Minimizing preventable trauma deaths in a limited-resource setting: a test-case of a multidisciplinary panel review approach at the Komfo Anokye Teaching Hospital in Ghana.

PubMed

Yeboah, Dominic; Mock, Charles; Karikari, Patrick; Agyei-Baffour, Peter; Donkor, Peter; Ebel, Beth

2014-07-01

Our objectives were to determine the proportion of preventable trauma deaths at a large trauma hospital in Kumasi, Ghana, and to identify opportunities for the improvement of trauma care. A multidisciplinary panel of experts evaluated pre-hospital, hospital, and postmortem data of consecutive trauma patients who died over a 5-month period in 2006-2007 at the Komfo Anokye Teaching Hospital. The panel judged the preventability of each death. For preventable and potentially preventable deaths, deficiencies in care that contributed to their deaths were identified. The panel reviewed 231 trauma deaths. Of these, 84 charts had sufficient information to review preventable factors. The panel determined that 23 % of trauma deaths were definitely preventable, 37 % were potentially preventable, and 40 % were not preventable. One main deficiency in care was identified for each of the 50 definitely preventable and potentially preventable deaths. The most common deficiencies were pre-hospital delays (44 % of the 50 deficiencies), delay in treatment (32 %), and inadequate fluid resuscitation (22 %). Among the 19 definitely preventable deaths, the most common cause of death was hemorrhage (47 %), and the most common deficiencies were inadequate fluid resuscitation (37 % of deficiencies in this group) and pre-hospital delay (37 %). A high proportion of trauma fatalities might have been preventable by decreasing pre-hospital delays, adequate resuscitation in hospital, and earlier initiation of care, including definitive surgical management. The study also showed that preventable death panel reviews are a feasible and useful quality improvement method in the study setting.

Technical efficiency of public district hospitals and health centres in Ghana: a pilot study

PubMed Central

Osei, Daniel; d'Almeida, Selassi; George, Melvill O; Kirigia, Joses M; Mensah, Ayayi Omar; Kainyu, Lenity H

2005-01-01

Background The Government of Ghana has been implementing various health sector reforms (e.g. user fees in public health facilities, decentralization, sector-wide approaches to donor coordination) in a bid to improve efficiency in health care. However, to date, except for the pilot study reported in this paper, no attempt has been made to make an estimate of the efficiency of hospitals and/or health centres in Ghana. The objectives of this study, based on data collected in 2000, were: (i) to estimate the relative technical efficiency (TE) and scale efficiency (SE) of a sample of public hospitals and health centres in Ghana; and (ii) to demonstrate policy implications for health sector policy-makers. Methods The Data Envelopment Analysis (DEA) approach was used to estimate the efficiency of 17 district hospitals and 17 health centres. This was an exploratory study. Results Eight (47%) hospitals were technically inefficient, with an average TE score of 61% and a standard deviation (STD) of 12%. Ten (59%) hospitals were scale inefficient, manifesting an average SE of 81% (STD = 25%). Out of the 17 health centres, 3 (18%) were technically inefficient, with a mean TE score of 49% (STD = 27%). Eight health centres (47%) were scale inefficient, with an average SE score of 84% (STD = 16%). Conclusion This pilot study demonstrated to policy-makers the versatility of DEA in measuring inefficiencies among individual facilities and inputs. There is a need for the Planning and Budgeting Unit of the Ghana Health Services to continually monitor the productivity growth, allocative efficiency and technical efficiency of all its health facilities (hospitals and health centres) in the course of the implementation of health sector reforms. PMID:16188021

Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana).

PubMed

Marchal, Bruno; Dedzo, McDamien; Kegels, Guy

2010-12-24

There is a growing consensus that linear approaches to improving the performance of health workers and health care organisations may only obtain short-term results. An alternative approach premised on the principle of human resource management described as a form of 'High commitment management', builds upon a bundles of balanced practices. This has been shown to contribute to better organisational performance. This paper illustrates an intervention and outcome of high commitment management (HiCom) at an urban hospital in Ghana. Few studies have shown how HiCom management might contribute to better performance of health services and in particular of hospitals in low and middle-income settings. A realist case study design was used to analyse how specific management practices might contribute to improving the performance of an urban district hospital in Ho, Volta Region, in Ghana. Mixed methods were used to collect data, including document review, in-depth interviews, group discussions, observations and a review of routine health information. At Ho Municipal Hospital, the management team dealt with the crisis engulfing the ailing urban district hospital by building an alliance between hospital staff to generate a sense of ownership with a focus around participative problem analysis. The creation of an alliance led to improving staff morale and attitude, and contributed also to improvements in the infrastructure and equipment. This in turn had a positive impact on the revenue generating capacity of the hospital. The quick turn around in the state of this hospital showed that change was indeed possible, a factor that greatly motivated the staff.In a second step, the management team initiated the development of a strategic plan for the hospital to maintain the dynamics of change. This was undertaken through participative methods and sustained earlier staff involvement, empowerment and feelings of reciprocity. We found that these factors acted as the core mechanisms

Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana)

PubMed Central

2010-01-01

Background There is a growing consensus that linear approaches to improving the performance of health workers and health care organisations may only obtain short-term results. An alternative approach premised on the principle of human resource management described as a form of 'High commitment management', builds upon a bundles of balanced practices. This has been shown to contribute to better organisational performance. This paper illustrates an intervention and outcome of high commitment management (HiCom) at an urban hospital in Ghana. Few studies have shown how HiCom management might contribute to better performance of health services and in particular of hospitals in low and middle-income settings. Methods A realist case study design was used to analyse how specific management practices might contribute to improving the performance of an urban district hospital in Ho, Volta Region, in Ghana. Mixed methods were used to collect data, including document review, in-depth interviews, group discussions, observations and a review of routine health information. Results At Ho Municipal Hospital, the management team dealt with the crisis engulfing the ailing urban district hospital by building an alliance between hospital staff to generate a sense of ownership with a focus around participative problem analysis. The creation of an alliance led to improving staff morale and attitude, and contributed also to improvements in the infrastructure and equipment. This in turn had a positive impact on the revenue generating capacity of the hospital. The quick turn around in the state of this hospital showed that change was indeed possible, a factor that greatly motivated the staff. In a second step, the management team initiated the development of a strategic plan for the hospital to maintain the dynamics of change. This was undertaken through participative methods and sustained earlier staff involvement, empowerment and feelings of reciprocity. We found that these factors acted

Motivation and retention of health workers in Ghana's district hospitals: addressing the critical issues.

PubMed

Adzei, Francis A; Atinga, Roger A

2012-01-01

This study seeks to undertake a systematic review to consolidate existing empirical evidence on the impact of financial and non-financial incentives on motivation and retention of health workers in Ghana's district hospitals. The study employed a purely quantitative design with a sample of 285 health workers from ten district hospitals in four regions of Ghana. A stepwise regression model was used in the analysis. The study found that financial incentives significantly influence motivation and intention to remain in the district hospital. Further, of the four factor model of the non-financial incentives, only three (leadership skill and supervision, opportunities for continuing professional development and availability of infrastructure and resources) were predictors of motivation and retention. A major limitation of the study is that the sample of health workers was biased towards nurses (n = 160; 56.1 percent). This is explained by their large presence in remote districts in Ghana. A qualitative approach could enrich the findings by bringing out the many complex views of health workers regarding issues of motivation and retention, since quantitative studies are better applied to establish causal relationships. The findings suggest that appropriate legislations backing salary supplements, commitment-based bonus payments with a set of internal regulations and leadership with sound managerial qualities are required to pursue workforce retention in district hospitals.

Exploring the use of smartphones and tablets by medical House Officers in Korle-Bu Teaching Hospital.

PubMed

Barnor-Ahiaku, Edem

2016-03-01

Smartphones and tablets are being used widely in the Western World creating benefits in healthcare. The Ministry of Health in Ghana has an e-Health strategy, with the aim of integrating such resources into healthcare. Whilst there are numerous mHealth projects going on in Ghana, there is little evidence of doctors using such devices in their practice. A qualitative study was undertaken in Korle-Bu Teaching Hospital. Random sampling was used to identify House Officers, who engaged in semi-structured interviews. Interviews were recorded, transcribed and analysed using thematic content analysis. Consent was gained from all participants and the University of Leeds granted ethical approval. The results demonstrate that current House Officers began using smartphones and tablets at various stages during medical school. Their use has increased since qualification. Although the overall use has increased, some staff remain resistant to the use of smartphones and tablets. In the future, the integration of smartphones and tablets into medical practice can be improved by integration with the medical curriculum and accepted practice. House Officers are routinely using smartphones and tablets to assist them in their daily practice. The use is informal and is peer led. Whilst they bring many benefits, there are issues, which need to be addressed. In Korle-Bu Teaching Hospital integrating smartphone and tablet use into practice is feasible and would prove beneficial.

Assessment of the Policy Guidelines for the Teaching and Learning of Geography at the Senior High School Level in Ghana

ERIC Educational Resources Information Center

Ababio, Bethel T.; Dumba, Hillary

2014-01-01

This article empirically assessed the extent to which geography teachers adhered to the Ghana Education Service policy guidelines on the teaching of geography at the Senior High School Level in Ghana. Census survey was used to collect data from seven geography teachers because of the researchers' objective of gaining a quick insight into the…

Factors associated with alcohol consumption: a survey of women childbearing at a national referral hospital in Accra, Ghana.

PubMed

Adeyiga, Georgetta; Udofia, Emilia A; Yawson, Alfred E

2014-06-01

A hospital based cross-sectional study was conducted to identify the factors associated with alcohol consumption in Ghanaian women of childbearing age. The sample consisted of 394 women of reproductive age, of which 234 were pregnant. Systematic random sampling was used to select respondents from the clinics of the Department of Obstetrics and Gynecology outpatient at the Korle Bu Teaching Hospital in Accra, Ghana. Data were collected using structured questionnaires and analyzed using SPSS for Windows version 17.0. In the three months preceding the survey, 37.6% imbibed alcoholic drinks, while 24.4% had ever imbibed an alcoholic herbal brew. Non-Islamic religion, not being in marital union, consuming an alcoholic herbal brew and considering alcohol was beneficial to health were strong predictors of alcohol consumption. We conclude that the prevalence of alcohol consumption is high among this cohort of Ghanaian women. Women should be screened for alcohol consumption and informed about the dangers of heavy alcohol consumption during pregnancy.

Quality of Care: A Review of Maternal Deaths in a Regional Hospital in Ghana.

PubMed

Adusi-Poku, Yaw; Antwil, Edward; Osei-Kwakye, Kingsley; Tetteh, Chris; Detoh, Eric Kwame; Antwi, Phyllis

2015-09-01

The government of Ghana and key stakeholders have put into place several interventions aimed at reducing maternal deaths. At the institutional level, the conduct of maternal deaths audit has been instituted. This also contributes to reducing maternal deaths as shortcomings that may have contributed to such deaths could be identified to inform best practice and forestall such occurrences in the future. The objective of this study was to review the quality of maternal care in a regional hospital. A review of maternal deaths using Quality of Care Evaluation Form adapted from the Komfo Anokye Teaching Hospital (KATH) Maternal Death Audit Evaluation Committee was used. About fifty-five percent, 18 (55%) of cases were deemed to have received adequate documentation, senior clinicians were involved in 26(85%) of cases. Poor documentation, non-involvement of senior clinicians in the management of cases, laboratory related issues particularly in relation to blood and blood products as well as promptness of care and adequacy of intensive care facilities and specialists in the hospital were contributory factors to maternal deaths . These are common themes contributing to maternal deaths in developing countries which need to be urgently tackled. Maternal death review with emphasis on quality of care, coupled with facility gap assessment, is a useful tool to address the adequacy of emergency obstetric care services to prevent further maternal deaths.

Ownership and technical efficiency of hospitals: evidence from Ghana using data envelopment analysis.

PubMed

Jehu-Appiah, Caroline; Sekidde, Serufusa; Adjuik, Martin; Akazili, James; Almeida, Selassi D; Nyonator, Frank; Baltussen, Rob; Asbu, Eyob Zere; Kirigia, Joses Muthuri

2014-04-08

In order to measure and analyse the technical efficiency of district hospitals in Ghana, the specific objectives of this study were to (a) estimate the relative technical and scale efficiency of government, mission, private and quasi-government district hospitals in Ghana in 2005; (b) estimate the magnitudes of output increases and/or input reductions that would have been required to make relatively inefficient hospitals more efficient; and (c) use Tobit regression analysis to estimate the impact of ownership on hospital efficiency. In the first stage, we used data envelopment analysis (DEA) to estimate the efficiency of 128 hospitals comprising of 73 government hospitals, 42 mission hospitals, 7 quasi-government hospitals and 6 private hospitals. In the second stage, the estimated DEA efficiency scores are regressed against hospital ownership variable using a Tobit model. This was a retrospective study. In our DEA analysis, using the variable returns to scale model, out of 128 district hospitals, 31 (24.0%) were 100% efficient, 25 (19.5%) were very close to being efficient with efficiency scores ranging from 70% to 99.9% and 71 (56.2%) had efficiency scores below 50%. The lowest-performing hospitals had efficiency scores ranging from 21% to 30%.Quasi-government hospitals had the highest mean efficiency score (83.9%) followed by public hospitals (70.4%), mission hospitals (68.6%) and private hospitals (55.8%). However, public hospitals also got the lowest mean technical efficiency scores (27.4%), implying they have some of the most inefficient hospitals.Regarding regional performance, Northern region hospitals had the highest mean efficiency score (83.0%) and Volta Region hospitals had the lowest mean score (43.0%).From our Tobit regression, we found out that while quasi-government ownership is positively associated with hospital technical efficiency, private ownership negatively affects hospital efficiency. It would be prudent for policy-makers to examine the

Ownership and technical efficiency of hospitals: evidence from Ghana using data envelopment analysis

PubMed Central

2014-01-01

Background In order to measure and analyse the technical efficiency of district hospitals in Ghana, the specific objectives of this study were to (a) estimate the relative technical and scale efficiency of government, mission, private and quasi-government district hospitals in Ghana in 2005; (b) estimate the magnitudes of output increases and/or input reductions that would have been required to make relatively inefficient hospitals more efficient; and (c) use Tobit regression analysis to estimate the impact of ownership on hospital efficiency. Methods In the first stage, we used data envelopment analysis (DEA) to estimate the efficiency of 128 hospitals comprising of 73 government hospitals, 42 mission hospitals, 7 quasi-government hospitals and 6 private hospitals. In the second stage, the estimated DEA efficiency scores are regressed against hospital ownership variable using a Tobit model. This was a retrospective study. Results In our DEA analysis, using the variable returns to scale model, out of 128 district hospitals, 31 (24.0%) were 100% efficient, 25 (19.5%) were very close to being efficient with efficiency scores ranging from 70% to 99.9% and 71 (56.2%) had efficiency scores below 50%. The lowest-performing hospitals had efficiency scores ranging from 21% to 30%. Quasi-government hospitals had the highest mean efficiency score (83.9%) followed by public hospitals (70.4%), mission hospitals (68.6%) and private hospitals (55.8%). However, public hospitals also got the lowest mean technical efficiency scores (27.4%), implying they have some of the most inefficient hospitals. Regarding regional performance, Northern region hospitals had the highest mean efficiency score (83.0%) and Volta Region hospitals had the lowest mean score (43.0%). From our Tobit regression, we found out that while quasi-government ownership is positively associated with hospital technical efficiency, private ownership negatively affects hospital efficiency. Conclusions It would be

Teacher Educators' Practice and Vision of Good Teaching in Teacher Education Reform Context in Ghana

ERIC Educational Resources Information Center

Akyeampong, Kwame

2017-01-01

Teacher education in sub-Sahara Africa (SSA) has been criticized for the lack of attention to learning to teach in real classrooms, which limits the opportunity for pre-service teachers to successfully introduce learner-centered pedagogy in African primary school classrooms. To address this problem, Ghana has implemented a teacher education reform…

Trends in concurrent maternal and perinatal deaths at a teaching hospital in Ghana: the facts and prevention strategies.

PubMed

Lassey, Anyetei T; Obed, Sam A

2004-09-01

To determine the trend of concurrent maternal and perinatal mortality at the Korle-Bu Teaching Hospital (KBTH), Ghana, and to propose measures for its prevention. A retrospective study, from January 1995 to December 2002, of all concurrent maternal and perinatal deaths in which the woman was 28 weeks' gestation or more (or, if gestational age was not known, the baby weighed 1000 g or more) and died either undelivered or in the perinatal period (within 1 week of delivery) at the KBTH. Over the 8-year study period, there was a total of 93 622 deliveries at the KBTH with 108 concurrent maternal and perinatal mortalities, giving a ratio of 115.4 concurrent maternal and perinatal deaths per 100 000 deliveries. More than 80% of the mothers who died had little or no formal education. Of the 108 mothers, 22 died undelivered. The leading cause of death was a medical condition in pregnancy along with eclampsia/gestational hypertension. Of the 86 delivered mothers, the leading cause of concurrent death was a medical condition in pregnancy. Approximately two-thirds (72/108) of the perinatal deaths were stillbirths. Over the study period, there was a rising trend of the obstetric disaster of losing both mother and baby. There is a rising trend of concurrent maternal and perinatal mortality at the KBTH. It is suggested that a regular antenatal clinic be established with both an internist and obstetrician to jointly see and manage women with medical problems. There is a need for improved and adequate resources to improve outcomes for both mother and baby. A waiver of user fees for maternity services may be one way to improve access for needy and at-risk mothers. Concurrent maternal and perinatal death is the latest negative reproductive health index of the deteriorating socioeconomic situation in developing countries and needs to be tackled decisively.

Career destinations of University of Ghana Medical School graduates of various year groups.

PubMed

Lassey, A T; Lassey, P D; Boamah, M

2013-06-01

To report on the current career destination of the University of Ghana Medical School (UGMS) qualified doctors in the year groups, 1998, 2000, 2003, 2005 and 2008. Interview of doctors from each year group currently working at the Korle-Bu Teaching Hospital corroborated by phone calls to the doctors. All Ghanaian doctors from each graduating year group. 1. Current location of employment in Ghana or abroad, 2. Gender ratios of the doctors retained in Ghana. Three hundred and seventy-two (372) UGMS doctors consisting of 353 Ghanaians and 19 foreign students graduated over the five year groups. Of the 353 Ghanaians, 113 emigrated, while all but one of the 240 living in Ghana, practice medicine. The retention rate improved from 54.2% in 1998 to 86.3% in 2008. The overall retention rate however is 68.0% while the retention rates for the male and female doctors were 69.3% and 64.6% respectively. Of the 177 doctors practicing in Ghana from the first 4 year-groups (i.e. 1998, 2000, 2003 and 2005,) 139 (i.e. 31, 31, 34 and 43 from the respective year groups) have either completed postgraduate training or are in the residency training programme. Thus 78.5% of these doctors working in Ghana have opted for postgraduate training. The establishment of the GCPS and to a lesser extent the introduction of the ADHA before it appear to have slowed down the medical brain drain as more and more doctors avail themselves of the local opportunities. The GCPS therefore needs supporting effectively in order to continue to be a strong incentive for the retention of doctors in Ghana, apart from helping to staff district general hospitals with specialists.

Indirect costs of teaching in Canadian hospitals.

PubMed Central

MacKenzie, T A; Willan, A R; Cox, M A; Green, A

1991-01-01

We sought to determine whether there are indirect costs of teaching in Canadian hospitals. To examine cost differences between teaching and nonteaching hospitals we estimated two cost functions: cost per case and cost per patient-day (dependent variables). The independent variables were number of beds, occupancy rate, teaching ratio (number of residents and interns per 100 beds), province, urbanicity (the population density of the county in which the hospital was situated) and wage index. Within each hospital we categorized a random sample of patient discharges according to case mix and severity of illness using age and standard diagnosis and procedure codes. Teaching ratio and case severity were each highly correlated positively with the dependent variables. The other variables that led to higher costs in teaching hospitals were wage rates and number of beds. Our regression model could serve as the basis of a reimbursement system, adjusted for severity and teaching status, particularly in provinces moving toward introducing case-weighting mechanisms into their payment model. Even if teaching hospitals were paid more than nonteaching hospitals because of the difference in the severity of illness there should be an additional allowance to cover the indirect costs of teaching. PMID:1898870

Sustained impact of rotavirus vaccine introduction on rotavirus gastroenteritis hospitalizations in children <5 years of age, Ghana, 2009-2016.

PubMed

Enweronu-Laryea, Christabel C; Armah, George; Sagoe, Kwamena W; Ansong, Daniel; Addo-Yobo, Emmanuel; Diamenu, Stanley K; Mwenda, Jason M; Parashar, Umesh D; Tate, Jacqueline E

2018-05-08

Ghana introduced monovalent rotavirus vaccine in April 2012. We sought to determine the long-term impact of routine rotavirus vaccination on rotavirus gastroenteritis hospitalizations in Ghana during the first 4 years following rotavirus vaccine introduction. Active sentinel surveillance for acute gastroenteritis hospitalizations among children <5 years of age was conducted at two sites from July 2009 through June 2016. Stool specimens were collected from enrolled children and tested by enzyme immunoassay. Changes in the proportion of all-cause gastroenteritis hospitalizations due to rotavirus pre- (July 2009-June 2012) and post-vaccine introduction (July 2012-June 2016) were compared using chi-square test. The proportion of acute gastroenteritis hospitalizations due to rotavirus among children <5 years of age significantly declined by 42% from a pre-vaccine median of 50% (343/684) to a post-vaccine median of 29% (118/396) (p < 0.001). The age distribution of rotavirus hospitalizations shifted toward older ages with 64% (759/1197) of rotavirus hospitalizations occurring in children <12 months of age pre-vaccine introduction to 47% (212/453) occurring in children <12 months of age post-vaccine introduction (p < 0.001). The decline in rotavirus hospitalizations following rotavirus vaccine introduction have been sustained over the first 4 years of the vaccination program in Ghana. Continued vaccination against rotavirus will ensure that this burden remains low. Copyright © 2018. Published by Elsevier Ltd.

Association Between Teaching Status and Mortality in US Hospitals

PubMed Central

Burke, Laura G.; Frakt, Austin B.; Khullar, Dhruv; Orav, E. John

2017-01-01

Importance Few studies have analyzed contemporary data on outcomes at US teaching hospitals vs nonteaching hospitals. Objective To examine risk-adjusted outcomes for patients admitted to teaching vs nonteaching hospitals across a broad range of medical and surgical conditions. Design, Setting, and Participants Use of national Medicare data to compare mortality rates in US teaching and nonteaching hospitals for all hospitalizations and for common medical and surgical conditions among Medicare beneficiaries 65 years and older. Exposures Hospital teaching status: major teaching hospitals (members of the Council of Teaching Hospitals), minor teaching hospitals (other hospitals with medical school affiliation), and nonteaching hospitals (remaining hospitals). Main Outcomes and Measures Primary outcome was 30-day mortality rate for all hospitalizations and for 15 common medical and 6 surgical conditions. Secondary outcomes included 30-day mortality stratified by hospital size and 7-day mortality and 90-day mortality for all hospitalizations as well as for individual medical and surgical conditions. Results The sample consisted of 21 451 824 total hospitalizations at 4483 hospitals, of which 250 (5.6%) were major teaching, 894 (19.9%) were minor teaching, and 3339 (74.3%) were nonteaching hospitals. Unadjusted 30-day mortality was 8.1% at major teaching hospitals, 9.2% at minor teaching hospitals, and 9.6% at nonteaching hospitals, with a 1.5% (95% CI, 1.3%-1.7%; P < .001) mortality difference between major teaching hospitals and nonteaching hospitals. After adjusting for patient and hospital characteristics, the same pattern persisted (8.3% mortality at major teaching vs 9.2% at minor teaching and 9.5% at nonteaching), but the difference in mortality between major and nonteaching hospitals was smaller (1.2% [95% CI, 1.0%-1.4%]; P < .001). After stratifying by hospital size, 187 large (≥400 beds) major teaching hospitals had lower adjusted overall 30-day

Principals' and Teachers' Attitudes and Knowledge of Inclusive Education as Predictors of Effective Teaching Practices in Ghana

ERIC Educational Resources Information Center

Kuyini, Ahmed Bawa; Desai, Ishwar

2007-01-01

Surveys and observations were undertaken in selected primary schools in Ghana to determine whether principals' and teachers' attitudes towards and knowledge of inclusive education, as well as principals' expectations of teachers in implementing inclusion, were predictors of effective teaching practices in their classrooms. The sample of 128…

Cervical Cancer in the Greater Accra and Ashanti Regions of Ghana

PubMed Central

Nartey, Yvonne; Hill, Philip C.; Amo-Antwi, Kwabena; Nyarko, Kofi M.; Yarney, Joel

2017-01-01

Purpose Cervical cancer is a common cancer among women worldwide. An estimated 528,000 new cases and 266,000 deaths occurred in 2012. More than 85% of invasive cervical cancer cases occur in low- and middle-income countries. Cervical cancer ranks as the most common cancer among women in Ghana. We conducted a retrospective study to assess the descriptive epidemiology of cervical cancer in Ghana. We describe cervical cancer incidence and mortality rates for the regions served by two large hospitals in Ghana. Patients and Methods Information for women diagnosed with invasive cervical cancer between 2010 and 2013 was collected from the Komfo Anokye and Korle Bu Teaching Hospitals through review of medical, computer, and pathology records at the oncology units and the obstetrics and gynecology departments. Telephone interviews were also conducted with patients and relatives. Data were analyzed using summary statistics. Results A total of 1,725 women with cervical cancer were included in the study. Their ages ranged from 11 to 100 years (mean, 56.9 years). The histology of the primary tumor was the basis of diagnosis in 77.5% of women and a clinical diagnosis was made in 22.5% of women. For the 1,336 women for whom tumor grade was available, 34.3% were moderately differentiated tumors. Late stage at presentation was common. The incidence and mortality rates of cervical cancer increased with age up until the 75 to 79–year age group and began to decrease at older ages. The Greater Accra region had higher overall incidence and mortality rates than the Ashanti region. Conclusion Our study suggests that improvements in the application of preventive strategies could considerably reduce the burden of cervical cancer in Ghana and other low- and middle-income countries. The study provides important information to inform policy on cancer prevention and control in Ghana. PMID:29244993

Experience of collaboration between a Dutch surgical team in a Ghanaian Orthopaedic Teaching Hospital.

PubMed

Timmers, T K; Kortekaas, E; Beyer, Bpc; Huizinga, E; V Hezik van, S M; Twagirayezu, E; Bemelman, M

2016-09-01

Surgery is an indivisible, indispensable part of healthcare. In Africa, surgery may be thought of as the neglected stepchild of global public health. We describe our experience over a 3-year period of intensive collaboration between specialized teams from a Dutch hospital and local teams of an orthopaedic hospital in Effiduase-Koforidua, Ghana. During 2010-2012, medical teams from our hospital were deployed to St. Joseph's Hospital. These teams were completely self-supporting. They were encouraged to work together with the local-staff. Apart from clinical work, effort was also spent on education/ teaching operation techniques/ regional anaesthesia techniques/ scrubbing techniques/ and principles around sterility. Knowledge and quality of care has improved. Nevertheless, the overall level of quality of care still lags behind compared to what we see in the Western world. This is mainly due to financial constraints; restricting the capacity to purchase good equipment, maintaining it, and providing regular education. The relief provided by institutions like Care-to-Move is very valuable and essential to improve the level of healthcare. The hospital has evolved to such a high level that general European teams have become redundant. Focused and dedicated teams should be the next step of support within the nearby future.

Blood pressure patterns and body mass index status in pregnancy: An assessment among women reporting for antenatal care at the Korle-Bu Teaching hospital, Ghana.

PubMed

Amoakoh-Coleman, Mary; Ogum-Alangea, Deda; Modey-Amoah, Emefa; Ntumy, Michael Yao; Adanu, Richard M; Oppong, Samuel A

2017-01-01

Maternal obesity in pregnancy has been linked with increased risk of pregnancy induced hypertension (PIH). In some tertiary referral hospitals in Ghana, PIH is the leading cause of institutional maternal mortality. To evaluate blood pressure changes during pregnancy amongst different body mass index (BMI) groups and how this relates to the risk of developing PIH. Women who had a dating ultrasound before 20 weeks gestation and registering for antenatal care at the Korle-Bu Teaching Hospital in Accra, between February and December 2013 and met the inclusion criteria were recruited into a cohort study. BMI was assessed at baseline. Blood pressure measurements were taken at (±2) 24, 28 and 36 weeks. Primary outcome measure of interest during follow-up was a diagnosis of PIH at these points. BP changes during follow up at the three points were measured. Descriptive analysis of baseline factors was carried out and compared for the BMI groups. Relative risk (RR) of PIH was estimated at 95% confidence interval. Mean (SD) age for the 361 women was 30.9 (4.8) years. Incidence of PIH amongst the cohort was 10.5% (95% CI: 7.45% - 14.45%) and 40.4% and 33.0% of them were overweight and obese respectively at baseline. Pregnant women who were obese at baseline had a three-fold increased risk of PIH compared to those with normal BMI [RR = 3.01 (1.06-8.52), p = 0.04]. Obese women have a significantly increased risk of PIH. Women should be screened at booking for obesity status. Antenatal protocols should have interventions for prevention or early detection of obesity and management of obesity to improve outcomes.

Is Hospital Teaching Status a Key Factor in Hospital Charge for Children with Hip Fractures?

PubMed Central

Gao, Yubo; Pugely, Andrew; Karam, Matthew; Phisitkul, Phinit; Mendoza, Sergio; Johnston, Richard C.

2013-01-01

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 (teaching hospital vs non-teaching hospital) 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 hospital teaching 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 teaching hospital and 435 (23.8%) were treated at a non-teaching hospital. The average age of the patients was 12.88 years old in teaching hospitals vs 14.33 years old in nonteaching hospitals. The propensity score based ad-justment method showed mean hospital charge was $34,779 in teaching hospitals and $32,891 in the non-teaching hospitals, but these differences were not significant (p=0.2940). Likewise, mean length of hospital stay was 4.1 days in teaching hospitals and 3.89 days in non-teaching hospitals, but these differences were also not significant (p=0.4220). Conclusions Hospital teaching 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

The immunological response of HIV-positive patients initiating HAART at the Komfo Anokye Teaching Hospital, Kumasi, Ghana.

PubMed

Annison, L; Dompreh, A; Adu-Sarkodie, Y

2013-12-01

The study sought to document the experience of immunological improvement among Ghanaian PLHIV on HAART comparing different categories of patients. Serology Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana. The study comprised a convenient sample of 303 treatment naïve HIV patients due to start HAART. Questionnaires were used to collect patient demographic and clinical data. Four CD4 counts were measured at six-monthly intervals to determine rates of CD4 change. These were pre-therapy, 1(st) post-therapy, 2(nd) post-therapy, and 3(rd) post-therapy counts. The rates of CD4 change among the different categories of patients were also compared. At baseline, women had higher CD4 count (mean of 77.4 cells/μl), and mean age of participants was 40 years. The CD4 count increased from a mean baseline of 70.2 cells/μl to 229.2, 270.0, and 297.6 cells/μl at 6, 12, and 18 months of treatment respectively (P < 0.0001 at each time point). There were no gender (P=0.46) and age (P=0.96) differences in treatment response. There was no difference (P=0.18) in treatment response comparing those with CD4 <250 cells/μl and those whose CD4 count was between 250 and 350 cells/μl at baseline although patients with baseline CD4 count <250 cells/μl showed larger increases after 12 months of treatment. Out of 282 patients with pre-therapy CD4 count ≤250 cells/μl, 241 (85.5%) and 41 (14.5%) were adherents and nonadherents respectively. Mean rate of increase was 15.2 and 8.4 cells/μl/month in adherent and non-adherent patients respectively (p=0.2). The study suggests that a sustained CD4 increase could be achieved in adherent patients commencing therapy with baseline CD4 count ≤250 cells/μl, and that these patients have greater ability for immunological recovery during 12 months of treatment The study, therefore, concludes that significant immunological improvement is possible among Ghanaian PLHIV on HAART as long as a high level of treatment adherence is observed.

Developing marketing strategies for university teaching hospitals.

PubMed

Fink, D J

1980-07-01

University teaching hospitals face increasing competition from community hospitals, expanding regulation of health care, a rising tide of consumerism, and in many cases a declining urban population base. These problems, which may threaten the teaching hospital's ability to continue tertiary care, teaching, and research functions, may be solved with the aid of new marketing strategies. In developing its marketing strategy, a hospital must assess its strengths and weaknesses, specify its goals in measurable terms, implement tactics to achieve these goals, and evaluate its marketing program. The strategies should be directed toward achieving better relationships with institutions, practitioners, and surrounding communities and increasing patient, visitor, and employee satisfaction. A wide variety of programs can be used to reach these goals and to help teaching hospitals meet the competitive challenges of this decade.

Improving the Quality of Teaching and Learning through Leadership for Learning: Changing Scenarios in Basic Schools of Ghana

ERIC Educational Resources Information Center

Malakolunthu, Suseela; McBeath, John; Swaffield, Sue

2014-01-01

This article emerged as a case study from a fact-finding mission of a joint programme between the Centre for Commonwealth Education (CCE) in Cambridge University and the Institute for Educational Planning and Administration (IEPA) in University of Cape Coast, Ghana, to embed innovative approaches to teaching and learning in the basic schools of…

Blood transfusion practice in a rural hospital in Northern Ghana, Damongo, West Gonja District.

PubMed

Kubio, Chrysantus; Tierney, Geraldine; Quaye, Theophilus; Nabilisi, James Wewoli; Ziemah, Callistus; Zagbeeb, Sr Mary; Shaw, Sandra; Murphy, William G

2012-10-01

Blood transfusion in rural sub-Saharan Africa presents special challenges. Transfusions are primarily given for emergencies--life-threatening blood loss or anemia; blood is usually collected from family or replacement donors; and facilities to store an adequate reserve in a hospital bank are constrained. We report the everyday and organizational practices in a medium-sized district hospital in Northern Ghana. Information and data on blood transfusion practices at West Gonja Hospital, Damongo, were available from the laboratory reports, from day books and workbooks, and from direct observation in the following four areas: blood collection and blood donors; blood donation testing; blood storage and logistics; and clinical transfusion practice, adverse events, and follow-up. The hospital serves a rural community of 86,000. In 2009, a total of 719 units of whole blood were collected, a rate of 8.36 units per 1000 population. All donors were family or replacement donors. Positivity rates for infectious disease markers were 7.5% (64/853) for hepatitis B surface antigen, 6.1% (50/819) for hepatitis C virus, 3.9% (33/846) for human immunodeficiency virus, and 4.7% (22/468) for syphilis. Supply of laboratory materials was sometimes problematic, especially for temperature-critical materials. Difficulties in sample labeling, storage of blood and laboratory supplies, and disposal of waste were also incurred by operational, material, and financial constraints. Follow-up for outcomes of transfusion is not currently feasible. The operational, demographic, and financial environment pertaining in a rural hospital in Northern Ghana differs substantially from that in which much of current blood transfusion practice and technology evolved. Considerable effort and innovation will be needed to address successfully the challenges posed. © 2012 American Association of Blood Banks.

Did recent changes in Medicare reimbursement hit teaching hospitals harder?

PubMed

Konetzka, R Tamara; Zhu, Jingsan; Volpp, Kevin G

2005-11-01

To inform the policy debate on Medicare reimbursement by examining the financial effects of the Balanced Budget Act of 1997 (BBA) and subsequent adjustments on major academic medical centers, minor teaching hospitals, and nonteaching hospitals. The authors simulated the impacts of BBA and subsequent BBA adjustments to predict the independent effects of changes in Medicare reimbursement on hospital revenues using 1997-2001 Medicare Cost Reports for all short-term acute-care hospitals in the United States. The authors also calculated actual (nonsimulated) operating and total margins among major teaching, minor teaching, and nonteaching hospitals to account for hospital response to the changes. The BBA and subsequent refinements reduced Medicare revenues to a greater degree in major teaching hospitals, but the fact that such hospitals had a smaller proportion of Medicare patients meant that the BBA reduced overall revenues by similar percentages across major, minor, and nonteaching hospitals. Consistently lower margins may have made teaching hospitals more vulnerable to cuts in Medicare support. Recent Medicare changes affected revenues at teaching and nonteaching hospitals more similarly than is commonly believed. However, the Medicare cuts under the BBA probably exacerbated preexisting financial strain on major teaching hospitals, and increased Medicare funding may not suffice to eliminate the strain. This report's findings are consistent with recent calls to support needed services of teaching hospitals through all-payer or general funds.

Group versus individual family planning counseling in Ghana: a randomized, noninferiority trial.

PubMed

Schwandt, Hilary M; Creanga, Andreea A; Danso, Kwabena A; Adanu, Richard M K; Agbenyega, Tsiri; Hindin, Michelle J

2013-08-01

Group, rather than individual, family planning counseling has the potential to increase family planning knowledge and use through more efficient use of limited human resources. A randomized, noninferiority study design was utilized to identify whether group family planning counseling is as effective as individual family planning counseling in Ghana. Female gynecology patients were enrolled from two teaching hospitals in Ghana in June and July 2008. Patients were randomized to receive either group or individual family planning counseling. The primary outcome in this study was change in modern contraceptive method knowledge. Changes in family planning use intention before and after the intervention and intended method type were also explored. Comparisons between the two study arms suggest that randomization was successful. The difference in change in modern contraceptive methods known from baseline to follow-up between the two study arms (group-individual), adjusted for study site, was -0.21, (95% confidence interval: -0.53 to 0.12) suggesting no difference between the two arms. Group family planning counseling was as effective as individual family planning counseling in increasing modern contraceptive knowledge among female gynecology patients in Ghana. Copyright © 2013 Elsevier Inc. All rights reserved.

Hospital all-risk emergency preparedness in Ghana.

PubMed

Norman, I D; Aikins, M; Binka, F N; Nyarko, K M

2012-03-01

This paper assessed the emergency preparedness programs of health facilities for all-risks but focused on Road Traffic Accidents, (RTA) resulting in surge demand. It adopted W. H. O checklist covering hospital preparedness, equipment, manpower and surge capacity planning as best practices for the mitigation of public health emergencies. This is a cross-sectional study of purposively selected health facilities. The method used consisted of site visit, questionnaire survey, literature and internet review. The W. H. O. standard for emergency preparedness of health facilities was used to evaluate and assess the nation's hospitals surge capacity programs. The study was conducted between March-June, 2010. A total of 22 district and regional health facilities including teaching hospitals participated in the study. All 10 regions of the country were covered. These were: (1) many of the nation's hospitals were not prepared for large RTA's resulting in surge demands, and did not possess general emergency preparedness programs. (2) The hospitals' respective abilities to handle large scale RTA's were compromised by the lack of competent medical and allied health personnel and adequate supplies. The inadequacies of the hospital system in responding to emergencies raise serious public health concerns. The biggest challenge facing the hospitals in their emergency intervention is the lack of pre-emergency and emergency preparedness plans as well as the coordination of the hospitals response mechanisms. The paper ended with recommendations on how the nation's hospitals and their supervisory agencies could improve emergency preparedness.

Multi-centre point prevalence survey of hospital-acquired infections in Ghana.

PubMed

Labi, Appiah-Korang; Obeng-Nkrumah, Noah; Owusu, Enid; Bjerrum, Stephanie; Bediako-Bowan, Antoinette; Sunkwa-Mills, Gifty; Akuffo, Christiana; Fenny, Ama Pokua; Opintan, Japheth Awuletey; Enweronu-Laryea, Christabel; Debrah, Samuel; Damale, Nelson; Bannerman, Cynthia; Newman, Mercy Jemima

2018-05-03

There is a paucity of data describing hospital acquired infections (HAIs) in Africa. To describe the prevalence and distribution of HAIs in acute care hospitals in Ghana. Between September and December 2016, point prevalence surveys were conducted in participating hospitals using protocols of the European Centre for Disease Prevention and Control. We reviewed medical records of eligible inpatients at or before 8am on the day of survey to identify HAIs present at the time of survey. Ten hospitals were surveyed, representing 32.9% of all acute care beds in government hospitals. Of 2107 inpatients surveyed, 184 HAIs were identified among 172 patients, corresponding to an overall prevalence of 8.2%. The prevalence values in hospitals ranged from 3.5 to 14.4% with higher proportion of infections in secondary and tertiary care facilities. The most frequent HAIs were surgical site infections (32.6%), bloodstream infections (19.5%), urinary tract infections (18.5%), and respiratory tract infections (16.3%). Device-associated infections accounted for 7.1% of HAIs. For 12.5% of HAIs, a microorganism was reported; the most isolated microorganism was Escherichia coli. Approximately 61% of all patients surveyed were on antibiotics; 89.5% of patients with an HAI received at least one antimicrobial agent on the day of survey. The strongest independent predictors for HAI were the presence of invasive device before onset of infection and duration of hospital stay. We recorded a low HAI burden compared to findings from other low and middle income countries. Copyright © 2018. Published by Elsevier Ltd.

The medico-legal prerequisite for initiating quarantine and isolation practices in public health emergency management in hospitals in Ghana.

PubMed

Norman, I D; Aikins, M; Binka, F N

2011-12-01

Hospitals and other health facilities in Ghana do not appear to have standardized practices for quarantine and isolation in public health emergency management. This paper reviews the legislative framework governing the medico-legal prerequisites for initiating quarantine and isolation procedures as articulated in the Infectious Disease Act (Cap 78) 1908 amended, 1935, the Quarantine Act (Cap 77) 1915 amended, 1938, the Emergency Powers Act of 1994, (Act 472), and the National Disaster Management Act, 1996, (Act 517) in consonance with the 1992 Constitution of Ghana. The findings provide that (1) The legislative framework outlines systematic standards and protocols to be followed in the committal of person or persons in quarantine and isolation during public health emergencies. (2) These standards and protocols consider as imperative, the creation of standardized national templates for the initiation of quarantine and isolation measures. (3) The non-compliance of the standards and protocols renders vulnerable medical facilities and hospitals with their personnel to the threat of medical malpractice suits and breach of professional ethics. This paper provides suggestions to hospital administrators and medical personnel of how to develop administrative templates in compliance with the law in managing public health emergencies. It also provides examples of such templates for possible adoption by hospitals and other health administrators.

General Practice Teaching--Within the Hospital

ERIC Educational Resources Information Center

Drury, M.

1976-01-01

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

Incidence of iatrogenic pneumothorax in the United States in teaching vs. non-teaching hospitals from 2000 to 2012.

PubMed

John, Jason; Seifi, Ali

2016-08-01

Iatrogenic pneumothorax is a patient safety indicator (PSI) representing a complication of procedures such as transthoracic needle aspiration, subclavicular needle stick, thoracentesis, transbronchial biopsy, pleural biopsy, and positive pressure ventilation. This study examined whether there was a significant difference in rate of iatrogenic pneumothorax in teaching hospitals compared to non-teaching hospitals from 2000 to 2012. We performed a retrospective cohort study on iatrogenic pneumothorax incidence from 2000 to 2012 using the Healthcare Cost and Utilization Project (HCUP) database. Pairwise t tests were performed. Odds ratios and P values were calculated, using a Bonferroni-adjusted α threshold, to examine differences in iatrogenic pneumothorax incidence in teaching vs. non-teaching hospitals. Our study revealed that after the year 2000, teaching hospitals had significantly greater iatrogenic pneumothorax incidence compared to non-teaching hospitals in every year of the study period (P<.001). Iatrogenic pneumothorax occurred with significantly greater incidence in teaching hospitals compared to non-teaching hospitals from 2000 to 2012. This trend may have been enhanced by the residency duty-hour regulations implemented in 2003 in teaching institutions, or due to higher rates of procedures in teaching institutions due to the nature of a tertiary center. Iatrogenic pneumothorax was more prevalent in teaching hospitals compared to non-teaching hospitals after the year 2000. Further randomized control studies are warranted to evaluate the etiology of this finding. Published by Elsevier Inc.

Estimating the cost of healthcare delivery in three hospitals in southern ghana.

PubMed

Aboagye, A Q Q; Degboe, A N K; Obuobi, A A D

2010-09-01

The cost burden (called full cost) of providing health services at a referral, a district and a mission hospital in Ghana were determined. Standard cost-finding and cost analysis tools recommended by World Health Organization are used to analyse 2002 and 2003 hospital data. Full cost centre costs were computed by taking into account cash and non-cash expenses and allocating overhead costs to intermediate and final patient care centres. The full costs of running the mission hospital in 2002 and 2003 were US$600,295 and US$758,647 respectively; for the district hospital, the respective costs were US$496,240 and US$487,537; and for the referral hospital, the respective costs were US$1,160,535 and US$1,394,321. Of these, overhead costs ranged between 20% and 42%, while salaries made up between 45% and 60%. Based on healthcare utilization data, in 2003 the estimated cost per outpatient attendance was US$ 2.25 at the mission hospital, US$ 4.51 at the district hospital and US$8.5 at the referral hospital; inpatient day costs were US$ 6.05, US$ 9.95 and US$18.8 at the respective hospitals. User fees charged at service delivery points were generally below cost. However, some service delivery points have the potential to recover their costs. Salaries are the major cost component of the three hospitals. Overhead costs constitute an important part of hospital costs and must be noted in efforts to recover costs. Cost structures are different at different types of hospitals. Unit costs at service delivery points can be estimated and projected into the future.

Immunologic and virological response to ART among HIV infected individuals at a tertiary hospital in Ghana.

PubMed

Obiri-Yeboah, Dorcas; Pappoe, Faustina; Baidoo, Ibrahim; Arthur, Francis; Hayfron-Benjamin, Anna; Essien-Baidoo, Samuel; Kwakye-Nuako, Godwin; Ayisi Addo, Stephen

2018-05-21

The need to study the outcome of Antiretroviral Therapy (ART) among Human Immunodeficiency Virus (HIV) infected individuals in Ghana, a sub-Saharan African country crucial in the era of the "Treat All" policy. The aim of this study was to analyze selected determinants of immunological and virological response to ART among HIV infected individuals in a tertiary facility in Cape Coast, Ghana. An analytical cross sectional study with a retrospective component was conducted in the Cape Coast Teaching Hospital (CCTH), Central Region. Clients aged 18 years and above attending the HIV Clinics for ART and who were on ART for 6 months or more were recruited. The viral loads, CD4 count and other socio-demographic data were analyzed using STATA version 13 (STATA Corp, Texas USA). Descriptive analysis was done and presented with appropriate measures of central tendencies. In addition, bivariate and multivariate analysis was carried out with p value of 0.05 interpreted as evidence of association between variables. A total of 440 participants were included in this study with a mean age of 45.5 (±11.6) years. The mean CD4 count at baseline, 6 months on ART and currently at study recruitment were 215.1 cells/mm 3 (±152.6), 386.6 cells/mm 3 (±178.5), and 579.6 cells/mm 3 (±203.0) respectively. After 6 months and 12 months on ART, the number who had achieved viral copies < 1000/ml were 149 (47.0%) and 368 (89.6%) respectively. There was strong evidence of an association between having CD4 count < 350 cells/mm 3 after 6 months on ART and having a diagnosis of tuberculosis since HIV diagnosis (aOR 8.5, 95% CI 1.1-73.0, p = 0.05) and clients having plasma viral load > 1000 copies/ml after 6 months on ART (aOR 2.0, 95% CI 1.2-3.2, p = 0.01). There was good response to ART among clients, high virological suppression and immunological recovery hence low rates of change to second line ART regimen in this cohort studied. With strict adherence to the national policy

Measuring Coverage in MNCH: Validating Women’s Self-Report of Emergency Cesarean Sections in Ghana and the Dominican Republic

PubMed Central

Tunçalp, Özge; Stanton, Cynthia; Castro, Arachu; Adanu, Richard; Heymann, Marilyn; Adu-Bonsaffoh, Kwame; Lattof, Samantha R.; Blanc, Ann; Langer, Ana

2013-01-01

Background Cesarean section is the only surgery for which we have nearly global population-based data. However, few surveys provide additional data related to cesarean sections. Given weaknesses in many health information systems, health planners in developing countries will likely rely on nationally representative surveys for the foreseeable future. The objective is to validate self-reported data on the emergency status of cesarean sections among women delivering in teaching hospitals in the capitals of two contrasting countries: Accra, Ghana and Santo Domingo, Dominican Republic (DR). Methods and Findings This study compares hospital-based data, considered the reference standard, against women’s self-report for two definitions of emergency cesarean section based on the timing of the decision to operate and the timing of the cesarean section relative to onset of labor. Hospital data were abstracted from individual medical records, and hospital discharge interviews were conducted with women who had undergone cesarean section in two hospitals. The study assessed sensitivity, specificity, and positive predictive value of responses to questions regarding emergency versus non-emergency cesarean section and estimated the percent of emergency cesarean sections that would be obtained from a survey, given the observed prevalence, sensitivity, and specificity from this study. Hospital data were matched with exit interviews for 659 women delivered via cesarean section for Ghana and 1,531 for the Dominican Republic. In Ghana and the Dominican Republic, sensitivity and specificity for emergency cesarean section defined by decision time were 79% and 82%, and 50% and 80%, respectively. The validity of emergency cesarean defined by operation time showed less favorable results than decision time in Ghana and slightly more favorable results in the Dominican Republic. Conclusions Questions used in this study to identify emergency cesarean section are promising but insufficient to

Improving medical records filing in a municipal hospital in Ghana.

