faults were detected in the macroscopic description of specimens and in the speed and accuracy of report typing by the secretarial staff. In 13 of 18 months, greater than 10% of reports were delayed because of the time taken in microscopic reporting by pathologists. Some (but not all) of this delay was attributable to the "checking out" of pathologists in training. We conclude that this audit system has uncovered substantial deficiencies in our departmental performance, some of which could affect the clinical course of patients. These surprising results suggest that a system of peer review should be adopted more widely. PMID:1599026
Staphylococcus aureus, including meticillin-sensitive and -resistant S. aureus (MSSA and MRSA, respectively), is associated with severe nosocomial human infections. This study aimed to investigate the molecular profile, including the dynamic changes and genotype/phenotype correlation, of S. aureus isolates recovered from different clinical specimens of inpatients with S. aureus infection over a 6-year span at a teachinghospital in Shanghai, China. Between 2005 and 2010, a random sample of 610 unique S. aureus isolates was collected from different clinical samples of inpatients with S. aureus infection for molecular and antibiotic susceptibility analysis. The results showed that, among the 610 S. aureus isolates, 20 sequence types (STs) determined by multi-locus sequence typing (primarily ST239, ST5, ST7, ST188 and ST398) and 52 spa types (primarily t002, t037, t030 and t601) were found. In total, 444 isolates (72.8?%) were MRSA and 166 (27.2?%) were MSSA. ST239-MRSA-III-spa t037 and ST5-MRSA-II-spa t002 were the predominant MRSA clones. From 2005 to 2010, spa t002, spa t037 and their corresponding STs (ST5 and ST239) were the most frequent clones among all of the S. aureus isolates and showed the most resistant phenotypes to various antibiotics. Generally, the different genotypes showed different drug resistance rates, but no isolates were resistant to vancomycin, teicoplanin or linezolid. The profiles of virulence and resistance genes differed by genetic background, with the ST239 and ST5 strains showing higher resistance rates to gentamicin, cefoxitin, ampicillin, cefazolin, erythromycin, clindamycin and levofloxacin than strains of other types. Moreover, the antiseptic resistance genes qacA/B were generally associated with these two types. The prevalence of STs was different among different clinical specimens and also changed by year. Recently (2009-2010), the distribution of predominant MRSA clones decreased, whilst the prevalence of non-predominant MSSA clones increased, especially for the isolates causing bacteraemia. Continual monitoring of clinical isolates is necessary to develop and maintain an effective strategy against S. aureus infection in the hospital setting. PMID:23118474
Song, Yan; Du, Xin; Li, Tianming; Zhu, Yuanjun; Li, Min
Background Peripheral arterial disease (PAD) is a marker of advanced atherosclerosis with an elevated risk of cardiovascular mortality and morbidity. Although intensive risk reduction therapy is critical in reducing the adverse cardiovascular outcomes in patients with PAD, the awareness of this information among all physicians is felt to be low. Given the role of family physicians (FP), general internists (GI), cardiologists (C), and vascular surgeons (VS) in treating patients with PAD, we sought to determine their perceptions and knowledge of risk reduction therapy in these patients. Methods and results We conducted a cross-sectional self-administered survey of 84 physicians who work at a major teachinghospital. FP, GI, C, and VS represent 39%, 33%, 16%, and 12% of the surveyed physicians, respectively. The recommended targets of LDL-cholesterol, blood glucose and blood pressure in PAD patients were known to 37.3%, 94.1% and 35.3% of physicians, respectively. The majority of physicians reported to screen for risk factors in PAD. Although 86.3% of physicians would recommend antiplatelets therapy in PAD, only 17.6% would recommend angiotensin converting enzyme (ACE) inhibitors; 25.5% would recommend nicotine replacement therapy for smokers and 62.7% would recommend statins. Compared to other specialties, cardiologists had the lowest threshold, whereas GI had the highest threshold for initiating antiplatelets and statins for patients with PAD. Conclusion The perceptions towards risk reduction in PAD identify glaring knowledge and action gaps. Effective strategies to encourage health professionals to use risk reduction therapy are needed.
Context: Inappropriate antimicrobial use increases the incidence of drug resistance, drug toxicity and superinfections, thereby increasing the healthcare costs. Various approaches for rationalizing the antimicrobial therapy, have been suggested. Collection of baseline data on the pattern of the antimicrobial use is usually suggested as the first step in this direction, which will help in identifying the problem areas, which demand our attention. Aims: To study the usage pattern of prophylactic antimicrobials in surgical patients, in order to detect any inappropriateness concerning the selection, timing, redosing and the duration of antimicrobial administration. Settings and Design: A retrospective review of the randomly selected medical records of general surgical cases over an 8 month period in a tertiary care teachinghospital. Methods and Material: The medical records of 258 patients who had undergone surgical procedures were verified for the appropriateness of the antimicrobial prophylaxis, with respect to the choice of the antimicrobial agent, the time of its administration, the intraoperative dosing, and the duration of the postoperative use. The obtained data was analyzed and conclusions were drawn with the help of descriptive statistics. Results: Third generation cephalosporins were used preoperatively in all the 258(100%) patients through the intravenous route. In addition, 77(30%) patients received metronidazole or amikacin. The antimicrobials were administered half an hour to one hour before the surgery. No intraoperative redosing was given. The duration of the postoperative prophylaxis was extended to 36 hours or more in 248(96%) of the cases. Conclusions: The timing of administration of the preoperative dose was appropriate and well delegated to the operating room nurse. The intra operative dose was appropriately omitted. The main concern was the increasing use of the third generation cephalosporins and the unnecessary prolonged duration of the postoperative prophylaxis, which needed to be addressed.
Khan A.K, Afzal; P.V, Mirshad; Rashed, Mohammed Rafiuddin; Banu, Gausia
Background Syndrome Z describes the interaction of obstructive sleep apnoea (OSA) with the metabolic syndrome. Purpose of study A pilot study to determine the prevalence of syndrome Z in a teachinghospital in Singapore. Methods Patients (age ?18?years) recruited for this prospective study had to satisfy three of the following five inclusion criteria: fasting glucose >6.1?mmol/l, blood pressure ?130/85?mm?Hg, HDL cholesterol <1.04?mmol/l in men and <1.2?mmol/l in women, triglycerides ?1.7?mmol/l, and a waist circumference >102?cm in men and >88?cm in women. All subjects underwent standard overnight polysomnography. Overnight fasting glucose and lipid levels were measured and baseline anthropometric data recorded. All sleep studies were scored and reported by a sleep physician. OSA was deemed to be present if the respiratory disturbance index (RDI) was ?5, with mild, moderate and severe categories classified according to the Chicago criteria. Results There were 24 patients (19 males and five females) of whom 10 were Chinese, eight Malay and five of Indian origin, with one other. Mean age was 48±13.5?years, mean body mass index was 34.9±6.1?kg/m2 and mean waist circumference was 111.3±15.7?cm. 23 (95.8%) of the patients had OSA with a mean RDI of 39.6±22.4 events/h with 15 patients (62.5%) in the severe category. The five patients who fulfilled all five criteria for diagnosis of the metabolic syndrome had severe OSA. Conclusion The prevalence of OSA in our studied population exhibiting the metabolic syndrome is very high. Therefore, a polysomnogram should always be considered for this subset of patients.