PubMed

Teviu, E A A; Aikins, M; Abdulai, T I; Sackey, S; Boni, P; Afari, E; Wurapa, F

2012-09-01

Medical records are kept in the interest of both the patient and clinician. Proper filing of patient's medical records ensures easy retrieval and contributes to decreased patient waiting time at the hospital and continuity of care. This paper reports on an intervention study to address the issue of misfiling and multiple patient folders in a health facility. Intervention study. Municipal Hospital, Goaso, Asunafo North District, Brong Ahafo Region, Ghana. Methods employed for data collection were records review, direct observation and tracking of folders. Interventions instituted were staff durbars, advocacy and communication, consultations, in-service trainings, procurement and monitoring. Factors contributing to issuance of multiple folders and misfiling were determined. Proportion of multiple folders was estimated. Results revealed direct and indirect factors contributing to issuance of multiple patient folders and misfiling. Interventions and monitoring reduce acquisition of numerous medical folders per patient and misfiling. After the intervention, there was significant reduction in the use of multiple folders (i.e., overall 97% reduction) and a high usage of single patient medical folders (i.e., 99%). In conclusion, a defined medical records filing system with adequate training, logistics and regular monitoring and supervision minimises issuance of multiple folders and misfiling.

Development of an emergency nursing training curriculum in Ghana.

PubMed

Bell, Sue Anne; Oteng, Rockefeller; Redman, Richard; Lapham, Jeremy; Bam, Victoria; Dzomecku, Veronica; Yakubu, Jamila; Tagoe, Nadia; Donkor, Peter

2014-10-01

The formal provision of emergency health care is a developing specialty in many sub-Saharan African countries, including Ghana. While emergency medicine training programs for physicians are on the rise, there are few established training programs for emergency nurses. The results of a unique collaboration are described between a university in the United States, a Ghanaian university and a Ghanaian teaching hospital that has developed an emergency nursing diploma program. The expected outcomes of this training program include: (a) an innovative, interdisciplinary, team-based clinical training model, (b) a unique and low-resource emergency nursing curriculum and (c) a comprehensive and sustainable training program to increase in-country retention of nurses. Copyright © 2014 Elsevier Ltd. All rights reserved.

DEVELOPMENT OF AN EMERGENCY NURSING TRAINING CURRICULUM IN GHANA

PubMed Central

Bell, Sue Anne; Oteng, Rockefeller; Redman, Richard; Lapham, Jeremy; Bam, Victoria; Dzomecku, Veronica; Yakubu, Jamila; Tagoe, Nadia; Donkor, Peter

2014-01-01

The formal provision of emergency health care is a developing specialty in many sub-Saharan African countries, including Ghana. While emergency medicine training programs for physicians are on the rise, there are few established training programs for emergency nurses. The results of a unique collaboration are described between a university in the United States, a Ghanaian university and a Ghanaian teaching hospital that has developed an emergency nursing diploma program. The expected outcomes of this training program include: a) an innovative, interdisciplinary, team-based clinical training model b) a unique and low-resource emergency nursing curriculum and c) a comprehensive and sustainable training program to increase in-country retention of nurses. PMID:24631161

Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals

PubMed Central

Baatiema, Leonard; de-Graft Aikins, Ama; Sav, Adem; Mnatzaganian, George; Chan, Carina K Y; Somerset, Shawn

2017-01-01

Objective Despite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals’ views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings. Design A qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes. Setting A multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana. Participants A total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian. Results Four key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals. Conclusion Barriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes. PMID:28450468

Is hospital teaching status a key factor in hospital charge for children with hip fractures?: preliminary findings from KID database.

PubMed

Gao, Yubo; Pugely, Andrew; Karam, Matthew; Phisitkul, Phinit; Mendoza, Sergio; Johnston, Richard C

2013-01-01

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 (teaching hospital vs non-teaching hospital) 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 selection bias. The 2006 Healthcare Cost and Utilization 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 Classification of Diseases, 9th Revision, Clinical Modification 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 hospital teaching status were assessed via two propensity score based methods. In total, 1,827 patients were nation-ally included for analysis: 1,392 (76.2%) were treated at a teaching hospital and 435 (23.8%) were treated at a non-teaching hospital. The average age of the patients was 12.88 years old in teaching hospitals vs 14.33 years old in nonteaching hospitals. The propensity score based adjustment method showed mean hospital charge was $34,779 in teaching hospitals and $32,891 in the non-teaching hospitals, but these differences were not significant (p=0.2940). Likewise, mean length of hospital stay was 4.1 days in teaching hospitals and 3.89 days in non-teaching hospitals, but these differences were also not significant (p=0.4220). Hospital teaching 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

Detection of Human Papillomavirus Genotypes and Epstein-Barr Virus in Nasopharyngeal Carcinomas at the Korle-Bu Teaching Hospital, Ghana

PubMed Central

Asmah, Richard Harry; Adjei, Andrew Anthony; Simpong, David Larbi; Brown, Charles Addoquaye; Gyasi, Richard Kwasi

2017-01-01

Nasopharyngeal carcinomas (NPC) are endemic in Far East Asia and commonly harbour Epstein-Barr virus (EBV) which is known to serve as a key oncogenic promoter. Human papillomavirus (HPV) is known to contribute to the pathogenesis of NPC. However, in Ghana these two viruses have not been linked to NPC prevalence. This study was designed to determine the HPV genotypes and EBV involved in NPC tissue biopsies. A retrospective study design involving 72 formalin-fixed paraffin-embedded tissue (FFPET) samples of NPC from 2006 to 2012 were retrieved from the Department of Pathology, University of Ghana School of Biomedical and Allied Health Sciences. Sections were taken for histological analysis and for DNA lysate preparation. The DNA lysates were subjected to polymerase chain reaction (PCR) analysis to determine the presence of HPV genotypes and EBV. HPV specific primers were used to type for fourteen HPV genotypes (HPV-16, 18, 6/11, 31, 33, 35, 44, 42, 43, 45, 56, 52, 58, and 59). Out of the 72 NPC biopsies analyzed by PCR, EBV DNA was present in 18 (25%) cases and HPV DNA in 14 (19.23%). High risk HPV (HR-HPV) genotypes 18 and 31 were associated with the NPC. There were 3 (4.2%) cases of coinfection by both viruses. The EBV DNA present in the undifferentiated variant of the NPC and the histopathology of the NPC in Ghana is similar to the type described in endemic areas. PMID:28421207

Case Mix Complexity Differences between Teaching and Nonteaching Hospitals.

ERIC Educational Resources Information Center

Ament, Richard P.; And Others

1981-01-01

The differences between teaching and nonteaching hospitals in complexity and variety of cases seen are described. The results show that teaching hospitals could be expected to cost somewhat more per patient even if case mix were the only factor. (Author/MLW)

Social Support Behaviors and Work Stressors among Nurses: A Comparative Study between Teaching and Non-Teaching Hospitals.

PubMed

Amarneh, Basil Hameed

2017-01-29

The concept of "work stressors" has been well studied. However, in the field of nursing, studies concerning social support behaviors are limited. The aim of this study was to compare nurse work stressors, social support behaviors, and predictors of these variables among nurses in Jordanian teaching and non-teaching hospitals. A convenience sampling technique and a comparative quantitative research design were used in the current study. Two hundred and ninety-one nurses were recruited from five teaching hospitals, and 172 were recruited from eight non-teaching hospitals in Jordan. The Nursing Stress Scale (NSS) and the Inventory of Social Supportive Behaviors (ISSB) were used to collect data. The studied variables differed across hospitals. In some subscales, as well as in some individual items of the scales, nurse work stressors and social support behaviors differed between teaching and non-teaching hospitals. In teaching hospitals, the work shift was the only predictor of nurses' work stressors, whereas the work shift and model of nursing care were predictors of social support behaviors. In non-teaching hospitals, the work shift, level of education, and model of nursing care were predictors of nurse work stressors. Predictors of social support behaviors were marital status, model of nursing, and organizational structure. Regardless of the type of hospital, nurse stressors should be assessed and, once identified, managed by providing various social support behaviors. By turning a work environment into a healthy workplace, researchers and nurse leaders believe that improvements can be realized in recruitment and patient safety and quality.

Social Support Behaviors and Work Stressors among Nurses: A Comparative Study between Teaching and Non-Teaching Hospitals

PubMed Central

Amarneh, Basil Hameed

2017-01-01

Purpose: The concept of “work stressors” has been well studied. However, in the field of nursing, studies concerning social support behaviors are limited. The aim of this study was to compare nurse work stressors, social support behaviors, and predictors of these variables among nurses in Jordanian teaching and non-teaching hospitals. Design: A convenience sampling technique and a comparative quantitative research design were used in the current study. Two hundred and ninety-one nurses were recruited from five teaching hospitals, and 172 were recruited from eight non-teaching hospitals in Jordan. Methods: The Nursing Stress Scale (NSS) and the Inventory of Social Supportive Behaviors (ISSB) were used to collect data. Results: The studied variables differed across hospitals. In some subscales, as well as in some individual items of the scales, nurse work stressors and social support behaviors differed between teaching and non-teaching hospitals. In teaching hospitals, the work shift was the only predictor of nurses’ work stressors, whereas the work shift and model of nursing care were predictors of social support behaviors. In non-teaching hospitals, the work shift, level of education, and model of nursing care were predictors of nurse work stressors. Predictors of social support behaviors were marital status, model of nursing, and organizational structure. Conclusions: Regardless of the type of hospital, nurse stressors should be assessed and, once identified, managed by providing various social support behaviors. Clinical relevance: By turning a work environment into a healthy workplace, researchers and nurse leaders believe that improvements can be realized in recruitment and patient safety and quality. PMID:28146045

The public health impact of training physicians to become obstetricians and gynecologists in Ghana.

PubMed

Anderson, Frank W J; Obed, Samuel A; Boothman, Erika L; Opare-Ado, Henry

2014-02-01

We assessed the public health effect of creating and sustaining obstetrics and gynecology postgraduate training in Ghana, established in 1989 to reverse low repatriation of physicians trained abroad. All 85 certified graduates of 2 Ghanaian university-based postgraduate training programs from program initiation in 1989 through June 2010 were identified and eligible for this study. Of these, 7 were unable to be contacted, inaccessible, declined participation, or deceased. Of the graduates, 83 provide clinical services in Ghana and work in 33 sites in 8 of 10 regions; 15% were the first obstetrician and gynecologist at their facility, 25% hold clinical leadership positions, 50% practice in teaching hospitals, and 14% serve as academic faculty. Creating capacity for university-based postgraduate training in obstetrics and gynecology is effective and sustainable for a comprehensive global approach to reduce maternal and neonatal morbidity and mortality. Policies to support training and research capacity in obstetrics and gynecology are an integral part of a long-term national plan for maternal health.

Maternal request CS--role of hospital teaching status and for-profit ownership.

PubMed

Xirasagar, Sudha; Lin, Herng-Ching

2007-05-01

To examine whether hospitals' for-profit (FP) ownership and non-teaching status are associated with greater likelihood of maternal request cesarean (CS) relative to public and not-for-profit (NFP) and teaching status, respectively. Retrospective, cross-sectional, population-based study of Taiwan's National Health Insurance claims data, covering all 739,531 vaginal delivery-eligible singleton deliveries during 1997-2000, using multiple logistic regression analyses. Adjusted for maternal age and geographic location, FP district hospitals (almost all non-teaching), followed by ob/gyn clinics were significantly more likely to perform request CS (OR=3.5-2.3) than public and NFP teaching hospitals. Among non-teaching and teaching hospitals, FPs were more likely to perform request CS than public and NFP hospitals (OR=2.3 and 2.5, respectively). Our findings are consistent with greater propensity of physicians in FP institutions to accommodate patient requests involving revenue-maximizing procedures such as request CS. This effect is moderated by teaching hospitals' preference for complicated cases, consistent with their teaching mission and hi-tech infrastructure.

Predictors of quality of life in patients with diabetes mellitus in two tertiary health institutions in Ghana and Nigeria.

PubMed

Ababio, Grace K; Bosomprah, Samuel; Olumide, Adesola; Aperkor, Nicholas; Aimakhu, Chris; Oteng-Yeboah, Audrey; Agama, Joan; Chaplin, William F; Okuyemi, Kola S; Amoah, Albert G B; Ogedegbe, Gbenga

2017-01-01

Patients with chronic diseases such as Type 2 diabetes mellitus (DM) usually have a relatively poor quality of life (QoL), because the cost of care (living expenses and health) or diet restrictions are heavily felt by these patients, and this is of a public health concern. However, limited data on DM QoL exist in Ghana and Nigeria. This makes it imperative for data to be collated in that regard. We adopted the Strengthening The reporting of observational studies in epidemiology (STROBE) consensus checklist to survey the patients with DM seen at the diabetic clinic at the Department of Medicine of the Korle-Bu Teaching Hospital and University College Hospital, Ibadan, Nigeria. Patients with Type 2 DM aged 40 years and older were recruited by using systematic random sampling method. The World Health Organization Quality of Life-BREF, diabetes empowerment scale, and DM knowledge scale were used to assess QoL, patient empowerment, and knowledge of DM, respectively. The predictors of QoL were determined using multiple linear regression analyses. A total of 198 patients in Ghana and 203 patients in Nigeria completed the survey, with female-to-male ratio being 3:1 and 2:1, respectively. The overall QoL in both countries was relatively low: 56.19 ± 8.23 in Ghana and 64.34 ± 7.34 in Nigeria. In Ghana, significant correlates of higher scores on the QoL scale were medication adherence (P = 0.02) and employment status (P = 0.02). Among patients in Nigeria, employment status (P = 0.02) and DM empowerment (0.03) were significant predictors of QoL in patients with DM. Our study revealed an association between a number of psychosocial factors and QoL among patients with DM in Ghana and Nigeria.

Wiring a medical school and teaching hospital for telemedicine.

PubMed

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

2002-06-01

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

Wiring a medical school and teaching hospital for telemedicine.

PubMed

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

2001-05-01

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

Progress with the implementation of kangaroo mother care in four regions in Ghana.

PubMed

Bergh, A-M; Manu, R; Davy, K; Van Rooyen, E; Quansah Asare, G; Awoonor-Williams, Jk; Dedzo, M; Twumasi, A; Nang-Beifubah, A

2013-06-01

To measure progress with the implementation of kangaroo mother care (KMC) for low birth-weight (LBW) infants at a health systems level. Action research design, with district and regional hospitals as the unit of analysis. Four regions in Ghana, identified by the Ghana Health Service and UNICEF. Health workers and officials, health care facilities and districts in the four regions. A one-year implementation programme with three phases: (1) introduction to KMC, skills development in KMC practice and the management of implementation; (2) advanced skills development for regional steering committee members; and (3) an assessment of progress at the end of the intervention. Description of practices, services and facilities for KMC and the identification of strengths and challenges. Twenty-six of 38 hospitals (68%) demonstrated sufficient progress with KMC implementation. Half of the hospitals had designated a special ward for KMC. 66% of hospitals used a special record for infants receiving KMC. Two of the main challenges were lack of support for mothers who had to remain with their LBW infants in hospital and no follow-up review services for LBW infants in 39% of hospitals. It was possible to roll out KMC in Ghana, but further support for the regions is needed to maintain the momentum. Lessons learned from this project could inform further scale-up of KMC and other projects in Ghana.

Review: Abortion care in Ghana: A critical review of the literature

PubMed Central

Rominski, Sarah D; Lori, Jody R

2015-01-01

The Government of Ghana has taken important steps to mitigate the impact of unsafe abortion. However, the expected decline in maternal deaths is yet to be realized. This literature review aims to present findings from empirical research directly related to abortion provision in Ghana and identify gaps for future research. A total of four (4) databases were searched with the keywords “Ghana and abortion” and hand review of reference lists was conducted. All abstracts were reviewed. The final include sample was 39 articles. Abortion-related complications represent a large component of admissions to gynecological wards in hospitals in Ghana as well as a large contributor to maternal mortality. Almost half of the included studies were hospital-based, mainly chart reviews. This review has identified gaps in the literature including: interviewing women who have sought unsafe abortions and with healthcare providers who may act as gatekeepers to women wishing to access safe abortion services. PMID:25438507

One Strategy for Controlling Costs in University Teaching Hospitals

ERIC Educational Resources Information Center

Thompson, John D.; And Others

1978-01-01

A methodology is outlined that can be used by teaching hospitals in determining their costs of treating patients with a complex mix of diagnoses. It is not held that case mix alone explains all cost differences between teaching and nonteaching hospitals, but that factor must be isolated before examining other variables. (Author/LBH)

Health insurance and quality of care: Comparing perceptions of quality between insured and uninsured patients in Ghana's hospitals.

PubMed

Abuosi, Aaron A; Domfeh, Kwame Ameyaw; Abor, Joshua Yindenaba; Nketiah-Amponsah, Edward

2016-05-12

The introduction of health insurance in Ghana in 2003 has resulted in a tremendous increase in utilization of health services. However, concerns are being raised about the quality of patient care. Some of the concerns include long waiting times, verbal abuse of patients by health care providers, inadequate physical examination by doctors and discrimination of insured patients. The study compares perceptions of quality of care between insured and uninsured out-patients in selected hospitals in Ghana to determine whether there is any unequal treatment between insured and uninsured patients in terms of quality of care, as empirical and anecdotal evidence seem to suggest. A cross-sectional survey of 818 out-patients was conducted in 17 general hospitals from three regions of Ghana. These are the Upper East, Brong Ahafo and Central Regions. Convenience sampling was employed to select the patients in exit interviews. Descriptive statistics, including frequency distributions, means and standard deviations, were used to describe socio-economic and demographic characteristics of respondents. Factor analysis was used to determine distinct quality of care constructs; t-test statistic was used to test for differences in quality perceptions between the insured and uninsured patients; and regression analysis was used to test the association between health insurance and quality of care. Overall, there was no significant difference in perceptions of quality between insured and uninsured patients. However, there was a significant difference between insured and uninsured patients in respect of financial access to care. The major quality of care concern affecting all patients was the problem of inadequate resources, especially lack of doctors, lack of drugs and other basic supplies and equipment to work with. It was concluded that generally, insured and uninsured patients are not treated unequally, contrary to prevailing anecdotal and empirical evidence. On the contrary, quality of

World Perspective Case Descriptions on Educational Programs for Adults: Ghana.

ERIC Educational Resources Information Center

Ansere, Joe K.; Mensah, Eric A.

This document contains two case studies, one by J. K. Ansere, concerning the modular program of distance education to prepare teachers in Ghana and the other, by E.A. Mensah, reporting on a research experiment that compared teaching methods used to teach the course of study at a Ghanian worker's college. The modular program described by Ansere is…

Creative payment strategy helps ensure a future for teaching hospitals.

PubMed

Vancil, D R; Shroyer, A L

1998-11-01

The Colorado Medicaid Program in years past relied on disproportionate share hospital (DSH) payment programs to increase access to hospital care for Colorado citizens, ensure the future financial viability of key safety-net hospitals, and partially offset the state's cost of funding the Medicaid program. The options to finance Medicaid care using DSH payments, however, recently have been severely limited by legislative and regulatory changes. Between 1991 and 1997, a creative Medicaid refinancing strategy called the major teaching hospital (MTH) payment program enabled $131 million in net payments to be distributed to the two major teaching hospitals in Colorado to provide enhanced funding related to their teaching programs and to address the ever-expanding healthcare needs of their low-income patients. This new Medicaid payment mechanism brought the state $69.5 million in Federal funding that otherwise would not have been received.

Implementing Medical Teaching Policy in University Hospitals

ERIC Educational Resources Information Center

Engbers, Rik; Fluit, Cornelia Cornelia R. M. G.; Bolhuis, Sanneke; de Visser, Marieke; Laan, Roland F. J. M.

2017-01-01

Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have…

The Public Health Impact of Training Physicians to Become Obstetricians and Gynecologists in Ghana

PubMed Central

Obed, Samuel A.; Boothman, Erika L.; Opare-Ado, Henry

2014-01-01

Objectives. We assessed the public health effect of creating and sustaining obstetrics and gynecology postgraduate training in Ghana, established in 1989 to reverse low repatriation of physicians trained abroad. Methods. All 85 certified graduates of 2 Ghanaian university-based postgraduate training programs from program initiation in 1989 through June 2010 were identified and eligible for this study. Of these, 7 were unable to be contacted, inaccessible, declined participation, or deceased. Results. Of the graduates, 83 provide clinical services in Ghana and work in 33 sites in 8 of 10 regions; 15% were the first obstetrician and gynecologist at their facility, 25% hold clinical leadership positions, 50% practice in teaching hospitals, and 14% serve as academic faculty. Conclusions. Creating capacity for university-based postgraduate training in obstetrics and gynecology is effective and sustainable for a comprehensive global approach to reduce maternal and neonatal morbidity and mortality. Policies to support training and research capacity in obstetrics and gynecology are an integral part of a long-term national plan for maternal health. PMID:24354828

Computer Attitude, and the Impact of Personal Characteristics and Information and Communication Technology Adoption Patterns on Performance of Teaching Faculty in Higher Education in Ghana, West Africa

ERIC Educational Resources Information Center

Larbi-Apau, Josephine A.

2011-01-01

This study examined computer attitude, and the impact of personal characteristics and ICT adoption patterns on performance of multidisciplinary teaching faculty in three public universities in Ghana. A cross-sectional research of mixed methods was applied in collecting data and information. Quantitative data from 164 respondents were analyzed…

Severity of Illness and the Teaching Hospital.

ERIC Educational Resources Information Center

Berman, Richard A.; And Others

1986-01-01

The Medicare prospective payment system does not adequately account for severity of illness. Whether teaching hospitals treat a case mix of patients with more severe illness than do nonteaching hospitals was tested in a study using two severity measures, Horn's severity of illness index and Gonnnella's "disease staging." (Author/MLW)

Viewing Teacher Motivation in the Ghana Education Service through a Postcolonial Lens

ERIC Educational Resources Information Center

Salifu, Inusah; Agbenyega, Joseph Seyram

2013-01-01

In recent times, quality teaching has become the focus of many education systems including that of Ghana, and yet little attention has been given to teacher motivation that could ensure quality teaching and improved learning outcomes. Drawing on contemporary literature on issues associated with teacher motivation, this conceptual paper critically…

Developing 21st century accreditation standards for teaching hospitals: the Taiwan experience.

PubMed

Huang, Chung-I; Wung, Cathy; Yang, Che-Ming

2009-12-15

The purpose of this study is to establish teaching hospital accreditation standards anew with the hope that Taiwan's teaching hospitals can live up to the expectations of our society and ensure quality teaching. 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. Our new teaching hospital 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). 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.

Undergraduate radiology education in private and public teaching hospitals in Karachi, Pakistan: teaching duties, methodologies, and rewards

PubMed Central

Nadeem, Naila; Khawaja, Ranish Deedar Ali; Beg, Madiha; Naeem, Muhammad; Majid, Zain

2013-01-01

Background In an integrated method of education, medical students are introduced to radiology in their preclinical years. However, no study has been conducted in Pakistan to demonstrate an academic framework of medical radiology education at an undergraduate level. Therefore, we aimed to document and compare the current level of teaching duties, teaching methodologies, and teaching rewards among radiologists and residents in private and public teaching hospitals in Karachi, Pakistan. Methods A survey was conducted among 121 radiologists and residents in two private and two public teaching hospitals in Karachi, Pakistan. Radiologists who were nationally registered with the Pakistan Medical and Dental Council either part-time or full-time were included. Radiology residents and fellows who were nationally registered with the Pakistan Medical and Dental Council were also included. Self-administered questionnaires addressing teaching duties, methods, and rewards were collected from 95 participants. Results The overall response rate was 78.51% (95/121). All of the radiologists were involved in teaching residents and medical students, but only 36% reported formal training in teaching skills. Although most of the respondents (76%) agreed that medical students appeared enthusiastic about learning radiology, the time spent on teaching medical students was less than five hours per week annually (82%). Only 37% of the respondents preferred dedicated clerkships over distributed clerkships (41%). The most common preferred teaching methodology overall was one-on-one interaction. Tutorials, teaching rounds, and problem-based learning sessions were less favored by radiologists than by residents. Teaching via radiology films (86%) was the most frequent mode of instruction. Salary (59%) was the most commonly cited teaching reward. The majority of respondents (88%) were not satisfied with their current level of teaching rewards. Conclusion All radiologists and residents working in an

Socio-demographic characteristics and psychosocial consequences of sickle cell disease: the case of patients in a public hospital in Ghana.

PubMed

Adzika, Vincent A; Glozah, Franklin N; Ayim-Aboagye, Desmond; Ahorlu, Collins S K

2017-01-31

Sickle cell disease (SCD) is of major public health concern globally, with majority of patients living in Africa. Despite its relevance, there is a dearth of research to determine the socio-demographic distribution and psychosocial impact of SCD in Ghana. The objective of this study was to examine the socio-demographic distribution and psychosocial consequences of SCD among patients in Ghana and to assess their quality of life and coping mechanisms. A cross-sectional research design was used that involved the completion of questionnaires on socio-demographic characteristics, quality of life, coping mechanisms, anxiety and depression. Participants were 387 male and female patients attending a sickle cell clinic in a public hospital. Results showed that majority of the patients were single, female, less than 39 years old and had attained secondary school level of education or less. Also, patients were more satisfied by the presence of love, friends and relatives as well as home, community and neighbourhood environment. While pains of varied nature and severity were the major reasons for attending hospital in SCD condition, going to the hospital as well as having faith in God was the most frequently reported mechanisms for coping with an unbearable SCD attacks. Results of multiple regression analysis showed that some socio-demographic and quality of life indicators had strong associations with anxiety and/or depression. It is recommended that a holistic intervention strategy incorporating psychosocial dimensions should be considered in the treatment and management of SCD.

Financing public healthcare institutions in Ghana.

PubMed

Akortsu, Mercy Akosua; Abor, Patience Aseweh

2011-01-01

The financing of healthcare services has been of a major concern to all governments in the face of increasing healthcare costs. For developing countries, where good health is considered a poverty reduction strategy, it is imperative that the hospitals used in the delivery of healthcare services are well financed to accomplish their tasks. The purpose of this paper is to examine how public hospitals in Ghana are financed, and the challenges facing the financing modes adopted. To achieve the objectives of the study, one major public healthcare institution in Ghana became the main focus. The findings of the study revealed that the main sources of financing the public healthcare institution are government subvention, internally-generated funds and donor-pooled funds. Of these sources, the internally generated fund was regarded as the most reliable, and the least reliable was the donor-pooled funds. Several challenges associated with the various financing sources were identified. These include delay in receipt of government subvention, delay in the reimbursement of services provided to subscribers of health insurance schemes, influence of government in setting user fees, and the specifications to which donor funds are put. The findings of this study have important implications for improving the financing of public healthcare institutions in Ghana. A number of recommendations are provided in this regard.

A Qualitative Study on Women’s Experiences of Intrapartum Nursing Care at Tamale Teaching Hospital (TTH), Ghana

PubMed Central

Afaya, Agani; Yakong, Vida N.; Afaya, Richard A.; Salia, Solomon M.; Adatara, Peter; Kuug, Anthony K; Nyande, Flex K.

2017-01-01

Introduction: Labor and delivery process is an exciting, anxiety-provoking, but rewarding time for a woman and her family after successful delivery of a newborn. The intrapartum period is the time where mothers expect more care. Taking care of a mother through delivery with no side effects is the task of a professional midwife who is trained with the skill to take the responsibility of caring for mothers and babies. Therefore, the aim of this study was to explore mother’s experiences regarding quality of intrapartum nursing/midwifery care. Methods: Focused ethnographic study was employed. Data were collected from May to June 2016 TTH, Ghana using semi structured interview guide. Purposive sampling was employed to recruit 20 participants. Eight individual interviews were conducted in the post natal ward after 48 hours of delivery, followed by three focus group discussions two weeks after delivery when mothers visited post natal clinic. Interviews lasted for about 30-45 minutes during each session. Data were analyzed using thematic analysis. Results: The average age of women were 29 years with ranging from 19-43 years. Participants’ experiences of nursing/midwifery care during birth were influenced by reception and respect, provision of information, technical skill, providers’ behavior, pain management and availability of nurses/midwives. Conclusion: The study findings have revealed that women’s experience of care is affected by a wide range of determinants. Therefore, maternal health programs and policies in Ghana must take into account women’s perspective on the care they need and their feedback on services they receive. Nursing education should re-enforce communication/relational skills. PMID:29302570

Factors Related to Incomplete Treatment of Breast Cancer in Kumasi, Ghana

PubMed Central

Obrist, Mark; Osei-Bonsu, Ernest; Ahwah, Baffour; Watanabe-Galloway, Shinobu; Merajver, Sofia D.; Schmid, Kendra; Soliman, Amr S.

2014-01-01

Purpose The burden of cancer in Africa is an enlarging public health challenge. Breast cancer in Ghana is the second most common cancer among Ghanaian women and the proportion of diagnosed patients who complete prescribed treatment is estimated to be very limited, thereby potentially adding to lower survival and poor quality of life after diagnosis. The objective of this study was to identify the patient and system factors related to incomplete treatment of breast cancer among patients. Methods This study was conducted at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. We interviewed 117 breast cancer patients and next of kin of breast cancer patients diagnosed from 2008 to 2010. Results Islamic religion, seeking treatment with traditional healers, and lack of awareness about national health insurance coverage of breast cancer treatment were predictors of incomplete treatment. Conclusions The results of this study support that Ghanaian women with diagnosed breast cancer have multiple addressable and modifiable patient factors that may deter them from completing the prescribed treatment. The results highlight the need for developing and testing specific interventions about the importance of completing treatment with a special focus on addressing religious, cultural, and system navigation barriers in developing countries. PMID:25282667

Maternity and parental leave policies at COTH hospitals: an update. Council of Teaching Hospitals.

PubMed

Philibert, I; Bickel, J

1995-11-01

Because residents' demands for parental leave are increasing, updated information about maternity and paternity leave policies was solicited from hospitals that are members of the Council of Teaching Hospitals (COTH) of the AAMC. A 20-item questionnaire, combining forced-choice categories and open-ended questions, was faxed to 405 COTH hospitals in October 1994; 45% responded. A total of 77% of the respondents reported having written policies for maternity and/or parental leave; in 1989, only 52% of COTH hospitals had reported having such policies. Forty-one percent of the 1994 responding hospitals offered dedicated paid maternity leave, with a mean of 42 days allowed. Twenty-five percent of the respondents offered paternity leave, and 15% offered adoption leave. It is encouraging that the majority of the teaching hospitals that responded to the survey had adopted written policies, but the 23% without written policies remain a source of concern. Well-defined policies for maternity, paternity, and adoption leave can reduce stress and foster equity both for trainees requiring leave and for their colleagues.

[Impact of the funding reform of teaching hospitals in Brazil].

PubMed

Lobo, M S C; Silva, A C M; Lins, M P E; Fiszman, R

2009-06-01

To assess the impact of funding reform on the productivity of teaching hospitals. Based on the Information System of Federal University Hospitals of Brazil, 2003 and 2006 efficiency and productivity were measured using frontier methods with a linear programming technique, data envelopment analysis, and input-oriented variable returns to scale model. The Malmquist index was calculated to detect changes during the study period: 'technical efficiency change,' or the relative variation of the efficiency of each unit; and 'technological change' after frontier shift. There was 51% mean budget increase and improvement of technical efficiency of teaching hospitals (previously 11, 17 hospitals reached the empirical efficiency frontier) but the same was not seen for the technology frontier. Data envelopment analysis set benchmark scores for each inefficient unit (before and after reform) and there was a positive correlation between technical efficiency and teaching intensity and dedication. The reform promoted management improvements but there is a need of further follow-up to assess the effectiveness of funding changes.

Changes in Teaching Hospitals' Community Benefit Spending After Implementation of the Affordable Care Act.

PubMed

Alberti, Philip M; Sutton, Karey M; Baker, Matthew

2018-05-22

U.S. teaching hospitals that qualify as 501(c)(3) organizations (a not-for-profit designation) are required to demonstrate community benefit annually. Increases in health insurance access driven by Affordable Care Act (ACA) implementation, along with new regulations, research opportunities, and educational expectations, may be changing hospitals' allocations of community benefit dollars. This study aimed to describe changes in teaching hospitals' community benefit spending between 2012 (pre-ACA implementation) and 2015 (post-ACA implementation), and to explore differences in spending changes between hospitals in Medicaid expansion and non-expansion states. In 2017, for each teaching hospital member of the Association of American Medical Colleges' (AAMC's) Council of Teaching Hospitals and Health Systems required to submit Form 990s to the Internal Revenue Service, the authors sought community benefit spending data for 2012 and 2015 as reported on Schedule H. The analysis included 169 pairs of Form 990s representing 184 AAMC member teaching hospitals (93% of 198 eligible hospitals). Compared with 2012, hospitals in 2015 spent $3.1 billion (20.14%) more on community benefit despite spending $804 million (16.17%) less on charity care. Hospitals in Medicaid expansion states increased spending on subsidized health services and Medicaid shortfalls at rates higher than hospitals in non-expansion states. The latter increased spending at higher rates on community health improvement and cash/in-kind contributions. After ACA implementation, teaching hospitals increased their overall community benefit spending while their charity care spending declined. Changes in community benefit spending differed according to states' Medicaid expansion status, demonstrating hospitals' responsiveness to state and local realities.

Drug-food interaction counseling programs in teaching hospitals.

PubMed

Wix, A R; Doering, P L; Hatton, R C

1992-04-01

The results of a survey to characterize drug-food interaction counseling programs in teaching hospitals and solicit opinions on these programs from pharmacists and dietitians are reported. A questionnaire was mailed to the pharmacy director and the director of dietary services at teaching hospitals nationwide. The questionnaire contained 33 questions relating to hospital characteristics, drug-food interaction counseling programs, and the standard calling for such programs issued by the Joint Commission on Accreditation of Healthcare Organizations. Of 792 questionnaires mailed, 425 were returned (response rate, 53.7). A majority of the pharmacists and dietitians (51.2%) did not consider their drug-food interaction counseling program to be formal; some had no program. The pharmacy department was involved more in program development than in the daily operation of such programs. The most frequent methods of identifying patients for counseling were using lists of patients' drugs and using physicians' orders. A mean of only five drugs were targeted per program. Slightly over half the respondents rated the Joint Commission standard less effective than other standards in its ability to improve patient care. A majority of teaching hospitals did not have formal drug-food interaction counseling programs. Pharmacists and dietitians did not view these programs as greatly beneficial and did not believe that the Joint Commission has clearly delineated the requirements for meeting its standard.

[Clinical research outside of teaching hospitals: Current situation in north-eastern France].

PubMed

Goetz, C; Dupoux, A; Déloy, L; Hertz, C; Jeanmaire, T; Parneix, N

2015-04-01

Most clinical research in France takes place in teaching hospitals. There are, however, many advantages to developing it in other hospitals: access to innovative treatments, improvement in healthcare quality, attractiveness of hospitals, increased trial inclusion rates and reduced selection bias. The objectives of our study were to report on the current situation of clinical research outside teaching hospitals. A three-stage survey was conducted between January 2012 and May 2013 in non-teaching hospitals of north-eastern France. First, questionnaires were sent to administrative and medical boards of all hospitals with more than 100 beds, then to head doctors of every department in hospitals with more than 300 beds and finally meetings were organized with members of 20 selected hospitals. The administrative and medical boards of 85 hospitals participated in the first stage of the survey; half of these hospitals were engaged in clinical research activities and for 10 the internal structuring was cross-disciplinary. Answers from 178 departments were obtained during the second stage; 47% reported a clinical research activity. Meetings with research teams in 20 hospitals allowed us to identify difficulties concerning research funding, transversal organization and sponsoring. Clinical research existed in more than half of the respondent non-teaching hospitals. Obstacles to its development can be grouped in three categories: 1) internal structuring of clinical research, 2) access to information and knowledge of how clinical research functions and to interlocutors outside the hospital and 3) access to skills necessary to sponsor clinical research. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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

PubMed

Langabeer, J

1998-01-01

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

Profile of breast diseases at a self-referral clinic in Ghana.

PubMed

Clegg-Lamptey, J N A; Aduful, H K; Yarney, J; Adu-Aryee, N A; Vanderpuye, V; Kyereh, M; Nkansah, A; Edwin, A

2009-03-01

Breast cancer is a common malignancy in Ghana, and many patients are referred with advanced disease and long duration of symptoms. To determine the spectrum of breast disease diagnosed through patient self-referral in Ghana. A breast clinic, where patients could walk in without referral, was started in the Korle Bu Teaching Hospital in 2001. A team of surgeons, radiation oncologists, oncology nurses, a clinical psychologist and a clinical pharmacist sat in conference once a week to see and discuss self-referred patients. Seven hundred and forty eight patients, mean age 38.6 (range 8-85) years, were seen during a four-year period. There were 741 females and seven males. The main complaints were pain 450 (50.2%), lump 257 (28.7%) and nipple discharge 62 (8.3%). Fifty (5.6%) came for check-up; 139 (18.6%) had more than one complaint. The mean (S.D.) duration of symptoms was; for nipple discharge 14.1 (10.5) months, lump 11.9 (7.7) months, and pain 11.3 (8.9) months. The main diagnoses were: Normal breasts 192 (27.7%), mastalgia 135 (18.1%), fibroadenosis 114 (15.2%), fibroadenomas 84 (11.2%), breast cancer 58 (7.8%), suspected breast cancer 25 (3.3%), galactorrhea 9 (1.2%), mastitis 8 (1.1%), musculoskeletal pain 8 (1.1%), duct ectasia 8 (1.1%), mondor's disease 7 (0.94%) and recurrent breast cancer 6 (0.8%). In patients with breast cancer, 42 (66%) had advanced disease, 6 (9.4%) had recurrent disease and 4 (63%) had metastatic disease. The number of self-referrals, detected breast cancers and duration of symptoms justify the need for self-referral clinics in Ghana.

Comparison of Surgical Outcomes Between Teaching and Nonteaching Hospitals in the Department of Veterans Affairs

PubMed Central

Khuri, Shukri F.; Najjar, Samer F.; Daley, Jennifer; Krasnicka, Barbara; Hossain, Monir; Henderson, William G.; Aust, J. Bradley; Bass, Barbara; Bishop, Michael J.; Demakis, John; DePalma, Ralph; Fabri, Peter J.; Fink, Aaron; Gibbs, James; Grover, Frederick; Hammermeister, Karl; McDonald, Gerald; Neumayer, Leigh; Roswell, Robert H.; Spencer, Jeannette; Turnage, Richard H.

2001-01-01

Objective To determine whether the investment in postgraduate education and training places patients at risk for worse outcomes and higher costs than if medical and surgical care was delivered in nonteaching settings. Summary Background Data The Veterans Health Administration (VA) plays a major role in the training of medical students, residents, and fellows. Methods The database of the VA National Surgical Quality Improvement Program was analyzed for all major noncardiac operations performed during fiscal years 1997, 1998, and 1999. Teaching status of a hospital was determined on the basis of a background and structure questionnaire that was independently verified by a research fellow. Stepwise logistic regression was used to construct separate models predictive of 30-day mortality and morbidity for each of seven surgical specialties and eight operations. Based on these models, a severity index for each patient was calculated. Hierarchical logistic regression models were then created to examine the relationship between teaching versus nonteaching hospitals and 30-day postoperative mortality and morbidity, after adjusting for patient severity. Results Teaching hospitals performed 81% of the total surgical workload and 90% of the major surgery workload. In most specialties in teaching hospitals, the residents were the primary surgeons in more than 90% of the operations. Compared with nonteaching hospitals, the patient populations in teaching hospitals had a higher prevalence of risk factors, underwent more complex operations, and had longer operation times. Risk-adjusted mortality rates were not different between the teaching and nonteaching hospitals in the specialties and operations studied. The unadjusted complication rate was higher in teaching hospitals in six of seven specialties and four of eight operations. Risk adjustment did not eliminate completely these differences, probably reflecting the relatively poor predictive validity of some of the risk

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

Code of Federal Regulations, 2011 CFR

2011-10-01

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

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

Are medical students accepted by patients in teaching hospitals?

PubMed Central

Marwan, Yousef; Al-Saddique, Muhammad; Hassan, Adnan; Karim, Jumanah; Al-Saleh, Mervat

2012-01-01

Background Worldwide, patients are the cornerstone of bedside teaching of medical students. In this study, the authors aimed to assess patients’ acceptability toward medical students in teaching hospitals of the Faculty of Medicine of Kuwait University. Methods Ninehundred and ninety five patients were approached in 14 teaching hospitals; 932 patients agreed to participate (refusal rate is 6.3%). A self-administered questionnaire was used to collect data. Results In general, higher acceptance of students by patients was found when there is no direct contact between the patient and the student (e.g., reading patients’ files, presenting in outpatient clinic, observing doctors performing examination or procedures) compared to other situations (e.g., performing physical examination or procedures). Pediatrics patients showed higher acceptance of students compared to patients in other specialties, while Obstetrics/Gynecology patients showed the highest refusal of students. Gender of patients (especially females) and students appeared to affect the degree of acceptance of medical students by patients. Majority of the patients (436; 46.8%) believed that the presence of medical students in hospitals improves the quality of health care. Conclusion Patients are an important factor of bedside teaching. Clinical tutors must take advantage of patients who accept medical students. Clinical tutors and medical students should master essential communication skills to convince patients in accepting students, thus improving bedside teaching. Also, using simulation and standardization should be considered to address scenarios that most patients are unwilling to allow students to participate. PMID:22509091

The development of sustainable emergency care in ghana: physician, nursing and prehospital care training initiatives.

PubMed

Martel, John; Oteng, Rockefeller; Mould-Millman, Nee-Kofi; Bell, Sue Anne; Zakariah, Ahmed; Oduro, George; Kowalenko, Terry; Donkor, Peter

2014-10-01

Ghana's first Emergency Medicine residency and nursing training programs were initiated in 2009 and 2010, respectively, at Komfo Anokye Teaching Hospital in the city of Kumasi in association with Kwame Nkrumah University of Science and Technology and the Universities of Michigan and Utah. In addition, the National Ambulance Service was commissioned initially in 2004 and has developed to include both prehospital transport services in all regions of the country and Emergency Medical Technician training. Over a decade of domestic and international partnership has focused on making improvements in emergency care at a variety of institutional levels, culminating in the establishment of comprehensive emergency care training programs. We describe the history and status of novel postgraduate emergency physician, nurse, and prehospital provider training programs as well as the prospect of creating a board certification process and formal continuing education program for practicing emergency physicians. Significant strides have been made in the development of emergency care and training in Ghana over the last decade, resulting in the first group of Specialist-level emergency physicians as of late 2012, as well as development of accredited emergency nursing curricula and continued expansion of a national Emergency Medical Service. This work represents a significant move toward in-country development of sustainable, interdisciplinary, team-based emergency provider training programs designed to retain skilled health care workers in Ghana and may serve as a model for similar developing nations. Copyright © 2014 Elsevier Inc. All rights reserved.

Income Analysis of University-Owned Teaching Hospitals.

ERIC Educational Resources Information Center

Isaacs, Joseph C.

1979-01-01

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

Pregnancy related causes of deaths in Ghana: a 5-year retrospective study.

PubMed

Der, E M; Moyer, C; Gyasi, R K; Akosa, A B; Tettey, Y; Akakpo, P K; Blankson, A; Anim, J T

2013-12-01

Data on maternal mortality varies by region and data source. Accurate local-level data are essential to appreciate its burden. This study uses autopsy results to assess maternal mortality causes in southern Ghana. Autopsy log books of the Department of Pathology, Korle-Bu Teaching Hospital Mortuary were reviewed from 2004 through 2008 for pregnancy related deaths. Data were entered into a database and analyzed using SPSS statistical software (Version 19). Of 5,247 deaths among women aged 15-49, 12.1% (634) were pregnancy-related. Eighty one percent of pregnancy-related deaths (517) occurred in the community or within 24 hours of admission to a health facility and 18.5% (117) occurred in a health facility. Out of 634 pregnancy-related deaths, 79.5% (504) resulted from direct obstetric causes, including: haemorrhage (21.8%), abortion (20.8%), hypertensive disorders (19.4%), ectopic gestation (8.7%), uterine rupture (4.3%) and genital tract sepsis (2.5%). The remaining 20.5% (130) resulted from indirect obstetric causes, including: infections outside the genital tract, (9.2%), anemia (2.8%), sickle cell disease (2.7%), pulmonary embolism (1.9%) and disseminated intravascular coagulation (1.3%). The top five causes of maternal death were: haemorrhage (21.8%), abortion (20.7%), hypertensive disorders (19.4%), infections (9.1%) and ectopic gestation (8.7%). Ghana continues to have persistently high levels of preventable causes of maternal deaths. Community based studies, on maternal mortality are urgently needed in Ghana, since our autopsy studies indicates that 81% of deaths recorded in this study occurred in the community or within 24 hours of admission to a health facility.

The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana.

PubMed

Goodman, David M; Ramaswamy, Rohit; Jeuland, Marc; Srofenyoh, Emmanuel K; Engmann, Cyril M; Olufolabi, Adeyemi J; Owen, Medge D

2017-01-01

To evaluate the cost-effectiveness of a quality improvement intervention aimed at reducing maternal and fetal mortality in Accra, Ghana. Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis. Data were collected on the cost and outcomes of a 5-year Kybele-Ghana Health Service Quality Improvement (QI) intervention conducted at Ridge Regional Hospital, a tertiary referral center in Accra, Ghana, focused on systems, personnel, and communication. Maternal deaths prevented were estimated comparing observed rates with counterfactual projections of maternal mortality and case-fatality rates for hypertensive disorders of pregnancy and obstetric hemorrhage. Stillbirths prevented were estimated based on counterfactual estimates of stillbirth rates. Cost-effectiveness was then calculated using estimated disability-adjusted life years averted and subjected to Monte Carlo and one-way sensitivity analyses to test the importance of assumptions inherent in the calculations. Incremental Cost-effectiveness ratio (ICER), which represents the cost per disability-adjusted life-year (DALY) averted by the intervention compared to a model counterfactual. From 2007-2011, 39,234 deliveries were affected by the QI intervention implemented at Ridge Regional Hospital. The total budget for the program was $2,363,100. Based on program estimates, 236 (±5) maternal deaths and 129 (±13) intrapartum stillbirths were averted (14,876 DALYs), implying an ICER of $158 ($129-$195) USD. This value is well below the highly cost-effective threshold of $1268 USD. Sensitivity analysis considered DALY calculation methods, and yearly prevalence of risk factors and case fatality rates. In each of these analyses, the program remained highly cost-effective with an ICER ranging from $97-$218. QI interventions to reduce maternal and fetal mortality in low resource settings can be highly cost effective. Cost-effectiveness analysis is feasible and should regularly be conducted to

Does outsourcing paramedical departments of teaching hospitals affect educational status of the students?

PubMed

Moslehi, Shandiz; Atefimanesh, Pezhman; Sarabi Asiabar, Ali; Ahmadzadeh, Nahal; Kafaeimehr, Mohamadhosein; Emamgholizadeh, Saeid

2016-01-01

There is an increasing trend of outsourcing public departments. Teaching hospitals also outsourced some of their departments to private sectors. The aim of this study was to investigate and compare the educational status of students in public and outsourced departments of teaching hospitals affiliated to Iran University of Medical Sciences. This study was conducted in six teaching hospitals of Iran University of Medical Sciences, which had public and outsourced teaching departments in 2015. One hundred fifty students from the departments of radiology, physiotherapy and laboratory participated in this study and their perceptions about their educational status were assessed. A valid and reliable questionnaire was used; participation in the study was voluntary. Descriptive statistics such as mean (SD), t-test and Kolmogorov-Smirnov were used. No difference was detected between the educational status of students in public and outsourced departments of radiology, physiotherapy and laboratory (p>0.05). Based on the students' perception, the private sectors could maintain the educational level of the teaching departments similar to the public departments. It is recommended to involve all the stakeholders such as hospital administrators, academic staff and students in the decision- making process when changes in teaching environments are being considered.

Mapping Population-Level Spatial Access to Essential Surgical Care in Ghana Using Availability of Bellwether Procedures.

PubMed

Stewart, Barclay T; Tansley, Gavin; Gyedu, Adam; Ofosu, Anthony; Donkor, Peter; Appiah-Denkyira, Ebenezer; Quansah, Robert; Clarke, Damian L; Volmink, Jimmy; Mock, Charles

2016-08-17

Conditions that can be treated by surgery comprise more than 16% of the global disease burden. However, 5 billion people do not have access to essential surgical care. An estimated 90% of the 87 million disability-adjusted life-years incurred by surgical conditions could be averted by providing access to timely and safe surgery in low-income and middle-income countries. Population-level spatial access to essential surgery in Ghana is not known. To assess the performance of bellwether procedures (ie, open fracture repair, emergency laparotomy, and cesarean section) as a proxy for performing essential surgery more broadly, to map population-level spatial access to essential surgery, and to identify first-level referral hospitals that would most improve access to essential surgery if strengthened in Ghana. Population-based study among all households and public and private not-for-profit hospitals in Ghana. Households were represented by georeferenced census data. First-level and second-level referral hospitals managed by the Ministry of Health and all tertiary hospitals were included. Surgical data were collected from January 1 to December 31, 2014. All procedures performed at first-level referral hospitals in Ghana in 2014 were used to sort each facility into 1 of the following 3 hospital groups: those without capability to perform all 3 bellwether procedures, those that performed 1 to 11 of each procedure, and those that performed at least 12 of each procedure. Candidates for targeted capability improvement were identified by cost-distance and network analysis. Of 155 first-level referral hospitals managed by the Ghana Health Service and the Christian Health Association of Ghana, 123 (79.4%) reported surgical data. Ninety-five (77.2%) did not have the capability in 2014 to perform all 3 bellwether procedures, 24 (19.5%) performed 1 to 11 of each bellwether procedure, and 4 (3.3%) performed at least 12. The essential surgical procedure rate was greater in bellwether

Mapping Population-Level Spatial Access to Essential Surgical Care in Ghana Using Availability of Bellwether Procedures

PubMed Central

Stewart, Barclay T.; Tansley, Gavin; Gyedu, Adam; Ofosu, Anthony; Donkor, Peter; Appiah-Denkyira, Ebenezer; Quansah, Robert; Clarke, Damian L.; Volmink, Jimmy; Mock, Charles

2017-01-01

IMPORTANCE Conditions that can be treated by surgery comprise more than 16% of the global disease burden. However, 5 billion people do not have access to essential surgical care. An estimated 90% of the 87 million disability-adjusted life-years incurred by surgical conditions could be averted by providing access to timely and safe surgery in low-income and middle-income countries. Population-level spatial access to essential surgery in Ghana is not known. OBJECTIVES To assess the performance of bellwether procedures (ie, open fracture repair, emergency laparotomy, and cesarean section) as a proxy for performing essential surgery more broadly, to map population-level spatial access to essential surgery, and to identify first-level referral hospitals that would most improve access to essential surgery if strengthened in Ghana. DESIGN, SETTING, AND PARTICIPANTS Population-based study among all households and public and private not-for-profit hospitals in Ghana. Households were represented by georeferenced census data. First-level and second-level referral hospitals managed by the Ministry of Health and all tertiary hospitals were included. Surgical data were collected from January 1 to December 31, 2014. MAIN OUTCOMES AND MEASURES All procedures performed at first-level referral hospitals in Ghana in 2014 were used to sort each facility into 1 of the following 3 hospital groups: those without capability to perform all 3 bellwether procedures, those that performed 1 to 11 of each procedure, and those that performed at least 12 of each procedure. Candidates for targeted capability improvement were identified by cost-distance and network analysis. RESULTS Of 155 first-level referral hospitals managed by the Ghana Health Service and the Christian Health Association of Ghana, 123 (79.4%) reported surgical data. Ninety-five (77.2%) did not have the capability in 2014 to perform all 3 bellwether procedures, 24 (19.5%) performed 1 to 11 of each bellwether procedure, and 4 (3

The Hospitalist Huddle: a 1-year experience of teaching Hospital Medicine utilizing the concept of peer teaching in medical education.

PubMed

Elhassan, Mohammed

2017-01-01

The relatively new specialty of Hospital Medicine in the USA is one of the fastest growing fields in internal medicine. Academic hospitalists are largely involved in the medical education of postgraduate residents and medical students. Little is known about the effectiveness of peer-to-peer teaching in internal medicine residency training programs and how the medical residents perceive its educational value in learning Hospital Medicine. The Hospitalist Huddle is a weekly educational activity newly established by our Hospitalist Division to facilitate the concept of peer-to-peer teaching. It requires medical residents to teach and educate their peers about the clinical topics related to Hospital Medicine. Faculty hospitalists serve as facilitators during the teaching sessions. A survey disseminated at the end of the first year of its implementation examined the residents' perception of the educational value of this new teaching activity. Most residents reported that they see the Huddle as a useful educational forum which may improve their skills in teaching, create a better educational and learning environment during their inpatient rotation, and improve their understanding of Hospital Medicine. Most residents also prefer that their peers, rather than faculty hospitalists, run the activity and do the teaching. The survey results support the notion that teaching and learning with flat hierarchies can be an appealing educational method to medical residents to help them understand Hospital Medicine during their medical wards rotation. Some areas need to be improved and others need to be continued and emphasized in order to make this novel educational activity grow and flourish in terms of its educational value and residents' satisfaction.

Expectations and Integration of Early Career Academics into the Teaching Career: Empirical Evidence from Ghana

ERIC Educational Resources Information Center

Alabi, Goski; Abdulai, Munkaila

2016-01-01

The preparation and induction of Early Career Academics (ECAs) in Ghana has been investigated using a qualitative study that employed an enumerative-ethnographic approach. The study combined reviews of policy documents, interviews of 50 Deans and Heads of Departments and surveys of ECAs in five purposively selected universities in Ghana to capture…

Pharmaceuticals in Australia: priorities in a teaching hospital.

PubMed

Kearney, B J

1993-01-01

In spite of rigorous government programs for control of the pricing and dissemination of pharmaceutical products in Australia, the list of new drugs continues to grow and prices to increase. To regain control over drug usage at Royal Adelaide Hospital, the Hospital Drug Committee developed a rating method that judged drugs on the basis of their cost-benefit to patients. The ratio of a total quality score to a total cost score becomes the determinant of additions to the hospital formulary. The background for the Australian approach to pharmaceuticals and the new evaluation technique at the teaching hospital are described in this report.

Using mortuary statistics in the development of an injury surveillance system in Ghana.

PubMed Central

London, Jason; Mock, Charles; Abantanga, Francis A.; Quansah, Robert E.; Boateng, K. A.

2002-01-01

OBJECTIVE: To develop, in a mortuary setting, a pilot programme for improving the accuracy of records of deaths caused by injury. METHODS: The recording of injury-related deaths was upgraded at the mortuary of the Komfo Anokye Teaching Hospital, Kumasi, Ghana, in 1996 through the creation of a prospectively gathered database. FINDINGS: There was an increase in the number of deaths reported annually as attributable to injury from 72 before 1995 to 633 in 1996-99. Injuries accounted for 8.6% of all deaths recorded in the mortuary and for 12% of deaths in the age range 15-59 years; 80% of deaths caused by injury occurred outside the hospital and thus would not have been indicated in hospital statistics; 88% of injury-related deaths were associated with transport, and 50% of these involved injuries to pedestrians. CONCLUSIONS: Injury was a significant cause of mortality in this urban African setting, especially among adults of working age. The reporting of injury-related deaths in a mortuary was made more complete and accurate by means of simple inexpensive methods. This source of data could make a significant contribution to an injury surveillance system, along with hospital records and police accident reports. PMID:12077610

Examining non-structural retrofitting status of teaching hospitals in Kerman against disasters.

PubMed

Moghadam, Mahmood Nekooi; Moradi, Seyed Mobin; Amiresmaili, Mohammadreza

2017-05-01

Continuous services provision of a hospital before and after a disaster is one of the most prominent issues that all people, especially the authorities must take into huge consideration. Concerning the experiences of previous earthquakes, the role and importance of nonstructural components becomes increasingly clear in the uninterrupted services of hospitals. In this study, non-structural retrofitting status of Kerman teaching hospitals was evaluated against natural disasters. This cross-sectional study was carried out in the second half of 2014 on the teaching hospitals in Kerman (Iran). The study population consisted of all Kerman teaching hospitals. The research instrument was World Health Organization/Pan American Health Organization (WHO/PAHO) standard checklist. Data analysis was carried out using descriptive statistics through SPSS 19. One hospital had a low retrofitting level, two hospitals had an average level and one had a high level. In the examined hospitals in this study, the medical gas section had the lowest preparedness against natural disasters, while the office, warehouse and furniture section had the highest resistance. Generally, the non-structural retrofitting status was 50% in one hospital and was between 65% and 85% in other hospitals. Generally, the retrofitting status of hospitals was not at the ideal condition, most hospitals were in average condition. Concerning the high risk of hospitals in disasters, it is necessary that senior executives and managers of Kerman Province and Kerman University of Medical Sciences take some measures to retrofit these buildings and to reduce the risk of vulnerability.

Factors associated with induced abortion at selected hospitals in the Volta Region, Ghana.

PubMed

Klutsey, Ellen Eyi; Ankomah, Augustine

2014-01-01

Induced abortion rates remained persistently high in the Volta Region of Ghana in the 5 years from 2006 to 2011. Some hospitals, both rural and urban, report induced abortion-related complications as one of the top ten conditions in hospital admissions. This study explored demographic and other factors associated with induced abortion, and also assessed awareness of abortion-related complications among women of reproductive age in the Volta Region. A quantitative, hospital-based, unmatched case-control study was performed. The Volta Region was stratified into two health administration zones, ie, north and south. For each zone, hospitals were stratified into government and private hospitals. Employing simple random sampling, one private and three government hospitals were selected from each zone. This study is therefore based on eight hospitals, ie, six government hospitals and two private hospitals. Marital status, employment status, number of total pregnancies, and knowledge about contraception were found to be associated with induced abortion. Multiple logistic regression showed a 4% reduction in the odds of induced abortion in married women compared with women who were single (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.07-0.22). Unemployed women of reproductive age were found to be 0.35 times less likely to seek induced abortion compared with their employed counterparts (OR 0.35, CI 0.19-0.65). It was also observed that women with their second pregnancies were 3.8 times more likely to seek induced abortion and women with more than two pregnancies were 6.6 times more likely to do so (OR 3.81, CI 1.94-7.49 and OR 6.58, CI 2.58-16.79, respectively). Women with no knowledge of contraceptive methods were 4.6 times likely to seek induced abortion (OR 4.64, CI 1.39-15.4). Compared with women who had not had induced abortion, women with a high number of pregnancies and no contraceptive knowledge were more likely to have induced abortion. It was found that lack

Factors associated with induced abortion at selected hospitals in the Volta Region, Ghana

PubMed Central

Klutsey, Ellen Eyi; Ankomah, Augustine

2014-01-01

Background Induced abortion rates remained persistently high in the Volta Region of Ghana in the 5 years from 2006 to 2011. Some hospitals, both rural and urban, report induced abortion-related complications as one of the top ten conditions in hospital admissions. This study explored demographic and other factors associated with induced abortion, and also assessed awareness of abortion-related complications among women of reproductive age in the Volta Region. Methods A quantitative, hospital-based, unmatched case-control study was performed. The Volta Region was stratified into two health administration zones, ie, north and south. For each zone, hospitals were stratified into government and private hospitals. Employing simple random sampling, one private and three government hospitals were selected from each zone. This study is therefore based on eight hospitals, ie, six government hospitals and two private hospitals. Results Marital status, employment status, number of total pregnancies, and knowledge about contraception were found to be associated with induced abortion. Multiple logistic regression showed a 4% reduction in the odds of induced abortion in married women compared with women who were single (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.07–0.22). Unemployed women of reproductive age were found to be 0.35 times less likely to seek induced abortion compared with their employed counterparts (OR 0.35, CI 0.19–0.65). It was also observed that women with their second pregnancies were 3.8 times more likely to seek induced abortion and women with more than two pregnancies were 6.6 times more likely to do so (OR 3.81, CI 1.94–7.49 and OR 6.58, CI 2.58–16.79, respectively). Women with no knowledge of contraceptive methods were 4.6 times likely to seek induced abortion (OR 4.64, CI 1.39–15.4). Compared with women who had not had induced abortion, women with a high number of pregnancies and no contraceptive knowledge were more likely to have

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

ERIC Educational Resources Information Center

Evans, Alison

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

Experiences of clinical teaching for dental core trainees working in hospital.

PubMed

Mannion, C J; Brotherton, P

2014-07-11

There is recognition that the provision of excellence in education and training results in a skilled and competent workforce. However, the educational experiences of dental core trainees (DCT's) working in the hospital oral and maxillofacial surgery (OMFS) setting have not been previously investigated. In this paper, we examine DCT's learning experiences both 'formal' and 'non-formal' within the hospital setting of ward and clinic-based teaching. Are hospital dental core trainees receiving a meaningful educational experience? To conclude this paper, the authors recommend methods, based upon sound educational principles, to maximise the value of clinical sessions for teaching.

The Epidemiology of Primary and Revision Total Hip Arthroplasty in Teaching and Nonteaching Hospitals in the United States.

PubMed

Kowalik, Thomas D; DeHart, Matthew; Gehling, Hanne; Gehling, Paxton; Schabel, Kathryn; Duwelius, Paul; Mirza, Amer

2016-06-01

The purpose of this study was to examine the epidemiology of primary and revision total hip arthroplasty (THA) in teaching and nonteaching hospitals. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was queried from 2006 to 2010 to identify primary and revision THAs at teaching and nonteaching hospitals. A total of 1,336,396 primary and 223,520 revision procedures were identified. Forty-six percent of all primary and 54% of all revision procedures were performed at teaching hospitals. Teaching hospitals performed 17% of their THAs as revisions; nonteaching hospitals performed 12% as revisions. For primary and revision THAs, teaching hospitals had fewer patients aged >65 years, fewer Medicare patients, similar gender rates, more nonwhite patients, and more patients in the highest income quartile compared with nonteaching hospitals. Costs, length of stay, and Charlson Comorbidity Index scores were similar; however, the mortality rate was lower at teaching hospitals. This study found small but significant differences in key epidemiologic and outcome variables in examining primary and revision THA at teaching and nonteaching hospitals. Level III.

Colonisation of antibiotic resistant bacteria in a cohort of HIV infected children in Ghana.

PubMed

Sampane-Donkor, Eric; Badoe, Ebenezer Vincent; Annan, Jennifer Adoley; Nii-Trebi, Nicholas

2017-01-01

Antibiotic use not only selects for resistance in pathogenic bacteria, but also in commensal flora of exposed individuals. Little is known epidemiologically about antibiotic resistance in relation to people with HIV infection in sub-Saharan Africa. This study investigated the carriage of antibiotic resistant bacteria among HIV infected children at a tertiary hospital in Ghana. One hundred and eighteen HIV positive children were recruited at the Korle-Bu Teaching Hospital in Ghana and nasopharyngeal specimens were collected from them. The specimens were cultured for bacteria, and the isolates were identified by standard microbiological methods. Antibiotic susceptibility tests were carried out on selected bacterial organisms by the Kirby Bauer method. Bacteria isolated from the study subjects included Moraxella catarrhalis (39.8%), coagulase negative staphylococci (33.1%), Streptococcus pneumoniae (30.5%), diptheroids (29.7%), viridian streptococci (27.1%), Staphylococcus aureus (22.0%), Citrobacter spp. (4.2%) and Neisseria meningitidis (0.9%). Prevalence of antibiotic resistance of S. pneumoniae ranged from 5.6% (ceftriaxone) to 58.3% (cotrimoxazole), M. catarrhalis ranged from 2.1% (gentamicin) to 80.6% (ampicillin), and S. aureus ranged from 7.7% (cefoxitin) to 100% (penicillin). The prevalence of multiple drug resistance was 16.7% for S. pneumoniae, 57.4% for M. catarrhalis and 84.6% for S. aureus. HIV infected children in the study area commonly carry multi-drug resistant isolates of several pathogenic bacteria such as S. aureus and S. pneumoniae. Infections arising in these patients that are caused by S. aureus and S. pneumoniae could be treated with ceftriaxone and cefoxitin respectively.

Colonisation of antibiotic resistant bacteria in a cohort of HIV infected children in Ghana

PubMed Central

Sampane-Donkor, Eric; Badoe, Ebenezer Vincent; Annan, Jennifer Adoley; Nii-Trebi, Nicholas

2017-01-01

Antibiotic use not only selects for resistance in pathogenic bacteria, but also in commensal flora of exposed individuals. Little is known epidemiologically about antibiotic resistance in relation to people with HIV infection in sub-Saharan Africa. This study investigated the carriage of antibiotic resistant bacteria among HIV infected children at a tertiary hospital in Ghana. One hundred and eighteen HIV positive children were recruited at the Korle-Bu Teaching Hospital in Ghana and nasopharyngeal specimens were collected from them. The specimens were cultured for bacteria, and the isolates were identified by standard microbiological methods. Antibiotic susceptibility tests were carried out on selected bacterial organisms by the Kirby Bauer method. Bacteria isolated from the study subjects included Moraxella catarrhalis (39.8%), coagulase negative staphylococci (33.1%), Streptococcus pneumoniae (30.5%), diptheroids (29.7%), viridian streptococci (27.1%), Staphylococcus aureus (22.0%), Citrobacter spp. (4.2%) and Neisseria meningitidis (0.9%). Prevalence of antibiotic resistance of S. pneumoniae ranged from 5.6% (ceftriaxone) to 58.3% (cotrimoxazole), M. catarrhalis ranged from 2.1% (gentamicin) to 80.6% (ampicillin), and S. aureus ranged from 7.7% (cefoxitin) to 100% (penicillin). The prevalence of multiple drug resistance was 16.7% for S. pneumoniae, 57.4% for M. catarrhalis and 84.6% for S. aureus. HIV infected children in the study area commonly carry multi-drug resistant isolates of several pathogenic bacteria such as S. aureus and S. pneumoniae. Infections arising in these patients that are caused by S. aureus and S. pneumoniae could be treated with ceftriaxone and cefoxitin respectively. PMID:28451037

In-hospital mortality for children with hypoplastic left heart syndrome after stage I surgical palliation: teaching versus nonteaching hospitals.

PubMed

Berry, Jay G; Cowley, Collin G; Hoff, Charles J; Srivastava, Rajendu

2006-04-01

Teaching hospitals are perceived to provide a higher quality of care for the treatment of rare disease and complex patients. A substantial proportion of stage I palliation for hypoplastic left heart syndrome (HLHS) may be performed in nonteaching hospitals. This study compares the in-hospital mortality of stage I palliation between teaching and nonteaching hospitals. The authors conducted a retrospective cohort study using the Kids' Inpatient Database 1997 and 2000. Patients with HLHS undergoing stage I palliation were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. Seven hundred fifty-four and 880 discharges of children with HLHS undergoing stage I palliation in 1997 and 2000, respectively, were identified. The in-hospital mortality for the study population was 28% in 1997 and 24% in 2000. Twenty percent of stage I palliation operations were performed in nonteaching hospitals in 1997. Two percent of operations were performed in nonteaching hospitals in 2000. In 1997 only, in-hospital mortality remained higher in nonteaching hospitals after controlling for stage I palliation hospital volume and condition-severity diagnoses. Low-volume hospitals performing stage I palliation were associated with increased in-hospital mortality in 1997 and 2000. Patients with HLHS undergoing stage I palliation in nonteaching hospitals experienced increased in-hospital mortality in 1997. A significant reduction in the number of stage I palliation procedures performed in nonteaching hospitals occurred between 1997 and 2000. This centralization of stage I palliation into teaching hospitals, along with advances in postoperative medical and surgical care for these children, was associated with a decrease in mortality. Patients in low-volume hospitals performing stage I palliation continued to experience increased mortality in 2000.

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

Code of Federal Regulations, 2011 CFR

2011-10-01

... services furnished in a teaching hospital. (g) Aggregate per diem methods of apportionment—(1) For the... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE... BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN...

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

Code of Federal Regulations, 2014 CFR

2014-10-01

... services furnished in a teaching hospital. (g) Aggregate per diem methods of apportionment—(1) For the... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE...) SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS...

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

Code of Federal Regulations, 2010 CFR

2010-10-01

... services furnished in a teaching hospital. (g) Aggregate per diem methods of apportionment—(1) For the... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE... BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN...

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

Code of Federal Regulations, 2012 CFR

2012-10-01

... services furnished in a teaching hospital. (g) Aggregate per diem methods of apportionment—(1) For the... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE...) SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS...

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

Code of Federal Regulations, 2013 CFR

2013-10-01

... services furnished in a teaching hospital. (g) Aggregate per diem methods of apportionment—(1) For the... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE...) SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS...

Does outsourcing paramedical departments of teaching hospitals affect educational status of the students?

PubMed Central

Moslehi, Shandiz; Atefimanesh, Pezhman; Sarabi Asiabar, Ali; Ahmadzadeh, Nahal; Kafaeimehr, Mohamadhosein; Emamgholizadeh, Saeid

2016-01-01

Background: There is an increasing trend of outsourcing public departments. Teaching hospitals also outsourced some of their departments to private sectors. The aim of this study was to investigate and compare the educational status of students in public and outsourced departments of teaching hospitals affiliated to Iran University of Medical Sciences. Methods: This study was conducted in six teaching hospitals of Iran University of Medical Sciences, which had public and outsourced teaching departments in 2015. One hundred fifty students from the departments of radiology, physiotherapy and laboratory participated in this study and their perceptions about their educational status were assessed. A valid and reliable questionnaire was used; participation in the study was voluntary. Descriptive statistics such as mean (SD), t-test and Kolmogorov-Smirnov were used. Results: No difference was detected between the educational status of students in public and outsourced departments of radiology, physiotherapy and laboratory (p>0.05). Conclusion: Based on the students’ perception, the private sectors could maintain the educational level of the teaching departments similar to the public departments. It is recommended to involve all the stakeholders such as hospital administrators, academic staff and students in the decision- making process when changes in teaching environments are being considered. PMID:27683645

Forceps Delivery Volumes in Teaching and Nonteaching Hospitals: Are Volumes Sufficient for Physicians to Acquire and Maintain Competence?

PubMed Central

Kyser, Kathy L.; Lu, Xin; Santillan, Donna; Santillan, Mark; Caughey, Aaron B.; Wilson, Mark C.; Cram, Peter

2015-01-01

Purpose The decline in the use of forceps in operative deliveries over the last two decades raises questions about teaching hospitals' ability to provide trainees with adequate experience in the use of forceps. The authors examined: (1) the number of operative deliveries performed in teaching and nonteaching hospitals, and (2) whether teaching hospitals performed a sufficient number of forceps deliveries for physicians to acquire and maintain competence. Method The authors used State Inpatient Data from nine states to identify all women hospitalized for childbirth in 2008. They divided hospitals into three categories: major teaching, minor teaching, and nonteaching. They calculated delivery volumes (total operative, cesarean, vacuum, forceps, two or more methods) for each hospital and compared data across hospital categories. Results The sample included 1,344,305 childbirths in 835 hospitals. The mean cesarean volumes for major teaching, minor teaching, and nonteaching hospitals were 969.8, 757.8, and 406.9. The mean vacuum volumes were 301.0, 304.2, and 190.4, and the mean forceps volumes were 25.2, 15.3, and 8.9. In 2008, 31 hospitals (3.7% of all hospitals) performed no vacuum extractions, and 320 (38.3%) performed no forceps deliveries. In 2008, 13 (23%) major teaching and 44 (44%) minor teaching hospitals performed five or fewer forceps deliveries. Conclusions Low forceps delivery volumes may preclude many trainees from acquiring adequate experience and proficiency. These findings highlighted broader challenges, faced by many specialties, in ensuring that trainees and practicing physicians acquire and maintain competence in infrequently performed, highly technical procedures. PMID:24280847

Examining non-structural retrofitting status of teaching hospitals in Kerman against disasters

PubMed Central

Moghadam, Mahmood Nekooi; Moradi, Seyed Mobin; Amiresmaili, Mohammadreza

2017-01-01

Background and objective Continuous services provision of a hospital before and after a disaster is one of the most prominent issues that all people, especially the authorities must take into huge consideration. Concerning the experiences of previous earthquakes, the role and importance of nonstructural components becomes increasingly clear in the uninterrupted services of hospitals. In this study, non-structural retrofitting status of Kerman teaching hospitals was evaluated against natural disasters. Methods This cross-sectional study was carried out in the second half of 2014 on the teaching hospitals in Kerman (Iran). The study population consisted of all Kerman teaching hospitals. The research instrument was World Health Organization/Pan American Health Organization (WHO/PAHO) standard checklist. Data analysis was carried out using descriptive statistics through SPSS 19. Results One hospital had a low retrofitting level, two hospitals had an average level and one had a high level. In the examined hospitals in this study, the medical gas section had the lowest preparedness against natural disasters, while the office, warehouse and furniture section had the highest resistance. Generally, the non-structural retrofitting status was 50% in one hospital and was between 65% and 85% in other hospitals. Conclusions Generally, the retrofitting status of hospitals was not at the ideal condition, most hospitals were in average condition. Concerning the high risk of hospitals in disasters, it is necessary that senior executives and managers of Kerman Province and Kerman University of Medical Sciences take some measures to retrofit these buildings and to reduce the risk of vulnerability. PMID:28713518

A comparison of medical students' perceptions of their initial basic clinical training placements in 'new' and established teaching hospitals.

PubMed

Mathers, Jonathan; Parry, Jayne; Scully, Edward; Popovic, Celia

2006-05-01

This study has examined students' perceptions of the factors influencing learning during initial hospital placements and whether differences in perceived experiences were evident between students attending new and established teaching hospitals. Five focus groups were conducted with Year III students at the University of Birmingham Medical School (UBMS): three with students attending three established teaching hospitals and two with students attached to a new teaching hospital (designated as part of the UBMS expansion programme). Extensive variation in student perception of hospital experiences was evident at the level of teaching hospital, teaching firm and individual teacher. Emergent themes were split into two main categories: 'students' perceptions of teaching and the teaching environment' and 'the new hospital learner'. Themes emerging that related to variation in student experience included the amount of structured teaching, enthusiasm of teachers, grade of teachers, specialty of designated firms and the number of students. The new teaching hospital was generally looked upon favourably by students in comparison to established teaching hospitals. Many of the factors influencing student experience relate to themes grouped under the 'new hospital learner', describing the period of adjustment experienced by students during their first encounter with this new learning environment. Interventions to improve student experience might be aimed at organisations and individuals delivering teaching. However, factors contributing to the student experience, such as the competing demand to teaching of heavy clinical workloads, are outside the scope of medical school intervention. In the absence of fundamental change, mechanisms to equip students with 'survival skills' as self-directed hospital learners should also be considered.

Large Variability in the Diversity of Physiologically Complex Surgical Procedures Exists Nationwide Among All Hospitals Including Among Large Teaching Hospitals.

PubMed

Dexter, Franklin; Epstein, Richard H; Thenuwara, Kokila; Lubarsky, David A

2017-11-22

Multiple previous studies have shown that having a large diversity of procedures has a substantial impact on quality management of hospital surgical suites. At hospitals with substantial diversity, unless sophisticated statistical methods suitable for rare events are used, anesthesiologists working in surgical suites will have inaccurate predictions of surgical blood usage, case durations, cost accounting and price transparency, times remaining in late running cases, and use of intraoperative equipment. What is unknown is whether large diversity is a feature of only a few very unique set of hospitals nationwide (eg, the largest hospitals in each state or province). The 2013 United States Nationwide Readmissions Database was used to study heterogeneity among 1981 hospitals in their diversities of physiologically complex surgical procedures (ie, the procedure codes). The diversity of surgical procedures performed at each hospital was quantified using a summary measure, the number of different physiologically complex surgical procedures commonly performed at the hospital (ie, 1/Herfindahl). A total of 53.9% of all hospitals commonly performed <10 physiologically complex procedures (lower 99% confidence limit [CL], 51.3%). A total of 14.2% (lower 99% CL, 12.4%) of hospitals had >3-fold larger diversity (ie, >30 commonly performed physiologically complex procedures). Larger hospitals had greater diversity than the small- and medium-sized hospitals (P < .0001). Teaching hospitals had greater diversity than did the rural and urban nonteaching hospitals (P < .0001). A total of 80.0% of the 170 large teaching hospitals commonly performed >30 procedures (lower 99% CL, 71.9% of hospitals). However, there was considerable variability among the large teaching hospitals in their diversity (interquartile range of the numbers of commonly performed physiologically complex procedures = 19.3; lower 99% CL, 12.8 procedures). The diversity of procedures represents a substantive

Effects of consumer and provider moral hazard at a municipal hospital out-patient department on Ghana's National Health Insurance Scheme.

PubMed

Yawson, A E; Biritwum, R B; Nimo, P K

2012-12-01

In 2003, Ghana introduced the national health insurance scheme (NHIS) to promote access to healthcare. This study determines consumer and provider factors which most influence the NHIS at a municipal health facility in Ghana. This is an analytical cross-sectional study at the Winneba Municipal Hospital (WHM) in Ghana between January-March 2010. A total of 170 insured and 175 uninsured out-patients were interviewed and information extracted from their folders using a questionnaire. Consumers were from both the urban and rural areas of the municipality. The mean number of visits by insured consumers to a health facility in previous six months was 2.48 +/- 1.007 and that for uninsured consumers was 1.18 +/- 0.387(p-value<0.001). Insured consumers visited the health facility at significantly more frequent intervals than uninsured consumers (χ(2) = 55.413, p-value< 0.001). Overall, insured consumers received more different types of medications for similar disease conditions and more laboratory tests per visit than the uninsured. In treating malaria (commonest condition seen), providers added multivitamins, haematinics, vitamin C and intramuscular injections as additional medications more for insured consumers than for uninsured consumers. Findings suggest consumer and provider moral hazard may be two critical factors affecting the NHIS in the Effutu Municipality. These have implications for the optimal functioning of the NHIS and may affect long-term sustainability of NHIS in the municipality. Further studies to quantify financial/ economic cost to NHIS arising from moral hazard, will be of immense benefit to the optimal functioning of the NHIS.

Financial, Resource Utilization and Mortality Impacts of Teaching Hospital Status on Pediatric Patients Admitted for Sepsis.

PubMed

Hsu, Benson S; Meyer, Benjamin D; Lakhani, Saquib A

2017-08-01

With the changing healthcare landscape in the United States, teaching hospitals face increasing pressure to provide medical education as well as cost-effective care. Our study investigated the financial, resource utilization and mortality impact of teaching hospital status on pediatric patients admitted with sepsis. We conducted a retrospective, weighted statistical analysis of hospitalized children with the diagnosis of sepsis. The Agency for Healthcare Research and Quality 2009 Kids' Inpatient Database provided the data for analysis. Diagnosis of sepsis and severity of illness levels were based on All Patient Refined Diagnosis-Related Groups of 720: Septicemia and Disseminated Infections. Teaching hospital status was based on presence of training programs. Statistical analysis was conducted using STATA 12.1 (Stata Corporation, College Station, TX). Weighted analysis revealed 17,461 patients with sepsis-9982 in teaching and 7479 in nonteaching hospitals. When comparing all patients, length of stay (8.2 vs. 4.8, P < 0.001), number of procedures received (2.03 vs. 0.87, P < 0.001), mortality (4.7% vs. 1.6%, P < 0.001), costs per day ($2326 vs. $1736, P < 0.001) and total costs ($20,428 vs. $7960, P < 0.001) were higher in teaching hospitals. Even when stratified by severity classes, length of stay, number of procedures received and total costs were higher in teaching hospitals with no difference in mortality. Our study suggested that teaching hospitals provide pediatric inpatient care for sepsis at greater costs and resource utilization without a clear improvement in overall mortality rates in comparison with nonteaching hospitals.

Anthropometric Measurements: Options for Identifying Low Birth Weight Newborns in Kumasi, Ghana

PubMed Central

Otupiri, Easmon; Wobil, Priscilla; Nguah, Samuel Blay; Hindin, Michelle J.

2014-01-01

Background In Ghana, 32% of deliveries take place outside a health facility, and birth weight is not measured. Low birth weight (LBW) newborns who are at increased risk of death and disability, are not identified; 13%–14% of newborns in Ghana are LBW. We aimed at determining whether alternative anthropometrics could be used to identify LBW newborns when weighing scales are not available to measure birth weight. Methods We studied 973 mother and newborn pairs at the Komfo Anokye Teaching and the Suntreso Government hospitals between November 2011 and October 2012. We used standard techniques to record anthropometric measurements of newborns within 24 hours of birth; low birth weight was defined as birth weight <2.5kg. Pearson's correlation coefficient and the area under the curve were used to determine the best predictors of low birth weight. The sensitivity, specificity and predictive values were reported with 95% confidence intervals at generated cut-off values. Results One-fifth (21.7%) of newborns weighed less than 2.5 kg. Among LBW newborns, the following measurements had the highest correlations with birth weight: chest circumference (r = 0.69), mid-upper arm circumference (r = 0.68) and calf circumference (r = 0.66); the areas under the curves of these three measurements demonstrated the highest accuracy in determining LBW newborns. Chest, mid-upper arm and calf circumferences at cut-off values of ≤29.8 cm, ≤9.4 cm and ≤9.5 cm respectively, had the best combination of maximum sensitivity, specificity and predictive values for identifying newborns with LBW. Conclusions Anthropometric measurements, such as the chest circumference, mid-upper arm circumference and calf circumference, offer an opportunity for the identification of and subsequent support for LBW newborns in settings in Ghana, where birth weights are not measured by standardized weighing scales. PMID:25226505

Ten thousand steps: a pedometer study of junior dentists in a major British teaching hospital and a district general hospital.

PubMed

Keat, R M; Thomas, M; McKechnie, A

2017-05-01

Sedentary behaviour is widely associated with deleterious health outcomes that in modern medicine have similar connotations to smoking tobacco and alcohol misuse. The integration of e-portfolio, e-logbook, British National Formulary (BNF) and encrypted emails has made smartphones a necessity for trainees. Smartphones also have the ability to record the amount of exercise taken, which allows activity at work to be monitored. The aim of this study to compare the activity of the same group of dental core trainees when they worked within a large multisite teaching hospital and a smaller district general hospital, to find out if supplementary activity was needed outside work. Data were collected from smartphones. To ensure continuity, data were collected only from those who had calibrated iPhones (n=10). At the teaching hospital six of the trainees walked over 10 000 steps a day while working (mean (SD) 10 004 (639)). At the district hospital none of the trainees walked 10 000 steps. The mean (SD) number of steps completed by all trainees was 6265 (119). Walking at work provides the full quota of recommended daily exercise most of the time for those working in the teaching hospital, but additional exercise is occasionally required. While working at the district hospital they walk less, meaning that they should try to increase their activity outside work. Trainees working in the teaching hospital walk significantly more steps than in the district hospital. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

HIV knowledge, stigma, and illness beliefs among pediatric caregivers in Ghana who have not disclosed their child's HIV status.

PubMed

Paintsil, Elijah; Renner, Lorna; Antwi, Sampson; Dame, Joycelyn; Enimil, Anthony; Ofori-Atta, Angela; Alhassan, Amina; Ofori, Irene Pokuaa; Cong, Xiangyu; Kyriakides, Tassos; Reynolds, Nancy R

2015-01-01

The majority of HIV-infected children in sub-Saharan Africa have not been informed of their HIV status. Caregivers are reluctant to disclose HIV status to their children because of concern about the child's ability to understand, parental sense of guilt, and fear of social rejection and isolation. We hypothesized that the low prevalence of pediatric HIV disclosure in Ghana is due to lack of accurate HIV information and high HIV stigma among caregivers. This is a preliminary analysis of baseline data of an HIV pediatric disclosure intervention study in Ghana ("Sankofa"). "Sankofa" - is a two-arm randomized controlled clinical trial comparing disclosure intervention plus usual care (intervention arm) vs usual care (control arm) at Korle-Bu Teaching Hospital (KBTH; control arm) and Komfo-Anokye Teaching Hospital (KATH; intervention arm). We enrolled HIV-infected children, ages 7-18 years who do not know their HIV status, and their caregivers. Baseline data of caregivers included demographic characteristics; Brief HIV Knowledge Questionnaire (HIV-KQ-18); Brief Illness Perception Questionnaire; and HIV Stigma Scale. Simple and multivariable linear regression analyses were used to assess the relationship between caregiver characteristics and HIV knowledge, stigma, and illness perception. Two hundred and ninety-eight caregivers were enrolled between January 2013 and July 2014 at the two study sites; KBTH (n = 167) and KATH (n = 131). The median age of caregivers was 41 years; 80.5% of them were female and about 60% of caregivers were HIV-positive. Seventy-eight percent of caregivers were self-employed with low household income. In both unadjusted and adjusted analyses, HIV negative status and lower level of education were associated with poor scores on HIV-KQ. HIV positive status remained significant for higher level of stigma in the adjusted analyses. None of the caregiver's characteristics predicted caregiver's illness perception. Intensification of HIV education in

The Balanced Budget Act of 1997 and the financial health of teaching hospitals.

PubMed

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

2004-01-01

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

Cataract surgery audit at an Australian urban teaching hospital.

PubMed

Kahawita, Shyalle K; Goggin, Michael

2015-08-01

To provide local data on visual acuity and surgical outcomes for cataract surgery performed in an Australian teaching hospital. Continuous audit over 7 years in a public teaching hospital. A total of 3740 eyes had cataract surgery performed at The Queen Elizabeth Hospital, South Australia, from May 2006 to September 2013. Visual acuity and complication rates were recorded for cataract surgery cases operated on between May 2006 and September 2013 on a digital database with data entry contemporaneous with final follow-up. Visual acuity and surgical complications. Of the patients, 91.4% achieved postoperative best-measured vision better than preoperative best-measured vision. The rate of posterior capsular tear was 2.59%, endophthalmitis was 0.11% and the overall complication rate was 11.7%. This audit is the first to document modern cataract surgery, overwhelmingly dominated by phacoemulsification in an Australian population and can be used to benchmark cataract surgery outcome in an urban Australian population. © 2015 Royal Australian and New Zealand College of Ophthalmologists.

[Costs of serious adverse events in a community teaching hospital, in Mexico].

PubMed

Gutiérrez-Mendoza, Luis Meave; Torres-Montes, Abraham; Soria-Orozco, Manuel; Padrón-Salas, Aldanely; Ramírez-Hernández, María Elizabeth

2015-01-01

Serious adverse events during hospital care are a worldwide reality and threaten the safety of the hospitalised patient. To identify serious adverse events related to healthcare and direct hospital costs in a Teaching Hospital in México. A study was conducted in a 250-bed Teaching Hospital in San Luis Potosi, Mexico. Data were obtained from the Quality and Patient Safety Department based on 2012 incidents report. Every event was reviewed and analysed by an expert team using the "fish bone" tool. The costs were calculated since the event took place until discharge or death of the patient. A total of 34 serious adverse events were identified. The average cost was $117,440.89 Mexican pesos (approx. €7,000). The great majority (82.35%) were largely preventable and related to the process of care. Undergraduate medical staff were involved in 58.82%, and 14.7% of patients had suffered adverse events in other hospitals. Serious adverse events in a Teaching Hospital setting need to be analysed to learn and deploy interventions to prevent and improve patient safety. The direct costs of these events are similar to those reported in developed countries. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Can teaching hospitals use serial formative OSCEs to improve student performance?

PubMed

Lien, Heng-Hui; Hsu, Sang-Feng; Chen, Shu-Chen; Yeh, Jiann-Horng

2016-10-14

We report on interns' clinical competence and experiences of an objective structured clinical examination (OSCE) training program over 3 years. We aimed to determine whether repeated formative OSCEs allow teaching hospitals to improve the effectiveness of clinical training and help interns to achieve high scores in the national summative OSCE. This study included 207 participants, among whom 82 were interns who had completed four mock OSCEs and a national OSCE at the clinical center of Cathay General Hospital (CGH). The other 125 participants were final-year medical students from Fu-Jen University who had completed the national OSCE between 2013 and 2015 at one of four teaching hospitals (including CGH). CGH interns were categorized into three groups according to the medical school attended and Fu-Jen University students were grouped according to their training hospitals. CGH held four mock OSCEs (30 stations), whereas each of the four training hospitals for Fu-Jen students each held one or two OSCEs (6-12 stations) annually. Differences in the mean OSCE scores among groups were analyzed. The medical school attended, pre-internship OSCE experience and the frequency of mock OSCEs held by training hospitals were independent factors in this study. The cumulative mean scores for five OSCEs among three groups of students trained at CGH tended to increase from the first OSCE (OSCE1) to the fifth (OSCE5). The mean score of the students who attended Fu-Jen Medical School was higher than that of students who graduated from foreign medical schools in all five OSCEs; however, the differences were significant only for OSCE2 (P = 0.022) and OSCE3 (P = 0.027). The mean national OSCE scores of FJU students showed no statistically significant differences among the four training hospitals for 2013; however, students training at CGH had significantly higher mean scores in the 2014 (P = 0.001) and 2015 (P = 0.005) OSCEs compared with students training at the other three

Serial Assessment of Trauma Care Capacity in Ghana in 2004 and 2014.

PubMed

Stewart, Barclay T; Quansah, Robert; Gyedu, Adam; Boakye, Godfred; Abantanga, Francis; Ankomah, James; Donkor, Peter; Mock, Charles

2016-02-01

Trauma care capacity assessments in developing countries have generated evidence to support advocacy, detailed baseline capabilities, and informed targeted interventions. However, serial assessments to determine the effect of capacity improvements or changes over time have rarely been performed. To compare the availability of trauma care resources in Ghana between 2004 and 2014 to assess the effects of a decade of change in the trauma care landscape and derive recommendations for improvements. Capacity assessments were performed using direct inspection and structured interviews derived from the World Health Organization's Guidelines for Essential Trauma Care. In Ghana, 10 hospitals in 2004 and 32 hospitals in 2014 were purposively sampled to represent those most likely to care for injuries. Clinical staff, administrators, logistic/procurement officers, and technicians/biomedical engineers who interacted, directly or indirectly, with trauma care resources were interviewed at each hospital. Availability of items for trauma care was rated from 0 (complete absence) to 3 (fully available). Factors contributing to deficiency in 2014 were determined for items rated lower than 3. Each item rated lower than 3 at a specific hospital was defined as a hospital-item deficiency. Scores for total number of hospital-item deficiencies were derived for each contributing factor. There were significant improvements in mean ratings for trauma care resources: district-level (smaller) hospitals had a mean rating of 0.8 for all items in 2004 vs 1.3 in 2014 (P = .002); regional (larger) hospitals had a mean rating of 1.1 in 2004 vs 1.4 in 2014 (P = .01). However, a number of critical deficiencies remain (eg, chest tubes, diagnostics, and orthopedic and neurosurgical care; mean ratings ≤ 2). Leading contributing factors were item absence (503 hospital-item deficiencies), lack of training (335 hospital-item deficiencies), and stockout of consumables (137 hospital-item deficiencies

Perceptions regarding workplace hazards at a veterinary teaching hospital.

PubMed

Weaver, Dustin R; Newman, Lee S; Lezotte, Dennis C; Morley, Paul S

2010-07-01

To assess perceptions of personnel working at a veterinary teaching hospital regarding risks of occupational hazards and compare those perceptions with assessments made by occupational safety experts. Cross-sectional study. A representative sample of personnel (n = 90) working at the veterinary teaching hospital at Colorado State University and a panel of 3 occupational safety experts. Hospital personnel ranked perceptions of 14 physical, chemical, and biological workplace hazards and listed the injuries, illnesses, and near misses they had experienced. The expert panel provided consensus rankings of the same 14 hazards for 9 sections of the facility. Risk perceptions provided by the 2 sources were compared. Risk perceptions did not differ significantly between hospital personnel and the expert panel for most of the site-specific comparisons (94/126 [75%]). Personnel perceived greater risks for some physical hazards (loud noises, sharps injuries, and ionizing radiation) and some chemical or materials exposures (insecticides or pesticides and tissue digester emissions). In contrast, the expert panel perceived greater risks for physical hazards (bite or crush and restraining and moving animals), chemical exposures (anesthetic waste gas), and biological exposures (Toxoplasma gondii, antimicrobial-resistant bacteria, and allergens). Participants and safety experts had similar perceptions about occupational risks, but there were important differences where hospital personnel apparently overestimated or underappreciated the risks for workplace hazards. This type of study may be useful in guiding development of optimal workplace safety programs for veterinary hospitals.

Progressivity of health care financing and incidence of service benefits in Ghana.

PubMed

Akazili, James; Garshong, Bertha; Aikins, Moses; Gyapong, John; McIntyre, Di

2012-03-01

The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. A comprehensive assessment of the financing and benefit incidence of health services in Ghana was undertaken. These analyses drew on secondary data from the Ghana Living Standards Survey (2005/2006) and from an additional household survey which collected data in 2008 in six districts covering the three main ecological zones of Ghana. Findings show that Ghana's health care financing system is progressive, driven largely by the progressivity of taxes. The national health insurance levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed. For Ghana to attain an equitable health system and fully achieve universal coverage, it must ensure that the poor, most of whom are not currently covered by the NHI, are financially protected, and it must address the many access barriers to health care.