Context: Inappropriate antimicrobial use increases the incidence of drug resistance, drug toxicity and superinfections, thereby increasing the healthcare costs. Various approaches for rationalizing the antimicrobial therapy, have been suggested. Collection of baseline data on the pattern of the antimicrobial use is usually suggested as the first step in this direction, which will help in identifying the problem areas, which demand our attention. Aims: To study the usage pattern of prophylactic antimicrobials in surgical patients, in order to detect any inappropriateness concerning the selection, timing, redosing and the duration of antimicrobial administration. Settings and Design: A retrospective review of the randomly selected medical records of general surgical cases over an 8 month period in a tertiary care teachinghospital. Methods and Material: The medical records of 258 patients who had undergone surgical procedures were verified for the appropriateness of the antimicrobial prophylaxis, with respect to the choice of the antimicrobial agent, the time of its administration, the intraoperative dosing, and the duration of the postoperative use. The obtained data was analyzed and conclusions were drawn with the help of descriptive statistics. Results: Third generation cephalosporins were used preoperatively in all the 258(100%) patients through the intravenous route. In addition, 77(30%) patients received metronidazole or amikacin. The antimicrobials were administered half an hour to one hour before the surgery. No intraoperative redosing was given. The duration of the postoperative prophylaxis was extended to 36 hours or more in 248(96%) of the cases. Conclusions: The timing of administration of the preoperative dose was appropriate and well delegated to the operating room nurse. The intra operative dose was appropriately omitted. The main concern was the increasing use of the third generation cephalosporins and the unnecessary prolonged duration of the postoperative prophylaxis, which needed to be addressed. PMID:23730643
Khan A K, Afzal; P V, Mirshad; Rashed, Mohammed Rafiuddin; Banu, Gausia
This study attempts to determine the impact of the Medicare Fee Schedule (MFS) on teaching physicians compared to nonteaching physicians and if these impacts varied across academic medical centers, other major teachinghospitals and minor teaching hospita...
Here, we report the draft genome sequences of four nosocomial methicillin-resistant Staphylococcus aureus strains (PPUKM-261-2009, PPUKM-332-2009, PPUKM-377-2009, and PPUKM-775-2009) isolated from a university teachinghospital in Malaysia. Three of the strains belong to sequence type 239 (ST239), which has been associated with sustained hospital epidemics worldwide.
Mohamed-Hussein, Zeti-Azura; Tan, Xin-Ee; B Raja Abd Rahman, Raja Mohd Fadhil; Hussin, Salasawati; Mohamad Zin, Noraziah; Jamal, Rahman
BACKGROUND: This study was designed to assess the motivations of senior medical clinicians to teach medical students. This understanding could improve the recruitment and retention of important clinical teachers. METHODS: The study group was 101 senior medical clinicians registered on a teaching list for a medical school teachinghospital (The Canberra Hospital, ACT, Australia). Their motivations to teach medical students
Jane Dahlstrom; Anna Dorai-Raj; Darryl McGill; Cathy Owen; Kathleen Tymms; D Ashley R Watson
16S rRNA methylase-mediated high-level resistance to aminoglycosides has been reported recently in clinical isolates of Gram-negative bacilli from several countries. Twenty-one (6.2%, 21\\/337) of 337 isolates of Klebsiella pneumoniae from a teachinghospital in Wenzhou, China, were positive for 16S rRNA methylase genes (3 for armA, 13 for rmtB, 5 for both armA and rmtB) and highly resistant to gentamicin,
Fangyou Yu; Liangxing Wang; Jingye Pan; Dan Yao; Chan Chen; Tao Zhu; Qiang Lou; Jian Hu; Yang Wu; Xueqing Zhang; Zengqiang Chen; Di Qu
Provided and maintained by the University of Iowa Health Care, the Virtual Hospital is designed as a "medical reference and health promotion tool for health care providers and patients." To that end, the site offers current and authoritative medical information for patients and professional and pedagogical information for health care providers. The former includes patient educational briefs browseable by organ system or by a topical list, a collection of peer-reviewed and annotated Web resources, an internal search engine, and archives of a column offering medical advice to middle-aged users. Resources in the health care provider section include several digital libraries aimed at certain specialties (Pediatrics, Pediatric Radiology, Family Medicine, and Medical Student); multimedia textbooks and teaching files grouped by organ system; lectures and publications; and clinical practice guidelines. Additional resources at the site include links to the Virtual Children's and Virtual Naval Hospitals, an internal search engine, and online continuing education courses.
A study of changes in hospital care suggests that for medical students and residents to be exposed to the same case mix of clinical disorders seen in the hospital in 1980, they must have experience in the ambulatory setting. (Author/MSE)
16S rRNA methylase-mediated high-level resistance to aminoglycosides has been reported recently in clinical isolates of Gram-negative bacilli from several countries. Twenty-one (6.2%, 21/337) of 337 isolates of Klebsiella pneumoniae from a teachinghospital in Wenzhou, China, were positive for 16S rRNA methylase genes (3 for armA, 13 for rmtB, 5 for both armA and rmtB) and highly resistant to gentamicin, amikacin, and tobramycin (MICs, > or =256 microg/mL). Nineteen of 21 isolates harboring 16S rRNA methyalse genes were extended-spectrum beta-lactamase (ESBL) producers. The plasmids harboring 16S rRNA methylase genes from 14 of 21 donors were transferred into the recipients, Escherichia coli J53. The armA and the rmtB usually coexisted with ESBL genes in the same isolate in clinical isolates and cotransferred with ESBL genes on a self-transmissible conjugative plasmid to the recipients. Among 5 isolates harboring both armA and rmtB, the armA genes were located on the chromosomes, and the rmtB genes were located on the plasmids, as determined by Southern hybridization. The result of pulsed-field gel electrophoresis showed that horizontal gene transfer and clonal spread were responsible for the dissemination of the rmtB and the armA genes. 16S rRNA methylase-producing isolates of Klebsiella pneumoniae were commonly identified in the Chinese teachinghospital with coexistence of rmtB and armA genes in the same isolate. PMID:19232867
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
Reporting system after performing echocardiography is very poor in almost all hospitals of Nepal. Special but simple attempt effort has been introduced to transfer analog video images and color still images of echocardiographic investigation into a desk top computer using a locally available imported video capture system, Snazzi Movie Studio S4. Analog video signals are converted into MPEG2 and still
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 teachinghospitals.
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
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 degrees C. The level of coliform contamination in the food samples from vendors and restaurants (geometric mean count 7.64-9.21; MPN > or = 50) were above the accepted 10(4) colony-forming unit/g or MPN < or = 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
Nkere, Chukwuemeka K; Ibe, Nnenne I; Iroegbu, Christian U
A case–control study was performed to find the risk factors in the acquisition of extended-spectrum ?-lactamase (ESBL) Klebsiella pneumoniae. From 1 May 2001 to 30 September 2001, 422 isolates ofK. pneumoniae identified by the microbiological laboratory in Hsin-Chu hospital were collected, 59 of which were ESBL-producing strains. The prevalence rate was 14% (59\\/422). There were 43 case patients (ESBL-producing K.
OBJECTIVES: The objective of this paper was to characterize the population seen at the dentistry unit of the hematology-oncology service of the Oncology-Hematology Service, Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Oral problems resulting from cancer therapy increase the risk of infection, length of hospital stay, treatment cost and negative impact on the course and prognosis of the disease. METHOD: Of the 367 medical records of cancer patients seen from November 2007 until December 2008: 186 with a cancer diagnosis and complete clinical data were selected, while 20 with a cancer diagnosis and incomplete records were excluded; 161 medical records with only hematological diagnosis were also excluded. The following characteristics were assessed: ethnicity, gender, age, diagnosis and characteristics of the neoplasm, cancer therapy status and performed dental procedures. RESULTS: Review of 1,236 visits indicated that 54% (n=100) of the patients had blood cancers, 46% (n=86) had solid tumors and 63% were undergoing anticancer therapy. The proportion of males (52.7%) in the study population was slightly greater. The most common cancer was acute lymphocytic leukemia (32.2%). Cancer occurred more often among those patients aged 5 to 9 years. The most common dental procedures were restorative treatment, preventive treatment and removal of infectious foci. CONCLUSION: The characteristics of the studied population were similar to those of the general Brazilian and global populations, especially regarding gender and diagnosis distributions. The aim of implementation of the dentistry unit was to maintain good oral health and patients’ quality of life, which is critical to provide oral care and prevent future oral problems.