A comparison of congestive heart failure readmissions among teaching and nonteaching hospital services.

PubMed

Palacio, Carlos; House, Jeffrey; Ibrahim, Saif; Touchan, Jean N; Mooradian, Ariana

2014-08-01

Heart failure (HF) is a leading cause of hospitalization in the United States. With the population trend shifting to a higher volume of elderly adults, the efficient management of HF will become increasingly essential. The development and implementation of The Patient Protection and Affordable Care Act and subsequent changes in reimbursement practices have made 30-day readmission rates a topic of much interest and relevance. The aim of the study was to compare rates of readmission among teaching and nonteaching hospitals. The authors gathered retrospective data on HF quality measures and readmission rates between August 2011 and July 2012, extracted from the institution's managerial accounting database. These data were compared among teaching and nonteaching hospitals. Patient demographics, readmission rates, readmission diagnoses, severity of illness, patient disposition, medications prescribed, cost of services, and mortality were reviewed. Analysis of variance was used for continuous variables; χ(2) analysis was used for evaluating categorical variables. A higher proportion of patients on the cardiology teaching service were men than on either the medicine teaching service or the medicine nonteaching service. Length of stay, case costs, and care costs were lowest for the cardiology teaching service; however, patient illness severity was lower on this service than on the other two services. Overall, readmissions and mortality were similar among all groups, but readmission for the same diagnosis was more likely on the cardiology service than on the medicine teaching and nonteaching services. Studies comparing teaching and nonteaching providers for an HF diagnosis are needed. Hospital readmission and mortality rates were similar across services and compared favorably with national data. Opportunities that target cost reduction and length of stay may be leveraged.

The application of a biometric identification technique for linking community and hospital data in rural Ghana

PubMed Central

Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

2016-01-01

Background The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Objective Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. Design A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. Results A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Conclusions Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information. PMID:26993473

The application of a biometric identification technique for linking community and hospital data in rural Ghana.

PubMed

Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

2016-01-01

The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information.

Management of febrile children under five years in hospitals and health centres of rural Ghana.

PubMed

Webster, Jayne; Baiden, Frank; Bawah, Justina; Bruce, Jane; Tivura, Mathilda; Delmini, Rupert; Amenga-Etego, Seeba; Chandramohan, Daniel; Owusu-Agyei, Seth

2014-07-09

The case management of febrile children in hospitals' and health centres' pre-roll out of the new WHO policy on parasitological diagnosis was assessed. The delivery of artemisinin combination therapy (ACT) at these two levels of the health system was compared. Structured observations and exit interviews of 1,222 febrile children attending five hospitals and 861 attending ten health centres were conducted in six districts of the Brong Ahafo Region of Ghana. Effectiveness of delivery of case management of malaria was assessed. Proportions of children receiving ACT, anti-malarial monotherapy and antibiotics were described. Predictors of: a febrile child being given an ACT, a febrile child being given an antibiotic and of carers knowing how to correctly administer the ACT were assessed using logistic regression models stratified by hospitals and health centres. The system's effectiveness of delivering an ACT to febrile children diagnosed with malaria (parasitologically or clinically) was 31.4 and 42.4% in hospitals and health centres, respectively. The most ineffective process was that of ensuring that carers knew how to correctly administer the ACT. Overall 278 children who were not given an ACT were treated with anti-malarial monotherapy other than quinine. The majority of these children, 232/278 were given amodiaquine, 139 of these were children attending hospitals and 93 attending health centres. The cadre of health staff conducting consultation was a common predictor of the outcomes of interest. Presenting symptoms and examinations conducted were predictive of being given an ACT in hospitals and antibiotic in hospitals and health centres but not of being given an ACT in health centres. Treatment-seeking factors were predictive of being given an ACT if it was more than seven days since the fever began and an antibiotic in hospitals but not in health centres. Interventions to improve adherence to negative parasitological tests are needed, together with guidance on

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

PubMed Central

Ojo, Adebowale I; Popoola, Sunday O

2015-01-01

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

Some correlates of electronic health information management system success in nigerian teaching hospitals.

PubMed

Ojo, Adebowale I; Popoola, Sunday O

2015-01-01

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

Teaching hospital performance: towards a community of shared values?

PubMed

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

2014-01-01

This paper explores the performance dimensions of Italian teaching hospitals (THs) by considering the multiple constituent model approach, using measures that are subjective and based on individual ideals and preferences. Our research replicates a study of a French TH and deepens it by adjusting it to the context of an Italian TH. The purposes of this research were as follows: to identify emerging views on the performance of teaching hospitals and to analyze how these views vary among hospital stakeholders. We conducted an in-depth case study of a TH using a quantitative survey method. The survey uses a questionnaire based on Parsons' social system action theory, which embraces the major models of organizational performance and covers three groups of internal stakeholders: physicians, caregivers and administrative staff. The questionnaires were distributed between April and September 2011. The results confirm that hospital performance is multifaceted and includes the dimensions of efficiency, effectiveness and quality of care, as well as organizational and human features. There is a high degree of consensus among all observed stakeholder groups about these values, and a shared view of performance is emerging. Our research provides useful information for defining management priorities to improve the performance of THs. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

PubMed

Kazemi, Alireza; Rabiei, Reza; Moghaddasi, Hamid; Deimazar, Ghasem

2016-07-01

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

Sustainable Development of Pathology in Sub-Saharan Africa: An Example From Ghana.

PubMed

Stalsberg, Helge; Adjei, Ernest Kwasi; Owusu-Afriyie, Osei; Isaksen, Vidar

2017-11-01

- Pathology services are poorly developed in Sub-Saharan Africa. Komfo Anokye Teaching Hospital in Kumasi, Ghana, asked for help from the pathology department of the University Hospital of North Norway, Tromsø. - To reestablish surgical pathology and cytology in an African pathology department in which these functions had ceased completely, and to develop the department into a self-supporting unit of good international standard and with the capacity to train new pathologists. - Medical technologists from Kumasi were trained in histotechnology in Norway, they were returned to Kumasi, and they produced histologic slides that were temporarily sent to Norway for diagnosis. Two Ghanaian doctors received pathology training for 4 years in Norway. Mutual visits by pathologists and technologists from the 2 hospitals were arranged for the introduction of immunohistochemistry and cytology. Pathologists from Norway visited Kumasi for 1 month each year during 2007-2010. Microscopes and immunohistochemistry equipment were provided from Norway. Other laboratory equipment and a new building were provided by the Ghanaian hospital. - The Ghanaian hospital had a surgical pathology service from the first project year. At 11 years after the start of the project, the services included autopsy, surgical pathology, cytopathology, frozen sections, and limited use of immunohistochemistry, and the department had 10 residents at different levels of training. - A Ghanaian pathology department that performed autopsies only was developed into a self-supported department with surgical pathology, cytology, immunohistochemistry, and frozen section service, with an active residency program and the capacity for further development that is independent from assistance abroad.

Translating research findings into practice--the implementation of kangaroo mother care in Ghana.

PubMed

Bergh, Anne-Marie; Manu, Rhoda; Davy, Karen; van Rooyen, Elise; Asare, Gloria Quansah; Williams, J Koku Awoonor; Dedzo, McDamien; Twumasi, Akwasi; Nang-Beifubah, Alexis

2012-08-13

Kangaroo mother care (KMC) is a safe and effective method of caring for low birth weight infants and is promoted for its potential to improve newborn survival. Many countries find it difficult to take KMC to scale in healthcare facilities providing newborn care. KMC Ghana was an initiative to scale up KMC in four regions in Ghana. Research findings from two outreach trials in South Africa informed the design of the initiative. Two key points of departure were to equip healthcare facilities that conduct deliveries with the necessary skills for KMC practice and to single out KMC for special attention instead of embedding it in other newborn care initiatives. This paper describes the contextualisation and practical application of previous research findings and the results of monitoring the progress of the implementation of KMC in Ghana. A three-phase outreach intervention was adapted from previous research findings to suit the local setting. A more structured system of KMC regional steering committees was introduced to drive the process and take the initiative forward. During Phase I, health workers in regions and districts were oriented in KMC and received basic support for the management of the outreach. Phase II entailed the strengthening of the regional steering committees. Phase III comprised a more formal assessment, utilising a previously validated KMC progress-monitoring instrument. Twenty-six out of 38 hospitals (68 %) scored over 10 out of 30 and had reached the level of 'evidence of practice' by the end of Phase III. Seven hospitals exceeded expected performance by scoring at the level of 'evidence of routine and institutionalised practice.' The collective mean score for all participating hospitals was 12.07. Hospitals that had attained baby-friendly status or had been re-accredited in the five years before the intervention scored significantly better than the rest, with a mean score of 14.64. The KMC Ghana initiative demonstrated how research findings

Validation of the World Health Organization tool for situational analysis to assess emergency and essential surgical care at district hospitals in Ghana.

PubMed

Osen, Hayley; Chang, David; Choo, Shelly; Perry, Henry; Hesse, Afua; Abantanga, Francis; McCord, Colin; Chrouser, Kristin; Abdullah, Fizan

2011-03-01

The World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care (hereafter called the WHO Tool) has been used in more than 25 countries and is the largest effort to assess surgical care in the world. However, it has not yet been independently validated. Test-retest reliability is one way to validate the degree to which tests instruments are free from random error. The aim of the present field study was to determine the test-retest reliability of the WHO Tool. The WHO Tool was mailed to 10 district hospitals in Ghana. Written instructions were provided along with a letter from the Ghana Health Services requesting the hospital administrator to complete the survey tool. After ensuring delivery and completion of the forms, the study team readministered the WHO Tool at the time of an on-site visit less than 1 month later. The results of the two tests were compared to calculate kappa statistics for each of the 152 questions in the WHO Tool. The kappa statistic is a statistical measure of the degree of agreement above what would be expected based on chance alone. Ten hospitals were surveyed twice over a short interval (i.e., less than 1 month). Weighted and unweighted kappa statistics were calculated for 152 questions. The median unweighted kappa for the entire survey was 0.43 (interquartile range 0-0.84). The infrastructure section (24 questions) had a median kappa of 0.81; the human resources section (13 questions) had a median kappa of 0.77; the surgical procedures section (67 questions) had a median kappa of 0.00; and the emergency surgical equipment section (48 questions) had a median kappa of 0.81. Hospital capacity survey questions related to infrastructure characteristics had high reliability. However, questions related to process of care had poor reliability and may benefit from supplemental data gathered by direct observation. Limitations to the study include the small sample size: 10 district hospitals in a

Exploring factors influencing health-seeking decisions and retention in childhood cancer treatment programmes: perspectives of parents in Ghana.

PubMed

Renner, Lorna Awo; McGill, Deborah

2016-09-01

Developing countries such as Ghana have very poor childhood cancer survival rates. There is a need to determine reasons for late presentation and treatment abandonment which are major causes of poor survival. Understanding these issues could inform effective strategies for childhood cancer control in resource-constrained settings. To explore factors influencing parental decision-making for children with cancer in Ghana with regard to health seeking and retention in treatment, in order to provide information that will guide Public Health interventions for childhood cancer control. This exploratory qualitative study was conducted based on an interpretative epistemology using a social constructionist approach. Purposive sampling of parents attending the Paediatric Oncology Unit, Korle Bu Teaching Hospital in Accra, Ghana was undertaken. Twelve semi-structured moderate interviews and two small focus group discussions with a total of seven participants were undertaken. Data analysis was through thematic content analysis. Five major themes emerged. Knowledge and perceptions revealed a total lack of appropriate knowledge prior to diagnosis. Health-seeking behaviour was determined by interplay of individual and environmental factors. Orthodox medical treatment was largely perceived favourably. The impact of cancer on parents and children included psychological, physical and socioeconomic effects. Financial, spiritual and psychosocial support helped in coping. Parents recommended public education and health financing to address the major barriers. Broad social determinants and experiences influence parental decision making for children with cancer. This implies Health Promotion strategies with multi-sectorial involvement will be required for effective implementation of the National Strategy for Cancer Control. Funded by authors.

Integrating biomedical and herbal medicine in Ghana - experiences from the Kumasi South Hospital: a qualitative study.

PubMed

Boateng, Millicent Addai; Danso-Appiah, Anthony; Turkson, Bernard Kofi; Tersbøl, Britt Pinkowski

2016-07-07

Over the past decade there has been growing interest in the use of herbal medicine both in developed and developing countries. Given the high proportion of patients using herbal medicine in Ghana, some health facilities have initiated implementation of herbal medicine as a component of their healthcare delivery. However, the extent to which herbal medicine has been integrated in Ghanaian health facilities, how integration is implemented and perceived by different stakeholders has not been documented. The study sought to explore these critical issues at the Kumasi South Hospital (KSH) and outline the challenges and motivations of the integration process. Qualitative phenomenological exploratory study design involving fieldwork observations, focus group discussion, in-depth interviews and key informants' interviews was employed to collect data. Policies and protocols outlining the definition, process and goals of integration were lacking, with respondents sharing different views about the purpose and value of integration of herbal medicine within public health facilities. Key informants were supportive of the initiative. Whilst biomedical health workers perceived the system to be parallel than integrated, health personnel providing herbal medicine perceived the system as integrated. Most patients were not aware of the herbal clinic in the hospital but those who had utilized services of the herbal clinic viewed the clinic as part of the hospital. The lack of a regulatory policy and protocol for the integration seemed to have led to the different perception of the integration. Policy and protocol to guide the integration are key recommendations.

Health providers' perception of quality of care for neonates in health facilities in a municipality in Southern Ghana.

PubMed

Elikplim Pomevor, Kokui; Adomah-Afari, Augustine

2016-10-10

Purpose The purpose of this paper is to assess available human resources for neonatal care and their skills, in order to explore health providers' perceptions of quality of neonatal care in health facilities in Ghana. Design/methodology/approach Data were gathered using qualitative interviews with health providers working in the maternity and paediatric wards and midwives; direct observation; and documentary review at a regional hospital, a municipal hospital and four health centres in a municipality in a region in Southern Ghana. Data were analysed using thematic framework through the process of coding in six phases to create and establish meaningful patterns. Findings The study revealed that health providers were concerned about the number of staff available, their competence and also equipment available for them to work more efficiently. Some essential equipment for neonatal care was either not available or was non-functional where it was available, while aseptic procedures were not adhered to. Moreover, personal protective equipment such as facemask, caps, aprons were not used except in the labour wards where staff had to change their footwear before entering. Research limitations/implications Limited number of health providers and facilities used, lack of exploration of parents of neonates' perspective of quality of neonatal care in this study and other settings, including the teaching hospitals. The authors did not examine issues related to the ineffective use of IV cannulation for neonates by nurses as well as referral of neonates. Additionally, the authors did not explore the perspectives of management of the municipal and regional health directorates or policy makers of the Ministry of Health and Ghana Health Service regarding the shortage of staff, inadequate provision of medical equipment and infrastructure. Practical implications This paper suggests the need for policy makers to redirect their attention to the issues that would improve the quality of

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

Code of Federal Regulations, 2012 CFR

2012-10-01

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

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

Code of Federal Regulations, 2014 CFR

2014-10-01

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

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

Code of Federal Regulations, 2013 CFR

2013-10-01

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

Performance of US teaching hospitals: a panel analysis of cost inefficiency.

PubMed

Rosko, Michael D

2004-02-01

This research summarizes an analysis of the impact of environment pressures on hospital inefficiency during the period 1990-1999. The panel design included 616 hospitals. Of these, 211 were academic medical centers and 415 were hospitals with smaller teaching programs. The primary sources of data were the American Hospital Association's Annual Survey of Hospitals and Medicare Cost Reports. Hospital inefficiency was estimated by a regression technique called stochastic frontier analysis. This technique estimates a "best practice cost frontier" for each hospital that is based on the hospital's outputs and input prices. The cost efficiency of each hospital was defined as the ratio of the stochastic frontier total costs to observed total costs. Average inefficiency declined from 14.35% in 1990 to 11.42% in 1998. It increased to 11.78% in 1999. Decreases in inefficiency were associated with the HMO penetration rate and time. Increases in inefficiency were associated with for-profit ownership status and Medicare share of admissions. The implementation of the provisions of the Balanced Budget Act of 1997 was followed by a small decrease in average hospital inefficiency. Analysis found that the SFA results were moderately sensitive to the specification of the teaching output variable. Thus, although the SFA technique can be useful for detecting differences in inefficiency between groups of hospitals (i.e., those with high versus those with low Medicare shares or for-profit versus not-for-profit hospitals), its relatively low precision indicates it should not be used for exact estimates of the magnitude of differences associated with inefficiency-effects variables.

Strategic assessment of the availability of pediatric trauma care equipment, technology and supplies in Ghana.

PubMed

Ankomah, James; Stewart, Barclay T; Oppong-Nketia, Victor; Koranteng, Adofo; Gyedu, Adam; Quansah, Robert; Donkor, Peter; Abantanga, Francis; Mock, Charles

2015-11-01

This study aimed to assess the availability of pediatric trauma care items (i.e. equipment, supplies, technology) and factors contributing to deficiencies in Ghana. Ten universal and 9 pediatric-sized items were selected from the World Health Organization's Guidelines for Essential Trauma Care. Direct inspection and structured interviews with administrative, clinical and biomedical engineering staff were used to assess item availability at 40 purposively sampled district, regional and tertiary hospitals in Ghana. Hospital assessments demonstrated marked deficiencies for a number of essential items (e.g. basic airway supplies, chest tubes, blood pressure cuffs, electrolyte determination, portable X-ray). Lack of pediatric-sized items resulting from equipment absence, lack of training, frequent stock-outs and technology breakage were common. Pediatric items were consistently less available than adult-sized items at each hospital level. This study identified several successes and problems with pediatric trauma care item availability in Ghana. Item availability could be improved, both affordably and reliably, by better organization and planning (e.g. regular assessment of demand and inventory, reliable financing for essential trauma care items). In addition, technology items were often broken. Developing local service and biomedical engineering capability was highlighted as a priority to avoid long periods of equipment breakage. Copyright © 2015 Elsevier Inc. All rights reserved.

Strategic assessment of the availability of pediatric trauma care equipment, technology and supplies in Ghana

PubMed Central

Ankomah, James; Stewart, Barclay T; Oppong-Nketia, Victor; Koranteng, Adofo; Gyedu, Adam; Quansah, Robert; Donkor, Peter; Abantanga, Francis; Mock, Charles

2015-01-01

Background This study aimed to assess the availability of pediatric trauma care items (i.e. equipment, supplies, technology) and factors contributing to deficiencies in Ghana. Methods Ten universal and 9 pediatric-sized items were selected from the World Health Organization’s Guidelines for Essential Trauma Care. Direct inspection and structured interviews with administrative, clinical and biomedical engineering staff were used to assess item availability at 40 purposively sampled district, regional and tertiary hospitals in Ghana. Results Hospital assessments demonstrated marked deficiencies for a number of essential items (e.g. basic airway supplies, chest tubes, blood pressure cuffs, electrolyte determination, portable Xray). Lack of pediatric-sized items resulting from equipment absence, lack of training, frequent stock-outs and technology breakage were common. Pediatric items were consistently less available than adult-sized items at each hospital level. Conclusion This study identified several successes and problems with pediatric trauma care item availability in Ghana. Item availability could be improved, both affordably and reliably, by better organization and planning (e.g. regular assessment of demand and inventory, reliable financing for essential trauma care items). In addition, technology items were often broken. Developing local service and biomedical engineering capability was highlighted as a priority to avoid long periods of equipment breakage. PMID:25841284

Self-efficacy and postpartum depression teaching behaviors of hospital-based perinatal nurses.

PubMed

Logsdon, M Cynthia; Foltz, Melissa Pinto; Scheetz, James; Myers, John A

2010-01-01

Based upon the Self-Efficacy Theory, this study examined the relationship between self-efficacy, self-efficacy-related variables, and postpartum depression teaching behaviors of hospital-based perinatal nurses. Findings revealed that teaching new mothers about postpartum depression is related to a perinatal nurse's self-efficacy in postpartum-depression teaching, self-esteem, and the following self-efficacy-related variables: social persuasion (supervisor's expectations for teaching); mastery (postpartum depression continuing education and teaching experience); and vicarious experience (observing other nurses teach new mothers about postpartum depression). Teaching new mothers about postpartum depression can assist mothers in overcoming barriers to depression treatment. Nurse educators and managers play an important role in encouraging postpartum depression education for perinatal nurses.

Factors associated with Salmonella shedding among equine colic patients at a veterinary teaching hospital.

PubMed

Kim, L M; Morley, P S; Traub-Dargatz, J L; Salman, M D; Gentry-Weeks, C

2001-03-01

To evaluate factors potentially associated with fecal Salmonella shedding among equine patients hospitalized for colic at a veterinary teaching hospital and to determine the effects of probiotic treatment on fecal Salmonella shedding and clinical signs. Longitudinal study and controlled trial. 246 equine colic patients. History and medical information were obtained from patient records. Fecal and environmental samples were submitted for aerobic bacterial culture for Salmonella enterica. Fifty-one patients were treated with a commercially available probiotic; 46 were treated with a placebo. Logistic regression was used to evaluate data. Salmonella organisms were detected in feces from 23 (9%) patients at least once during hospitalization. Patients were more likely to shed Salmonella organisms if diarrhea was evident < or = 6 hours after hospitalization and duration of hospitalization exceeded 8 days (odds ratio [OR], 20.3), laminitis developed during hospitalization (OR, 12.0), results of nasogastric intubation were abnormal (OR, 4.9), leukopenia was evident < or =6 hours after hospitalization (OR, 4.6), or travel time to the teaching hospital exceeded 1 hour (OR, 3.5). Horses treated with the probiotic did not differ from control horses in regard to likelihood of fecal Salmonella shedding (OR, 1.5) or prevalence of clinical signs. Results suggest that certain risk factors are associated with fecal shedding of S enterica among equine patients hospitalized at a veterinary teaching hospital because of colic and that pathogen monitoring in patients and the hospital environment and use of barrier nursing precautions for equine colic patients are beneficial.

Destigmatising abortion: expanding community awareness of abortion as a reproductive health issue in Ghana.

PubMed

Lithur, Nana Oye

2004-04-01

Traditional and cultural values, social perceptions, religious teachings and criminalisation have facilitated stigmatisation of abortion in Ghana. Abortion is illegal in Ghana except in three instances. Though the law allows for performance of abortion in three circumstances, the Ghana reproductive health service policy did not have any induced legal abortion services component to cover the three exceptions until it was revised in 2003. The policy only had 'unsafe and post-abortion' care components, and abortions performed in health facilities operated by the Ghana Health Service were performed under this component. Though the policy has been revised, women and girls who need abortion services in Ghana more often resort to the backstreet dangerous methods and procedures. Criminalisation of abortion and those who perform abortions has contributed to unsafe abortion, the second leading cause of maternal deaths in Ghana. Most of these are performed outside the formal health service structures. Traditionally, abortion is perceived as a shameful act and the community may shun and give a woman who has caused anabortion derogatory names. Would provision of legal abortion services be culturally acceptable within a Ghanaian community? Yes, if they are made aware of the reproductive health benefits of providing safe abortion services. Three major strategies that would help to destigmatise abortion in the community are (1) the liberal interpretation of the three exceptions to the law on abortion; (2) expanding community awareness of its reproductive health benefits; and (3) improving and increasing access to legal abortion services within the formal health facilities.

Ghana's education reform 2007: A realistic proposition or a crisis of vision?

NASA Astrophysics Data System (ADS)

Kuyini, Ahmed Bawa

2013-07-01

Ghana's recent "Education Reform 2007" envisions a system that strives to achieve both domestic and internationally-oriented goals emanating (1) from the Education for All (EFA) initiative, (2) from the UN Convention on the Rights of the Child and (3) from global trends in education. Emboldened by the implementation of foreign-donor-funded programmes such as EFA, the restructuring of the Ghana Education Sector Project (EdSeP) and the Science Resource Centres (SRC) project, both the education reform of 2007 and recent educational policy debates have reiterated the need to emphasise the teaching of science and information and communication technology to make Ghana's students/graduates more competitive in the global labour market. However, the bulk of Ghana's economic activity actually remains domestic or unglobalised. And given a weak economy and declining social spending due to strict adherence to the prescribed structural adjustment policies of the International Monetary Fund (IMF) and the World Bank (WB), there is concern that a focus on international competitiveness may be a crisis of vision. On the basis of the Ghanaian government's failure to meet the stated goals of previous reforms such as that of 1974, and the education system's continuing dependence on foreign donor support, this paper argues that the goals of the new reform may be unachievable on a sustainable basis. It also argues that rather than subjugate national domestic priorities to a mirage of international credibility/competitiveness, Ghana should concentrate on capacitating her students/graduates to make maximum impact at domestic and local community levels.

Concurrent Use of Herbal and Orthodox Medicines among Residents of Tamale, Northern Ghana, Who Patronize Hospitals and Herbal Clinics

PubMed Central

Ibrahim, Mohammed; Ibrahim, Halimatu-Sadia; Habib, Rabiatu Hamisu; Gbedema, Stephen Yao

2018-01-01

Despite the development of more researched and formulated orthodox medicines, herbal medicines continue to be well patronized for persons across the world with some patrons concurrently using both forms, oblivious of the unwanted effects that may occur. Using a multistage sampling procedure, a semistructured questionnaire was used to collect data in April 2016 from 240 informants from three selected hospitals and three herbal clinics in Tamale, a city in northern Ghana. Using Statistical Package for the Social Sciences, binary logistic regression was used to determine sociodemographic predictors of concurrent use of herbal and orthodox medicines. Orthodox medicines were the drug of choice for 54.2% and 49.2% of patrons of hospitals and herbal clinics, respectively. Also, 67.5% of herbal clinic patrons used orthodox medicines, while 25.0% of hospital attendees used herbal medications prior to their visit to the health facilities. Up to 17.9% of respondents concurrently used herbal and orthodox medicines for their prevailing ailment with age, less than 30 years being the only predictor of this habit (p = 0.015; 95% CI, 1.183–4.793; cOR = 2.4). All health professionals including those in herbal clinics should therefore be interested in the drug history of their clients. PMID:29743917

[Pneumocystis pneumonia biological diagnosis at Fann Teaching Hospital in Dakar, Senegal].

PubMed

Dieng, Y; Dieng, T; Sow, D; Wlouhou, S; Sylla, K; Tine, R; Ndiaye, M; Ndiaye, J L; Faye, B; Faye, O; Gaye, O

2016-03-01

Data relative to Pneumocystis pneumonia in sub-Saharan Africa are not well known. Weakness of the technical material and use of little sensitive biological tools of diagnosis are among the evoked reasons. The objective of this study is to update the data of the disease at the Fann Teaching Hospital in Dakar and to estimate biological methods used in diagnosis. A descriptive longitudinal study was carried out from January 5th, 2009 to October 31st, 2011 in the parasitology and mycology laboratory of the Fann Teaching Hospital in Dakar. The bronchoalveolar lavages received in the laboratory were examined microscopically for Pneumocystis jirovecii by indirect fluorescent assay or after Giemsa or toluidine blue O staining. One hundred and eighty-three bronchoalveolar lavages withdrawn from 183 patients were received in the laboratory. Sixteen were positive for P. jirovecii at 9% frequency. Four among these patients were HIV positive. Indirect fluorescent assay allowed finding of P. jirovecii among 16 patients while Giemsa staining discovered P. jirovecii only in a single patient. No case was diagnosed by toluidine blue O staining. Pneumocystis pneumonia in Parasitology and Mycology Laboratory of Fann Teaching Hospital at Dakar was mainly diagnosed among HIV patients. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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

PubMed Central

Pouragha, Behrouz; Zarei, Ehsan

2016-01-01

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

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

PubMed

Pouragha, Behrouz; Zarei, Ehsan

2016-02-01

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

Innovative Model for Information Assurance Curriculum: A Teaching Hospital

ERIC Educational Resources Information Center

Goel, Sanjay; Pon, Damira; Bloniarz, Peter; Bangert-Drowns, Robert; Berg, George; Delio, Vince; Iwan, Laura; Hurbanek, Thomas; Schuman, Sandoor P.; Gangolly, Jagdish; Baykal, Adnan; Hobbs, Jon

2006-01-01

A novel idea for information security education created by the New York State Center for Information Forensics and Assurance (CIFA) is presented. This new approach incorporates a teaching hospital model originally developed for medical training. In this model, information security problems from industry and government are solved and abstracted…

Comparative Study on Knowledge About Autism Spectrum Disorder Among Paediatric and Psychiatric Nurses in Public Hospitals in Kumasi, Ghana.

PubMed

Sampson, Wireko-Gyebi; Sandra, Ashiagbor Emelia

2018-01-01

Despite the existence of autism spectrum disorder in Ghana, few studies have provided the necessary information on the phenomenon. These studies have mostly focused on speech and language therapy for children and modification of classroom environment for children with autism spectrum disorder. This approach has resulted in a paucity of knowledge on nurse's knowledge of autism spectrum disorder in Ghana. The study sought to assess the knowledge of paediatric and psychiatric on autism spectrum disorder. In this study, 130 paediatric and 93 psychiatric nurses sampled from five public hospitals in the Kumasi Metropolis participated in the survey. The Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire was employed to assess their knowledge of autism spectrum disorder. It emerged from the study that psychiatric nurses were more knowledgeable on autism spectrum disorder than paediatric nurses in general and specifically on each of the four domains on the KCAHW questionnaire. However, the level of knowledge on autism spectrum disorder among both groups of nurses remains low. Apart from the previous encounter, there were no significant differences between paediatric and psychiatric nurses' gender, age, marital status, working experience and their knowledge. In view of the findings, it will be appropriate for autism spectrum disorder to be included in the clinical training curriculum as well as the continuous professional education for both paediatric and psychiatric nurses. This will go a long way in helping paediatric and psychiatric nurses to increase their knowledge of autism spectrum disorder.

Traffic flow and microbial air contamination in operating rooms at a major teaching hospital in Ghana.

PubMed

Stauning, M T; Bediako-Bowan, A; Andersen, L P; Opintan, J A; Labi, A-K; Kurtzhals, J A L; Bjerrum, S

2018-07-01

Current literature examining the relationship between door-opening rate, number of people present, and microbial air contamination in the operating room is limited. Studies are especially needed from low- and middle-income countries, where the risk of surgical site infections is high. To assess microbial air contamination in operating rooms at a Ghanaian teaching hospital and the association with door-openings and number of people present. Moreover, we aimed to document reasons for door-opening. We conducted active air-sampling using an MAS 100 ® portable impactor during 124 clean or clean-contaminated elective surgical procedures. The number of people present, door-opening rate and the reasons for each door-opening were recorded by direct observation using pretested structured observation forms. During surgery, the mean number of colony-forming units (cfu) was 328 cfu/m 3 air, and 429 (84%) of 510 samples exceeded a recommended level of 180 cfu/m 3 . Of 6717 door-openings recorded, 77% were considered unnecessary. Levels of cfu/m 3 were strongly correlated with the number of people present (P = 0.001) and with the number of door-openings/h (P = 0.02). In empty operating rooms, the mean cfu count was 39 cfu/m 3 after 1 h of uninterrupted ventilation and 52 (51%) of 102 samples exceeded a recommended level of 35 cfu/m 3 . The study revealed high values of intraoperative airborne cfu exceeding recommended levels. Minimizing the number of door-openings and people present during surgery could be an effective strategy to reduce microbial air contamination in low- and middle-income settings. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

How do Supervising Clinicians of a University Hospital and Associated Teaching Hospitals Rate the Relevance of the Key Competencies within the CanMEDS Roles Framework in Respect to Teaching in Clinical Clerkships?

PubMed

Jilg, Stefanie; Möltner, Andreas; Berberat, Pascal; Fischer, Martin R; Breckwoldt, Jan

2015-01-01

In German-speaking countries, the physicians' roles framework of the "Canadian Medical Education Directives for Specialists" (CanMEDS) is increasingly used to conceptualize postgraduate medical education. It is however unclear, whether it may also be applied to the final year of undergraduate education within clinical clerkships, called "Practical Year" (PY). Therefore, the aim of this study was to explore how clinically active physicians at a university hospital and at associated teaching hospitals judge the relevance of the seven CanMEDS roles (and their (role-defining) key competencies) in respect to their clinical work and as learning content for PY training. Furthermore, these physicians were asked whether the key competencies were actually taught during PY training. 124 physicians from internal medicine and surgery rated the relevance of the 28 key competencies of the CanMEDS framework using a questionnaire. For each competency, following three aspects were rated: "relevance for your personal daily work", "importance for teaching during PY", and "implementation into actual PY teaching". In respect to the main study objective, all questionnaires could be included into analysis. All seven CanMEDS roles were rated as relevant for personal daily work, and also as important for teaching during PY. Furthermore, all roles were stated to be taught during actual PY training. The roles "Communicator", "Medical Expert", and "Collaborator" were rated as significantly more important than the other roles, for all three sub-questions. No differences were found between the two disciplines internal medicine and surgery, nor between the university hospital and associated teaching hospitals. Participating physicians rated all key competencies of the CanMEDS model to be relevant for their personal daily work, and for teaching during PY. These findings support the suitability of the CanMEDS framework as a conceptual element of PY training.

Culture and the environment in Ghana

NASA Astrophysics Data System (ADS)

Dyasi, Hubert M.

1985-03-01

The traditional culture of Ghana stressed a strong relationship with the environment, and a culturally acceptable environmental management resulted from strictures and taboos related to the land. Following its independence in 1957, Ghana has enacted laws that reflect an enlightened environmental policy. These are especially important because of the difficulties Ghana has had in its economic development using Western technology that has damaged the fragile tropical ecosystem. A key aspect of Ghana's policy is the attempt to marry scientific knowledge and traditional beliefs for environmentally sound management of Ghana's resources.

Comparison of the treatment practice and hospitalization cost of percutaneous coronary intervention between a teaching hospital and a general hospital in Malaysia: A cross sectional study

PubMed Central

Wan Ahmad, Wan Azman; Low, Ee Vien; Liau, Siow Yen; Anchah, Lawrence; Hamzah, Syuhada; Liew, Houng-Bang; Mohd Ali, Rosli B.; Ismail, Omar; Ong, Tiong Kiam; Said, Mas Ayu; Dahlui, Maznah

2017-01-01

Introduction The increasing disease burden of coronary artery disease (CAD) calls for sustainable cardiac service. Teaching hospitals and general hospitals in Malaysia are main providers of percutaneous coronary intervention (PCI), a common treatment for CAD. Few studies have analyzed the contemporary data on local cardiac facilities. Service expansion and budget allocation require cost evidence from various providers. We aim to compare the patient characteristics, procedural outcomes, and cost profile between a teaching hospital (TH) and a general hospital (GH). Methods This cross-sectional study was conducted from the healthcare providers’ perspective from January 1st to June 30th 2014. TH is a university teaching hospital in the capital city, while GH is a state-level general hospital. Both are government-funded cardiac referral centers. Clinical data was extracted from a national cardiac registry. Cost data was collected using mixed method of top-down and bottom-up approaches. Total hospitalization cost per PCI patient was summed up from the costs of ward admission and cardiac catheterization laboratory utilization. Clinical characteristics were compared with chi-square and independent t-test, while hospitalization length and cost were analyzed using Mann-Whitney test. Results The mean hospitalization cost was RM 12,117 (USD 3,366) at GH and RM 16,289 (USD 4,525) at TH. The higher cost at TH can be attributed to worse patients’ comorbidities and cardiac status. In contrast, GH recorded a lower mean length of stay as more patients had same-day discharge, resulting in 29% reduction in mean cost of admission compared to TH. For both hospitals, PCI consumables accounted for the biggest proportion of total cost. Conclusions The high PCI consumables cost highlighted the importance of cost-effective purchasing mechanism. Findings on the heterogeneity of the patients, treatment practice and hospitalization cost between TH and GH are vital for formulation of cost

Comparison of the treatment practice and hospitalization cost of percutaneous coronary intervention between a teaching hospital and a general hospital in Malaysia: A cross sectional study.

PubMed

Lee, Kun Yun; Wan Ahmad, Wan Azman; Low, Ee Vien; Liau, Siow Yen; Anchah, Lawrence; Hamzah, Syuhada; Liew, Houng-Bang; Mohd Ali, Rosli B; Ismail, Omar; Ong, Tiong Kiam; Said, Mas Ayu; Dahlui, Maznah

2017-01-01

The increasing disease burden of coronary artery disease (CAD) calls for sustainable cardiac service. Teaching hospitals and general hospitals in Malaysia are main providers of percutaneous coronary intervention (PCI), a common treatment for CAD. Few studies have analyzed the contemporary data on local cardiac facilities. Service expansion and budget allocation require cost evidence from various providers. We aim to compare the patient characteristics, procedural outcomes, and cost profile between a teaching hospital (TH) and a general hospital (GH). This cross-sectional study was conducted from the healthcare providers' perspective from January 1st to June 30th 2014. TH is a university teaching hospital in the capital city, while GH is a state-level general hospital. Both are government-funded cardiac referral centers. Clinical data was extracted from a national cardiac registry. Cost data was collected using mixed method of top-down and bottom-up approaches. Total hospitalization cost per PCI patient was summed up from the costs of ward admission and cardiac catheterization laboratory utilization. Clinical characteristics were compared with chi-square and independent t-test, while hospitalization length and cost were analyzed using Mann-Whitney test. The mean hospitalization cost was RM 12,117 (USD 3,366) at GH and RM 16,289 (USD 4,525) at TH. The higher cost at TH can be attributed to worse patients' comorbidities and cardiac status. In contrast, GH recorded a lower mean length of stay as more patients had same-day discharge, resulting in 29% reduction in mean cost of admission compared to TH. For both hospitals, PCI consumables accounted for the biggest proportion of total cost. The high PCI consumables cost highlighted the importance of cost-effective purchasing mechanism. Findings on the heterogeneity of the patients, treatment practice and hospitalization cost between TH and GH are vital for formulation of cost-saving strategies to ensure sustainable and

Assessing Governance Alternatives for University-Owned Public Teaching Hospitals.

ERIC Educational Resources Information Center

Whitley, Evangeline L.

The governance options matrix is provided to offer a way for state and university policymakers to examine the functioning environments of specific university-owned public teaching hospitals. With it, they can consider the benefits and problems involved with different options for governance. The issues related to the environmental factors affecting…

Prevalence of Intestinal Helminths Infestation in Children Attending Princess Marie Louise Children's Hospital in Accra, Ghana

PubMed Central

Mirisho, Robert; Neizer, Margaret L.

2017-01-01

The deworming exercise program does not cover all children who are not in school. This study determined the prevalence and species type of helminth infestation and associated factors among children attending Princess Marie Louise Children's Hospital in Accra, Ghana. Children (225) below the age of 10 who have not taken antihelminthic drugs prior to the study period were recruited between May and June 2015. Children or guardians were interviewed using structured questionnaires and fresh stools were collected and processed for helminths species identification using microscopy. Data were analyzed using Stata version 12. Overall helminths infestation prevalence was 17.33% (39/225). The identified species were hookworm (10.22% (23/225)) and Ascaris lumbricoides (7.11% (16/225)). No double infestation was observed. Significant associations were observed between infestation and age group beyond 4 years (48 months) (aOR = 16.72, 95% CI 1.00–279.72), place of residence (aOR = 7.35, 95% CI 1.68–32.11), washing hands after using toilet (0.04, 95% CI 0.01–0.20), and dirt on fingernails of children (7.96, 95% CI 1.73–36.65). This study demonstrates high prevalence of helminths parasites, hookworm, and Ascaris lumbricoides in children attending PMLCH. Deworming exercise should be extended to children hospitals in developing countries. PMID:29057116

Mortality among high-risk patients with acute myocardial infarction admitted to U.S. teaching-intensive hospitals in July: a retrospective observational study.

PubMed

Jena, Anupam B; Sun, Eric C; Romley, John A

2013-12-24

Studies of whether inpatient mortality in US teaching hospitals rises in July as a result of organizational disruption and relative inexperience of new physicians (July effect) find small and mixed results, perhaps because study populations primarily include low-risk inpatients whose mortality outcomes are unlikely to exhibit a July effect. Using the US Nationwide Inpatient sample, we estimated difference-in-difference models of mortality, percutaneous coronary intervention rates, and bleeding complication rates, for high- and low-risk patients with acute myocardial infarction admitted to 98 teaching-intensive and 1353 non-teaching-intensive hospitals during May and July 2002 to 2008. Among patients in the top quartile of predicted acute myocardial infarction mortality (high risk), adjusted mortality was lower in May than July in teaching-intensive hospitals (18.8% in May, 22.7% in July, P<0.01), but similar in non-teaching-intensive hospitals (22.5% in May, 22.8% in July, P=0.70). Among patients in the lowest three quartiles of predicted acute myocardial infarction mortality (low risk), adjusted mortality was similar in May and July in both teaching-intensive hospitals (2.1% in May, 1.9% in July, P=0.45) and non-teaching-intensive hospitals (2.7% in May, 2.8% in July, P=0.21). Differences in percutaneous coronary intervention and bleeding complication rates could not explain the observed July mortality effect among high risk patients. High-risk acute myocardial infarction patients experience similar mortality in teaching- and non-teaching-intensive hospitals in July, but lower mortality in teaching-intensive hospitals in May. Low-risk patients experience no such July effect in teaching-intensive hospitals.

Mortality among High Risk Patients with Acute Myocardial Infarction Admitted to U.S. Teaching-Intensive Hospitals in July: A Retrospective Observational Study

PubMed Central

Jena, Anupam B.; Sun, Eric C.; Romley, John A.

2014-01-01

Background Studies of whether inpatient mortality in U.S. teaching hospitals rises in July as a result of organizational disruption and relative inexperience of new physicians (‘July effect’) find small and mixed results, perhaps because study populations primarily include low-risk inpatients whose mortality outcomes are unlikely to exhibit a July effect. Methods and Results Using the U.S. Nationwide Inpatient sample, we estimated difference-in-difference models of mortality, percutaneous coronary intervention (PCI) rates, and bleeding complication rates, for high and low risk patients with acute myocardial infarction (AMI) admitted to 98 teaching-intensive and 1353 non-teaching-intensive hospitals during May and July 2002 to 2008. Among patients in the top quartile of predicted AMI mortality (high risk), adjusted mortality was lower in May than July in teaching-intensive hospitals (18.8% in May, 22.7% in July, p<0.01), but similar in non-teaching-intensive hospitals (22.5% in May, 22.8% in July, p=0.70). Among patients in the lowest three quartiles of predicted AMI mortality (low risk), adjusted mortality was similar in May and July in both teaching-intensive hospitals (2.1% in May, 1.9% in July, p=0.45) and non-teaching-intensive hospitals (2.7% in May, 2.8% in July, p=0.21). Differences in PCI and bleeding complication rates could not explain the observed July mortality effect among high risk patients. Conclusions High risk AMI patients experience similar mortality in teaching- and non-teaching-intensive hospitals in July, but lower mortality in teaching-intensive hospitals in May. Low risk patients experience no such “July effect” in teaching-intensive hospitals. PMID:24152859

Is there a relationship between high-quality performance in major teaching hospitals and residents' knowledge of quality and patient safety?

PubMed

Pingleton, Susan K; Horak, Bernard J; Davis, David A; Goldmann, Donald A; Keroack, Mark A; Dickler, Robert M

2009-11-01

The relationship of the quality of teaching hospitals' clinical performance to resident education in quality and patient safety is unclear. The authors studied residents' knowledge of these areas in major teaching hospitals with higher- and lower-quality performance rankings. They assessed the presence of formal and informal quality curricula to determine whether programmatic differences exist. The authors used qualitative research methodology with purposeful sampling. They gathered data from individual structured interviews with residents and key educational and quality leaders in six medical schools and teaching hospitals, which represented a range of quality performance rankings, geographic regions, and public or private status. No relationship emerged between a hospital's quality status, residents' curriculum, and the residents' understanding of quality. Residents' definitions of quality and safety and their knowledge of the practice-based learning and systems-based practice competencies were indistinguishable between hospitals. Residents in all programs had extensive patient safety knowledge acquired through an informal curriculum in the hospital setting. A formal curriculum existed in only two programs, both of them ambulatory settings. Residents' learning about quality and patient safety is extensive, largely through a positive informal curriculum in the teaching hospital and, less frequently, via a formal curriculum. No relationship was found between the quality performance of the teaching hospital and the residents' curriculum or understanding of quality or safety. Residents seem to learn through an informal curriculum provided by hospital initiatives and resources, and thus these data suggest the importance of major teaching hospitals in quality education.

Factors affecting length of stay in teaching hospitals of a middle-income country

PubMed Central

Khosravizadeh, Omid; Vatankhah, Soudabeh; Bastani, Peivand; Kalhor, Rohollah; Alirezaei, Samira; Doosty, Farzane

2016-01-01

Introduction The length of stay (LOS) in hospitals is a widely used and important criteria for evaluating hospital performance. The aim of this study was to determine factors affecting LOS in teaching hospitals of Qazvin Providence. Methods In this cross-sectional study, patients’ health records were randomly selected from archives in teaching hospitals of Qazvin in 2013. Data were collected through a data entry form and were analyzed using Kolmogorov–Smirnov, Kruskal–Wallis, and Mann–Whitney U tests at the significant level of 0.05. Results The mean of hospital LOS was 5.45 ± 6.14 days. Age, employment, marital status, history of previous admission, patient condition at discharge, method of payment, and type of treatment had an impact on LOS (p<0.05). Other factors, including gender, place of residence, and type of admission, did not affect LOS. Conclusion Because hospitals consume a perceptible part of resources in a health system, controlled and optimized use of its resources help to save a lot. Therefore, this study showed many clinical and nonclinical factors affect LOS in evaluating these factors, which may reduce inappropriate hospital stays and decrease costs. PMID:27957301

Effect of anti-malarial interventions on trends of malaria cases, hospital admissions and deaths, 2005-2015, Ghana.

PubMed

Aregawi, Maru; Malm, Keziah L; Wahjib, Mohammed; Kofi, Osae; Allotey, Naa-Korkor; Yaw, Peprah Nana; Abba-Baffoe, Wilmot; Segbaya, Sylvester; Owusu-Antwi, Felicia; Kharchi, Abderahmane T; Williams, Ryan O; Saalfeld, Mark; Workneh, Nibretie; Shargie, Estifanos Biru; Noor, Abdisalan M; Bart-Plange, Constance

2017-04-26

Since 2005, the Government of Ghana and its partners, in concerted efforts to control malaria, scaled up the use of artemisinin-based combination therapy (ACT) and insecticide-treated nets (ITNs). Beginning in 2011, a mass campaign of long-lasting insecticidal nets (LLINs) was implemented, targeting all the population. The impact of these interventions on malaria cases, admissions and deaths was assessed using data from district hospitals. Records of malaria cases and deaths and availability of ACT in 88 hospitals, as well as at district level, ITN distribution, and indoor residual spraying were reviewed. Annual proportion of the population potentially protected by ITNs was estimated with the assumption that each LLIN covered 1.8 persons for 3 years. Changes in trends of cases and deaths in 2015 were estimated by segmented log-linear regression, comparing trends in post-scale-up (2011-2015) with that of pre-scale-up (2005-2010) period. Trends of mortality in children under 5 years old from population-based household surveys were also compared with the trends observed in hospitals for the same time period. Among all ages, the number of outpatient malaria cases (confirmed and presumed) declined by 57% (95% confidence interval [CI], 47-66%) by first half of 2015 (during the post-scale-up) compared to the pre-scale-up (2005-2010) period. The number of microscopically confirmed cases decreased by 53% (28-69%) while microscopic testing was stable. Test positivity rate (TPR) decreased by 41% (19-57%). The change in malaria admissions was insignificant while malaria deaths fell significantly by 65% (52-75%). In children under 5 years old, total malaria outpatient cases, admissions and deaths decreased by 50% (32-63%), 46% (19-75%) and 70% (49-82%), respectively. The proportion of outpatient malaria cases, admissions and deaths of all-cause conditions in both all ages and children under five also fell significantly by >30%. Similar decreases in the main malaria

Recall of symptoms and treatment of syphilis and yaws by healthy blood donors screening positive for syphilis in Kumasi, Ghana.