Subtitled "a professional development Website for teachers," Teaching Heritage is an impressive collection of information and resources for teaching Australian history and culture. There are eight main sections to the site: four offer teaching resources and four provide teaching units. The resource sections include an examination of different ways of defining heritage, an Australian heritage timeline, discussions of different approaches to teaching heritage through media, and outcomes-based approaches in teaching and assessing heritage coursework. The teaching units deal in depth with issues of citizenship, nationalism, Australian identities, and new cultural values. A Heritage Gallery features images of various culturally significant or representative places in Australia, such as New Italy, the Dundullimal Homestead, Australian Hall, Kelly's Bush, and many more. Obviously, teachers of Civics on the southern continent will find this site extremely useful, but the teaching units -- rich with texts and images -- also offer fascinating introductions for anyone interested in the issues of Australian nation-making.
This study looks at the teaching of familynursing in the broader context of nursing education. The aim was to find out how Finnish teachers in nursing colleges define the concept of family, what sort of theoretical premises lie behind their teaching, and what kind of teaching methods they use. Teachers' information needs, as well as the use of knowledge concerning
|Articles in this volume of the "Illinois English Bulletin" include "Competencies in Teaching English" by Alan C. Purves, which sets forth a tentative model for planning competency-based instruction and certification based on concepts, teaching acts, skills, and strategies; "Passing the Buck Versus the Teaching of English" by Dennis Q. McInerny,…
|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…
In response to a request by hospital management to evaluate employee exposures to aerosolized ribavirin (36791045) (AR), an investigation was made at Florida Hospital (SIC-8062), Orlando, Florida. The hospital was an 801 bed medical center and teaching ho...
This study attempts to document Medicare's total payment for physician services teachinghospitals including billing for Part B physician services as well as direct and indirect medical education (DME, IME) payments and possible evidence of substitution o...
|Suggests alternatives to the medical education model for teaching geriatrics. Proposes geriatric learning that shows interdisciplinary care, stresses wellness over illness, and demonstrates examples of care, support, independence, and limited maintenance away from nursing homes and hospitals. (Author/ABB)|
Between 1997 and 2001, 17 teaching and 56 non-teaching acute English hospitals conducted hospital-wide surveillance of hospital-acquired bacteraemia (HAB) using a standard protocol drawn up by the Nosocomial Infection National Surveillance Scheme (NINSS). The sources of organisms, the incidence of device-related HAB, and the distribution of HABs from individual device-related sources by specialty and type of hospital were determined for
R. Coello; A. Charlett; V. Ward; J. Wilson; A. Pearson; J. Sedgwick; P. Borriello
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…
Fenstermacher, Gary D.; Osguthorpe, Richard D.; Sanger, Matthew N.
The Harvard University Medical School (Massachusetts) and a community health maintenance organization (HMO) have formed the first medical school department to be based in a freestanding HMO, replicating the conventional teachinghospital clinical teaching model in a managed care situation. The model is seen as potentially transforming medical…
OBJECTIVE--To assess the quality of toilet facilities available for disabled people in a large provincial teachinghospital. DESIGN--Survey of toilet facilities for patients on the wards and in the outpatient department. SETTING--Teachinghospital in Leeds. RESULTS--Although the quality of toilet facilities varied, none met the standards recommended by the British Standards Institution. The worst facilities were found on a ward
A. F. Travers; E. Burns; N. D. Penn; S. C. Mitchell; G. P. Mulley
Ensuring that patients' informational needs have been met prior to hospital discharge sets the stage for successful self-management of recovery at home. This secondary analysis study aims to identify differences in the amount of discharge teaching content needed and received by adult medical-surgical patients on the basis of their sociodemographic characteristics and hospitalization-related factors. The Quality of Discharge Teaching Scale
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.