PubMed

Sarkodie, Francis; Owusu-Dabo, Ellis; Hassall, Oliver; Bates, Imelda; Bygbjerg, Ib C; Ullum, Henrik

2016-09-01

To describe the recalled medical history, clinical manifestations, and treatment of yaws and syphilis by syphilis seroreactive blood donors in Kumasi, Ghana. Of the blood donors at Komfo Anokye Teaching Hospital, Kumasi, Ghana tested with the syphilis rapid diagnostic test (RDT) and later by rapid plasma reagin (RPR) test, 526 were seroreactive. Four hundred and seventy-one (89.5%) of these subjects were confirmed with the Ortho-Vitros Syphilis TP test as the gold standard and were interviewed to determine past or present clinical manifestations of yaws and syphilis. Of the 471 respondent donors, 28 (5.9%) gave a history of skin lesions and sores; four (14.3%) of these subjects, who were all male and RPR-positive, recalled a diagnosis of syphilis. All four reported having had skin lesions/bumps with slow-healing sores, but only one of them had had these symptoms before the age of 15 years. A small proportion of confirmed seroreactive donors in this sample had any recall of symptoms or treatment for yaws or syphilis. These data suggest that clinical questioning adds little further information to the current screening algorithm. The relative contribution of yaws and syphilis to frequent positive tests in endemic areas remains speculative. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Teaching Quality, Learning Satisfaction, and Academic Performance among Hospitality Students in Taiwan

ERIC Educational Resources Information Center

Ko, Wen-Hwa; Chung, Feng-Ming

2014-01-01

The purpose of this study is to examine the effect of the teaching quality of culinary arts teachers and student learning satisfaction on the academic performance of hospitality students. This study surveys the students in hospitality departments at universities in Taiwan. A total of 406 (81.2%) valid questionnaires were received. Research results…

Students as Teaching Resources; A Survey of Teaching Models Using Non-Professionals (Peer Tutoring).

ERIC Educational Resources Information Center

Klaus, David J.

This preliminary survey was designed to explore the possible use of students as teaching resources in the developing countries. In carrying out the survey, available literature was reviewed, visits made to selected ongoing projects in the United States, and interviews conducted overseas with indigenous educational researchers in Ghana, Sierra…

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

PubMed

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

2013-01-01

Teaching hospitals (THs) simultaneously serve three different roles: offering medical treatment, teaching future doctors and promoting research. The international literature recognises such organisations as 'peaks of excellence' and highlights their economic function in the health system. In addition, the literature describes the urgent need to manage the complex dynamics and inefficiency issues that threaten the survival of teaching hospitals worldwide. In this context, traditional performance measurement systems that focus only on accounting and financial measures appear to be inadequate. Given that THs are highly specific and complex, a multidimensional system of performance measurement, such as the Balanced Scorecard (BSC), may be more appropriate because of the multitude of stakeholders, each of whom seek a specific type of accountability. The aim of the paper was twofold: (i) to review the literature on the BSC and its applications in teaching hospitals and (ii) to propose a scorecard framework that is suitable for assessing the performance of THs and serving as a guide for scholars and practitioners. In addition, this research will contribute to the ongoing debate on performance evaluation systems by suggesting a revised BSC framework and proposing specific performance indicators for THs. Copyright © 2012 John Wiley & Sons, Ltd.

The experiences of people with diabetes-related lower limb amputation at the Komfo Anokye Teaching Hospital (KATH) in Ghana.

PubMed

Amoah, Vida Maame Kissiwaa; Anokye, Reindolf; Acheampong, Enoch; Dadson, Helina Rubby; Osei, Mary; Nadutey, Alberta

2018-01-24

Lower limb amputation not only causes major disfigurement, but renders people less mobile and at risk of loss of independence. Yet with appropriate rehabilitation, many people can learn to walk or function again and live high quality lives. This study sought to explore the experiences of patients with diabetes-related lower limb amputation at the Komfo Anokye Teaching Hospital. An exploratory study design was adopted using a qualitative approach and a purposive sampling to select 10 participants for the study. A semi-structured interview guide was used with an in-depth face-to-face interview. The interview was tape-recorded with an audio recorder while notes were taken in addition to the audio recording. There were varying degrees of experiences ranging from physical as well as psychological and economic challenges. Amputees had to cope with playing entirely new roles after the amputation. They also experienced some economic challenges which were as a result of their inability to work. Some of the amputees consoled themselves with the fact that, despite their condition, they were better than other people. Others believed that whatever happened was Gods doing and nothing could be done about it. This self-consolation and the belief in God helped them to cope.

Spectrum of Endocrine Disorders in Central Ghana

PubMed Central

Sarfo, Fred Stephen; Ansah, Eunice Oparebea; Kyei, Ishmael

2017-01-01

Background. Although an increasing burden of endocrine disorders is recorded worldwide, the greatest increase is occurring in developing countries. However, the spectrum of these disorders is not well described in most developing countries. Objective. The objective of this study was to profile the frequency of endocrine disorders and their basic demographic characteristics in an endocrine outpatient clinic in Kumasi, central Ghana. Methods. A retrospective review was conducted on endocrine disorders seen over a five-year period between January 2011 and December 2015 at the outpatient endocrine clinic of Komfo Anokye Teaching Hospital. All medical records of patients seen at the endocrine clinic were reviewed by endocrinologists and all endocrinological diagnoses were classified according to ICD-10. Results. 3070 adults enrolled for care in the endocrine outpatient service between 2011 and 2015. This comprised 2056 females and 1014 males (female : male ratio of 2.0 : 1.0) with an overall median age of 54 (IQR, 41–64) years. The commonest primary endocrine disorders seen were diabetes, thyroid, and adrenal disorders at frequencies of 79.1%, 13.1%, and 2.2%, respectively. Conclusions. Type 2 diabetes and thyroid disorders represent by far the two commonest disorders seen at the endocrine clinic. The increased frequency and wide spectrum of endocrine disorders suggest the need for well-trained endocrinologists to improve the health of the population. PMID:28326101

[Noise level in a care and teaching hospital institution].

PubMed

Mendoza-Sánchez, R S; Roque-Sánchez, R H; Moncada-González, B

1996-01-01

Noise in the environment is increasing over the years. Disturbances produced by noise are varied, some lead to serious health consequences. Noise level was registered in a teaching hospital. Levels in the wards were between 50 and 59 dB. In the Intensive Care Unit, main hallways and outpatients department levels were higher than 59 dB. Isolated peaks up to 90.0 dB (Pediatrics) were detected. The noise level recommended for a hospital is under 50.0 dB. We found that the principal source of noise came from the medical and nursing staff.

Translating research findings into practice – the implementation of kangaroo mother care in Ghana

PubMed Central

2012-01-01

Background Kangaroo mother care (KMC) is a safe and effective method of caring for low birth weight infants and is promoted for its potential to improve newborn survival. Many countries find it difficult to take KMC to scale in healthcare facilities providing newborn care. KMC Ghana was an initiative to scale up KMC in four regions in Ghana. Research findings from two outreach trials in South Africa informed the design of the initiative. Two key points of departure were to equip healthcare facilities that conduct deliveries with the necessary skills for KMC practice and to single out KMC for special attention instead of embedding it in other newborn care initiatives. This paper describes the contextualisation and practical application of previous research findings and the results of monitoring the progress of the implementation of KMC in Ghana. Methods A three-phase outreach intervention was adapted from previous research findings to suit the local setting. A more structured system of KMC regional steering committees was introduced to drive the process and take the initiative forward. During Phase I, health workers in regions and districts were oriented in KMC and received basic support for the management of the outreach. Phase II entailed the strengthening of the regional steering committees. Phase III comprised a more formal assessment, utilising a previously validated KMC progress-monitoring instrument. Results Twenty-six out of 38 hospitals (68 %) scored over 10 out of 30 and had reached the level of ‘evidence of practice’ by the end of Phase III. Seven hospitals exceeded expected performance by scoring at the level of ‘evidence of routine and institutionalised practice.’ The collective mean score for all participating hospitals was 12.07. Hospitals that had attained baby-friendly status or had been re-accredited in the five years before the intervention scored significantly better than the rest, with a mean score of 14.64. Conclusion The KMC Ghana

Who will pay for medical education in our teaching hospitals?

PubMed

Relman, A S

1984-10-05

Although most medical educators believe that education, research, and patient care are inseparable and essential to their academic mission, the educational component of this triad has never been given adequate, earmarked support. To fund educational programs, medical centers first relied on research grants and later on third-party payments intended for patient care. However, research money has long since ceased to be available for other purposes and recent federal cost containment measures have started to reduce payments for patient care. Teaching hospitals are threatened with loss of support not only for education, but for their capital improvements and care of the poor. Many institutions are now hoping to generate new income through business deals with for-profit health care corporations, but this effort probably will also fail and may compromise professional traditions. Teaching hospitals serve the public interest and will have to depend, at least in part, on public subsidy of their unavoidable extra costs.

Comparative Study on Knowledge About Autism Spectrum Disorder Among Paediatric and Psychiatric Nurses in Public Hospitals in Kumasi, Ghana

PubMed Central

Sampson, Wireko-Gyebi; Sandra, Ashiagbor Emelia

2018-01-01

Background: Despite the existence of autism spectrum disorder in Ghana, few studies have provided the necessary information on the phenomenon. These studies have mostly focused on speech and language therapy for children and modification of classroom environment for children with autism spectrum disorder. This approach has resulted in a paucity of knowledge on nurse’s knowledge of autism spectrum disorder in Ghana. Objective: The study sought to assess the knowledge of paediatric and psychiatric on autism spectrum disorder. Method: In this study, 130 paediatric and 93 psychiatric nurses sampled from five public hospitals in the Kumasi Metropolis participated in the survey. The Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire was employed to assess their knowledge of autism spectrum disorder. Results: It emerged from the study that psychiatric nurses were more knowledgeable on autism spectrum disorder than paediatric nurses in general and specifically on each of the four domains on the KCAHW questionnaire. However, the level of knowledge on autism spectrum disorder among both groups of nurses remains low. Apart from the previous encounter, there were no significant differences between paediatric and psychiatric nurses’ gender, age, marital status, working experience and their knowledge. Conclusion: In view of the findings, it will be appropriate for autism spectrum disorder to be included in the clinical training curriculum as well as the continuous professional education for both paediatric and psychiatric nurses. This will go a long way in helping paediatric and psychiatric nurses to increase their knowledge of autism spectrum disorder. PMID:29785200

How do Supervising Clinicians of a University Hospital and Associated Teaching Hospitals Rate the Relevance of the Key Competencies within the CanMEDS Roles Framework in Respect to Teaching in Clinical Clerkships?

PubMed Central

Jilg, Stefanie; Möltner, Andreas; Berberat, Pascal; Fischer, Martin R.; Breckwoldt, Jan

2015-01-01

Background and aim: In German-speaking countries, the physicians’ roles framework of the “Canadian Medical Education Directives for Specialists” (CanMEDS) is increasingly used to conceptualize postgraduate medical education. It is however unclear, whether it may also be applied to the final year of undergraduate education within clinical clerkships, called “Practical Year” (PY). Therefore, the aim of this study was to explore how clinically active physicians at a university hospital and at associated teaching hospitals judge the relevance of the seven CanMEDS roles (and their (role-defining) key competencies) in respect to their clinical work and as learning content for PY training. Furthermore, these physicians were asked whether the key competencies were actually taught during PY training. Methods: 124 physicians from internal medicine and surgery rated the relevance of the 28 key competencies of the CanMEDS framework using a questionnaire. For each competency, following three aspects were rated: “relevance for your personal daily work”, “importance for teaching during PY”, and “implementation into actual PY teaching”. Results: In respect to the main study objective, all questionnaires could be included into analysis. All seven CanMEDS roles were rated as relevant for personal daily work, and also as important for teaching during PY. Furthermore, all roles were stated to be taught during actual PY training. The roles “Communicator”, “Medical Expert”, and “Collaborator” were rated as significantly more important than the other roles, for all three sub-questions. No differences were found between the two disciplines internal medicine and surgery, nor between the university hospital and associated teaching hospitals. Conclusion: Participating physicians rated all key competencies of the CanMEDS model to be relevant for their personal daily work, and for teaching during PY. These findings support the suitability of the Can

Teaching hospital financial status and patient outcomes following ACGME duty hour reform.

PubMed

Navathe, Amol S; Silber, Jeffrey H; Small, Dylan S; Rosen, Amy K; Romano, Patrick S; Even-Shoshan, Orit; Wang, Yanli; Zhu, Jingsan; Halenar, Michael J; Volpp, Kevin G

2013-04-01

To examine whether hospital financial health was associated with differential changes in outcomes after implementation of 2003 ACGME duty hour regulations. Observational study of 3,614,174 Medicare patients admitted to 869 teaching hospitals from July 1, 2000 to June 30, 2005. Interrupted time series analysis using logistic regression to adjust for patient comorbidities, secular trends, and hospital site. Outcomes included 30-day mortality, AHRQ Patient Safety Indicators (PSIs), failure-to-rescue (FTR) rates, and prolonged length of stay (PLOS). All eight analyses measuring the impact of duty hour reform on mortality by hospital financial health quartile, in postreform year 1 ("Post 1") or year 2 ("Post 2") versus the prereform period, were insignificant: Post 1 OR range 1.00-1.02 and Post 2 OR range 0.99-1.02. For PSIs, all six tests showed clinically insignificant effect sizes. The FTR rate analysis demonstrated nonsignificance in both postreform years (OR 1.00 for both). The PLOS outcomes varied significantly only for the combined surgical sample in Post 2, but this effect was very small, OR 1.03 (95% CI 1.02, 1.04). The impact of 2003 ACGME duty hour reform on patient outcomes did not differ by hospital financial health. This finding is somewhat reassuring, given additional financial pressure on teaching hospitals from 2011 duty hour regulations. © Health Research and Educational Trust.

Highlights of the COTH (Council of Teaching Hospitals) Survey of House Staff Policy, 1973

ERIC Educational Resources Information Center

Journal of Medical Education, 1973

1973-01-01

The Council of Teaching Hospitals (COTH) of the Association of American Medical Colleges has surveyed its member hospitals on the following subjects: trends in stipends, benefits, budget allocations, funding sources, extra-curricular employment, and night/weekend duty. (Author/PG)

Transfusion-transmitted malaria in Ghana.

PubMed

Owusu-Ofori, Alex K; Betson, Martha; Parry, Christopher M; Stothard, J Russell; Bates, Imelda

2013-06-01

In sub-Saharan Africa, the prevalence of malaria parasitemia in blood donors varies from 0.6% to 50%. Although the burden of TTM in malaria-endemic countries is unknown, it is recommended that all donated blood is screened for malaria parasites. This study aimed to establish the incidence of TTM and identify a suitable screening test. Pregnant women, children, and immunocompromised malaria-negative transfusion recipients in a teaching hospital in Ghana were recruited over the course of 1 year. Parasites detected in recipients within 14 days of the transfusion were genotyped and compared to parasites in the transfused blood. The presence of genotypically identical parasites in the recipient and the transfused blood confirmed transfusion-transmitted malaria. Four malaria screening tests were compared to assess their usefulness in the context of African blood banks. Of the 50 patients who received transfusions that were positive for Plasmodium falciparum by polymerase chain reaction (PCR), 7 recipients developed PCR-detectable parasitemia. In only 1 of the 50 recipients (2%) was the parasite identical to that in the transfused blood. The prevalence of P. falciparum malaria in transfused blood was 4.7% (21/445) by microscopy, 13.7% (60/440) by rapid diagnostic test, 18% (78/436) by PCR, and 22.2% (98/442) by enzyme immunoassay. Although malaria parasites are commonly detected in blood donors in malaria-endemic areas, transfusion-transmitted malaria occurs infrequently. Policies recommend screening blood donors for malaria, but none of the commonly used methods is sufficiently sensitive to be used by blood banks in malaria-endemic countries.

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

PubMed

Wray, J L; Sadowski, S M

1998-04-01

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

A Teaching Hospital Medical Clinic: Secondary Rather than Primary Care.

ERIC Educational Resources Information Center

Fletcher, Suzanne; And Others

1979-01-01

A review of 287 patient visits to a teaching hospital 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…

Relationship between organizational structure and creativity in teaching hospitals.

PubMed

Rezaee, Rita; Marhamati, Saadat; Nabeiei, Parisa; Marhamati, Raheleh

2014-07-01

Organization structure and manpower constitute two basic components of anorganization and both are necessary for stablishing an organization. The aim of this survey was to investigate the type of the organization structure (mechanic and organic) from viewpoint of senior and junior managers in Shiraz teaching hospitals and creativity in each of these two structures. In this cross-sectional and descriptive-analytic study, organization structure and organizational creation questionnaires were filled out by hospital managers. According to the statistical consultation and due to limited target population, the entire study population was considered as sample. Thus, the sample size in this study was 84 (12 hospitals and every hospital, n = 7). For data analysis, SPSS 14 was used and Spearman correlation coefficient and t-test were used. RESULTS showed that there is a negative association between centralization and complexity with organizational creation and its dimensions. Also there was a negative association between formalization and 4 organizational creation dimensions: reception change, accepting ambiguity, abet new view and less control outside (p=0.001). The results of this study showed that the creation in hospitals with organic structure is more than that in hospitals with mechanic structure.

Relationship between organizational structure and creativity in teaching hospitals

PubMed Central

REZAEE, RITA; MARHAMATI, SAADAT; NABEIEI, PARISA; MARHAMATI, RAHELEH

2014-01-01

Introduction: Organization structure and manpower constitute two basic components of anorganization and both are necessary for stablishing an organization. The aim of this survey was to investigate the type of the organization structure (mechanic and organic) from viewpoint of senior and junior managers in Shiraz teaching hospitals and creativity in each of these two structures. Methods: In this cross-sectional and descriptive-analytic study, organization structure and organizational creation questionnaires were filled out by hospital managers. According to the statistical consultation and due to limited target population, the entire study population was considered as sample. Thus, the sample size in this study was 84 (12 hospitals and every hospital, n = 7). For data analysis, SPSS 14 was used and Spearman correlation coefficient and t-test were used. Results: Results showed that there is a negative association between centralization and complexity with organizational creation and its dimensions. Also there was a negative association between formalization and 4 organizational creation dimensions: reception change, accepting ambiguity, abet new view and less control outside (p=0.001). Conclusion: The results of this study showed that the creation in hospitals with organic structure is more than that in hospitals with mechanic structure. PMID:25512934

Current practice of preoperative fasting: a nationwide survey in Japanese anesthesia-teaching hospitals.

PubMed

Shime, Nobuaki; Ono, Akira; Chihara, Eiichi; Tanaka, Yoshifumi

2005-01-01

We conducted a nationwide survey to investigate the current practice of the preoperative fasting period in Japanese anesthesia-teaching hospitals. Acceptance of the clinical practice guideline published by the American Society of Anesthesiologists (ASA) was also surveyed. A written type of questionnaire was mailed to 795 teaching hospitals. The response rate of the questionnaires was 57%. Most (>90%) of the respondents had been applying a longer fasting period than the ASA-recommended minimum period specifically in adults; the median duration of fasting was 12-13 h for solids and 6-9 h for liquids. Children or infants were allowed a more liberalized fasting period, frequently being permitted an oral intake of clear fluids up to 3 h before anesthesia. The incidence of pulmonary aspiration was 1/12,500 general anesthesia cases, and application of the ASA guideline appeared not to affect the incidence. Japanese anesthesiologists were still reluctant to depart from their traditional long fasting periods, as most of them could find little benefit in reducing the fasting periods. The long preoperative fasting period is still common practice in Japanese anesthesia-teaching hospitals. A national guideline for a preoperative fasting policy is worth exploring to change the current practice.

Prevalence of obesity and systemic hypertension among diabetes mellitus patients attending an out-patient diabetes clinic in a Ghanaian Teaching Hospital.

PubMed

Mogre, Victor; Abedandi, Robert; Salifu, Zenabankara S

2014-01-01

Diabetes Mellitus is now a prevalent disease in both developed and developing countries. Overweight/obesity and hypertension are potential modifiable risk factors for diabetes mellitus and persist during the course of the disease. This study was aimed at reporting the prevalence of overweight/obesity and systemic hypertension and their association to blood glucose levels in persons with diabetes mellitus attending a diabetic clinic in Ghanaian Teaching Hospital. This cross-sectional study was conducted among 100 previously diagnosed diabetes mellitus patients attending a diabetic clinic at the Tamale Teaching Hospital, Ghana. Anthropometric variables of age, weight and height were measured with appropriate instruments, computed into BMI and classified according to WHO classifications. Systolic and diastolic blood pressures were measured by an appropriate instrument and classified by WHO standards. Fasting plasma glucose levels of the study participants were recorded from their personal health folder. All data was analysed by GraphPad prism version 5. In general, 7.0% of the participants were underweight and 32.0% were overweight or obese. The mean±SD weight, height and BMI of the participants were 67.53±13.32, 1.68±0.12 and 24.18±5.32. Twenty-one percent of the studied participants were hypertensive. Mean±SD fasting plasma glucose of 7.94±2.82 was observed among the diabetic patients. As the prevalence of hyperglycaemia was higher among patients aged ≤40 years (88.9% vs. 75.8%), normoglycaemia (11.1% vs. 24.2%) was higher among those over 40 years. The differences were not significant. The prevalence of hyperglycaemia was significantly higher in participants with overweight/obese (0.0% vs. 41.6%, p<0.0001) than those with underweight (26.1% vs. 1.3%, p=0.0005) and normal weight (73.9% vs. 57.1%, p=0.2228). A high prevalence of overweight/obesity and systemic hypertension was found. Hyperglycaemia was more prevalent among overweight/obese participants

Teaching the teacher program to assist nurse managers to educate nursing staff in Ecuadorian hospitals.

PubMed

Palmer, Sheri P; Heaston, Sondra

2009-03-01

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

Determining Distance Education Students' Readiness for Mobile Learning at University of Ghana Using the Theory of Planned Behavior

ERIC Educational Resources Information Center

Tagoe, Michael Ayitey; Abakah, Ellen

2014-01-01

The use of mobile technologies in the classroom is transforming teaching and learning in higher institutions. This study investigated University of Ghana Distance Education students' perceptions toward mobile learning. The paper using the theory of planned behaviour (TPB) explained how students' beliefs influenced students' intention to adopt…

Experiences of frontline nursing staff on workplace safety and occupational health hazards in two psychiatric hospitals in Ghana.

PubMed

Alhassan, Robert Kaba; Poku, Kwabena Adu

2018-06-06

Psychiatric hospitals need safe working environments to promote productivity at the workplace. Even though occupational health and safety is not completely new to the corporate society, its scope is largely limited to the manufacturing/processing industries which are perceived to pose greater dangers to workers than the health sector. This paper sought to explore the experiences of frontline nursing personnel on the occupational health and safety conditions in two psychiatric hospitals in Ghana. This is an exploratory cross-sectional study among 296 nurses and nurse-assistants in Accra (n = 164) and Pantang (n = 132) psychiatric hospitals using the proportional stratified random sampling technique. Multivariate Ordinary Least Squares (OLS) regression test was conducted to ascertain the determinants of staff exposure to occupational health hazards and the frequency of exposure to these occupational health hazards on daily basis. Knowledge levels on occupational health hazards was high in Accra and Pantang psychiatric hospitals (i.e. 92 and 81% respectively), but barely 44% of the 296 interviewed staff in the two hospitals said they reported their most recent exposure to an occupational health hazard to hospital management. It was found that staff who worked for more years on the ward had higher likelihood of exposure to occupational health hazards than those who worked for lesser years (p = 0.002). The category of occupational health hazards reported most were the physical health hazards. Psychosocial hazards were the least reported health hazards. Frequency of exposure to occupational health hazards on daily basis was positively associated with work schedules of staff particularly, staff on routine day schedule (Coef = 4.49, p = 0.011) and those who alternated between day and night schedules (Coef = 4.48, p = 0.010). Occupational health and safety conditions in the two hospitals were found to be generally poor. Even though majority of

Introduction of Geographical Information Systems (GIS) in Technical University Education in Ghana: Challenges and the Way Forward

ERIC Educational Resources Information Center

Acquah, Prince C.; Asamoah, Jack N.; Konadu, Daniel D.

2017-01-01

Geographic Information System (GIS) continue to play very important role in improving spatial thinking skills of graduates from higher educational institutions. However, teaching and learning of GIS at the technical university level in Ghana remains very limited due to some implementation challenges. This paper reviews the implementation of GIS in…

Views of Teacher-Trainees on Clothing and Textiles Education in Two Teacher Education Universities in Ghana

ERIC Educational Resources Information Center

Forster, Phyllis; Quarcoo, Rosemary; Ashong, Elizabeth Lani; Ghanney, Victoria

2017-01-01

The study explored the views of teacher-trainees on Clothing and Textiles (C&T) education in two teacher education universities in Ghana. The objectives were to find out whether pre-tertiary Sewing/C&T lessons provided them with small-scale business skills, and foundation for higher education, they could teach Sewing/C&T competently on…

The introduction of a midwife-led obstetric triage system into a regional referral hospital in Ghana.

PubMed

Floyd, Liz; Bryce, Fiona; Ramaswamy, Rohit; Olufolabi, Adeyemi; Srofenyoh, Emmanuel; Goodman, David; Pearson, Nancy; Morgan, Kerry; Tetteh, Cecilia; Ahwireng, Victoria; Owen, Medge

2018-06-01

to introduce and embed a midwife-led obstetric triage system in a busy labour ward in Accra, Ghana to improve the quality of care and to reduce delay. the study utilized a participatory action research design. Local staff participated in baseline data collection, the triage training course design and delivery, and post-training monitoring and evaluation. a regional referral hospital in Accra, Ghana undertaking 11,032 deliveries in 2012. all midwives and medical staff. measurements included maternal health outcomes, observations of labour ward activity, structured assessments of midwife actions during admission, waiting times, focus group discussions, and learning needs assessments which informed the course content. During training, two quality improvement tools were developed; coloured risk acuity wristbands and a one page triage assessment form. Participants measured compliance and accuracy in the use of these tools following course completion. initially, no formal triage system was in place. The environment was chaotic with poor compliance to existing protocols. Sixty-two midwives received triage training between 2013 and 2014. Two Triage Champions became responsible for triage implementation, monitoring and further training. Following training, the 'in-charge' midwives recorded a cumulative average of 83.4% of women wearing coloured wristbands. A separate audit by the Triage Champions found that 495/535 (93%) of the wristbands were correctly applied based on the diagnosis. Quarterly monitoring of the triage assessment forms by Kybele trainers, showed that 92% recorded the risk acuity colour, 85% a 'working diagnosis' and 82% a 'plan.' Median (interquartile range) waiting times were reduced from 40 (15-100) to 29 (11-60) minutes (p = 007). Twenty of 25 of the staff reported that the wristbands were helpful. an interactive triage training course led to the development of a triage assessment form and the use of coloured patient wristbands which resulted in delay

[Ophthalmological screening via a hospital boat: field study for planning future health care services in remote villages at the Volta Lake in Ghana].

PubMed

Frimpong-Boateng, A; Rüfer, F; Fiadoyor, S; Nkrumah-Mills, J; Mensah-Tetteh, F; Kudoadzi, N; Roider, J

2009-09-01

A maiden voyage on a hospital boat was carried out to determine the spectrum of ophthalmological diseases in a rural and secluded area on the Volta Lake in Ghana in order to improve future health care services. Portable water, electricity, and an operating theatre were available on the hospital boat. Visual acuity was determined using Snellen E charts, and Lea boards were used in children up to the age of 4 years. The anterior segments were examined using hand held slit lamps. After pupil dilation indirect binocular ophthalmoscopy was performed and tonometry was carried out using a Perkins tonometer A total of 1,246 citizens were examined. The mean age was 23.7 years and the mean visual acuity was 6/6 (log MAR 0.0+/-0.3. The main cause of blindness was a cataract with 45.8%, followed by pathological conditions of the optic disc with 29.2%. The hospital boat is suitable for screening and for carrying out minor extraocular operations. Looking just at the technical aspect, it is possible to perform major intraocular operations on the hospital boat. However, due to the lack of immediate follow-up visits, it is advisable to carry out major operations in the next eye clinic on shore.

Assessment and management of burn pain at the Komfo Anokye Teaching Hospital: a best practice implementation project.

PubMed

Bayuo, Jonathan; Munn, Zachary; Campbell, Jared

2017-09-01

Pain management is a significant issue in health facilities in Ghana. For burn patients, this is even more challenging as burn pain has varied facets. Despite the existence of pharmacological agents for pain management, complaints of pain still persist. The aim of this project was to identify pain management practices in the burns units of Komfo Anokye Teaching Hospital, compare these approaches to best practice, and implement strategies to enhance compliance to standards. Ten evidence-based audit criteria were developed from evidence summaries. Using the Joanna Briggs Institute Practical Application of Clinical Evidence Software (PACES), a baseline audit was undertaken on a convenience sample of ten patients from the day of admission to the seventh day. Thereafter, the Getting Research into Practice (GRiP) component of PACES was used to identify barriers, strategies, resources and outcomes. After implementation of the strategies, a follow-up audit was undertaken using the same sample size and audit criteria. The baseline results showed poor adherence to best practice. However, following implementation of strategies, including ongoing professional education and provision of assessment tools and protocols, compliance rates improved significantly. Atlhough the success of this project was almost disrupted by an industrial action, collaboration with external bodies enabled the successful completion of the project. Pain management practices in the burns unit improved at the end of the project which reflects the importance of an audit process, education, providing feedback, group efforts and effective collaboration.

Options in human papillomavirus (HPV) detection for cervical cancer screening: comparison between full genotyping and a rapid qualitative HPV-DNA assay in Ghana.

PubMed

Obiri-Yeboah, Dorcas; Adu-Sarkodie, Yaw; Djigma, Florencia; Akakpo, Kafui; Aniakwa-Bonsu, Ebenezer; Amoako-Sakyi, Daniel; Jacques, Simpore; Mayaud, Philippe

2017-01-01

Modern cervical cancer screening increasingly relies on the use of molecular techniques detecting high-risk oncogenic human papillomavirus (hr-HPV). A major challenge for developing countries like Ghana has been the unavailability and costs of HPV DNA-based testing. This study compares the performance of care HPV, a semi-rapid and affordable qualitative detection assay for 14 hr-HPV genotypes, with HPV genotyping, for the detection of cytological cervical squamous intraepithelial lesions (SIL). A study comparing between frequency matched HIV-1 seropositive and HIV-seronegative women was conducted in the Cape Coast Teaching Hospital, Ghana. A systematic sampling method was used to select women attending clinics in the hospital. Cervical samples were tested for HPV by care HPV and Anyplex-II HPV28 genotyping assay, and by conventional cytology. A total of 175 paired results (94 from HIV-1 seropositive and 81 from HIV-seronegative women) were analyzed based on the ability of both tests to detect the 14 hr-HPV types included in the care HPV assay. The inter-assay concordance was 94.3% (95%CI: 89.7-97.2%, kappa = 0.88), similar by HIV serostatus. The care HPV assay was equally sensitive among HIV-1 seropositive and seronegative women (97.3% vs. 95.7%, p  = 0.50) and slightly more specific among HIV-seronegative women (85.0% vs. 93.1%, p  = 0.10). care HPV had good sensitivity (87.5%) but low specificity (52.1%) for the detection of low SIL or greater lesions, but its performance was superior to genotyping (87.5 and 38.8%, respectively). Reproducibility of care HPV, tested on 97 samples by the same individual was 82.5% (95%CI: 73.4-89.4%). The performance characteristics of care HPV compared to genotyping suggest that this simpler and cheaper HPV detection assay could offer a suitable alternative for HPV screening in Ghana.

Teaching Interactive Art Lessons with Recycled Waste Materials as Instructional Resources

ERIC Educational Resources Information Center

Yeboah, Rita; Asante, Eric Appau; Opoku-Asare, Nana Afia

2016-01-01

The study examines the use of waste materials as instructional resources in teaching and learning Art lessons. Primary, Junior and Senior High School Art teachers in Ghana mostly teach their lessons without instructional resources because the government is not able to provide materials to create the needed resources. The study therefore explored…

Ambulatory surgery and anaesthesia in HUKM, a teaching hospital in Malaysia: the first two years experience.

PubMed

Norsidah, A M; Yahya, N; Adeeb, N; Lim, A L

2001-03-01

Ambulatory or day care surgery is still in its infancy in this part of the world. Our newly built university affiliated hospital started its Day Surgery Centre in February 1998. It is the first multidisciplinary ambulatory surgery centre in a teaching hospital in the country. It caters for Orthopaedic surgery, Urology, Plastic surgery, Otorhinolaryngology, General surgery, Paediatric surgery and Ophthalmology. We have done 2,604 cases and our unanticipated admission rate is less than 2%. There has been no major morbidity or mortality. The problems of setting up a multidisciplinary ambulatory centre in a teaching hospital are discussed.

Views of Family Medicine Trainees of a Teaching Hospital in Riyadh regarding their Hospital Rotations: A Qualitative Study.

PubMed

Alquaiz, Aljohara M; Abdulghani, Hamza M; Karim, Syed Irfan; Qureshi, Riaz

2013-01-01

To explore Family Medicine Trainees views regarding the hospital component of their Family Medicine (FM) training program. This is a qualitative focus group discussion based study. Thirteen trainees, eight from final year of FM training program and five from third year of the same program participated in the study. The structure for discussion included a previously distributed and completed questionnaire that included three sections. The first section was evaluation of the satisfaction of trainees with the different hospital specialties rotations. The second section related to reasons for rating the different rotations as excellent and very good. The third section related to deficiencies in training for those rotations which received a score of 3-5. The items in the questionnaire were utilized in the focus group discussion. Two facilitators who were investigators facilitated the discussion. The data was qualitatively analyzed to identify emergent themes and subthemes that described the trainees' views. The trainees highlighted the following views: Teaching in the hospital component is not relevant to the needs of Family Medicine trainees. Duration of the hospital posts should be reviewed. Emphasis should be on out-patient clinics rather than in-patient. More emphasis must be given to procedural skills, minor surgery and teaching in clinical contexts. Hospital training component of the Family Medicine training program should be reviewed, as the structure and its implementation doesn't reflect the views of trainees regarding its relevance to their day to day practice.

Teaching Hospital Financial Status and Patient Outcomes Following ACGME Duty Hour Reform

PubMed Central

Navathe, Amol S; Silber, Jeffrey H; Small, Dylan S; Rosen, Amy K; Romano, Patrick S; Even-Shoshan, Orit; Wang, Yanli; Zhu, Jingsan; Halenar, Michael J; Volpp, Kevin G

2013-01-01

Objective To examine whether hospital financial health was associated with differential changes in outcomes after implementation of 2003 ACGME duty hour regulations. Data Sources/Study Setting Observational study of 3,614,174 Medicare patients admitted to 869 teaching hospitals from July 1, 2000 to June 30, 2005. Study Design Interrupted time series analysis using logistic regression to adjust for patient comorbidities, secular trends, and hospital site. Outcomes included 30-day mortality, AHRQ Patient Safety Indicators (PSIs), failure-to-rescue (FTR) rates, and prolonged length of stay (PLOS). Principal Findings All eight analyses measuring the impact of duty hour reform on mortality by hospital financial health quartile, in postreform year 1 (“Post 1”) or year 2 (“Post 2”) versus the prereform period, were insignificant: Post 1 OR range 1.00–1.02 and Post 2 OR range 0.99–1.02. For PSIs, all six tests showed clinically insignificant effect sizes. The FTR rate analysis demonstrated nonsignificance in both postreform years (OR 1.00 for both). The PLOS outcomes varied significantly only for the combined surgical sample in Post 2, but this effect was very small, OR 1.03 (95% CI 1.02, 1.04). Conclusions The impact of 2003 ACGME duty hour reform on patient outcomes did not differ by hospital financial health. This finding is somewhat reassuring, given additional financial pressure on teaching hospitals from 2011 duty hour regulations. PMID:22862427

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

PubMed

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

2016-01-01

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

Investigating parents/caregivers financial burden of care for children with non-communicable diseases in Ghana.

PubMed

Abuosi, Aaron A; Adzei, Francis A; Anarfi, John; Badasu, Delali M; Atobrah, Deborah; Yawson, Alfred

2015-11-16

The introduction of the Ghana national health insurance scheme (NHIS) has led to progressive and significant increase in utilization of health services. However, the financial burden of caring for children with non-communicable diseases (NCDs) under the dispensation of the NHIS, especially during hospitalization, is less researched. This paper therefore sought to assess the financial burden parents/caregivers face in caring for children hospitalized with NCDs in Ghana, in the era of the Ghana NHIS. We conducted a cross-sectional survey of 225 parents or caregivers of children with NCDS hospitalized in three hospitals. Convenience sampling was used to select those whose children were discharged from hospital after hospitalization. Descriptive statistics such as frequencies and chi-square and logistic regression were used in data analysis. The main outcome variable was financial burden of care, proxied by cost of hospitalization. The independent variable included socio-economic and other indicators such as age, sex, income levels and financial difficulties faced by parents/caregivers. The study found that over 30 % of parents/caregivers spend more than Gh¢50 (25$) as cost of treatment of children hospitalized with NCDs; and over 40 % of parents/caregivers also face financial difficulties in providing health care to their wards. It was also found that even though many children hospitalized with NCDs have been covered by the NHIS, and that the NHIS indeed, provides significant financial relief to parents in the care of children with NCDs, children who are insured still pay out-of-pocket for health care, in spite of their insurance status. It was also found that there is less support from relatives and friends in the care of children hospitalized with NCDs, thus exacerbating parents/caregivers financial burden of caring for the children. Even though health insurance has proven to be of significant relief to the financial burden of caring for children with NCDs

A survey on depression among infertile women in Ghana.

PubMed

Alhassan, Abass; Ziblim, Abdul Razak; Muntaka, Sirina

2014-03-10

The desire of many young women to become parents may be influenced by the premium placed on children by society. In Africa, children are highly valued for social, cultural and economic reasons. Infertile and childless women in Africa are therefore confronted with a series of societal discrimination and stigmatization which may lead to psychological disorders such as anxiety and depression. Even though some research has been done on the prevalence of infertility in Ghana, very little is known about the psychological impact of childlessness among infertile women. The present study aimed to examine prevalence and severity of depression in relation to age, type of infertility and duration of infertility in Ghanaian infertile women. A total of 100 infertile women who met the selection criteria and had agreed to participate in the study were interviewed using the Beck Depression Inventory questionnaire from December 2012 to April 2013 at the Tamale Teaching Hospital, Tamale/Ghana. Data concerning socio-demographic characteristics such as age, monthly income, duration of infertility, marital status, educational level, number of previous conception, number of previous children, religion, as well as occupation of the respondents were recorded. The prevalence of depression among the women was 62.0% with the level of depression showing a significant positive correlation with age of the women and the duration of infertility. The level of depression was significantly higher among subjects with low or no formal education and among the unemployed. Women with primary infertility also presented with high depression scores as measured by BDI. In conclusion, the prevalence of depression among the infertile women is high, especially among infertile women age 26 and above, those who are less educated, those with primary infertility, as well as those who have been diagnosed as infertile for more than 3 years. Interventions to decrease and prevent the development of severe depression

High rate of burnout among anaesthesiologists in Belgrade teaching hospitals: Results of a cross-sectional survey.

PubMed

Milenović, Miodrag; Matejić, Bojana; Vasić, Vladimir; Frost, Elizabeth; Petrović, Nataša; Simić, Dušica

2016-03-01

Decisions by anaesthesiologists directly impact the treatment, safety, recovery and quality of life of patients. Physical or mental collapse due to overwork or stress (burnout) in anaesthesiologists may, therefore, be expected to negatively affect patients, departments, healthcare facilities and families. To evaluate the prevalence of burnout among anaesthesiologists in Belgrade public teaching hospitals. A cross-sectional survey. Anaesthesiologists in 10 Belgrade teaching hospitals. Burnout was assessed using Maslach Burnout Inventory-Human Services Survey. The response rate was 76.2% (205/272) with the majority of respondents women (70.7%). The prevalence of total burnout among anaesthesiologists in Belgrade teaching hospitals was 6.34%. Measured level of burnout as assessed by high emotional exhaustion, high depersonalisation and low personal accomplishment was 52.7, 12.2 and 28.8%, respectively. More than a quarter of the studied population responded in each category with symptoms of moderate burnout. We detected that sex, additional academic education, marital status and working conditions were risk factors for emotional exhaustion and depersonalisation. Ageing increased the likelihood of burnout by 21.3% with each additional year. Shorter professional experience and increased educational accomplishment increased the risk of total burnout by 272%. Burnout rates in Belgrade teaching hospitals among anaesthesiologists are higher than in foreign hospitals. Emotional and/or physical breakdowns can have serious effects when these individuals care for patients in extremely stressed situations that may occur perioperatively. Causes for burnout should be examined more closely and means implemented to reverse this process.

Student Loans in Ghana.

ERIC Educational Resources Information Center

Kotey, N.

1992-01-01

This article summarizes the current pattern of finance of higher education in Ghana, gives a brief history of student loans in Ghana, and describes a new program, which is administered by the Social Security and National Insurance Trust and is expected to result in a higher rate of loan repayment. (Author/DB)

Assessment of infection control practices in teaching hospitals of Quetta.

PubMed

Anwar, Muhammad; Majeed, Abdul; Saleem, Rana Muhammad; Manzoor, Farkhanda; Sharif, Saima

2016-08-01

To identify the gaps in infection control and prevention practices in teaching hospitals. This cross-sectional study was conducted at Bolan Medical Complex and Sandeman Medical College Hospital, Quetta, from August 2012 to January 2013.The study comprised members (n=7) of infection control committee who were interviewed through a self-developed, closed-ended questionnaire and their perception regarding infection control and prevention was recorded. Data was analysed using SPSS 16. Only 3(42.9%) of the committee members believed that the administrative factors for causing hospital-acquired infections were nurse-patient ratio. On the patient care side, 1(14.3%) participants at one of the hospitals attributed infections to antibiotic use, 5(71.4%) to invasive medical device and 1(14.3%) to other factors. Poor perception held by the members of infection control committee was the basic cause of bad outcome. Capacity-building of all the stakeholders is required.

Injuries among Artisanal and Small-Scale Gold Miners in Ghana

PubMed Central

Kyeremateng-Amoah, E.; Clarke, Edith E.

2015-01-01

Artisanal and small-scale gold miners are confronted with numerous hazards often resulting in varying degrees of injuries and fatalities. In Ghana, like many developing countries, there is paucity of information on the causes and nature of the accidents that result in the injuries. The study was a retrospective, cross sectional type that examined the records of injuries of artisanal and small-scale gold miners presented to the emergency department of a district hospital in the Eastern Region of Ghana from 2006 to 2013. The causes, types, and outcomes of reported injuries were analyzed for 72 cases. Occurrences of mining accidents reported in selected Ghanaian media during the year 2007–2012 were also analyzed to corroborate the causes of the accidents. Fractures and contusions constituted the most frequently occurring injuries, with collapse of the mine pits and falls being the most frequent cause of accidents reported both by the hospital and media records. This study shows that though varied degrees of injuries occur among the miners, the potential for serious injuries is substantial. Measures to reduce the incidence of injuries and fatalities should include education and training on the use of safe working tools and means of creating a safe working environment. PMID:26404345

The Implementation of the Basic School English Curriculum: The Case of the Cape Coast Metropolis in Ghana

ERIC Educational Resources Information Center

Torto, Gertrude Afiba

2017-01-01

The English language curriculum for primary schools in Ghana spells out the various aspects, topics and sub topics that teachers must teach the child within a specified time. The syllabus again specifies the various topics and sub topics that should be taught in an integrated manner so as to enhance meaningful learning. For this meaningful…

"Ghana faces ecological disaster".

PubMed

Asmah, G F

1990-05-01

The rate of deforestation in Ghana is alarming and urgent steps need to be taken to reverse the trend, Robert D. Mann, a British tropical agriculturist, has warned. He says, "There will be further disintegration of the local climate, deterioration of soil fertility and reduced food-crop production, if the present trend of denudation by felling trees and uncontrolled bush fires is not halted and reversed." Mann, who has conducted research on "deforestation, drought and famine in Africa" was in Ghana recently to speak on the "role of the Church in West Africa in stimulating action to combat desertification". Representatives of protestant churches in Ghana, Togo, Liberia, Gambia, Nigeria, Cote d'Ivoire and Sierra Leone attended the 3-day conference which was organized by the Overseas Department of the British Methodist Church. It was to enable participants to share perspectives on the nature, scale and seriousness of the deforestation problem. Participants also exchanged experiences on village-based projects for promoting tree planting and agro-forestry, and developed strategies for the rural development programs. Robert Mann noted that Ghana was not only affected by its proximity to the Sahel, but also by its own deforestation. The situation in Ghana, once renowned for her extensive forests and woodland, has now drastically changed. By 1980/81 the area of closed forest had been reduced to 17,000 sq km from 47,9000 sq km in 1937/38. He said in 1939 the volume of wood exported from Ghana was 42,450 cubic meters but it rose to 1,471,600 cubic meters by 1987. Such activities, Mann said, put severe strain on the environment and affected both the economy and sociocultural basis of the country. full text

Equipment and Energy Usage in a Large Teaching Hospital in Norway.

PubMed

Rohde, Tarald; Martinez, Robert

2015-01-01

This article presents a study of how equipment is used in a Norwegian University hospital and suggests ways to reduce hospital energy consumption. Analysis of energy data from Norway's newest teaching hospital showed that electricity consumption was up to 50% of the whole-building energy consumption. Much of this is due to the increasing energy intensity of hospital-specific equipment. Measured power and reported usage patterns for equipment in the studied departments show daytime energy intensity of equipment at about 28.5 kBTU/ft2 per year (90 kWh/m2 per year), compared to building code standard value of only 14.9 kBTU/ft2 (47 kWh/m2 per year) for hospitals. This article intends to fill gaps in our understanding of how users and their equipment affect the energy balance in hospitals and suggests ways in which designers and equipment suppliers can help optimize energy performance while maintaining quality in the delivery of health services.

Case study: the Stanford University School of Medicine and its teaching hospitals.

PubMed

Pizzo, Philip A

2008-09-01

There is wide variation in the governance and organization of academic health centers (AHCs), often prompted by or associated with changes in leadership. Changes at AHCs are influenced by institutional priorities, economic factors, competing needs, and the personality and performance of leaders. No organizational model has uniform applicability, and it is important for each AHC to learn what works or does not on the basis of its experiences. This case study of the Stanford University School of Medicine and its teaching hospitals--which constitute Stanford's AHC, the Stanford University Medical Center--reflects responses to the consequences of a failed merger of the teaching hospitals and related clinical enterprises with those of the University of California-San Francisco School of Medicine that required a new definition of institutional priorities and directions. These were shaped by a strategic plan that helped define goals and objectives in education, research, patient care, and the necessary financial and administrative underpinnings needed. A governance model was created that made the medical school and its two major affiliated teaching hospitals partners; this arrangement requires collaboration and coordination that is highly dependent on the shared objectives of the institutional leaders involved. The case study provides the background factors and issues that led to these changes, how they were envisioned and implemented, the current status and challenges, and some lessons learned. Although the current model is working, future changes may be needed to respond to internal and external forces and changes in leadership.

Ghana Country Analysis Brief

EIA Publications

2016-01-01

Ghana is a small oil and natural gas producer in West Africa. Oil and natural gas production are both expected to increase within the next five years with the start of new offshore projects. Ghana exports its crude oil production to international markets, while the country’s natural gas production is used to fuel its domestic power plants.

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

PubMed Central

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

2016-01-01

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

The intricate relationship between a medical school and a teaching hospital: A case study in Uganda.

PubMed

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

2014-01-01

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

Evaluation of the medical records system in an upcoming teaching hospital-a project for improvisation.

PubMed

Kumar, B Deepak; Kumari, C M Vinaya; Sharada, M S; Mangala, M S

2012-08-01

The medical records system of an upcoming teaching hospital in a developing nation was evaluated for its accessibility, completeness, physician satisfaction, presence of any lacunae, suggestion of necessary steps for improvisation and to emphasize the importance of Medical records system in education and research work. The salient aspects of the medical records department were evaluated based on a questionnaire which was evaluated by a team of 40 participants-30 doctors, 5 personnel from Medical Records Department and 5 from staff of Hospital administration. Most of the physicians (65%) were partly satisfied with the existing medical record system. 92.5% were of the opinion that upgradation of the present system is necessary. The need of the hour in the present teaching hospital is the implementation of a hospital-wide patient registration and medical records re-engineering process in the form of electronic medical records system and regular review by the audit commission.

Job satisfaction of nurses in Jimma University Specialized Teaching Hospital, Ethiopia.

PubMed

Negussie, Nebiat

2016-03-01

In Ethiopia nurses have played a very important role in providing timely and quality health service in healthcare organizations. However, there is a limited literature in the area of nurses' job satisfaction in Ethiopian public hospitals. The objective of this research is to measure job satisfaction of nurses in Jimma University Specialized Teaching Hospital and to determine the influencing factors. A cross-sectional survey was conducted from January 2012 to June 2012 in Jimma University Specialized Teaching Hospital. All full-time nurses with nonsupervisory management position and more than 1 year of work experience were invited to participate in the study. Minnesota Satisfaction Questionnaire was used to collect the data. A total of 175 copies of the questionnaires were returned out of 186 copies distributed to the respondents. The results indicated that nurses were not satisfied by their job (mean=2.21, SD=0.52). Remuneration (r=0.71, P<0.01) and job advancement (r=0.69, P<0.01) were statically significant and strongly correlated with nurses' job satisfaction. Job security was associated with highest satisfaction (r=0.41, P<0.05) CONCLUSION AND RECOMMENDATIONS: Remuneration and job advancement were the most important factors for nurses' job satisfaction. Hospital administrators as well as health policy makers need to address the two major identified sources of nurses' job dissatisfaction in the study (i.e. remuneration and narrow opportunity of job advancement) and take appropriate measures to overcome their consequences.

The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients' views.

PubMed

Barke, Antonia; Nyarko, Seth; Klecha, Dorothee

2011-11-01

Stigma is a frequent accompaniment of mental illness leading to a number of detrimental consequences. Most research into the stigma connected to mental illness was conducted in the developed world. So far, few data exist on countries in sub-Saharan Africa and no data have been published on population attitudes towards mental illness in Ghana. Even less is known about the stigma actually perceived by the mentally ill persons themselves. A convenience sample of 403 participants (210 men, mean age 32.4±12.3 years) from urban regions in Accra, Cape Coast and Pantang filled in the Community Attitudes towards the Mentally Ill (CAMI) questionnaire. In addition, 105 patients (75 men, mean age 35.9±11.0 years) of Ghana's three psychiatric hospitals (Accra Psychiatry Hospital, Ankaful Hospital, Pantang Hospital) answered the Perceived Stigma and Discrimination Scale. High levels of stigma prevailed in the population as shown by high proportions of assent to items expressing authoritarian and socially restrictive views, coexisting with agreement with more benevolent attitudes. A higher level of education was associated with more positive attitudes on all subscales (Authoritarianism, Social Restrictiveness, Benevolence and Acceptance of Community Based Mental Health Services). The patients reported a high degree of experienced stigma with secrecy concerning the illness as a widespread coping strategy. Perceived stigma was not associated with sex or age. The extent of stigmatising attitudes within the urban population of Southern Ghana is in line with the scant research in other countries in sub-Saharan Africa and mirrored by the experienced stigma reported by the patients. These results have to be seen in the context of the extreme scarcity of resources within the Ghanaian psychiatric system. Anti-stigma efforts should include interventions for mentally ill persons themselves and not exclusively focus on public attitudes.

[Nursing personnel downsizing in a teaching hospital].

PubMed

Fakih, Flávio Trevisan; Carmagnani, Maria Isabel Sampaio; Cunha, Isabel Cristina Kowal Olm

2006-01-01

The objective of this study was to adjust the downsizing of nursing personnel in a teaching hospital to the resolution of Federal Nursing Council no. 293/2004. The classification of patients in levels of complexity care was done and the required time for the nurse care also was verified. The present number of employees was compared to the measured one. The outcomes showed the levels of patients'care complexity is on intermediate care (42%), and the required time to the nurse care was greater on intensive care patients (42%). The present staff has a deficit of 205 nurses and an exceding of 284 professionals of techinical college level.

Hospitable Kinship in Theological Education: Cross-Cultural Perspectives on Teaching and Learning as Gift Exchange

ERIC Educational Resources Information Center

Wimberly, Anne E. Streaty

2004-01-01

Using an autobiographical approach for pedagogical reflection, the author raises questions about how to include "hospitable kinship" and "gift exchange" in teaching and learning. Her experience with a Zimbabwean community circle of hospitable kinship has prompted her to consider how this method of community formation might be…

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

PubMed Central

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

2015-01-01

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

Breast Cancer and African Ancestry: Lessons Learned at the 10-Year Anniversary of the Ghana-Michigan Research Partnership and International Breast Registry

PubMed Central

Jiagge, Evelyn; Oppong, Joseph Kwaku; Bensenhaver, Jessica; Aitpillah, Francis; Gyan, Kofi; Kyei, Ishmael; Osei-Bonsu, Ernest; Adjei, Ernest; Ohene-Yeboah, Michael; Toy, Kathy; Jackson, Karen Eubanks; Akpaloo, Marian; Acheampong, Dorcas; Antwi, Beatrice; Agyeman, Faustina Obeng; Alhassan, Zainab; Fondjo, Linda Ahenkorah; Owusu-Afriyie, Osei; Brewer, Robert Newman; Gyamfuah, Amma; Salem, Barbara; Johnson, Timothy; Wicha, Max; Merajver, Sofia; Kleer, Celina; Pang, Judy; Amankwaa-Frempong, Emmanuel; Stark, Azadeh; Abantanga, Francis; Awuah, Baffour

2016-01-01

Women with African ancestry in western, sub-Saharan Africa and in the United States represent a population subset facing an increased risk of being diagnosed with biologically aggressive phenotypes of breast cancer that are negative for the estrogen receptor, the progesterone receptor, and the HER2/neu marker. These tumors are commonly referred to as triple-negative breast cancer. Disparities in breast cancer incidence and outcome related to racial or ethnic identity motivated the establishment of the International Breast Registry, on the basis of partnerships between the Komfo Anokye Teaching Hospital in Kumasi, Ghana, the University of Michigan Comprehensive Cancer Center in Ann Arbor, Michigan, and the Henry Ford Health System in Detroit, Michigan. This research collaborative has featured educational training programs as well as scientific investigations related to the comparative biology of breast cancer in Ghanaian African, African American, and white/European American patients. Currently, the International Breast Registry has expanded to include African American patients throughout the United States by partnering with the Sisters Network (a national African American breast cancer survivors’ organization) and additional sites in Ghana (representing West Africa) as well as Ethiopia (representing East Africa). Its activities are now coordinated through the Henry Ford Health System International Center for the Study of Breast Cancer Subtypes. Herein, we review the history and results of this international program at its 10-year anniversary. PMID:28717716

Investigating the prevention of hospital-acquired infection through standardized teaching ward rounds in clinical nursing.

PubMed

Zhang, R

2015-04-22

This study aimed to explore the effect of standardized teaching ward rounds in clinical nursing on preventing hospital-acquired infection. The experimental group comprised 120 nursing students from our hospital selected between June 2010 and June 2012. The control group consisted of 120 nursing students selected from May 2008 to May 2010. Traditional teaching ward rounds for nursing education were carried out with the control group, while a standardized teaching ward round was carried out with the experimental group. The comprehensive application of nursing abilities and skills, the mastering of situational infection knowledge, and patient satisfaction were compared between the two groups. The applied knowledge of nursing procedures and the pass rate on comprehensive skill tests were significantly higher in the experimental group than in the control group (P < 0.05). The rate of mastery of sterilization and hygiene procedures was also higher in the experimental group than in the control group (P < 0.05). The patient satisfaction rate with infection control procedures in the experimental group time period was 98.09%, which was significantly higher than patient satisfaction in the control group time period (93.05%, P < 0.05). Standardized teaching ward rounds for nursing education expanded the knowledge of the nursing staff in controlling hospital-acquired infection and enhanced the ability of comprehensive application and awareness of infection control procedures.

Ghana watershed prototype products

USGS Publications Warehouse

,

2007-01-01

A number of satellite data sets are available through the U.S. Geological Survey (USGS) for monitoring land surface features. Representative data sets include Landsat, Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER), and Shuttle Radar Topography Mission (SRTM). The Ghana Watershed Prototype Products cover an area within southern Ghana, Africa, and include examples of the aforementioned data sets along with sample SRTM derivative data sets.

Impact and Effectiveness of Monovalent Rotavirus Vaccine Against Severe Rotavirus Diarrhea in Ghana.

PubMed

Armah, George; Pringle, Kimberly; Enweronu-Laryea, Christabel C; Ansong, Daniel; Mwenda, Jason M; Diamenu, Stanley K; Narh, Clement; Lartey, Belinda; Binka, Fred; Grytdal, Scott; Patel, Manish; Parashar, Umesh; Lopman, Ben

2016-05-01

Ghana was among the first African nations to introduce monovalent rotavirus vaccine (RV1) into its childhood immunization schedule in April 2012. We aimed to assess the impact of vaccine introduction on rotavirus and acute gastroenteritis (AGE) hospitalizations and to estimate vaccine effectiveness (VE). Using data from 2 teaching hospitals, monthly AGE and rotavirus admissions by age were examined 40 months before and 31 months after RV1 introduction using interrupted time-series analyses. From January 2013, we enrolled children <2 years of age who were eligible for RV1 from a total of 7 sentinel sites across the country. To estimate VE, we fit unconditional logistic regression models to calculate odds ratios of vaccination by rotavirus case-patient status, controlling for potential confounders. Vaccine coverage ranged from 95% to 100% for dose 1 and 93% to 100% for dose 2. In the first 3 years after vaccine introduction, the percentage of hospital admissions positive for rotavirus fell from 48% in the prevaccine period to 28% (49% adjusted rate reduction; 95% confidence interval [CI], 32%-63%) postvaccination among <5-year-olds. With high vaccine coverage, it was not possible to arrive at robust VE estimates; any-dose VE against rotavirus hospitalization was estimated at 60% (95% CI, -2% to 84%;P= .056). Results from the first 3 years following RV1 introduction suggest substantial reductions of pediatric diarrheal disease as a result of vaccination. Our VE estimate is consistent with the observed rotavirus decrease and with efficacy estimates from elsewhere in sub-Saharan Africa. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Factors influencing choice of care-seeking for acute fever comparing private chemical shops with health centres and hospitals in Ghana: a study using case-control methodology.

PubMed

Ansah, Evelyn K; Gyapong, Margaret; Narh-Bana, Solomon; Bart-Plange, Constance; Whitty, Christopher J M

2016-05-25

Several public health interventions to improve management of patients with fever are largely focused on the public sector yet a high proportion of patients seek care outside the formal healthcare sector. Few studies have provided information on the determinants of utilization of the private sector as against formal public sector. Understanding the differences between those who attend public and private health institutions, and their pathway to care, has significant practical implications. The chemical shop is an important source of care for acute fever in Ghana. Case-control methodology was used to identify factors associated with seeking care for fever in the Dangme West District, Ghana. People presenting to health centres, or hospital outpatients, with a history or current fever were compared to counterparts from the same community with fever visiting a chemical shop. Of 600 patients, 150 each, were recruited from the district hospital and two health centres, respectively, and 300 controls from 51 chemical shops. Overall, 103 (17.2 %) patients tested slide positive for malaria. Specifically, 13.7 % (41/300) of chemical shop patients, 30.7 % (46/150) health centre and 10.7 % (16/150) hospital patients were slide positive. While it was the first option for care for 92.7 % (278/300) chemical shop patients, 42.7 % (64/150) of health centre patients first sought care from a chemical shop. More health centre patients (61.3 %; 92/150) presented with fever after more than 3 days than chemical shop patients (27.7 %; 83/300) [AOR = 0.19; p < 0.001 CI 0.11-0.30]. Although the hospital was the first option for 83.3 % (125/150) of hospital patients, most (63.3 %; 95/150) patients arrived there over 3 days after their symptoms begun. Proximity was significantly associated with utilization of each source of care. Education, but not other socioeconomic or demographic factors were significantly associated with chemical shop use. The private drug retail sector is

Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of Primary Health Care? Perspectives of key stakeholders in northern Ghana.

PubMed

Awoonor-Williams, John Koku; Tindana, Paulina; Dalinjong, Philip Ayizem; Nartey, Harry; Akazili, James

2016-08-30

In 2005, the World Health Assembly (WHA) of the World Health Organization (WHO) urged member states to aim at achieving affordable universal coverage and access to key promotive, preventive, curative, rehabilitative and palliative health interventions for all their citizens on the basis of equity and solidarity. Since then, some African countries, including Ghana, have taken steps to introduce national health insurance reforms as one of the key strategies towards achieving universal health coverage (UHC). The aim of this study was to get a better understanding of how Ghana's health insurance institutions interact with stakeholders and other health sector programmes in promoting primary health care (PHC). Specifically, the study identified the key areas of misalignment between the operations of the NHIS and that of PHC. Using qualitative and survey methods, this study involved interviews with various stakeholders in six selected districts in the Upper East region of Ghana. The key stakeholders included the National Health Insurance Authority (NHIA), district coordinators of the National Health Insurance Schemes (NHIS), the Ghana Health Service (GHS) and District Health Management Teams (DHMTs) who supervise the district hospitals, health centers/clinics and the Community-based Health and Planning Services (CHPS) compounds as well as other public and private PHC providers. A stakeholders' workshop was organized to validate the preliminary results which provided a platform for stakeholders to deliberate on the key areas of misalignment especially, and to elicit additional information, ideas and responses, comments and recommendations from participants for the achievement of the goals of UHC and PHC. The key areas of misalignments identified during this pilot study included: delays in reimbursements of claims for services provided by health care providers, which serves as a disincentive for service providers to support the NHIS, inadequate coordination among

Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of Primary Health Care? Perspectives of key stakeholders in northern Ghana.

PubMed

Awoonor-Williams, John Koku; Tindana, Paulina; Dalinjong, Philip Ayizem; Nartey, Harry; Akazili, James

2016-09-05

In 2005, the World Health Assembly (WHA) of the World Health Organization (WHO) urged member states to aim at achieving affordable universal coverage and access to key promotive, preventive, curative, rehabilitative and palliative health interventions for all their citizens on the basis of equity and solidarity. Since then, some African countries, including Ghana, have taken steps to introduce national health insurance reforms as one of the key strategies towards achieving universal health coverage (UHC). The aim of this study was to get a better understanding of how Ghana's health insurance institutions interact with stakeholders and other health sector programmes in promoting primary health care (PHC). Specifically, the study identified the key areas of misalignment between the operations of the NHIS and that of PHC. Using qualitative and survey methods, this study involved interviews with various stakeholders in six selected districts in the Upper East region of Ghana. The key stakeholders included the National Health Insurance Authority (NHIA), district coordinators of the National Health Insurance Schemes (NHIS), the Ghana Health Service (GHS) and District Health Management Teams (DHMTs) who supervise the district hospitals, health centers/clinics and the Community-based Health and Planning Services (CHPS) compounds as well as other public and private PHC providers. A stakeholders' workshop was organized to validate the preliminary results which provided a platform for stakeholders to deliberate on the key areas of misalignment especially, and to elicit additional information, ideas and responses, comments and recommendations from respondents for the achievement of the goals of UHC and PHC. The key areas of misalignments identified during this pilot study included: delays in reimbursements of claims for services provided by health care providers, which serves as a disincentive for service providers to support the NHIS; inadequate coordination among

Organ damage in sickle cell disease study (ORDISS): protocol for a longitudinal cohort study based in Ghana.

PubMed

Anie, Kofi A; Paintsil, Vivian; Owusu-Dabo, Ellis; Ansong, Daniel; Osei-Akoto, Alex; Ohene-Frempong, Kwaku; Amissah, Kofi Aikins; Addofoh, Nicholas; Ackah, Ezekiel Bonwin; Owusu-Ansah, Amma Twumwa; Ofori-Acquah, Solomon Fiifi

2017-08-28

Sickle cell disease is highly prevalent in Africa with a significant public health burden. Nonetheless, morbidity and mortality in sickle cell disease that result from the progression of organ damage is not well understood. The Organ Damage in Sickle Cell Disease Study (ORDISS) is designed as a longitudinal cohort study to provide critical insight into cellular and molecular pathogenesis of chronic organ damage for the development of future innovative treatment. ORDISS aims to recruit children aged 0-15 years who attend the Kumasi Centre for Sickle Cell Disease based at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Consent is obtained to collect blood and urine samples from the children during specified clinic visits and hospitalisations for acute events, to identify candidate and genetic markers of specific organ dysfunction and end-organ damage, over a 3 year period. In addition, data concerning clinical history and complications associated with sickle cell disease are collected. Samples are stored in biorepositories and analysed at the Kumasi Centre for Collaborative Research in Tropical Medicine, Ghana and the Centre for Translational and International Haematology, University of Pittsburgh, USA. Appropriate statistical analyses will be performed on the data acquired. Research ethics approval was obtained at all participating sites. Results of the study will be submitted for publication in peer-reviewed journals, and the key findings presented at national and international conferences. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Patient attitudes towards medical students at Damascus University teaching hospitals

PubMed Central

2012-01-01

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 teaching hospitals 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. PMID:22439893

Patient attitudes towards medical students at Damascus University teaching hospitals.

PubMed

Sayed-Hassan, Rima M; Bashour, Hyam N; Koudsi, Abir Y

2012-03-22

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. This cross-sectional study was conducted at three teaching hospitals 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. 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. 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.

A realist evaluation of the management of a well- performing regional hospital in Ghana

PubMed Central

2010-01-01

Background Realist evaluation offers an interesting approach to evaluation of interventions in complex settings, but has been little applied in health care. We report on a realist case study of a well performing hospital in Ghana and show how such a realist evaluation design can help to overcome the limited external validity of a traditional case study. Methods We developed a realist evaluation framework for hypothesis formulation, data collection, data analysis and synthesis of the findings. Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. Mixed methods were used in data collection, including individual and group interviews, observations and document reviews. Results We found that the human resource management approach (the actual intervention) included induction of new staff, training and personal development, good communication and information sharing, and decentralised decision-making. We identified 3 additional practices: ensuring optimal physical working conditions, access to top managers and managers' involvement on the work floor. Teamwork, recognition and trust emerged as key elements of the organisational climate. Interviewees reported high levels of organisational commitment. The analysis unearthed perceived organisational support and reciprocity as underlying mechanisms that link the management practices with commitment. Methodologically, we found that realist evaluation can be fruitfully used to develop detailed case studies that analyse how management interventions work and in which conditions. Analysing the links between intervention, mechanism and outcome increases the explaining power, while identification of essential context elements improves the usefulness of the findings for decision-makers in other settings (external validity). We also identified a number of practical difficulties and priorities for further methodological development

A realist evaluation of the management of a well-performing regional hospital in Ghana.

PubMed

Marchal, Bruno; Dedzo, McDamien; Kegels, Guy

2010-01-25

Realist evaluation offers an interesting approach to evaluation of interventions in complex settings, but has been little applied in health care. We report on a realist case study of a well performing hospital in Ghana and show how such a realist evaluation design can help to overcome the limited external validity of a traditional case study. We developed a realist evaluation framework for hypothesis formulation, data collection, data analysis and synthesis of the findings. Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. Mixed methods were used in data collection, including individual and group interviews, observations and document reviews. We found that the human resource management approach (the actual intervention) included induction of new staff, training and personal development, good communication and information sharing, and decentralised decision-making. We identified 3 additional practices: ensuring optimal physical working conditions, access to top managers and managers' involvement on the work floor. Teamwork, recognition and trust emerged as key elements of the organisational climate. Interviewees reported high levels of organisational commitment. The analysis unearthed perceived organisational support and reciprocity as underlying mechanisms that link the management practices with commitment. Methodologically, we found that realist evaluation can be fruitfully used to develop detailed case studies that analyse how management interventions work and in which conditions. Analysing the links between intervention, mechanism and outcome increases the explaining power, while identification of essential context elements improves the usefulness of the findings for decision-makers in other settings (external validity). We also identified a number of practical difficulties and priorities for further methodological development. This case suggests that a well

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

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-31

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1459-N... Slots AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. SUMMARY: This notice announces the closure of two teaching hospitals and the initiation of an application process where hospitals...

Human Resource Local Content in Ghana's Upstream Petroleum Industry

NASA Astrophysics Data System (ADS)

Benin, Papa

Enactment of Ghana's Petroleum (Local Content and Local Participation) Regulations, 2013 (L.I. 2204) was intended to regulate the percentage of local products, personnel, financing, and goods and services rendered within Ghana's upstream petroleum industry value chain. Five years after the inception of Ghana's upstream oil and gas industry, a gap is evident between the requirements of L.I. 2204 and professional practice. Drawing on Lewin's change theory, a cross-sectional study was conducted to examine the extent of differences between the prevailing human resource local content and the requirements of L.I. 2204 in Ghana's upstream petroleum industry. The extent to which training acquired by indigenous Ghanaians seeking jobs in Ghana's oil fields affects the prevalent local content in its upstream petroleum industry was also examined. Survey data were collected from 97 management, technical, and other staff in 2 multinational petroleum companies whose oil and gas development plans have been approved by the Petroleum Commission of Ghana. To answer the research questions and test their hypotheses, one-way ANOVA was performed with staff category (management, technical, and other) as the independent variable and prevalent local content as the dependent variable. Results indicated that prevailing local content in Ghana's upstream petroleum industry meets the requirements of L.I. 2204. Further, training acquired by indigenous Ghanaians seeking jobs in Ghana's oil fields affects the prevalent local content in its offshore petroleum industry. Findings may encourage leaders within multinational oil companies and the Petroleum Commission of Ghana to organize educational seminars that equip indigenous Ghanaians with specialized skills for working in Ghana's upstream petroleum industry.

Knowledge and beliefs about cervical cancer screening among men in Kumasi, Ghana.

PubMed

Williams, M S; Amoateng, P

2012-09-01

The age-standardized mortality rate for cervical cancer in Ghana, West Africa is more than three times the global cervical cancer mortality rate (27.6/100,000 vs. 7.8/100,000 respectively). The Pap test and visual inspection with acetic acid are available at public and private hospitals in Ghana. Approximately, 2.7% of Ghanaian women obtain cervical cancer screenings regularly. Men in middle-income countries play a key role in cervical cancer prevention. Increasing spousal support for cervical cancer screening may increase screening rates in Ghana. Five focus groups were conducted with Ghanaian men (N = 29) to assess their cervical cancer and cervical cancer screening knowledge and beliefs. The qualitative data was analyzed via indexed coding. Targets for education interventions were identified including inaccurate knowledge about cervical cancer and stigmatizing beliefs about cervical cancer risk factors. Cultural taboos regarding women's health care behaviours were also identified. Several participants indicated that they would be willing to provide spousal support for cervical cancer screening if they knew more about the disease and the screening methods. Men play a significant role in the health behaviours of some Ghanaian women. Cervical cancer education interventions targeting Ghanaian men are needed to correct misconceptions and increase spousal support for cervical cancer screening.

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

PubMed

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

2014-01-01

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

Cost-effectiveness analysis of unsafe abortion and alternative first-trimester pregnancy termination strategies in Nigeria and Ghana.

PubMed

Hu, Delphine; Grossman, Daniel; Levin, Carol; Blanchard, Kelly; Adanu, Richard; Goldie, Sue J

2010-06-01

To explore the policy implications of increasing access to safe abortion in Nigeria and Ghana, we developed a computer-based decision analytic model which simulates induced abortion and its potential complications in a cohort of women, and comparatively assessed the cost-effectiveness of unsafe abortion and three first-trimester abortion modalities: hospital-based dilatation and curettage, hospital- and clinic-based manual vacuum aspiration (MVA), and medical abortion using misoprostol (MA). Assuming all modalities are equally available, clinic-based MVA is the most cost-effective option in Nigeria. If clinic-based MVA is not available, MA is the next best strategy. Conversely, in Ghana, MA is the most cost-effective strategy, followed by clinic-based MVA if MA is not available. From a real world policy perspective, increasing access to safe abortion in favor over unsafe abortion is the single most important factor in saving lives and societal costs, and is more influential than the actual choice of safe abortion modality.

The real world of blood glucose point-of-care testing (POCT) system running in China teaching hospital.

PubMed

Li, Feng-Fei; Xie, Yun; Shi, Bing-Yin; Niu, Min; Guo, Hui; Cao, Yan; Liu, Bing-Li; Yan, Reng-Na; Su, Xiao-Fei; Wu, Jin-Dan; Zhang, Dan-Feng; Chen, Li-Ming; Ma, Jian-Hua

2018-06-01

 The blood glucose point-of-care testing (POCT) system is important in the decision-making process involving patients suspected of having hypoglycemia. To investigate the real world of the POCT system being used in teaching hospitals in China. The survey was conducted by Hisend Research Group from May 2015 to July 2015 in four teaching hospitals in China. The survey questions were referred to the ISO 15197:2013 standard requirements for the use of the POCT system in a hospital setting. A total of 170 subjects were included from 4 hospitals, which included nursing staff, nurse unit managers, employees from the department of medical instruments, and staff members employed by the clinical laboratories in the Tianjin Metabolism Hospital, Nanjing First Hospital, First Affiliated Hospital of Dalian Medical University, and the First hospital affiliated with the Xi'an Transportation University. The average score for the four hospitals surveyed in this study was 66.6, which varied from 46.1 to 79.7. The main factors influencing the scores were the multiple choices of blood-glucose meters, and the quality control assessment. Our data indicates that the real world use of the POCT system in hospital settings in China needs more closer adherence to a quality management framework.

Outbreak of Salmonella infantis infection in a large animal veterinary teaching hospital.

PubMed

Tillotson, K; Savage, C J; Salman, M D; Gentry-Weeks, C R; Rice, D; Fedorka-Cray, P J; Hendrickson, D A; Jones, R L; Nelson, W; Traub-Dargatz, J L

1997-12-15

During the past 11 years, there have been numerous reports of outbreaks of salmonellosis involving horses in veterinary teaching hospitals. Some of these outbreaks have been associated with Salmonella serotypes not commonly associated with infection of horses. Salmonella infantis is among the more common Salmonella serotypes isolated from human beings, and is an important pathogen in the broiler chicken industry. However, it was not commonly isolated from horses or cattle on a national basis between 1993 and 1995. In this report, we describe an outbreak of S infantis infection among large animals, primarily horses, in a veterinary teaching hospital and the control measures that were implemented. Factors that appeared to be key in control of this outbreak in this hospital included providing biosecurity training sessions for hospital personnel, adopting a standard operating procedure manual for biosecurity procedures, installing additional handwashing sinks throughout the facility, painting the interior of the facility with a nontoxic readily cleanable paint, replacing the dirt flooring in 4 stalls with concrete flooring, and removing noncleanable surfaces such as rubber stall mats, wooden hay storage bins, and open grain bins. Our experience with this outbreak suggests that although it is virtually impossible to eliminate Salmonella organisms from the environment, minimizing contamination is possible. Prevention of nosocomial infection must be approached in a multifaceted manner and care must be taken to search out covert sources of contamination, especially if standard intervention procedures do not prevent spread of the disease.

Surgical decision making in a teaching hospital: a linguistic analysis.

PubMed

Bezemer, Jeff; Murtagh, Ged; Cope, Alexandra; Kneebone, Roger

2016-10-01

The aim of the study was to gain insight in the involvement of non-operating surgeons in intraoperative surgical decision making at a teaching hospital. The decision to proceed to clip and cut the cystic duct during laparoscopic cholecystectomy was investigated through direct observation of team work. Eleven laparoscopic cholecystectomies performed by consultant surgeons and specialty trainees at a London teaching hospital were audio and video recorded. Talk among the surgical team was transcribed and subjected to linguistic analysis, in conjunction with observational analysis of the video material, sequentially marking the unfolding operation. Two components of decision making were identified, participation and rationalization. Participation refers to the degree to which agreement was sought within the surgical team prior to clipping the cystic duct. Rationalization refers to the degree to which the evidential grounds for clipping and cutting were verbalized. The decision to clip and cut the cystic duct was jointly made by members of the surgical team, rather than a solitary surgeon in the majority of cases, involving verbal explication of clinical reasoning and verbal agreement. The extent of joint decision making appears to have been mitigated by two factors: trainee's level of training and duration of the case. © 2014 Royal Australasian College of Surgeons.

Supervisory needs of research doctoral students in a university teaching hospital setting.

PubMed

Caldwell, Patrina Hy; Oldmeadow, Wendy; Jones, Cheryl A

2012-10-01

Teaching hospitals affiliated with universities are now common sites for research higher degree supervision. We hypothesised that the hospital environment poses unique challenges to supervision compared with the traditional university research institute setting. This study aimed to identify and rank important supervision issues in a clinical setting from the students' perspective. Using the Delphi method to explore issues and facilitate consensus, small group discussions were conducted with 10 research doctoral students from a tertiary teaching hospital. We identified supervision issues that are unique to the hospital-based context. These include the demands placed on supervisors combining clinical and supervisory roles, the challenges of academic medical/scientific writing and career issues for students who are already established in their professions. Other issues identified, common to all doctoral students, include differing expectations between students and supervisors (with students wanting support for their career plans, training in research skills and increasing autonomy and responsibility), supervisor access, quality and frequency of meetings, lack of training in writing and dealing with conflicts. Our research identified that postgraduate students of supervisors who combine clinical and supervisory roles report significant issues with supervision, some of which are unique to the clinical setting. Clinician researchers who supervise postgraduate students need to balance clinical and supervisory responsibilities, identify and negotiate student expectations early in candidature and provide career counselling to students who are already highly experienced. Furthermore, clinician supervisors should undertake postgraduate supervisor training programme tailored to the hospital setting to better support their students. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of

[The effects of a new model of hospital management on undergraduate teaching of urology].

PubMed

Bogado S, Justo; Bogado C, Mariana; López C, Ilse; Rosselot J, Eduardo

2010-04-01

Since January 2005, a new model for hospital coordinated assistance was implanted in Chile, denominated Self Managed Hospitals in net, to improve resource use effectiveness and efficiency. This new design changed health care and teaching models. To analyze, understand and to reflect on how teachers and students of the Urology Unit of the Eastern Campus of the Faculty of Medicine in the University of Chile, perceive learning in this new hospital scenario. A qualitative methodology was used, including semi-structured interviews to chief teachers and focal groups of teachers and students. Also, a written structured questionnaire was answered by a group of 5th year students and interns. University teachers perceive that undergraduate learning is affected in the new hospital scenario. Students think that they have less opportunities to directly interact with patients, and therefore have fewer possibilities to take medical histories, perform physical examinations, and fewer occasions to discuss cases with their tutors. The new health system that runs hospitals under a network could jeopardize undergraduate teaching. This is the case for the Urology Service at Hospital and the corresponding Department of Specialties, where the dominant perception of teachers and a number of students is that their clinical learning is endangered by these innovations. To obtain the learning objectives of the undergraduate program in this subject, reorientation of their ambulatory practice and derivation skills must be rationally elaborated to improve students accomplishment.

Transfusion monitoring: care practice analysis in a public teaching hospital

PubMed Central

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

2016-01-01

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

Relative Susceptibilities of ABO Blood Groups to Plasmodium falciparum Malaria in Ghana.

PubMed

Afoakwah, Richmond; Aubyn, Edmond; Prah, James; Nwaefuna, Ekene Kwabena; Boampong, Johnson N

2016-01-01

The clinical outcome of falciparum malaria in endemic areas is influenced by erythrocyte polymorphisms including the ABO blood groups. Studies have reported association of ABO blood group to resistance, susceptibility, and severity of P. falciparum malaria infection. Individuals with blood group "A" have been found to be highly susceptible to falciparum malaria whereas blood group "O" is said to confer protection against complicated cases. We analyzed samples from 293 young children less than six years old with malaria in the Korle-Bu Teaching Hospital in Accra, Ghana. It was observed that group O was present in about 16.1% of complicated cases weighed against 40.9% of uncomplicated controls. Individuals with complicated malaria were about twice likely to be of blood groups A and B compared to group O (A versus O, OR = 1.90, 95% CI = 1.59-2.26, P < 0.0001; B versus O, OR = 1.82. 95% CI = 1.57-2.23, P < 0.0001). Blood group O participants with complicated diseases had low parasitaemia compared to the other blood groups (P < 0.0001). This may give blood group O individuals a survival advantage over the other groups in complicated malaria as suggested. Participants with complicated falciparum malaria were generally anaemic and younger than those with uncomplicated disease.

Effect of teaching and checklist implementation on accuracy of medication history recording at hospital admission.

PubMed

Lea, Marianne; Barstad, Ingeborg; Mathiesen, Liv; Mowe, Morten; Molden, Espen

2016-02-01

Medication discrepancies at hospital admission is an extensive problem and knowledge is limited regarding improvement strategies. To investigate the effect of teaching and checklist implementation on accuracy of medication history recording during hospitalization. Patients admitted to an internal medicine ward were prospectively included in two consecutive periods. Between the periods, non-mandatory teaching lessons were provided and a checklist assisting medication history recording implemented. Discrepancies between the recorded medications at admission and the patient's actual drug use, as revealed by pharmacist-conducted medication reconciliation, were compared between the periods. The primary endpoint was difference between the periods in proportion of patients with minimum one discrepancy. Difference in median number of discrepancies was included as a secondary endpoint. 56 and 119 patients were included in period 1 (P1) and period 2 (P2), respectively. There was no significant difference in proportion of patients with minimum one discrepancy in P2 (68.9 %) versus P1 (76.8 %, p = 0.36), but a tendency of lower median number of discrepancies was observed in P2 than P1, i.e. 1 and 2, respectively (p = 0.087). More powerful strategies than non-mandatory teaching activities and checklist implementation are required to achieve sufficient improvements in medication history recording during hospitalization.

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2015-11-01

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

Hospital management principles applicable to the veterinary teaching hospital.

PubMed

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

2004-01-01

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

Medical physics practice and training in Ghana.

PubMed

Amuasi, John H; Kyere, Augustine K; Schandorf, Cyril; Fletcher, John J; Boadu, Mary; Addison, Eric K; Hasford, Francis; Sosu, Edem K; Sackey, Theophilus A; Tagoe, Samuel N A; Inkoom, Stephen; Serfor-Armah, Yaw

2016-06-01

Medical physics has been an indispensable and strategic stakeholder in the delivery of radiological services to the healthcare system of Ghana. The practice has immensely supported radiation oncology and medical imaging facilities over the years, while the locally established training programme continues to produce human resource to feed these facilities. The training programme has grown to receive students from other African countries in addition to local students. Ghana has been recognised by the International Atomic Energy Agency as Regional Designated Centre for Academic Training of Medical Physicists in Africa. The Ghana Society for Medical Physics collaborates with the School of Nuclear and Allied Sciences of the University of Ghana to ensure that training offered to medical physicists meet international standards, making them clinically qualified. The Society has also worked together with other bodies for the passage of the Health Profession's Regulatory Bodies Act, giving legal backing to the practice of medical physics and other allied health professions in Ghana. The country has participated in a number of International Atomic Energy Agency's projects on medical physics and has benefited from its training courses, fellowships and workshops, as well as those of other agencies such as International Organization for Medical Physics. This has placed Ghana's medical physicists in good position to practice competently and improve healthcare. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

AIDS: An ICT Model for Integrating Teaching, Learning and Research in Technical University Education in Ghana

ERIC Educational Resources Information Center

Asabere, Nana; Togo, Gilbert; Acakpovi, Amevi; Torby, Wisdom; Ampadu, Kwame

2017-01-01

Information and Communication Technologies (ICT) has changed the way we communicate and carry out certain daily activities. Globally, ICT has become an essential means for disseminating information. Using Accra Technical University in Ghana as a case study, this paper proposes an ICT model called Awareness Incentives Demand and Support (AIDS). Our…

Transfusion-transmitted malaria: donor prevalence of parasitaemia and a survey of healthcare workers knowledge and practices in a district hospital in Ghana.

PubMed

Owusu-Ofori, Alex; Gadzo, Dominic; Bates, Imelda

2016-04-23

Transfusion-transmitted malaria (TTM) is a risk of transfusion that has not been well described in malaria endemic regions. The risk of the recipient getting malaria is related to the prevalence of malaria in the blood donors. There is however little information on the prevalence of malaria among donors in Akatsi district of Ghana. Further, the knowledge and practices of healthcare workers to TTM is unknown. The study was undertaken to determine the prevalence of malaria parasite infection among blood donors and to evaluate the knowledge and practices of healthcare workers to TTM in the Akatsi district of Ghana. The study was conducted at Akatsi South District Hospital between May and August 2014. To screen for Plasmodium falciparum, 5 µl of capillary blood was obtained by finger prick from 200 participants (100 donors and 100 healthy controls). Plasmodium falciparum screening was done using CareStart™ Malaria Antigen kit. To obtain information regarding TTM knowledge and practices, questionnaires were completed by 100 health workers including nurses, doctors and laboratory staff. The prevalence of P. falciparum was the same (10 %) in both donors and controls. All those who were malaria RDT positive were aged 15-25 years. Out of the 100 healthcare workers (31 males and 69 females) surveyed, 45 % of respondents (45/100) had never heard of transfusion-transmitted malaria. Almost all respondents (91 %) had not attended any lecture/seminar/workshop on blood transfusion in the past 12 months. There were 44 respondents (44 %) who wrongly said malaria was being screened for prior to transfusion in their hospital. However, 98.2 % (54/55) of those who had heard about TTM rightly stated that TTM can be prevented. The prevalence of P. falciparum parasitaemia is 10 % in healthy blood donors in the Akatsi district and represents a risk for TTM though the extent of this risk is unclear. Knowledge about TTM in healthcare workers in the district is low. Continuous

Bridging the Gap: A Framework and Strategies for Integrating the Quality and Safety Mission of Teaching Hospitals and Graduate Medical Education.

PubMed

Tess, Anjala; Vidyarthi, Arpana; Yang, Julius; Myers, Jennifer S

2015-09-01

Integrating the quality and safety mission of teaching hospitals and graduate medical education (GME) is a necessary step to provide the next generation of physicians with the knowledge, skills, and attitudes they need to participate in health system improvement. Although many teaching hospital and health system leaders have made substantial efforts to improve the quality of patient care, few have fully included residents and fellows, who deliver a large portion of that care, in their efforts. Despite expectations related to the engagement of these trainees in health care quality improvement and patient safety outlined by the Accreditation Council for Graduate Medical Education in the Clinical Learning Environment Review program, a structure for approaching this integration has not been described.In this article, the authors present a framework that they hope will assist teaching hospitals in integrating residents and fellows into their quality and safety efforts and in fostering a positive clinical learning environment for education and patient care. The authors define the six essential elements of this framework-organizational culture, teaching hospital-GME alignment, infrastructure, curricular resources, faculty development, and interprofessional collaboration. They then describe the organizational characteristics required for each element and offer concrete strategies to achieve integration. This framework is meant to be a starting point for the development of robust national models of infrastructure, alignment, and collaboration between GME and health care quality and safety leaders at teaching hospitals.

Factors that influence the clinical utilization of the nursing process at a hospital in Accra, Ghana.

PubMed

Agyeman-Yeboah, Joana; Korsah, Kwadwo Ameyaw; Okrah, Jane

2017-01-01

The nursing process is a tool that is recommended for use by all professional nurses working in Ghana, in order to provide nursing care. However, there is currently a limited use of this tool by nurses in Ghana. The purpose of this research study was to explore the various factors that influence the utilization of this nursing process. An exploratory descriptive qualitative-research design was employed. Ten participants were involved by using the purposive sampling method. A semi-structured interview guide was used to collect the data from the research participants; and the data were analysed by using content analysis. One main theme, with five subthemes, emerged from the analysis. It was found that there are factors, such as nurses not having a better understanding of the nursing process, whilst in school; the absence of the care plan in the ward, as well as the lack of adequate staff, with limited time being available for coping with contributed to the non-usage of the nursing process. We conclude that the clinical utilization of the Nursing process at the clinical setting is influenced by lack of understanding of Nurses on the Nursing process and care plan as well as lack of adequate nurses and time. We recommend that the care-plan form be made officially a part of the admission documents. Furthermore, the nursing administration should put measures in place to provide nurses with the needed resources to implement the nursing process. Additionally, they should ensure that the care-plan forms and other resources needed by the nurses are regularly and adequately provided. Nurses should further see the nursing process as a means of providing comprehensive care to their patients and addressing their specific problems. They should therefore make time despite their busy schedules to use it in order to improve quality of care and the image of nursing in Ghana.

Ghana. Country Demographic Profiles, No. 5.

ERIC Educational Resources Information Center

Bureau of the Census (DOC), Suitland, MD. Population Div.

Tables of demographic information about Ghana are presented, including size of population and estimates of fertility and mortality. The data were obtained primarily from population censuses in 1960 and 1970, a 1960 post-enumeration survey, and a 1971 supplementary enquiry. Because Ghana's vital registration system is incomplete, the data are not…

Opinions of clinical veterinarians at a US veterinary teaching hospital regarding antimicrobial use and antimicrobial-resistant infections.

PubMed

Jacob, Megan E; Hoppin, Jane A; Steers, Nicola; Davis, Jennifer L; Davidson, Gigi; Hansen, Bernie; Lunn, Katharine F; Murphy, K Marcia; Papich, Mark G

2015-10-15

To determine opinions of faculty members with clinical appointments, clinical veterinarians, residents, and interns at a US veterinary teaching hospital regarding antimicrobial use and antimicrobial-resistant infections. Cross-sectional survey. 71 veterinarians. An online questionnaire was sent to all veterinarians with clinical service responsibilities at the North Carolina State University veterinary teaching hospital (n = 167). The survey included 23 questions regarding demographic information, educational experiences, current prescribing practices, and personal opinions related to antimicrobial selection, antimicrobial use, restrictions on antimicrobial use, and antimicrobial resistance. Of the 167 veterinarians eligible to participate, 71 (43%) responded. When respondents were asked to rate their level of concern (very concerned = 1; not concerned = 5) about antimicrobial-resistant infections, most (41/70 [59%]) assigned a score of 1, with mean score for all respondents being 1.5. Most survey participants rated their immediate colleagues (mean score, 1.9) as more concerned than other veterinary medical professionals (mean score, 2.3) and their clients (mean score, 3.4). Fifty-nine of 67 (88%) respondents felt that antimicrobials were overprescribed at the hospital, and 32 of 69 (46%) respondents felt uncomfortable prescribing at least one class of antimicrobials (eg, carbapenems or glycopeptides) because of public health concerns. Findings indicated that veterinarians at this teaching hospital were concerned about antimicrobial resistance, thought antimicrobials were overprescribed, and supported restricting use of certain antimicrobial classes in companion animals. Findings may be useful in educating future veterinarians and altering prescribing habits and antimicrobial distribution systems in veterinary hospitals.

Feasibility of introducing rejection criteria for stool cultures in a teaching hospital in Portugal.

PubMed

Hänscheid, T; Cristino, J M; Salgado, M J

2002-02-01

The possible introduction of rejection criteria for stool cultures (hospitalization and teaching hospital in Portugal. During 12 months, 854 specimens from 537 patients (37% of them adults) were observed. Sixteen percent of inpatients had a positive stool culture (adults 9.7%, pediatric 21.7%). Eighty-five percent had hospitalization. Application of the '3-day-rule' would have led to 12 missed cases. Only in three cases would previously proposed exceptions to the rejection criteria have applied. A '5-day-rule' and hospital conditions present here.

Penile fracture: experience at Ayub Teaching Hospital.

PubMed

Khan, Raza Muhammad; Malik, Masud Akhtar; Jamil, Muhammad; Khan, Delawar; Shah, Iftikhar Hussain

2008-01-01

Penile fracture is a relatively rare traumatic rupture of the tunica albuginea of one or both corpora cavernosa of an erect penis. It is a real urological emergency which needs early assessment and surgical management. Twelve (12) cases of penile fracture were reviewed from July, 1997 to July, 2007 in the Department of Urology, Ayub Teaching Hospital Abbottabad. All cases presented with classical history of penile fracture and the diagnosis was made on the basis of history and clinical examination only. All the patients underwent immediate surgical repair with well preserved potency and excellent overall results. Penile fracture has typical signs. Standard treatment consists of immediate surgical repair of penile fracture with a low incidence of late complications. Post op complications including urethral strictures and erectile dysfunction should be ruled out by regular follow-up.

Parental responses to involvement in rounds on a pediatric inpatient unit at a teaching hospital: a qualitative study.

PubMed

Latta, Linda C; Dick, Ronald; Parry, Carol; Tamura, Glen S

2008-03-01

In pediatric teaching hospitals, medical decisions are traditionally made by the attending and resident physicians during rounds that do not include parents. This structure limits the ability of the medical team to provide "family-centered care" and the attending physician to model communication skills. The authors thus set out to identify how parents responded to participation in interdisciplinary teaching rounds conducted in a large tertiary care children's teaching hospital. A qualitative descriptive study was conducted using data from semistructured interviews of parents who had participated in rounds on the inpatient medical unit of a large academic children's hospital. From December 2004 to April 2005, 18 parents were interviewed after their participation in rounds. Questions assessed their experiences, expectations, preferred communication styles, and suggestions for improvement. Transcripts of the interviews were analyzed using qualitative content analysis. Being able to communicate, understand the plan, and participate with the team in decision making about their child's care were the most frequently cited outcomes of importance to parents. All 18 participants described the overall experience as positive, and 17 of 18 described themselves as "comfortable" with inclusion in rounds. Use of lay terminology and inclusion of nurses in rounds were preferred. Including parents on ward rounds at a teaching hospital was viewed positively by parents. Specific themes of particular importance to parents were identified. Further study is needed to assess the impact of inclusion of parents on rounds on patient outcomes and the resident experience.

Computer-assisted instruction: a library service for the community teaching hospital.