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.
Background Despite cost containment efforts, parenteral (IV) ciprofloxacin appears to be overutilized at Vancouver General Hospital. In November 2003, the Pharmacist-managed intravenous to oral (IV-PO) Dosage Form Conversion Service was implemented, enabling autonomous pharmacist-initiated dosage form conversion for ciprofloxacin. This study evaluates characteristics of ciprofloxacin use prior to and following implementation of this conversion service. Methods This was a single-centre, two-phase (pre/post), unblinded study. Phase I occurred between November 12, 2002 and November 11, 2003 (365 days), and Phase II between November 12, 2003 and March 11, 2004 (120 days). All patients receiving ciprofloxacin IV during these periods were reviewed. The primary endpoint was IV:PO ciprofloxacin use ratio. Secondary endpoints were total number of ciprofloxacin doses, proportion of inappropriate IV ciprofloxacin doses, cost of therapy between phases, and estimated cost avoidance with the intervention. Results Two hundred ciprofloxacin IV treatment courses were evaluated (100 per phase). The IV:PO ciprofloxacin use ratio was 3.03 (Phase I) vs. 3.48 (Phase II). Total number of doses and ratio of IV to total doses across phases were similar (p = 0.2830). IV-PO ciprofloxacin conversion occurred in 27/100 (27%) of IV courses in Phase I and 23/100 (23%) in Phase II. Proportion of inappropriate ciprofloxacin IV doses decreased between Phases I and II (244/521 (47%) vs. 201/554 (36%) (p = 0.0005), respectively). Furthermore, the proportion of pharmacist-preventable inappropriate ciprofloxacin IV doses was reduced between Phases I and II (114/244 (47%) vs. 65/201 (32%) (p = 0.0026). Proportional cost avoidance associated with total inappropriate IV use was $7,172/$16,517 (43%) (in Canadian dollars) in Phase I vs. $6,012/$17,919 (34%) in Phase II (p = 0.001). Similarly, proportional cost avoidance associated with pharmacist-preventable inappropriate IV doses was reduced from $3,367/$16,517 (20%) in Phase I to $1,975/$17,919 (11%) in Phase II (p = 0.001). Conclusion While overall utilization of ciprofloxacin remained unchanged and the proportion of IV to total doses was stable during the study period, the proportion of inappropriate IV doses and its associated costs appear to have declined subsequent to implementation of a Pharmacist-managed IV-PO Dosage Form Conversion Service. Such a program may be a beneficial adjunct in facilitating appropriate and cost-effective usage of ciprofloxacin.
Ho, Bradley P; Lau, Tim TY; Balen, Robert M; Naumann, Terryn L; Jewesson, Peter J
Discusses the past, present, and future of the use of nursing homes as teaching sites. Suggests that teaching nursing homes must provide state-of-the-art care while avoiding the pitfalls that threaten academic hospitals; balance must be maintained between the benefits of teaching and the burdens placed on patients and staff. (JOW)
Administrative changes causing a planned decrease in outpatient services offered at a teachinghospital resulted in adverse effects on teaching programs and hospital finances. These results emphasize the important of vertical integration of services to the survival of academic health centers. (Author/MSE)
|Administrative changes causing a planned decrease in outpatient services offered at a teachinghospital resulted in adverse effects on teaching programs and hospital finances. These results emphasize the important of vertical integration of services to the survival of academic health centers. (Author/MSE)|
Reports of nine workshop participants on the interactions between universities, their medical schools, and their teachinghospitals are summarized. Focus was on balancing academic requirements of teaching and research with patient care. The functioning of the various institutions is examined in the broader context of community and government…
|Forty medical residents from major teachinghospitals in Boston, Massachusetts, participated in small group teaching sessions about caregiver stress. A teaching tool was developed that included a teaching handout, interactive cases, standard instruments for assessing caregiver stress, peer-reviewed articles about caregiving, and a list of…
Forty medical residents from major teachinghospitals in Boston, Massachusetts, participated in small group teaching sessions about caregiver stress. A teaching tool was developed that included a teaching handout, interactive cases, standard instruments for assessing caregiver stress, peer-reviewed articles about caregiving, and a list of…
|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…
|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.…
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.…
The participative management plan selected, adapted, and implemented by Beth Israel Hospital (Boston, Massachusetts) in 1989 is described. Successes, lessons learned, and plans for the future are also discussed. The teachinghospital chose the Scanlon Plan from among others as a means to quality improvement. (Author/MSE)
The report contains data from a sample of 36 teachinghospitals and 9 nonteaching hospitals were collected at the hospital, department, and patient case levels. The report, the second in a series of five, focuses on the effect of teaching on cost per case...
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|This article surveys information resources, contemporary issues and trends, and selected instructional strategies useful in teaching undergraduate criminology. Instructional resources reviewed include textbooks, professional journals, and reference works. Twelve issues and trends are identified and three exemplary learning activities are…
This website is a compilation of information for the development and production of online teaching and learning experiences. The information covers critical questions that one may have before utilizing technology in a course.
Virtual University Design and Technology (Michigan State University)
|Discusses experience of teaching optical experiments with emphasis upon the student's design and construction of refracting and reflecting telescopes. Concludes that the student's interest and acquired knowledge are greatly enhanced through the use of realistic experiments. (CC)|
A backpacking course offered at the Pennsylvania State University teaches safety and proper use of equipment. This well planned course resulted in an appreciation for the outdoors, ecological awareness, self-reliance, and attainment of new experiences and skills. (CJ)
Outlines ideas for teaching an introductory course in propaganda, including an historical perspective and review of the etymology of the word and an examination of those characteristics that separate propaganda from other communication arts. (JMF)
This study examined how competitive market dynamics between 1994 and 2000 have affected the financial stability of Academic Health Center (AHC) hospitals and their ability to support their academic and social missions. It looked at the financial challenges facing AHC hospitals through a survey involving 1,138 teachinghospitals. Findings…
Dobson, Allen; Koenig, Lane; Sen, Namrata; Ho, Silver; Gilani, Jawaria
A survey of 177 teachinghospitals investigated, first, the extent of cooperation between hospital continuing medical education (CME) providers and medical schools and, second, whether community hospitals will seek competitive or cooperative relationships with medical schools for CME in the near future. A trend toward collaboration was found.…
This paper describes the development of an internship program between St. Vincent Hospital (SVH), a large community teachinghospital, and Worcester Polytechnic Institute (WPI), a school of engineering. The primary objective of the internship program is the education of the student through problem solving in the hospital environment under close faculty-physician supervision. WPI receives an expanded educational base, and SVH
Robert A. Peura; John R. Boyd; Albert Shahnarian; Walter G. Driscoll; H. Brownell Wheeler
Summary The University of Iowa Hospitals and Clinics is located in the center of the United States in Eastern Iowa, has 1,000 hospital beds, and is the largest university owned teachinghospital in the country. Over 35,000 patients are admitted each year. The infection control efforts began in 1969 and were broadened in 1976 with the establishment and implementation of
D. Rasley; R. P. Wenzel; R. M. Massanari; S. Streed; W. J. Hierholzer
BACKGROUND: Despite improved use of peri-operative antibiotic prophylaxis, surgical site infections following coronary artery bypass grafting (CABG) continue to occur, with high case-fatality rates and costs. Few data are currently available on the impact of deep sternal wound infections (DSWI) on length of hospital stay, and no such data exist for community hospitals (as opposed to teachinghospitals). We assessed