PubMed

McCorkel, J; Cook, V

1986-04-01

This paper reports on five years of experience with computer-assisted instruction (CAI) at Winthrop-University Hospital, a major affiliate of the SUNY at Stony Brook School of Medicine. It compares CAI programs available from Ohio State University and Massachusetts General Hospital (accessed by telephone and modem), and software packages purchased from the Health Sciences Consortium (MED-CAPS) and Scientific American (DISCOTEST). The comparison documents one library's experience of the cost of these programs and the use made of them by medical students, house staff, and attending physicians. It describes the space allocated for necessary equipment, as well as the marketing of CAI. Finally, in view of the decision of the National Board of Medical Examiners to administer the Part III examination on computer (the so-called CBX) starting in 1988, the paper speculates on the future importance of CAI in the community teaching hospital.

Nursing in Ghana: A Search for Florence Nightingale in an African City.

PubMed

Adu-Gyamfi, Samuel; Brenya, Edward

2016-01-01

Nursing in Ghana is a crucial subject that permeates almost every issue in the society especially the field of hospital care. To a large extent, the frontiers of nursing have expanded since the time of Florence Nightingale. Globally some studies have been done to study nursing icons like her. The values in nursing practice however continue to preoccupy our minds. The need to accentuate the gains made by historical figures in nursing in present times as well as the nature of interactions between practitioners and patients continues to be of paramount concern to many across the globe and Ghana in particular. This study does an analysis of existing literature on Florence Nightingale and the nature of nursing in Ghana from the colonial times. Additionally, it analyzes responses concerning the activities of nurses and their interactions with patients in Kumasi. The varied information has been thematically pieced together to make inferences that are of great interest to nursing practitioners, policy makers, administrators, and educators among others. The findings to the study suggest among other things that the challenges faced by the nursing institution in modern times are similar to those of the earlier period. The study calls for the emulation of the positive ideas of Florence Nightingale to promote the interest of patients, a core objective championed by a revered nurse.

Nursing in Ghana: A Search for Florence Nightingale in an African City

PubMed Central

Adu-Gyamfi, Samuel; Brenya, Edward

2016-01-01

Nursing in Ghana is a crucial subject that permeates almost every issue in the society especially the field of hospital care. To a large extent, the frontiers of nursing have expanded since the time of Florence Nightingale. Globally some studies have been done to study nursing icons like her. The values in nursing practice however continue to preoccupy our minds. The need to accentuate the gains made by historical figures in nursing in present times as well as the nature of interactions between practitioners and patients continues to be of paramount concern to many across the globe and Ghana in particular. This study does an analysis of existing literature on Florence Nightingale and the nature of nursing in Ghana from the colonial times. Additionally, it analyzes responses concerning the activities of nurses and their interactions with patients in Kumasi. The varied information has been thematically pieced together to make inferences that are of great interest to nursing practitioners, policy makers, administrators, and educators among others. The findings to the study suggest among other things that the challenges faced by the nursing institution in modern times are similar to those of the earlier period. The study calls for the emulation of the positive ideas of Florence Nightingale to promote the interest of patients, a core objective championed by a revered nurse. PMID:27382644

Key influences in the design and implementation of mental health information systems in Ghana and South Africa.

PubMed

Ahuja, S; Mirzoev, T; Lund, C; Ofori-Atta, A; Skeen, S; Kufuor, A

2016-01-01

Strengthening of mental health information systems (MHIS) is essential to monitor and evaluate mental health services in low and middle-income countries. While research exists assessing wider health management information systems, there is limited published evidence exploring the design and implementation of MHIS in these settings. This paper aims to identify and assess the key factors affecting the design and implementation of MHIS, as perceived by the key stakeholders in Ghana and South Africa. We report findings from the Mental Health and Poverty Project, a 5-year research programme implemented within four African countries. The MHIS strengthening in South Africa and Ghana included two related components: intervention and research. The intervention component aimed to strengthen MHIS in the two countries, and the research component aimed to document interventions in each country, including the key influences. Data were collected using semi structured interviews with key stakeholders and reviews of key documents and secondary data from the improved MHIS. We analyzed the qualitative data using a framework approach. Key components of the MHIS intervention involved the introduction of a redesigned patient registration form, entry into computers for analysis every 2 months by clinical managerial staff, and utilization of data in hospital management meetings in three psychiatric hospitals in Ghana; and the introduction of a new set of mental health indicators and related forms and tally sheets at primary care clinics and district hospitals in five districts in the KwaZulu-Natal and Northern Cape provinces in South Africa. Overall, the key stakeholders perceived the MHIS strengthening as an effective intervention in both countries with an enhanced set of indicators in South Africa and introduction of a computerized system in Ghana. Influences on the design and implementation of MHIS interventions in Ghana and South Africa relate to resources, working approaches

Incidence and risk factors of workplace violence against nurses in a Chinese top-level teaching hospital: A cross-sectional study.

PubMed

Chen, Xiaoming; Lv, Ming; Wang, Min; Wang, Xiufeng; Liu, Junyan; Zheng, Nan; Liu, Chunlan

2018-04-01

To investigate the incidence of workplace violence involving nurses and to identify related risk factors in a high-quality Chinese teaching hospital. A cross-sectional study design was used. The final sample comprised responses from 1831 registered nurses collected with a whole-hospital survey from June 1 to June 15, 2016. The demographic characteristics of the nurses who had experienced any form of violence were collected, and logistic regression analysis was applied to evaluate the risk factors for nurses related to workplace violence. Out of the total number of nurses surveyed, 904 (49.4%) nurses reported having experienced any type of violence in the past year. The frequencies of exposure to physical and non-physical violence were 6.3% (116) and 49.0% (897), respectively. All the incidence rates of violence were lower than those of other studies based on regional hospitals in China and were at the same level found in developed countries and districts. Binary logistic regression analysis revealed that nurses at levels 2 to 4 and female nurses in clinical departments were the most vulnerable to non-physical violence. For physical violence, the two independent risk factors were working in an emergency department and having 6-10 years of work experience. Workplace violence directly threatens nurses from high-quality Chinese teaching hospitals. However, the incidence of WPV against nurses in this teaching hospital was better than that in regional hospitals. This study also provides reference material to identify areas where nurses encounter relatively high levels of workplace violence in high-quality Chinese teaching hospitals. Copyright © 2018 Elsevier Inc. All rights reserved.

Hand hygiene compliance by health care workers at a teaching hospital, Kingston, Jamaica.

PubMed

Nicholson, Alison M; Tennant, Ingrid A; Martin, Allie C; Ehikhametalor, Kelvin; Reynolds, Glendee; Thoms-Rodriguez, Camille-Ann; Nagassar, Rajeev; Hoilett, Tena-Kim; Allen, Roxanne; Redwood, Tahira; Crandon, Ivor

2016-10-31

Consistent practice of hand hygiene (HH) has been shown to reduce the incidence and spread of hospital acquired infections. The objectives of this study were to determine the level of compliance and possible factors affecting compliance with HH practices among HCWs at a teaching hospital in Kingston, Jamaica. A prospective observational study was undertaken at the University Hospital of the West Indies (UHWI) over a two weeks period. Trained, validated observers identified opportunities for hand hygiene as defined by the WHO "Five Hand Hygiene Moments" and recorded whether appropriate hand hygiene actions were taken or missed. Observations were covert to prevent the observer's presence influencing the behaviour of the healthcare workers (HCWs) and targeted areas included the intensive care units (ICUs), surgical wards and surgical outpatient departments. A ward infrastructure survey was also done. Data were entered and analysed using SPSS version 16 for Windows. Chi-square analysis using Pearson's formula was used to test associations between 'exposure' factors and the outcome 'compliance'. A total of 270 hand hygiene opportunities were observed and the overall compliance rate was 38.9%. No differences were observed between the various types of HCWs or seniority. HCWs were more likely to perform hand hygiene if the indication was 'after' rather than 'before' patient contact (p = 0.001). This study underscores the need for improvement in HH practices among HCWs in a teaching hospital. Health education with particular attention to the need for HH prior to physical contact with patients is indicated.

Epidemiology of Staphylococcus aureus in a burn unit of a tertiary care center in Ghana.

PubMed

Amissah, Nana Ama; van Dam, Lieke; Ablordey, Anthony; Ampomah, Opoku-Ware; Prah, Isaac; Tetteh, Caitlin S; van der Werf, Tjip S; Friedrich, Alexander W; Rossen, John W; van Dijl, Jan Maarten; Stienstra, Ymkje

2017-01-01

In developing countries, hospitalized burn victims are at high risk of nosocomial infections caused by Staphylococcus aureus. Risk factors include poor infection control practices, prolonged hospitalisation and limited capacity for laboratory microbiological analyses. These problems are compounded by widespread use of antibiotics that drives the spread of multi-drug resistant bacteria. During the study period (November 2014-June 2015), nasal and invasive S. aureus isolates were collected consecutively from patients and healthcare workers (HCWs) within the burn unit of the Reconstructive Plastic Surgery and Burn Center of Korle Bu Teaching Hospital in Ghana. Antibiotic prescription, antibiotic susceptibility and bacterial typing were used to assess antibiotic pressure, antibiotic resistance, and possible transmission events among patients and HCWs. Eighty S. aureus isolates were obtained from 37 of the 62 included burn patients and 13 of the 29 HCWs. At admission, 50% of patients carried or were infected with S. aureus including methicillin resistant S. aureus (MRSA). Antibiotic use per 100 days of hospitalization was high (91.2 days), indicating high selective pressure for resistant pathogens. MRSA isolates obtained from 11 patients and one HCW belonged to the same spa-type t928 and multi-locus sequence type 250, implying possible transmission events. A mortality rate of 24% was recorded over the time of admission in the burn unit. This study revealed a high potential for MRSA outbreaks and emergence of resistant pathogens amongst burn patients due to lack of patient screening and extended empirical use of antibiotics. Our observations underscore the need to implement a system of antibiotic stewardship and infection prevention where microbiological diagnostics results are made available to physicians for timely and appropriate patient treatment.

Advanced Hysteroscopic Surgery: Quality Assurance in Teaching Hospitals.

PubMed

Erian, Mark M S; McLaren, Glenda R; Erian, Anna-Marie

2017-01-01

Advanced hysteroscopic surgery (AHS) is a vitally important technique in the armamentarium for the management of many day-to-day clinical problems, such as menorrhagia, surgical excision of uterine myomata and septa in the management of female infertility, hysteroscopic excision of chronically retained products of conception (placenta accreta), and surgical removal of intramural ectopic pregnancy. In today's climate of accountability, it is necessary that gynecologists take a more active role in assuring the quality of their work. In this article, we discuss the quality assurance system from the point of view of the surgical audit meetings in some of the major teaching hospitals affiliated with the University of Queensland (Brisbane, Queensland, Australia).

Advanced Hysteroscopic Surgery: Quality Assurance in Teaching Hospitals

PubMed Central

McLaren, Glenda R.; Erian, Anna-Marie

2017-01-01

Advanced hysteroscopic surgery (AHS) is a vitally important technique in the armamentarium for the management of many day-to-day clinical problems, such as menorrhagia, surgical excision of uterine myomata and septa in the management of female infertility, hysteroscopic excision of chronically retained products of conception (placenta accreta), and surgical removal of intramural ectopic pregnancy. In today's climate of accountability, it is necessary that gynecologists take a more active role in assuring the quality of their work. In this article, we discuss the quality assurance system from the point of view of the surgical audit meetings in some of the major teaching hospitals affiliated with the University of Queensland (Brisbane, Queensland, Australia). PMID:28729781

Program planning for the community teaching hospital medical library.

PubMed Central

McCorkel, J; Cook, V

1985-01-01

To respond to the increasing demand for information from medical educators and clinicians and to persuade administrators to purchase the newly available microcomputer library systems, medical librarians in community teaching hospitals may find it useful to engage in intermediate term (for example, five-year) program planning. To increase the probability that the plan which emerges will be implemented, the planning process should fit the organizational nexus. Planning involves needs assessment, prioritized program elements, a written plan, and facilities planning (if applicable), which lead to program implementation. Components of a model program plan are presented. PMID:4027443

Clinical teaching and learning within a preceptorship model in an acute care hospital in Ireland; a qualitative study.

PubMed

McSharry, Edel; Lathlean, Judith

2017-04-01

A preceptorship model of clinical teaching was introduced to support the new all-graduate nurse education programme in Ireland in 2002. Little is known about how this model impacts upon the pedagogical practices of the preceptor or student learning in clinical practice leading to question what constitutes effective teaching and learning in clinical practice at undergraduate level. This study aimed to explore the clinical teaching and learning within a preceptorship model in an acute care hospital in Ireland and identify when best practice, based on current theoretical professional and educational principles occurred. A qualitative research study of a purposively selected sample of 13 students and 13 preceptors, working together in four clinical areas in one hospital in Ireland. Methods were semi-structured interviews, analysed thematically, complemented by documentary analysis relating to the teaching and assessment of the students. Ethical approval was gained from the hospital's Ethics Committee. Preceptor-student contact time within an empowering student-preceptor learning relationship was the foundation of effective teaching and learning and assessment. Dialoguing and talking through practice enhanced the students' knowledge and understanding, while the ability of the preceptor to ask higher order questions promoted the students' clinical reasoning and problem solving skills. Insufficient time to teach, and an over reliance on students' ability to participate in and contribute to practice with minimal guidance were found to negatively impact students' learning. Concepts such as cognitive apprenticeship, scaffolding and learning in communities of practice can be helpful in understanding the processes entailed in preceptorship. Preceptors need extensive educational preparation and support to ensure they have the pedagogical competencies necessary to provide the cognitive teaching techniques that foster professional performance and clinical reasoning. National

A multi-center prospective cohort study to evaluate the effect of differential pricing and health systems strengthening on access to medicines and management of hypertension and diabetes in Ghana: A study protocol.

PubMed

Mobula, Linda Meta; Sarfo, Stephen; Arthur, Lynda; Burnham, Gilbert; Plange-Rhule, Jacob; Ansong, Daniel; Gavor, Edith; Ofori-Adjei, David

2018-02-07

Background: There is evidence to suggest that the prevalence of non-communicable diseases (NCDs), in particular cardiovascular diseases and diabetes, are being recognized as forming a substantial proportion of the burden of disease among populations in Low- and Middle-Income Countries (LMICs).  Access to treatment is likely a key barrier to the control and prevention of NCD outcomes.  Differential pricing, an approach used to price drugs based on the purchasing power of patients in different socioeconomic segments, has been shown to be beneficial and leads to improved access and affordability. Methods: This is a quasi-experimental study, with a pragmatic trial design, to be conducted over the course of three years. A mixed methods design will be used to evaluate the effects of health systems strengthening and differential pricing on the management of diabetes, hypertension and selected cancers in Ghana. A public private partnership was established between all sites that will receive multi-level interventions, including health systems strengthening  and access to medicines interventions. Study populations and sites: Study participants will include individuals with new or recently diagnosed hypertension and diabetes (n=3,300), who present to two major referral hospitals, Komfo Anokye Teaching Hospital and Tamale Teaching Hospital, as well as three district hospitals, namely Kings Medical Centre, Agogo Presbyterian District Hospital, and Atua Government Hospital. Discussion: The objective of this study aims to test approaches intended to improve access to drugs for the treatment of hypertension and diabetes, and improve disease control. Patients with these conditions will benefit from health systems strengthening interventions (education, counseling, improved management of disease), and increased access to innovative medicines via differential pricing. Pilot programs also will facilitate health system strengthening at the participating institutions, which includes

Promoting Teaching and Learning in Ghanaian Basic Schools through ICT

ERIC Educational Resources Information Center

Natia, James Adam; Al-hassan, Seidu

2015-01-01

The Basic School Computerization policy was created in 2011 to introduce computers and e-learning into the entire educational system to promote training and life-long learning. Using data obtained by Connect for Change Education Ghana Alliance, this paper investigates the extent to which school administration, and teaching and learning are…

An Investigation into Physics Teaching in Senior High Schools

ERIC Educational Resources Information Center

Buabeng, Isaac; Ossei-Anto, Theophilus Aquinas; Ampiah, Joseph Ghartey

2014-01-01

This study sought to examine the activities that go on in physics classrooms in Senior High Schools in Ghana. Specifically, the study sought to investigate the pattern of interaction and instructional methods used for teaching physics and level of coverage of physics syllabus. The survey design was employed for the study in which questionnaire was…

Integrating herbal medicine into mainstream healthcare in Ghana: clients' acceptability, perceptions and disclosure of use.

PubMed

Agyei-Baffour, Peter; Kudolo, Agnes; Quansah, Dan Yedu; Boateng, Daniel

2017-12-01

Although there are current efforts to integrate herbal medicine (HM) into mainstream healthcare in Ghana, there is paucity of empirical evidence on the acceptability and concurrent use of HM, in the formal health facilities in Ghana. This study sought to determine client perception, disclosure and acceptability of integrating herbal medicine in mainstream healthcare in Kumasi, Ghana. A cross-sectional study was conducted from May to August, 2015. Five hundred patients presenting at the outpatient departments of Kumasi South, Suntreso and Tafo Government Hospitals in Kumasi were randomly selected. Interviews were conducted with the use of structured questionnaires. A logistic regression analysis, using backward selection, was conducted to determine the influence of socio-demographic and facility related factors on the odds of using HM at the facility. All statistical tests were two-sided and considered significant at a p-value of <0.05. Majority of the study respondents were females (64.8%) and the median age was 36 years. Less than half, 42.2%, of the respondents utilized HM services when they visited the health facility. Reasons for using HM at the facility level included 'being effective' (24.4%), 'easy to access' (25.3%) and 'being comparatively cheaper' (16%). About 86% never disclosed previous use of HM to their health care providers. Socio-economic status and perception of service provision influenced use of herbal medicines. Respondents who rated themselves wealthy had increased odds of using herbal medicines at the health facility as compared to those who rated themselves poor (OR = 4.9; 95%CI = 1.6-15.3). This study shows that integration of herbal medicine is feasible and herbal medicines may be generally accepted as a formal source of healthcare in Ghana. The results of this study might serve as a basis for improvement and upscale of the herbal medicine integration programme in Ghana.

Evidence-based training and mentorship combined with enhanced outcomes surveillance to address the leading causes of neonatal mortality at the district hospital level in Ghana.

PubMed

Brantuo, Mary N A; Cristofalo, Elizabeth; Meheš, Mira M; Ameh, Juliana; Brako, Nana Okai; Boahene, Frederick; Adjei, Stella B; Opoku, Ernest; Banda, Harriet; Wang, Yu T; Forgor, Abdulai A; Punguire, Damien; Brightson, Kennedy; Sottie, Cynthia; Owusu-Agyei, Seth; Williams, John E; Sulemana, Abubakari; Oduro, Abraham R; Gyampong, Margaret; Sarpong, Doris; Andrews, Edith; Gyansa-Lutterodt, Martha; Hodgson, Abraham; Bannerman, Cynthia; Abdullah, Fizan

2014-04-01

To evaluate the impact of a district hospital intervention focused on enhancing healthcare provider capacity to address leading causes of neonatal death: birth asphyxia, infection and prematurity. The neonatal quality improvement initiative was launched at two intervention referral district hospitals in Ghana. Local Health and Demographic Surveillance Systems were enlisted to enhance recording of neonatal and infant deaths in the community and at the facility. After baseline site assessments, a team of local paediatric experts conducted three clinical trainings on-site at each intervention hospital. Assessments were conducted to evaluate participant knowledge before and after participation in training modules. Monthly mentorship visits provided additional training to support the adoption of essential early neonatal care practices. In the first year of implementation, the initiative provided focused clinical training to 278 participants. A comparison of pre- and post-training test results demonstrates significant improvement in provider knowledge (73% vs. 89% correct, P < 0.001), with even greater improvement among trainees receiving recurrent refresher training (86% vs. 94% correct, P < 0.001). Participant feedback following training revealed enthusiasm about the programme and improved confidence. Locally led initiatives that invest directly in healthcare provider education and health systems strengthening represent a promising avenue for reducing neonatal morbidity and mortality. The NQI initiative demonstrates the positive impact of a district hospital intervention that combines on-site training, mentorship and enhanced demographic surveillance. © 2014 John Wiley & Sons Ltd.

Understanding tobacco use and socioeconomic inequalities among men in Ghana, and Lesotho.

PubMed

Dickson, Kwamena Sekyi; Ahinkorah, Bright Opoku

2017-01-01

Tobacco use is one of the leading causes of preventable deaths and has become a significant public health issue. Previous studies have paid less attention to tobacco use and socio-economic equalities among men in developing countries. This study examines the relationship between tobacco use and socio-economic inequalities among men in Ghana and Lesotho. The study made use of data from the 2014 Demographic and Health Survey (DHS) from Ghana, and Lesotho. Binary logistic regression was employed to examine the associations between socio-economic inequality characteristics of respondents and tobacco use. The results showed that the prevalence of tobacco use was high in Lesotho (47.9%) as compared to that of Ghana (6.3%). Tobacco use was generally high across all age groups in Lesotho and in contrast, it was relatively low across all ages in Ghana. A statistically significant association was found between all the socio-economic variables and tobacco use in both countries. The prevalence of tobacco use was smaller in age group 15-24 years compared to the age groups 25-34 years and 35-59 years in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR's in Ghana are respectively 5.3 (95% CI: 3.29-8.59) and 9.7 (95% CI: 6.20-15.06), compared to respectively 1.7 (95% CI: 1.32-2.11) and 1.7 (95% CI: 1.36-2.12). Smoking prevalence was smaller in men with higher level of education compared to men with no education in both Ghana and Lesotho, although the association was weaker in Ghana. The AOR in Ghana is 0.1 (95% CI: (0.02-0.11), compared to 0.2 (95% Cl: (0.17-0.30). The prevalence of tobacco use was smaller among men in urban areas compared to rural areas in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR in Ghana is 2.1 (95% CI: 1.67-2.73), compared to 1.6 (95% CI: (1.31-1.95). In both countries, prevalence of tobacco use was higher in men who are traditionalist/spiritualists or who had no religion compared to Christians

Perception and practice of Kangaroo Mother Care after discharge from hospital in Kumasi, Ghana: a longitudinal study.

PubMed

Nguah, Samuel B; Wobil, Priscilla N L; Obeng, Regina; Yakubu, Ayi; Kerber, Kate J; Lawn, Joy E; Plange-Rhule, Gyikua

2011-12-01

The practice of Kangaroo Mother Care (KMC) is life saving in babies weighing less than 2000 g. Little is known about mothers' continued unsupervised practice after discharge from hospitals. This study aimed to evaluate its in-hospital and continued practice in the community among mothers of low birth weight (LBW) infants discharged from two hospitals in Kumasi, Ghana. A longitudinal study of 202 mothers and their inpatient LBW neonates was conducted from November 2009 to May 2010. Mothers were interviewed at recruitment to ascertain their knowledge of KMC, and then oriented on its practice. After discharge, the mothers reported at weekly intervals for four follow up visits where data about their perceptions, attitudes and practices of KMC were recorded. A repeated measure logistic regression analysis was done to assess variability in the binary responses at the various reviews visits. At recruitment 23 (11.4%, 95%CI: 7.4 to 16.6%) mothers knew about KMC. At discharge 95.5% were willing to continue KMC at home with 93.1% willing to practice at night. 95.5% thought KMC was beneficial to them and 96.0% beneficial to their babies. 98.0% would recommend KMC to other mothers with 71.8% willing to practice KMC outdoors.At first follow up visit 99.5% (181) were still practicing either intermittent or continuous KMC. This proportion did not change significantly over the four weeks (OR: 1.4, 95%CI: 0.6 to 3.3, p-value: 0.333). Over the four weeks, increasingly more mothers practiced KMC at night (OR: 1.7, 95%CI: 1.2 to 2.6, p = 0.005), outside their homes (OR: 2.4, 95%CI: 1.7 to 3.3, p < 0.001) and received spousal help (OR: 1.6, 95%CI: 1.1 to 2.4, p = 0.007). Household chores and potentially negative community perceptions of KMC did not affect its practice with odds of 0.8 (95%CI: 0.5 to 1.2, p = 0.282) and 1.0 (95%CI: 0.6 to 1.7, p = 0.934) respectively. During the follow-up period the neonates gained 23.7 sg (95%CI: 22.6 g to 24.7 g) per day. Maternal knowledge of KMC was

A cross-sectional study of tuberculosis drug resistance among previously treated patients in a tertiary hospital in Accra, Ghana: public health implications of standardized regimens.

PubMed

Forson, Audrey; Kwara, Awewura; Kudzawu, Samuel; Omari, Michael; Otu, Jacob; Gehre, Florian; de Jong, Bouke; Antonio, Martin

2018-04-02

Mycobacterium tuberculosis drug resistance is a major challenge to the use of standardized regimens for tuberculosis (TB) therapy, especially among previously treated patients. We aimed to investigate the frequency and pattern of drug resistance among previously treated patients with smear-positive pulmonary tuberculosis at the Korle-Bu Teaching Hospital Chest Clinic, Accra. This was a cross-sectional survey of mycobacterial isolates from previously treated patients referred to the Chest Clinic Laboratory between October 2010 and October 2013. The Bactec MGIT 960 system for mycobactrerial culture and drug sensitivity testing (DST) was used for sputum culture of AFB smear-positive patients with relapse, treatment failure, failure of smear conversion, or default. Descriptive statistics were used to summarize patient characteristics, and frequency and patterns of drug resistance. A total of 112 isolates were studied out of 155 from previously treated patients. Twenty contaminated (12.9%) and 23 non-viable isolates (14.8%) were excluded. Of the 112 studied isolates, 53 (47.3%) were pan-sensitive to all first-line drugs tested Any resistance (mono and poly resistance) to isoniazid was found in 44 isolates (39.3%) and any resistance to streptomycin in 43 (38.4%). Thirty-one (27.7%) were MDR-TB. Eleven (35.5%) out of 31 MDR-TB isolates were pre-XDR. MDR-TB isolates were more likely than non-MDR isolates to have streptomycin and ethambutol resistance. The main findings of this study were the high prevalence of MDR-TB and streptomycin resistance among previously treated TB patients, as well as a high prevalence of pre-XDR-TB among the MDR-TB patients, which suggest that first-line and second-line DST is essential to aid the design of effective regimens for these groups of patients in Ghana.

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Mentor Tutoring: An Efficient Method for Teaching Laparoscopic Colorectal Surgical Skills in a General Hospital.

PubMed

Ichikawa, Nobuki; Homma, Shigenori; Yoshida, Tadashi; Ohno, Yosuke; Kawamura, Hideki; Wakizaka, Kazuki; Nakanishi, Kazuaki; Kazui, Keizo; Iijima, Hiroaki; Shomura, Hiroki; Funakoshi, Tohru; Nakano, Shiro; Taketomi, Akinobu

2017-12-01

We retrospectively assessed the efficacy of our mentor tutoring system for teaching laparoscopic colorectal surgical skills in a general hospital. A series of 55 laparoscopic colectomies performed by 1 trainee were evaluated. Next, the learning curves for high anterior resection performed by the trainee (n=20) were compared with those of a self-trained surgeon (n=19). Cumulative sum analysis and multivariate regression analyses showed that 38 completed cases were needed to reduce the operative time. In high anterior resection, the mean operative times were significantly shorter after the seventh average for the tutored surgeon compared with that for the self-trained surgeon. In cumulative sum charting, the curve reached a plateau by the seventh case for the tutored surgeon, but continued to increase for the self-trained surgeon. Mentor tutoring effectively teaches laparoscopic colorectal surgical skills in a general hospital setting.

Integrating the hospital library with patient care, teaching and research: model and Web 2.0 tools to create a social and collaborative community of clinical research in a hospital setting.

PubMed

Montano, Blanca San José; Garcia Carretero, Rafael; Varela Entrecanales, Manuel; Pozuelo, Paz Martin

2010-09-01

Research in hospital settings faces several difficulties. Information technologies and certain Web 2.0 tools may provide new models to tackle these problems, allowing for a collaborative approach and bridging the gap between clinical practice, teaching and research. We aim to gather a community of researchers involved in the development of a network of learning and investigation resources in a hospital setting. A multi-disciplinary work group analysed the needs of the research community. We studied the opportunities provided by Web 2.0 tools and finally we defined the spaces that would be developed, describing their elements, members and different access levels. WIKINVESTIGACION is a collaborative web space with the aim of integrating the management of all the hospital's teaching and research resources. It is composed of five spaces, with different access privileges. The spaces are: Research Group Space 'wiki for each individual research group', Learning Resources Centre devoted to the Library, News Space, Forum and Repositories. The Internet, and most notably the Web 2.0 movement, is introducing some overwhelming changes in our society. Research and teaching in the hospital setting will join this current and take advantage of these tools to socialise and improve knowledge management.

A Survey of Managers' Access to Key Performance Indicators via HIS: The Case of Iranian Teaching Hospitals.

PubMed

Ahmadi, Maryam; Khorrami, Farid; Dehnad, Afsaneh; Golchin, Mohammad H; Azad, Mohsen; Rahimi, Shafei

2018-01-01

The challenges of using health information systems in developing countries are different from developed countries for various reasons such as infrastructure and data culture of organizations. The aim of this study is to assess managers' access to key performance indicators (KPI) via Hospital Information System (HIS) in teaching hospitals of Iran. All managers (Census method) of the four teaching hospitals affiliated to Hormozgan University of Medical Sciences (HUMS) were included in this study. KPIs which are linked to the strategic objectives of organizations were adopted from the strategic plan of HUMS. The questionnaire used in this study included three categories: Financial, Human Resources and clinical. One-sample t-test was used and the significant difference score was calculated for the acceptable level. We found that HIS cannot facilitate access to KPIs for managers in the main categories, but it was effective in two subcategories of income (p = 0.314) and salary (P = 0.289)). A study of barriers to the use of managers of HIS in hospitals is suggested.

Microbiological assessment of indoor air of a teaching hospital in Nigeria.

PubMed

Awosika, S A; Olajubu, F A; Amusa, N A

2012-06-01

To investigate the quality of indoor air of different wards and units of Olabisi Onabanjo University Teaching Hospital, Sagamu, to ascertain their contribution to infection rate in the hospital. The microbial quality of indoor air of nine wards/units of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria was conducted. Sedimentation technique using open Petri-dishes containing different culture media was employed and samplings were done twice daily, one in the morning shortly after cleaning and before influx of people/patients into the wards/units and the other in the evening when a lot of activities would have taken place in these wards. Isolates were identified according to standard methods. Results showed that there was a statistically significant difference (χ(2) = 6.016 7) in the bacteria population of the different sampling time whereas it was not so for fungi population (χ(2) = 0.285 7). Male medical ward (MMW) and male surgical general (MSG) recorded the highest bacterial and fungal growth while the operating theatre (OT) was almost free of microbial burden. The bacteria isolates were Staphylococcus aureus, Klebsiella sp., Bacillus cereus, Bacillus subtilis, Streptococcus pyogenes and Serratia marscences while the fungi isolates included Aspergillus flavus, Penicillium sp., Fusarium sp., Candida albicans and Alternaria sp. Staphylococcus aureus was the predominantly isolated bacterium while Penicillium sp. was the most isolated fungus. Though most of the microbial isolates were potential and or opportunistic pathogens, there was no correlation between the isolates in this study and the surveillance report of nosocomial infection during the period of study, hence the contribution of the indoor air cannot be established. From the reduction noticed in the morning samples, stringent measures such as proper disinfection and regular cleaning, restriction of patient relatives' movement in and out of the wards/units need to be enforced so as to

Under-reporting of road traffic crash data in Ghana.

PubMed

Salifu, Mohammed; Ackaah, Williams

2012-01-01

Having reliable estimates of the shortfalls in road traffic crash data is an important prerequisite for setting more realistic targets for crash/casualty reduction programmes and for a better appreciation of the socio-economic significance of road traffic crashes. This study was carried out to establish realistic estimates of the overall shortfall (under-reporting) in the official crash statistics in Ghana over an eight-year period (1997-2004). Surveys were conducted at hospitals and among drivers to generate relevant alternative data which were then matched against records in police crash data files and the official database. Overall shortfalls came from two sources, namely, 'non-reporting' and 'under-recording'. The results show that the level of non-reporting varied significantly with the severity of the crash from about 57% for property damage crashes through 8% for serious injury crashes to 0% for fatal crashes. Crashes involving cyclists and motorcyclists were also substantially non-reported. Under-recording on the other hand declined significantly over the period from an average of 37% in 1997-1998 to 27% in 2003-2004. Thus, the official statistics of road traffic crashes in Ghana are subject to significant shortfalls that need to be accounted for. Correction factors have therefore been suggested for adjusting the official data.

Penile fracture at LAUTECH Teaching Hospital, Osogbo.

PubMed

Aderounmu, A O A; Salako, A A; Olatoke, S A; Eziyi, A K; Agodinrin, O

2009-09-01

We have seen three cases of penile fracture presenting in diverse ways in our teaching hospital. We want to highlight the difficulties of management when patients present late. Three case reports of young men whose ages range between 22-32 years and who presented at 1 year 6 months, four weeks, and 3 hours respectively, following penile fracture. The patient that presented within 3 hours had immediate exploration and primary repair with good results while the one that presented after four weeks is still being followed up. The patient that presented very late has been lost to follow up after he was told that he would require surgery. Early surgical intervention in penile trauma still gives the best result and is hereby advocated. Decision to operate or not should also be based on the empirical finding of size of tear if there is no associated urethra injury.

A study on job satisfaction among clinical and non-clinical hospital staff in a teaching hospital in Lagos, Nigeria.

PubMed

Coker, O O; Coker, A O; Onuoha, B

2011-12-01

Previous studies had demonstrated that continuous and effective productivity of hospital staff are linked to job satisfaction and only those who are satisfied with their job can be maximally effective and productive. This cross-sectional descriptive survey was designed to determine the levels of job satisfaction among various groups of health care professionals working in a teaching hospital in Lagos, Nigeria. Two hundred clinical and non-clinical hospital staff were invited to take part in the study. They completed a sociodemographic questionnaire and the Job Descriptive Index (JDI). The results indicated that majority clinical and non-clinical staff were satisfied with their jobs as regards the parameters of the JDI compared with those not satisfied with their jobs. The government and health policy makers should continue to pay attention to boost job morale and satisfaction of medical health workers to continue to make them to be satisfied with their job.

Stigmatized by association: challenges for abortion service providers in Ghana.

PubMed

Aniteye, Patience; O'Brien, Beverley; Mayhew, Susannah H

2016-09-10

Unsafe abortion is an issue of public health concern and contributes significantly to maternal morbidity and mortality globally. Abortion evokes religious, moral, ethical, socio-cultural and medical concerns which mean it is highly stigmatized and this poses a threat to both providers and researchers. This study sought to explore challenges to providing safe abortion services from the perspective of health providers in Ghana. A descriptive qualitative study using in-depth interviews was conducted. The study was conducted in three (3) hospitals and five (5) health centres in the capital city in Ghana. Participants (n = 36) consisted of obstetrician/gynaecologists, nurse-midwives and pharmacists. Stigma affects provision of safe-abortion services in Ghana in a number of ways. The ambiguities in Ghanaian abortion law and lack of overt institutional support for practitioners increased reluctance to openly provide for fear of stigmatisation and legal threat. Negative provider attitudes that stigmatised women seeking abortion care were frequently driven by socio-cultural and religious norms that highly stigmatise abortion practice. Exposure to higher levels of education, including training overseas, seemed to result in more positive, less stigmatising views towards the need for safe abortion services. Nevertheless, physicians open to practicing abortion were still very concerned about stigma by association. Stigma constitutes an overarching impediment for abortion service provision. It affects health providers providing such services and even researchers who study the subject. Exposure to wider debate and education seem to influence attitudes and values clarification training may prove useful. Proper dissemination of existing guidelines and overt institutional support for provision of safe services also needs to be rolled out.

Microbial food safety in Ghana: a meta-analysis.

PubMed

Saba, Courage K S; Gonzalez-Zorn, Bruno

2012-12-16

Food safety is a crucial factor in the growth of developing countries worldwide. In this study, we present a meta-analysis of microbiological food safety publications from Ghana. The search words "Ghana food safety", "Ghana food research", and "Ghana food bacteria" were used to search for microbiological food safety publications with related abstracts or titles in PubMed, published between 1997 and 2009. We obtained 183 research articles, from which we excluded articles concerning ready-to-eat microbial fermented foods and waterborne microorganisms as well as articles without abstracts. The criteria used for analysis of these publications were based on an assessment of methodological soundness previously developed for use in the medical field, with some modifications incorporated. The most predominant bacteria in Ghanain foods are Enterobacter spp., Citrobacter spp., Klebsiella spp. and Escherichia spp., which were found to be present in 65%, 50%, 46% and 38% respectively, of the food samples considered in the studies analysed. The most contaminated food samples were macaroni, salad, and milk. Although the methodological quality of the articles was generally sound, most of them did not give directions for future research. Several did not state possible reasons for differences between studies. The microbiological food contamination in Ghana is alarming. However, we found that the downward trend in publications of microbial food safety articles is appalling. Hence a concerted effort in research on food safety is needed in Ghana to help curb the incidence of preventable food-borne disease.

Hospital waste management status in Iran: a case study in the teaching hospitals of Iran University of Medical Sciences.

PubMed

Farzadkia, Mahdi; Moradi, Arash; Mohammadi, Mojtaba Shah; Jorfi, Sahand

2009-06-01

Hospital waste materials pose a wide variety of health and safety hazards for patients and healthcare workers. Many of hospitals in Iran have neither a satisfactory waste disposal system nor a waste management and disposal policy. The main objective of this research was to investigate the solid waste management in the eight teaching hospitals of Iran University of Medical Sciences. In this cross-sectional study, the main stages of hospital waste management including generation, separation, collection, storage, and disposal of waste materials were assessed in these hospitals, located in Tehran city. The measurement was conducted through a questionnaire and direct observation by researchers. The data obtained was converted to a quantitative measure to evaluate the different management components. The results showed that the waste generation rate was 2.5 to 3.01 kg bed(-1) day(-1), which included 85 to 90% of domestic waste and 10 to 15% of infectious waste. The lack of separation between hazardous and non-hazardous waste, an absence of the necessary rules and regulations applying to the collection of waste from hospital wards and on-site transport to a temporary storage location, a lack of proper waste treatment, and disposal of hospital waste along with municipal garbage, were the main findings. In order to improve the existing conditions, some extensive research to assess the present situation in the hospitals of Iran, the compilation of rules and establishment of standards and effective training for the personnel are actions that are recommended.

Sociodemographic Determinants of Malaria among Under-Five Children in Ghana.

PubMed

Nyarko, Samuel Harrenson; Cobblah, Anastasia

2014-01-01

Background. Malaria is an entrenched global health challenge particularly in the sub-Saharan African countries. However, in Ghana, little is known about the determinants of malaria prevalence among under-five children. As such, this study sought to examine the sociodemographic factors that determine malaria among under-five children in Ghana. Methods. This paper used secondary data drawn from the 2008 Ghana Demographic and Health Survey. Bivariate analysis and complementary log-log regression models were used to examine the determinants of malaria prevalence among under-five children in Ghana for the study period. Results. The results therefore revealed that region of residence, age of child, and ownership of mosquito net were the key predictors of malaria cases among under-five children in Ghana for the five-year period preceding the survey. Conclusion. It is therefore imperative that special education on prevention of malaria should be intensified by the National Malaria Control Programme in all the regions in order to reduce malaria prevalence particularly among under-five children in Ghana.

Outpatient drug oversupply at a teaching hospital in Thailand.

PubMed

Kaojarern, Sming; Ongphiphadhanakul, Boonsong; Pattanaprateep, Oraluck

2011-09-01

A part of rising drug expenditure in Thailand was causedfrom drug oversupply, which was a result from policy of civil servants to get direct reimbursement from Ministry ofFinance. Describe the problem oforal drug oversupply at outpatient service in a teaching hospital and determine the cost that affects hospital between October 1, 2008 and September 30, 2009. Data of oral drug prescribing for outpatients were retrievedfrom the hospital database in the format of Microsoft Visual Fox Pro 9.0 and analyzed by Microsoft Access 2007. Two assessment methods are applied to estimate drug oversupply more than 30 days, by month and by year. In addition, September 2009 was selected to study for a pattern of monthly drug oversupply. Total oversupply expenditure for fiscal year 2009 was 56.9 million Baht when summedfrom monthly basis and 62.0 million when performed as a whole year. Oversupply expenditure was 2.12 to 2.73%per month in term of money and 2.91 to 3.46% in term of quantity. In September 2009, cardiovascular & hematopoietic system had the most oversupply. By brand of drug, the most frequently oversupply were Calcium carbonate (7.60%), Simvastatin (3.69%) and Omeprazole (3.20%). In term of money, the top three highest costs were for Atorvastatin (7.27%), Clopidogrel (6.83%) and Rosuvastatin (4.24%). By health schemes, patients under CSMBS trend to be the most of prescribed drug oversupply at 8.31% (3.21 million Baht in September 2009) with average number of oversupply per patient at 1.83 items and average day left per drug item at 61.83 days. The most oversupply expenditures were for chronic diseases. These data will focus the problem for hospital administrators to plan for suitable strategy to control drug oversupply in their hospital.

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

ERIC Educational Resources Information Center

Young, Philip E.

1976-01-01

The changing social milieu has removed the charity patient but not the need for a teaching population. The University Hospital's program is described, in which patients prepaid a fixed, single fee for all obstetrics-related care through the third post partum day. (LBH)

The first cases of Lassa fever in Ghana.

PubMed

Dzotsi, E K; Ohene, S-A; Asiedu-Bekoe, F; Amankwa, J; Sarkodie, B; Adjabeng, M; Thouphique, A M; Ofei, A; Oduro, J; Atitogo, D; Bonney, J H K; Paintsil, S C N; Ampofo, W

2012-09-01

Lassa fever is a zoonotic disease endemic in West Africa but with no previous case reported in Ghana. We describe the first two laboratory confirmed cases of Lassa fever from the Ashanti Region of Ghana detected in October and December, 2011.

Improving Skilled Birth Attendance in Ghana: An Evidence-Based Policy Brief.

PubMed

Apanga, Paschal Awingura; Awoonor-Williams, John Koku

2017-01-01

This commentary has the objective of improving skilled birth attendance in Ghana to reduce maternal and neonatal mortality and morbidity. We have provided evidence of causes of low-skilled birth attendance in Ghana. Physical accessibility of health care, sociocultural factors, economic factors and health care system delivery problems were found as the main underlying causes of low levels of skilled birth attendance in Ghana. The paper provides potential strategies in addressing maternal and child health issues in Ghana.

Computer Attitude of Teaching Faculty: Implications for Technology-Based Performance in Higher Education

ERIC Educational Resources Information Center

Larbi-Apau, Josephine A.; Moseley, James L.

2012-01-01

This study examined the validity of Selwyn's computer attitude scale (CAS) and its implication for technology-based performance of randomly sampled (n = 167) multidiscipline teaching faculty in higher education in Ghana. Considered, computer attitude is a critical function of computer attitude and potential performance. Composed of four…

Implementation science in low-resource settings: using the interactive systems framework to improve hand hygiene in a tertiary hospital in Ghana.

PubMed

Kallam, Brianne; Pettitt-Schieber, Christie; Owen, Medge; Agyare Asante, Rebecca; Darko, Elizabeth; Ramaswamy, Rohit

2018-05-19

Low-resource clinical settings often face obstacles that challenge the implementation of recommended evidence-based practices (EBPs). Implementation science approaches are useful in identifying barriers and developing strategies to address them. Ridge Regional Hospital (RRH), a tertiary referral hospital in Accra, Ghana experienced a spike in rates of neonatal sepsis and launched a quality improvement (QI) initiative that identified poor adherence to hand hygiene in the neonatal intensive care unit as a potential source of infections. A multi-modal change package of World Health Organization-recommended solutions was created to address this issue. To ensure that the outputs of the QI effort were adopted within the organization, leaders at RRH and Kybele, Inc. used an implementation science framework called the 'Interactive Systems Framework for Dissemination and Implementation' (ISF) to create a package of locally acceptable implementation strategies. The ISF has never been used before to guide implementation in low-resource settings. Hand hygiene compliance rose from 67% to 92% overall, including a 36% increase during the night shifts-a group of healthcare workers with typically very low levels of compliance. The drastic improvement in adherence to hand hygiene suggests the potential value of the joint use of QI and implementation science to promote the creation and application of contextually appropriate EBPs in low-resource settings. Our results also suggest that using an implementation framework such as the ISF could rapidly increase the uptake of other evidence-based interventions in low-resource settings.

Part II--IEPS Reports. The proper function of teaching hospitals within health systems.

PubMed

1998-01-01

The main points of the discussions from the international seminar organised by the World Health Organisation and the Institute for the Study of Health Policies (IEPS) were published in French by Flammarion Medecine-Sciences in the Collection entitled "The IEPS Reports" and in English by the WHO under the title "The Proper Function of Teaching Hospitals within Health Systems" (1995).

You have no Choice but to go on: How Physicians and Midwives in Ghana Cope with High Rates of Perinatal Death.

PubMed

Petrites, Alissa D; Mullan, Patricia; Spangenberg, Kathryn; Gold, Katherine J

2016-07-01

Objectives Healthcare providers in low-resource settings confront high rates of perinatal mortality. How providers cope with such challenges can affect their well-being and patient care; we therefore sought to understand how physicians and midwives make sense of and cope with these deaths. Methods We conducted semi-structured interviews with midwives, obstetrician-gynecologists, pediatricians and trainee physicians at a large teaching hospital in Kumasi, Ghana. Interviews focused on participants' coping strategies surrounding perinatal death. We identified themes from interview transcripts using qualitative content analysis. Results Thirty-six participants completed the study. Themes from the transcripts revealed a continuum of control/self-efficacy and engagement with the deaths. Providers demonstrated a commitment to push on with their work and provide the best care possible. In select cases, they described the transformative power of attitude and sought to be agents of change. Conclusions Physicians and midwives in a low-resource country in sub-Saharan Africa showed remarkable resiliency in coping with perinatal death. Still, future work should focus on training clinicians in coping and strengthening their self-efficacy and engagement.

Educational Access in Ghana. Country Policy Brief

ERIC Educational Resources Information Center

Akyeampong, K.; Djangmah, J.; Oduro, A.; Seidu, A.; Hunt, F.

2008-01-01

This Policy Brief describes and explains patterns of access to schools in Ghana. It outlines policy and legislation on access to education and provides an analysis of access, vulnerability and exclusion. It is based on findings from the Country Analytic Report on Access to Basic Education in Ghana (Akyeampong et al, 2007) [ED508809] which can be…

Muddy puddles - the microbiology of puddles located outside tertiary university teaching hospitals.

PubMed

Furukawa, M; McCaughan, J; Stirling, J; Millar, B C; Bell, J; Goldsmith, C E; Reid, A; Misawa, N; Moore, J E

2018-04-01

In the British Isles, the frequency of rain results in the formation of puddles on footpaths and roads in/around hospitals. No data are available demonstrating the microbiological composition of such puddles and therefore a study was undertaken to examine the microbiology of puddles in the grounds of two tertiary university-teaching hospitals (18 sites) and compared with control puddles from non-hospital rural environments (eight sites), estimating (i) total viable count; (ii) identification of organisms in puddles; (iii) enumeration of Escherichia coli: (iv) detection of Extended Spectrum β-Lactamase producing organisms and (v) direct antimicrobial susceptibility testing. A mean count of 2·3 × 10 3  CFU per ml and 1·0 × 10 9  CFU per ml was obtained for hospital and non-hospital puddles respectively. Isolates (n = 77; 54 hospital and 23 non-hospital) were isolated comprising of 23 species among 17 genera (hospital sites), where the majority (10/16; 62·5%) of genera identified were Gram-negative approximately, a fifth (20·6%) were shared by hospital and non-hospital rural samples. Escherichia coli was detected in half of the hospital puddles and under-half (37·5%) of the rural puddles extended spectrum β-lactamase organisms were not detected in any samples examined. Rainwater puddles from the hospital and non-hospital environments contain a diverse range of bacteria, which are capable of causing infections. This study demonstrated the presence of a wide diversity of bacterial taxa associated with rainwater puddles around hospitals, many of which are capable of causing human disease. Of clinical significance is the presence of Pseudomonas aeruginosa isolated from a hospital puddle, particularly for patients with cystic fibrosis. The presence of potentially disease-causing bacteria in puddles in and around hospitals identifies a new potential environmental reservoir of bacteria. Furthermore work is now needed to define their potential of entering or

Radiation Protection, Safety and Security Issues in Ghana.

PubMed

Boadu, Mary; Emi-Reynolds, Geoffrey; Amoako, Joseph Kwabena; Akrobortu, Emmanuel; Hasford, Francis

2016-11-01

Although the use of radioisotopes in Ghana began in 1952, the Radiation Protection Board of Ghana was established in 1993 and served as the national competent authority for authorization and inspection of practices and activities involving radiation sources until 2015. The law has been superseded by an Act of Parliament, Act 895 of 2015, mandating the Nuclear Regulatory Authority of Ghana to take charge of the regulation of radiation sources and their applications. The Radiation Protection Institute in Ghana provided technical support to the regulatory authority. Regulatory and service activities that were undertaken by the Institute include issuance of permits for handling of a radiation sources, authorization and inspection of radiation sources, radiation safety assessment, safety assessment of cellular signal towers, and calibration of radiation-emitting equipment. Practices and activities involving application of radiation are brought under regulatory control in the country through supervision by the national competent authority.

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

ERIC Educational Resources Information Center

Trentin, Guglielmo

2014-01-01

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

Etiology of strokes and hemiplegia in children presenting at Ayub Teaching Hospital, Abbottabad.

PubMed

Siddiqui, Tahir Saeed; Rehman, Anis ur; Ahmed, Basharat

2006-01-01

Strokes in pediatric age group are not common. However diagnosing the cause of stroke will help in providing preventive and curative treatment. Present study was conducted to find etiology of strokes/hemiplegia in children. This study was conducted in Department of Pediatrics, Ayub Teaching Hospital Abbottabad from December 2002 to December 2005. All children from two months to fifteen years of age were included in the study. Children with weakness due to acute poliomyelitis and Guillan barre syndrome were excluded. Investigations were based on findings on history and clinical examination and included full blood count, PT, APTT, Platelets count, ECG, Echocardiography, hematocrit, lumber puncture with CSF analysis and culture and CT-scan skull. Data of all the patients presenting with strokes/hemiplegia was entered on prepared proforma. The main etiology of strokes was intracranial infection causing strokes in 23(56.09%)children and majority of children (78.26%) in this group were below five years. Etiology was un-known in 7(17.07%) children after necessary available investigations. Intracranial infection Infections that is meningitis and encephalitis are commonest etiology of strokes and hemiplegia in paediatrics patients presenting at Ayub Teaching Hospital, Abbottabad.

Impact of Electronic Resources and Usage in Academic Libraries in Ghana: Evidence from Koforidua Polytechnic & All Nations University College, Ghana

ERIC Educational Resources Information Center

Akussah, Maxwell; Asante, Edward; Adu-Sarkodee, Rosemary

2015-01-01

The study investigates the relationship between impact of electronic resources and its usage in academic libraries in Ghana: evidence from Koforidua Polytechnic & All Nations University College, Ghana. The study was a quantitative approach using questionnaire to gather data and information. A valid response rate of 58.5% was assumed. SPSS…

Smoking in Ghana: a review of tobacco industry activity

PubMed Central

Owusu-Dabo, E; Lewis, S; McNeill, A; Anderson, S; Gilmore, A; Britton, J

2009-01-01

Background: African countries are a major potential market for the tobacco industry, and the smoking epidemic is at various stages of evolution across the continent. Ghana is an African country with a low prevalence of smoking despite an active tobacco industry presence for over 50 years. This study explores potential reasons for this apparent lack of industry success. Objective: To explore the history of tobacco industry activity in Ghana and to identify potential reasons for the current low prevalence of smoking. Methods: A search was made of tobacco industry archives and other local sources to obtain data relevant to marketing and consumption of tobacco in Ghana. Findings: British American Tobacco, and latterly the International Tobacco Company and its successor the Meridian Tobacco Company, have been manufacturing cigarettes in Ghana since 1954. After an initial sales boom in the two decades after independence in 1957, the sustained further increases in consumption typical of the tobacco epidemic in most countries did not occur. Possible key reasons include the taking of tobacco companies into state ownership and a lack of foreign exchange to fund tobacco leaf importation in the 1970s, both of which may have inhibited growth at a key stage of development, and the introduction of an advertising ban in 1982. BAT ceased manufacturing cigarettes in Ghana in 2006. Conclusion: The tobacco industry has been active in Ghana for over 50 years but with variable success. The combination of an early advertising ban and periods of unfavourable economic conditions, which may have restricted industry growth, are likely to have contributed to the sustained low levels of tobacco consumption in Ghana to date. PMID:19359263

Smoking in Ghana: a review of tobacco industry activity.

PubMed

Owusu-Dabo, E; Lewis, S; McNeill, A; Anderson, S; Gilmore, A; Britton, J

2009-06-01

African countries are a major potential market for the tobacco industry, and the smoking epidemic is at various stages of evolution across the continent. Ghana is an African country with a low prevalence of smoking despite an active tobacco industry presence for over 50 years. This study explores potential reasons for this apparent lack of industry success. To explore the history of tobacco industry activity in Ghana and to identify potential reasons for the current low prevalence of smoking. A search was made of tobacco industry archives and other local sources to obtain data relevant to marketing and consumption of tobacco in Ghana. British American Tobacco, and latterly the International Tobacco Company and its successor the Meridian Tobacco Company, have been manufacturing cigarettes in Ghana since 1954. After an initial sales boom in the two decades after independence in 1957, the sustained further increases in consumption typical of the tobacco epidemic in most countries did not occur. Possible key reasons include the taking of tobacco companies into state ownership and a lack of foreign exchange to fund tobacco leaf importation in the 1970s, both of which may have inhibited growth at a key stage of development, and the introduction of an advertising ban in 1982. BAT ceased manufacturing cigarettes in Ghana in 2006. The tobacco industry has been active in Ghana for over 50 years but with variable success. The combination of an early advertising ban and periods of unfavourable economic conditions, which may have restricted industry growth, are likely to have contributed to the sustained low levels of tobacco consumption in Ghana to date.

Perception and practice of Kangaroo Mother Care after discharge from hospital in Kumasi, Ghana: A longitudinal study

PubMed Central

2011-01-01

Background The practice of Kangaroo Mother Care (KMC) is life saving in babies weighing less than 2000 g. Little is known about mothers' continued unsupervised practice after discharge from hospitals. This study aimed to evaluate its in-hospital and continued practice in the community among mothers of low birth weight (LBW) infants discharged from two hospitals in Kumasi, Ghana. Methods A longitudinal study of 202 mothers and their inpatient LBW neonates was conducted from November 2009 to May 2010. Mothers were interviewed at recruitment to ascertain their knowledge of KMC, and then oriented on its practice. After discharge, the mothers reported at weekly intervals for four follow up visits where data about their perceptions, attitudes and practices of KMC were recorded. A repeated measure logistic regression analysis was done to assess variability in the binary responses at the various reviews visits. Results At recruitment 23 (11.4%, 95%CI: 7.4 to 16.6%) mothers knew about KMC. At discharge 95.5% were willing to continue KMC at home with 93.1% willing to practice at night. 95.5% thought KMC was beneficial to them and 96.0% beneficial to their babies. 98.0% would recommend KMC to other mothers with 71.8% willing to practice KMC outdoors. At first follow up visit 99.5% (181) were still practicing either intermittent or continuous KMC. This proportion did not change significantly over the four weeks (OR: 1.4, 95%CI: 0.6 to 3.3, p-value: 0.333). Over the four weeks, increasingly more mothers practiced KMC at night (OR: 1.7, 95%CI: 1.2 to 2.6, p = 0.005), outside their homes (OR: 2.4, 95%CI: 1.7 to 3.3, p < 0.001) and received spousal help (OR: 1.6, 95%CI: 1.1 to 2.4, p = 0.007). Household chores and potentially negative community perceptions of KMC did not affect its practice with odds of 0.8 (95%CI: 0.5 to 1.2, p = 0.282) and 1.0 (95%CI: 0.6 to 1.7, p = 0.934) respectively. During the follow-up period the neonates gained 23.7 sg (95%CI: 22.6 g to 24.7 g) per day

Cardiovascular diseases in Ghana within the context of globalization.

PubMed

Ofori-Asenso, Richard; Garcia, Daireen

2016-02-01

This paper discusses how globalization and its elements are influencing health dynamics and in particular Cardiovascular diseases (CVDs) in Ghana. It assesses the growing burden of CVDs and its relationship with globalization. It further describes the conceptual framework on which to view the impact of globalization on CVDs in Ghana. It also set out the dimensions of the relationship between CVD risk factors and globalization. The paper concludes with a discussion on strategies for tackling the growing burden of CVDs in Ghana.

Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool.

PubMed

Choo, Shelly; Perry, Henry; Hesse, Afua A J; Abantanga, Francis; Sory, Elias; Osen, Hayley; Fleischer-Djoleto, Charles; Moresky, Rachel; McCord, Colin W; Cherian, Meena; Abdullah, Fizan

2010-09-01

To survey infrastructure characteristics, personnel, equipment and procedures of surgical, obstetric and anaesthesia care in 17 hospitals in Ghana. The assessment was completed by WHO country offices using the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, which surveyed infrastructure, human resources, types of surgical interventions and equipment in each facility. Overall, hospitals were well equipped with general patient care and surgical supplies. The majority of hospitals had a basic laboratory (100%), running water (94%) and electricity (82%). More than 75% had the basic supplies needed for general patient care and basic intra-operative care, including sterilization. Almost all hospitals were able to perform major surgical procedures such as caesarean sections (88%), herniorrhaphy (100%) and appendectomy (94%), but formal training of providers was limited: a few hospitals had a fully qualified surgeon (29%) or obstetrician (36%) available. The greatest barrier to improving surgical care at district hospitals in Ghana is the shortage of adequately trained medical personnel for emergency and essential surgical procedures. Important future steps include strengthening their number and qualifications. © 2010 Blackwell Publishing Ltd.

Overdosed prescription of paracetamol (acetaminophen) in a teaching hospital.

PubMed

Charpiat, B; Henry, A; Leboucher, G; Tod, M; Allenet, B

2012-07-01

Paracetamol is the most commonly used analgesic and antipyretic. Reviews of hospital use of paracetamol are scarce. Little is known about the appropriateness of the dose of paracetamol prescribed for hospitalized adults. The aim of this study was to report on the nature and the frequency of the overdosed prescription of paracetamol observed in adult patients over a 4.5-year period in a teaching hospital. Prescription analysis by pharmacists was performed once a week in six medical and three surgical departments and daily in a post-emergency unit. In cases of prescription error, the pharmacist notified the physician through an electronic alert when a computerized prescription order entry system was available or otherwise by face-to-face discussion. For each drug-related problem detected, the pharmacists recorded relevant details in a database. From October 2006 to April 2011, 44,404 prescriptions were reviewed and 480 alerts related to the overdosed prescription of paracetamol were made (1% of analyzed prescriptions). The extent of errors of dosage was within the intervals [90-120 mg/kg/d] and greater than 120 mg/kg/d for 87 and 11 patients respectively, who were prescribed a single non-combination paracetamol containing product. Sixty alerts concerned co-prescription of at least two paracetamol containing products with similar frequency for computerized (1.4/1000) or handwritten (1.2/1000) prescriptions. Prescriptions of paracetamol for hospitalized adults frequently exceed the recommended dosage. These results highlight the need for increased awareness of unintentional paracetamol overdose and support the initiation of an educational program aimed at physicians and nurses. Copyright © 2012. Published by Elsevier Masson SAS.

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

PubMed

Morris, D E

1985-06-01

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

Patients' feelings about the presence of medical students in a New Teaching Hospital in Southwestern Nigeria.

PubMed

Adebayo, Philip Babatunde; Asaolu, Stephen Olabode; Akinboro, Adeolu Oladayo; Akintunde, Adeseye Abiodun; Olakulehin, Olawale Adebayo; Ayodele, Olugbenga Edward

2016-01-01

This study aimed to evaluate how patients feel about the introduction of medical students into a former general hospital transformed to a teaching hospital in southwestern Nigeria and to also assess the extent to which they are willing to involve medical students in the management of their conditions. In a descriptive cross-sectional study, a sample of 251 randomly selected patients were interviewed using a pretested questionnaire that assessed patients' demography, patients' acceptance of and reaction to the involvement of medical students in their clinical care including the specific procedures the patients would allow medical students to perform. Two hundred and fifty-one patients with mean age ± standard deviation of 37.33 ± 19.01 (age range = 16-120 years; M:F = 1:1.26) were recruited between January 01 and March 31, 2013. Most patients (86.5%) preferred to be treated in a teaching hospital and were comfortable with medical students as observers (83.7%) and serving as the doctors' assistant (83.3%) during common diagnostic procedures. Men were more willing to have invasive procedures such as insertion of urinary catheter (56.6% vs. 43.4%, P = 0.001). Acceptability of medical students (such as willingness of patients to have students read their medical notes) was significantly higher in nonsurgical specialties than in surgical specialties (77.5% vs. 22.5%, P< 0.001). Factors associated with a positive disposition include age> 40 years, male gender, and higher level of education as well as consultation in nonsurgical specialties (P = 0.001). Medical students are well received into this new teaching hospital setting. However, there is a need for more education of younger, less educated female patients of surgical subspecialties so that they can understand their importance as irreplaceable partners in the training of medical students.

Ocular injuries and eye care seeking patterns following injuries among cocoa farmers in Ghana.

PubMed

Bert, Boadi-Kusi Samuel; Rekha, Hansraj; Percy, Mashige Khathutshelo

2016-03-01

The work environment of cocoa farmers exposes them to several ocular hazards that predispose them to eye diseases and injuries. However, the extent of ocular injuries and health seeking patterns following these injuries are unknown among cocoa farmers in Ghana. To determine the prevalence of ocular injuries and health seeking behaviour following injury among cocoa farmers in Ghana. Five hundred and fifty six participants were recruited through simple random sampling using a multistage approach from four cocoa growing districts in Ghana. A structured questionnaire was used to collect relevant information such as demography, ocular hazards and injuries experienced. An ocular examination was also conducted to assess the eye health of the participants. Descriptive and regression statistics were used to analyze the data. The rate of ocular injuries was calculated by using the number of injuries reported that resulted in lost work time/days divided by the number of worker years at risk of injury (sum of years worked in cocoa farms for all the participants). The rate of ocular injuries was 11.3/1000 worker years (95% CI: 9.4 - 31) which led to lost work time of 37.3/1000 worker years (95% CI: 34.1 - 40.8). The major causes of ocular injury were plants/branches (n=73, 51.1%), chemicals (n=27, 18.9%), cocoa pod/husk (n=14, 9.8%) and occurred mostly during weeding, harvesting and chemical spraying. Few (n=34, 6.1%) participants reported the use of ocular protection. Fifty-five (38.5%) participants visited the local chemical shops, while 37 (25.9%) visited hospitals/clinics for ocular treatment of their injuries. There is a high rate of ocular injuries among cocoa farmers who make insufficient use of appropriate eye care services. There is the need for eye health education among cocoa farmers in Ghana.

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

PubMed

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

2016-06-01

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

Cardiovascular diseases in Ghana within the context of globalization

PubMed Central

Garcia, Daireen

2016-01-01

This paper discusses how globalization and its elements are influencing health dynamics and in particular Cardiovascular diseases (CVDs) in Ghana. It assesses the growing burden of CVDs and its relationship with globalization. It further describes the conceptual framework on which to view the impact of globalization on CVDs in Ghana. It also set out the dimensions of the relationship between CVD risk factors and globalization. The paper concludes with a discussion on strategies for tackling the growing burden of CVDs in Ghana. PMID:26885494

Mapping mental health finances in Ghana, Uganda, Sri Lanka, India and Lao PDR

PubMed Central

2010-01-01

Background Limited evidence about mental health finances in low and middle-income countries is a key challenge to mental health care policy initiatives. This study aimed to map mental health finances in Ghana, Uganda, India (Kerala state), Sri Lanka and Lao PDR focusing on how much money is available for mental health, how it is spent, and how this impacts mental health services. Methods A researcher in each region reviewed public mental health-related budgets and interviewed key informants on government mental health financing. A total of 43 key informant interviews were conducted. Quantitative data was analyzed in an excel matrix using descriptive statistics. Key informant interviews were coded a priori against research questions. Results National ring-fenced budgets for mental health as a percentage of national health spending for 2007-08 is 1.7% in Sri Lanka, 3.7% in Ghana, 2.0% in Kerala (India) and 6.6% in Uganda. Budgets were not available in Lao PDR. The majority of ring-fenced budgets (76% to 100%) is spent on psychiatric hospitals. Mental health spending could not be tracked beyond the psychiatric hospital level due to limited information at the health centre and community levels. Conclusions Mental health budget information should be tracked and made publically accessible. Governments can adapt WHO AIMS indicators for reviewing national mental health finances. Funding allocations work more effectively through decentralization. Mental health financing should reflect new ideas emerging from community based practice in LMICs. PMID:20507558

"If I Should Stop Teaching Now, Where Will I Go?" Turnover Intentions among High School Teachers in Ghana

ERIC Educational Resources Information Center

Adusei, Henry; Sarfo, Jacob Owusu; Manukure, Portia; Cudjoe, Josephine

2016-01-01

Teachers form one of the essential professional groups in the development domain of every country. Although most senior high school teachers in Ghana complains about poor conditions of service, a lot of them are still at post. The key research goal was to explore the retaining factors of senior high school teachers, within their existing…

Reproductive health laws and fertility decline in Ghana.

PubMed

Finlay, Jocelyn E; Fox, Ashley M

2013-11-01

An unresolved debate in demography concerns the causal sequence between the supply of contraception and the demand for smaller families in fertility decline. Through a mixed-methods approach, we explored the effect of a sudden increase in access to legal abortion on subsequent fertility decline when Ghana's criminal code was amended in 1985. Using Ghana Demographic and Health Surveys, we constructed a panel of women aged 15-34 years and undertook a spline regression analysis to examine the effect of legal changes in 1985 and fertility decline controlling for social determinants of fertility. In addition, we conducted 17 key informant interviews (KIIs) to understand the reasons for the legal change and competing explanations for fertility decline. Multivariate results indicated that the timing of the liberalization of the abortion law coincided with the onset of Ghana's fertility decline. The KIIs indicated that the reasons for the liberalization of reproductive health laws were in response to famine and physician advocacy. While the timing of the abortion law liberalization coincided with the fertility decline in Ghana, we are unable to decouple the effect of the legal change from the effects of a severe famine that affected the region at the same time. Further research on documented and undocumented abortion in Ghana should be conducted to validate the contribution of legal abortion to fertility decline. © 2013.

Teachers' Beliefs on Inclusion and Teaching Students with Disabilities: A Representation of Diverse Voices

ERIC Educational Resources Information Center

Hodge, Samuel R.; Sato, Takahiro; Samalot-Rivera, Amaury; Hersman, Bethany L.; LaMaster, Kathryn; Casebolt, Kevin M.; Ammah, Jonathan O. A.

2009-01-01

The purpose of this study was to analyze the beliefs of physical education teachers on teaching students with disabilities in inclusive classes. Participants were 29 physical education teachers from Ghana (Africa), Japan, the United States, and Puerto Rico. The research paradigm was qualitatively descriptive using a multisite interview design…

Perceptions of traditional, complementary and alternative medicine among conventional healthcare practitioners in Accra, Ghana: Implications for integrative healthcare.

PubMed

Kretchy, Irene A; Okere, Harry A; Osafo, Joseph; Afrane, Barima; Sarkodie, Joseph; Debrah, Philip

2016-09-01

Integrative medicine refers to ongoing efforts to combine the best of conventional and evidence-based complementary therapies. While this effort for collaboration is increasing, traditional complementary and alternative medicine (TM-CAM) remains poorly integrated into the current healthcare system of Ghana. At present, it is not clear if practitioners of mainstream medicine favor integrative medicine. The present study, therefore, sought to explore the perceptions of conventional healthcare professionals on integrative medicine. A qualitative design composed of semi-structured interviews was conducted with 23 conventional healthcare professionals comprising pharmacists, physicians, nurses and dieticians from two quasi-government hospitals in Accra, Ghana. Participants' knowledge of TM-CAM was low, and although they perceived alternative medicine as important to current conventional healthcare in Ghana, they expressed anxieties about the potential negative effects of the use of TM-CAM. This paradox was found to account for the low levels of use among these professionals, as well as the low level of recommendation to their patients. The practitioners surveyed recommended that alternative medicine could be integrated into mainstream allopathic healthcare in Ghana through improving knowledge, training as well as addressing concerns of safety and efficacy. These findings are discussed under the themes: the knowledge gap, the paradox of TM-CAM, experience of use and prescription, and guided integration. We did not observe any differences in views among the participants. The conventional healthcare professionals were ready to accept the idea of integrative medicine based on knowledge of widespread use and the potential role of TM-CAM products and practices in improving healthcare delivery in the country. However, to achieve an institutional integration, practitioners' understanding of TM-CAM must be improved, with specific attention to issues of safety, regulation and

Profile of neurological admissions at the University of Nigeria Teaching Hospital Enugu.

PubMed

Ekenze, O S; Onwuekwe, I O; Ezeala Adikaibe, B A

2010-01-01

The burden of Neurological diseases may be on the increase especially in developing countries. Improved outcome in these settings may require appreciation of the spectrum of Neurological diseases and the impediments to their management. We aim to determine the profile of neurological admissions and the challenges of managing these diseases at the University of Nigeria Teaching Hospital Enugu South East Nigeria. Analysis of Neurological admissions into the medical wards of the University of Nigeria Teaching Hospital Enugu from January 2003 to December 2007. Neurological admissions comprise about 14.8% of medical admissions. There were 640 (51%) males and 609 (49%) females. The spectrum of neurological diseases were stroke 64.9%, central nervous system infections (21.8% ), HIV related neurological diseases 3.5%, hypertensive encephalopathy (3.4%), dementia (3%), subarachnoid haemorrhage (2.2%), Guillian Barre syndrome (1.2%), Parkinson's disease (1.1%), myasthenia gravis (1.0%), motor neurone disease and peripheral neuropathy and accounted for 0.8% and 0.6% respectively. Overall, noninfectious disease accounted for 78.2% of neurological admissions while infectious diseases accounted for 11.8%. A wide spectrum of neurological diseases occurs in our setting. The high incidence of CNS infections indicates that efforts should be geared towards preventive measures. A major challenge to be addressed in the management of neurological diseases in our setting is the lack of specialized facilities.

E-waste interventions in Ghana.

PubMed

Asante, Kwadwo Ansong; Pwamang, John A; Amoyaw-Osei, Yaw; Ampofo, Joseph Addo

2016-03-01

Electrical and electronic waste (e-waste) has become an emerging environmental and human health problem in the world in the 21st century. Recently, the developing nations of West Africa (e.g. Ghana and Nigeria) have become a major destination for e-waste worldwide. In Ghana, the e-waste recyclers use primitive methods (mechanical shredding and open burning) to remove plastic insulation from copper cables. This technique can release highly toxic chemicals and severely affect the environment and human health if improperly managed. It is as a result of the adverse impact on human health that some interventions are being made in Ghana to reduce exposure. The present mode of recycling/dismantling, which happens at Agbogbloshie must be replaced by official receiving/recycling centers to be established. Currently, equipment to strip both large and small cables are available in the country via the Blacksmith Institute (USA) and it is expected that the e-waste workers will embrace the use of these machines. This technology will go a long way to help prevent the burning of e-waste and will be replicated in other smaller e-waste centers in the country.

Hospital diversification strategy.

PubMed

Eastaugh, Steven R

2014-01-01

To determine the impact of health system restructuring on the levels of hospital diversification and operating ratio this article analyzed 94 teaching hospitals and 94 community hospitals during the period 2008-2013. The 47 teaching hospitals are matched with 47 other teaching hospitals experiencing the same financial market position in 2008, but with different levels of preference for risk and diversification in their strategic plan. Covariates in the analysis included levels of hospital competition and the degree of local government planning (for example, highly regulated in New York, in contrast to Texas). Moreover, 47 nonteaching community hospitals are matched with 47 other community hospitals in 2008, having varying manager preferences for service-line diversification and risk. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as jointly dependent. Institutional diversification is found to yield better financial position, and the better operating profits provide the firm the wherewithal to diversify. Some services are in a growth phase, like bariatric weight-loss surgery and sleep disorder clinics. Hospital managers' preferences for risk/return potential were considered. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification, and divestiture, occasionally leading to closure or merger.

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

PubMed

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

1997-01-01

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

Fit for purpose? Evaluation of CPD courses for nurses in an Irish university teaching hospital.

PubMed

Ryder, Mary; Browne, Freda; Galvin, Cáit; Leonard, Orla; O'Reilly, Jody

2018-04-26

acute tertiary hospitals require knowledgeable, skilled registered nurses to care for patients in specialist areas. It is also a professional responsibility that nurses maintain skills and competence. This article reports on stage 1 of an action research study to evaluate the delivery of continuing professional development (CPD) courses for registered nurses in an acute hospital in Ireland. an audit and qualitative self-reporting questionnaire was used to obtain data. The questionnaire focused on the areas of teaching learning and outcomes. Overall, five CPD courses, each of 26 weeks' duration, were evaluated. teaching delivery was all didactic and was delivered primarily by clinical staff with expert knowledge and skills, but the teaching approaches varied. The curriculum content was identified as excessive and at a high level for an introductory course, with a large volume of classroom-based theoretical delivery. Participant learning was reported as excellent in the clinical areas; however, this was counterbalanced by heavy workloads and staffing shortages. Participant motivation was also found to influence learning. From an outcome perspective the development of new knowledge and skills was reported in participants who had undertaken the courses, and participants reported that the CPD courses assisted in recruitment and retention. although many positive aspects of the CPD courses were identified, it is clear that some changes were required with particular reference to theoretical delivery and curriculum content.

Health care workers indicate ill preparedness for Ebola Virus Disease outbreak in Ashanti Region of Ghana.

PubMed

Annan, Augustina Angelina; Yar, Denis Dekugmen; Owusu, Michael; Biney, Eno Akua; Forson, Paa Kobina; Okyere, Portia Boakye; Gyimah, Akosua Adumea; Owusu-Dabo, Ellis

2017-06-06

The recent Ebola Virus Disease (EVD) epidemic that hit some countries in West Africa underscores the need to train front line high-risk health workers on disease prevention skills. Although Ghana did not record (and is yet to) any case, and several health workers have received numerous training schemes, there is no record of any study that assessed preparedness of healthcare workers (HCWS) regarding EVD and any emergency prone disease in Ghana. We therefore conducted a hospital based cross sectional study involving 101 HCWs from two facilities in Kumasi, Ghana to assess the level of preparedness of HCWs to respond to any possible EVD. We administered a face-to-face questionnaire using an adapted WHO (2015) and CDC (2014) Checklist for Ebola Preparedness and assessed overall knowledge gaps, and preparedness of the Ghanaian HCWs in selected health facilities of the Ashanti Region of Ghana from October to December 2015. A total 92 (91.09%) HCWs indicated they were not adequately trained to handle an EVD suspected case. Only 25.74% (n = 26) considered their facilities sufficiently equipped to handle and manage EVD patients. When asked which disinfectant to use after attending to and caring for a suspected patient with EVD, only 8.91% (n = 9) could correctly identify the right disinfectant (χ 2  = 28.52, p = 0.001). Our study demonstrates poor knowledge and ill preparedness and unwillingness of many HCWs to attend to EVD. Beyond knowledge acquisition, there is the need for more training from time to time to fully prepare HCWs to handle any possible EVD case.

Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement.

PubMed

Abeeleh, Mahmoud Abu; Tareef, Tareq M; Hani, Amjad Bani; Albsoul, Nader; Samarah, Omar Q; ElMohtaseb, M S; Alshehabat, Musa; Ismail, Zuhair Bani; Alnoubani, Omar; Obeidat, Salameh S; Halawa, Sami Abu

2017-08-01

To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes and recommended interventions were suggested accordingly. Future research, available resources, hospital policies, and strategic measures directed to tackle these reasons should take priority.

Oil: Lessons from Comparative Perspectives for Ghana

NASA Astrophysics Data System (ADS)

Osei-Boakye, Maame Frema

Oil as it relates to maintenance of energy consumption is becoming a very important acquired resource all around the world. This thesis focuses on Ghana as a place where recent oil discoveries have taken place, to assess the current policies being put in place to avoid the oil pitfalls of their other African counterparts and to examine oil models that could possibly work to reinforce a positive outcome for the new found oil industry in Ghana. These research aims were met through extensive research of relevant literature. The research resulted in the finding that the Ghanaian government would benefit from a combination of economic models that have been used in the past (spend all, save all and spend interest only). The main conclusion that has resulted from this research is that through strong fiscal policies towards the Ghanaian oil industry Ghana should be able to maintain a relatively stable economy which in turn will produce a stable country all around. This research argues that by creating strong policies and using a combination of the econometric oil models this will help Ghana account for the immediate need for things like infrastructure while also saving money for when/if the oil is no longer being produced in the country.

High frequency of methicillin-resistant Staphylococcus aureus (MRSA) with SCCmec type III and spa type t030 in Karaj's teaching hospitals, Iran.

PubMed

Bayat, Bahareh; Zade, Masoumeh Hallaj; Mansouri, Samaneh; Kalantar, Enayat; Kabir, Kourosh; Zahmatkesh, Ehsan; Sepehr, Mohammad Noori; Naseri, Mohammmad Hassan; Darban-Sarokhalil, Davood

2017-09-01

Methicillin-resistant Staphylococcus aureus (MRSA) has been one of the most important antibiotic-resistant pathogen in many parts of the world over the past decades. This cross-sectional study was conducted to investigate MRSA isolated between July 2013 and July 2014 in Karaj, Iran. All tested isolates were collected in teaching hospitals from personnel, patients, and surfaces and each MRSA was analyzed by SCCmec and spa typing. Antibiotic susceptibility testing was accomplished by disk diffusion method. Out of 49 MRSA isolates from the Karaj's teaching hospitals, 82%, 10%, and 6% of the isolates were SCCmec types III, II, and I, respectively. The main spa type in this study was spa t030 with frequency as high as 75.5% from intensive care unit (ICU) of the hospitals and high rate of resistance to rifampicin (53%) was found in MRSA isolates. In conclusion, high frequency of spa t030 with SCCmec type III and MRSA phenotype illustrated circulating of one of the antibiotic-resistant strains in ICU of Karaj's teaching hospitals and emphasizes the need for ongoing molecular surveillance, antibiotic susceptibility monitoring, and infection control.

The do-not-resuscitate order in teaching hospitals.

PubMed

Evans, A L; Brody, B A

1985-04-19

We studied the use of do-not-resuscitate (DNR) orders at three teaching hospitals that did not have official protocols for such orders to see whether their use meets the goals (decision making before a crisis and promoting patient autonomy) that have been identified for such orders. We found that 20% of all patients had or were being considered for DNR orders, that the patient and/or family was usually involved (83%) in the decision not to resuscitate, but rarely involved (25%) in decisions to resuscitate, or in cases of no decision, that a wide range of care was provided to patients with a DNR status, and that partial resuscitative efforts would be employed in some cases. Our main conclusion in light of our findings is that DNR orders are currently not fulfilling their major goals. We offer six proposals for improving future DNR protocols.

Causes of childhood blindness in Ghana: results from a blind school survey in Upper West Region, Ghana, and review of the literature.

PubMed

Huh, Grace J; Simon, Judith; Grace Prakalapakorn, S

2017-06-13

Data on childhood blindness in Ghana are limited. The objectives of this study were to determine the major causes of childhood blindness and severe visual impairment (SVI) at Wa Methodist School for the Blind in Northern Ghana, and to compare our results to those published from other studies conducted in Ghana. In this retrospective study, data from an eye screening at Wa Methodist School in November 2014 were coded according to the World Health Organization/Prevention of Blindness standardized reporting methodology. Causes of blindness/SVI were categorized anatomically and etiologically, and were compared to previously published studies. Of 190 students screened, the major anatomical causes of blindness/SVI were corneal scar/phthisis bulbi (CS/PB) (n = 28, 15%) and optic atrophy (n = 23, 12%). The major etiological causes of blindness/SVI were unknown (n = 114, 60%). Eighty-three (44%) students became blind before age one year. Of four published blind school surveys conducted in Ghana, CS/PB was the most common anatomical cause of childhood blindness. Over time, the prevalence of CS/PB within blind schools decreased in the north and increased in the south. Measles-associated visual loss decreased from 52% in 1987 to 10% in 2014 at Wa Methodist School. In a blind school in northern Ghana, CS/PB was the major anatomical cause of childhood blindness/SVI. While CS/PB has been the most common anatomical cause of childhood blindness reported in Ghana, there may be regional changes in its prevalence over time. Being able to identify regional differences may guide future public health strategies to target specific causes.

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

PubMed

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

2017-06-01

Coronary artery disease is prevalent in China, with concomitant increases in the volume of coronary artery bypass grafting (CABG). The present study aims to compare CABG-related outcomes between China and the United States among large teaching and urban hospitals. Observational analysis of patients aged ≥18 years, discharged from acute-care, large teaching and urban hospitals in China and the United States after hospitalization for an isolated CABG surgery. Data were obtained from the Chinese Cardiac Surgery Registry in China and the National Inpatient Sample in the United States. Analysis was stratified by 2 periods: 2007, 2008, and 2010; and 2011 to 2013 periods. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay. The sample included 51 408 patients: 32 040 from 77 hospitals in the China-CABG group and 19 368 from 303 hospitals in the US-CABG group. In the 2007 to 2008, 2010 period and for all-age and aged ≥65 years, the China-CABG group had higher mortality than the US-CABG group (1.91% versus 1.58%, P =0.059; and 3.12% versus 2.20%, P =0.004) and significantly higher age-, sex-, and comorbidity-adjusted odds of death (odds ratio, 1.58; 95% confidential interval, 1.22-2.04; and odds ratio, 1.73; 95% confidential interval, 1.24-2.40). There were no significant mortality differences in the 2011 to 2013 period. For preoperative, postoperative, and total hospital stay, respectively, the median (interquartile range) length of stay across the entire study period between China-CABG and US-CABG groups were 9 (8) versus 1 (3), 9 (6) versus 6 (3), and 20 (12) versus 7 (5) days (all P <0.001). This difference did not change significantly over time. In 2011 to 2013, there was no significant difference in in-hospital mortality among patients who underwent an isolated CABG surgery in large teaching and urban hospitals in China and the United States. The longer length of stay in China may represent an opportunity for

English Teaching Profiles from the British Council: Burma, Cyprus, Czechoslovakia, Ethiopia, Ghana, India, Lesotho, New Zealand, Pakistan, Qatar, Malaysia.

ERIC Educational Resources Information Center

British Council, London (England). English Language and Literature Div.

The role of English and the status of English language instruction is reported for Burma, Cyprus, Czechoslovakia, Ethiopia, Ghana, India, Lesotho, New Zealand, Pakistan, Qatar, and Malaysia. The profile for each country contains a summary of English instruction within and outside of the educational system, teacher supply and qualifications,…

[The profile urological emergencies at the Conakry University Teaching Hospital, Guinea].

PubMed

Bobo Diallo, A; Bah, I; Diallo, T M O; Bah, O R; Amougou, B; Bah, M D; Guirassy, S; Bobo Diallo, M

2010-03-01

To stick out the profile urological emergencies at the Conakry University Teaching Hospital, Guinea. This retrospective study, carried out over a period of 3 years (January 2005-December 2007), included 757 urological emergencies admitted to the urology department of the university hospital of Conakry, Guinea. The mean age of patients was 56 years. These patients had an age equal to or higher than 60 years in 58% of the cases. The sex ratio (M/F) was 16.6. According to the social profession, the farmer (40,6%) and workers (21%) were the dominant patients. The most frequent illness was vesical urinary retention (73.9%), hematuria (9.6%) and genito-urinary system trauma (7%). The most performed procedures were the installation of a urethral catheter (55.25%) and the installation of a suprapubic catheter (24.14%). The most frequent urological emergency in our country was vesical urinary retention, the hematuria and genito-urinary system trauma are not rare there. Copyright 2009 Elsevier Masson SAS. All rights reserved.

Awareness of Patients' Rights among Inpatients of a Tertiary Care Teaching Hospital- A Cross-sectional Study.

PubMed

Agrawal, Upasana; D'Souza, Brayal C; Seetharam, Arun Mavaji

2017-09-01

The rights of a patient are a set of rules of conduct which govern the interaction between the patients' and healthcare professionals. Every patient has a right to be informed about their rights and also the responsibility of the healthcare provider. To assess awareness among inpatient about patients' rights at an academic accredited hospital. A questionnaire based cross-sectional study was carried out among 350 patients admitted to the wards of a Tertiary Care Teaching Hospital. A 21-point questionnaire was developed based on standards of the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and patients' charter of rights and validated. This charter of rights is also displayed in the hospital for patient's awareness. Frequencies and percentages were depicted. Chi-square test was used for statistical analysis. Positive awareness among the patients ranged from 28% to 97.4%. Females were more aware of their rights than males for 11 out of the 21 patient rights items. Younger adults were more aware than any other age group participants. Participants who were admitted to wards of higher categories (deluxe rooms) had high degree of awareness about patients' rights and education. Patients from urban areas and higher educational status were more aware than patients coming from rural areas. The study concludes that effective measures should be taken to improve the overall awareness not only among patients but also among different stakeholders in the healthcare delivery system. Readability of the patients' rights charter with good readability score, developing and distributing patient education materials in simple language about the rights and responsibilities to the patient and their family/relatives during their stay in the hospital or at the time of registration.Continuing nursing and medical education in medical teaching institutions and hospitals should focus on patients' rights and its importance, its need for awareness and its consequences

The relationship of centralization, organizational culture and performance indexes in teaching hospitals affiliated to Tehran University of Medical Sciences.

PubMed

Nasirpour, Amir Ashkan; Gohari, Mahmoud Reza; Moradi, Saied

2010-01-01

One of the main problems in the efficiency and efficacy of an organization is its structural issue. Organizational culture is also considered as an effective factor in the performance of many organizations. The main goal of the present study was to determine the relationship of Centralization and organizational culture and performance indexes in Teaching Hospitals affiliated to Tehran University of Medical Sciences. This correlation study was performed in the year 2007. The population studied consisted of 4408 personnel from 13 hospitals among whom 441 subjects were selected and studied via a class sampling method. Data was compiled using a check list concerning the evaluation status of Centralization and another form concerning performance indexes as well as Robbin's organizational culture questionnaire. Data were obtained from the subjects by self answering and analyzed by using descriptive statistical indexes, T- test and Fisher's exact tests. Among the organizational culture indexes of the hospitals studied, control and organizational identity was better as compared to others (mean=3.32 and 3.30). Concerning the extent of Centralization in the hospitals studied, 53.85 % and 46.15 % were reported to have upper and lower organizational Centralization, respectively. Mean ratio of surgical operations to inpatients was 40%, the mean rate of admissions per active bed was 60.83, mean bed occupancy coefficient was 70.79%, average length of stay was 6.96 days, and mean net death rate was 1.41%. No significant correlation was seen between Centralization degree, organizational culture and performance indexes in teaching hospitals Tehran university of medical sciences. (with 95% confidence interval). Due to the fact that first grade Teaching hospitals use board certified members, expert personnel, and advanced equipments and because of the limitation of patients choice and, the extent of Centralization and many organizational culture components have no significant

An Analysis of Deaths Due to Tuberculosis at the Lagos University Teaching Hospital

PubMed Central

Bandele, E.O.; Olude, I.O.

1985-01-01

An analysis was made of deaths from tuberculosis in the Lagos University Teaching Hospital from 1976 to 1980. Of the 320 patients assessed, 240 were determined to have died from tuberculosis. Tuberculous meningitis was the main cause of death. Forty-two percent of the deaths occurred in the age group of 0 to 10 years old, and 47.5 percent of the patients died within one week of diagnosis. Potentially avoidable factors contributing to death include late reporting by patients to medical personnel, lack of bacillus of Calmette and Guerin (BCG) vaccine, irregular taking of medications by patients, and late referral of patients to specialized hospitals. There is a need for improved education of patients and medical personnel about the management of tuberculosis in Lagos. PMID:4046063

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

PubMed

Narita, M; Tokuda, Y; Barnett, P

2016-07-01

It poses a serious problem if physicians leave a hospital without having a replacement or without permission. A huge earthquake followed by a devastating tsunami seriously damaged the Fukushima-Daiichi nuclear power plant. This disaster overwhelmed a major teaching hospital in the local area and many hospital employees, including some resident physicians, left the premises. Since the threat of severe radiation exposure poses a potentially greater lifetime risk to younger individuals, letting the young resident physicians leave the hospital was not only allowed, it was actually recommended by many attending physicians and hospital administrators. The hospital administrator was required to make the difficult decision of whether to make all efforts to provide the highest level of medical care, including keeping all of the physicians on the premises, or to evacuate the resident physicians in order to preserve their health and their potential future contributions to healthcare. Consideration and compassion needed to be provided to all people, regardless of the reason they wanted to leave. From an ethical perspective, the roles of performance under these complex circumstances should be understood and embraced by us as individuals, professionals, supervisors and society as a whole. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Pattern Of Leukaemia Patients Admitted In Ayub Teaching Hospital Abbottabad.

PubMed

Khan, Tariq Mehmood

2016-01-01

Any tissue of the body can give rise to cancer. However, those tissues which multiply rapidly are at high risk of developing cancer and haematopoietic system is one of them. Neoplasms of this system are known as leukaemia and lymphoma, according to the types of white cells involved. Study of cancer patterns in different societies, however can contribute a substantial knowledge about the aetiology of cancer. The present Study was designed and aimed to estimate the frequency of different types of leukaemia in patients admitted in Ayub Teaching hospital Abbottabad. Data from the patients admitted at oncology Department of Ayub Teaching Hospital Abbottabad from 2010 to 2015 was collected and analysed to calculate cumulative and year-wise frequency of leukaemia and its major types. Frequency distribution with reference to gender and age was also calculated. In our analysis about 16% patients had acute myelocytic leukaemia and 32% patients had acute lymphocytic leukaemia; while chronic myeloid leukaemia outnumbered chronic lymphocytic leukaemia (11% and 3%); Hodgkin lymphoma was seen in 18% cases while Non Hodgkin lymphoma (NHL) was present in 20% cases. Out of the total, 150 cases (75%) belonged to mountainous areas of Hazara, i.e., 40 cases belonged to Kohistan, another 40 cases were residents of Battagram, 45 cases belonged to hilly areas of Mansehra and 25 cases to Kaghan valley, while only 50 (25%) cases were from the plain areas of Abbottabad and Haripur districts, i.e., 20 and 30 cases respectively. Leukaemia is more common in hilly areas of Hazara, since majority of the cases belonged to well-known mountainous regions of Kohistan, Battagram, Kaghan or Mansehra and only few cases belonged to the plain areas of Abbottabad and Haripur districts.

Infection after open heart surgery in Golestan teaching hospital of Ahvaz, Iran.

PubMed

Nashibi, Roohangiz; Mohammadi, Mohammad Javad; Alavi, Seyed Mohammad; Yousefi, Farid; Salmanzadeh, Shokrolah; Ahmadi, Fatemeh; Varnaseri, Mehran; Ramazani, Asghar; Moogahi, Sasan

2018-02-01

The present study surveyed demographic and infection data which were obtained after open heart surgery (OHS) through patient's admission in Golestan teaching hospital, Ahvaz metropolitan city of Iran, taking into account the confirmed location of the infection, microorganism and antibiotic susceptibility. The occurrence of infection among patients during 48 to 72 h after surgery and hospital admission is the definition of Nosocomial infections (NIs) (Salmanzadeh et al., 2015) [1]. All of them after OHS were chosen for this study. In this paper, type of catheter, fever, type of microorganism, antibiotic susceptibility, location of the infection and outcome (live or death) were studied (Juhl et al., 2017; Salsano et al., 2017) [2], [3]. After the completion of the observations and recording patients' medical records, the coded data were fed into EXCELL. Data analysis was performed using SPSS 16.

Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study.

PubMed

Gyamfi, Joyce; Plange-Rhule, Jacob; Iwelunmor, Juliet; Lee, Debbie; Blackstone, Sarah R; Mitchell, Alicia; Ntim, Michael; Apusiga, Kingsley; Tayo, Bamidele; Yeboah-Awudzi, Kwasi; Cooper, Richard; Ogedegbe, Gbenga

2017-02-02

Nurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses' knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH). A pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses' satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management. A total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses' knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention. Findings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana. Trial registration for parent TASSH study: NCT01802372 . Registered February 27, 2013.

The changing face of women in physics in Ghana

NASA Astrophysics Data System (ADS)

Andam, Aba Bentil; Amponsah, Paulina Ekua; Nsiah-Akoto, Irene; Gyamfi, Kwame; Hood, Christiana Odumah

2013-03-01

Ghana is said to be the first independent sub-Saharan African country outside South Africa to promote science education and the application of science in industrial and social development. It has long been recognized that many schools' science curricula extend the extracurricular activities of boys more than those of girls. In order to bridge this gap, efforts have been made to give girls extra assistance in the learning of science by exposing them to science activities through specific camps, road shows, exhibitions, and so on. The best known of such efforts is the Science, Technology, and Mathematics Education (STME) camps and clinics for girls, which started in Ghana 23 years ago. Since our attendance at the Third International Conference on Women in Physics in Seoul, Korea, a lot has been achieved to further improve female science education, and this credit goes to STME. The first female nuclear engineer from Ghana graduated from the University of Ghana in March 2010.

Awareness and attitudes towards face and organ transplant in Kumasi, Ghana.

PubMed

Agbenorku, P; Agbenorku, M; Agamah, G

2013-03-01

This study aimed to determine the level of awareness and attitudes towards face and organ transplant among the people of Kumasi, Ghana. An observational study was employed, where participants were randomly selected for the study. The respondents were commuters waiting to board public vehicles at the Kejetia lorry station, Bantama/Komfo Anokye Teaching Hospital taxi station, Buokrom Estate F-line lorry station, traders, and residents of Adum and Bantama, all in Kumasi. The descriptive study was conducted from 1(st) February to 30(th) April 2009. An interview-based questionnaire was used for the convenient sample of respondents. Data obtained included: demographic profile and items covering awareness, attitudes and beliefs towards face and organ transplant. Out of the 1020 respondents, females (53.2%) outnumbered males. The age of respondents ranged from 10 to 89 years; mean was 27.50± 2.98 years; majority (72.3%) was Christians, whilst 61.8% had gone through tertiary education. Few (33.5%) of the respondents were aware of face transplant; 70.0% and 62.1% were willing to receive a face if their face was disfigured or donate their face when dead respectively. Also, 50.6% were aware of organ transplant, whiles 59.1% would receive/donate an organ when required. Multiple regression analysis shows statistical significant association between attitudes, awareness and demographic variables listed. Face and organ transplant were found to have a relatively low and high awareness level respectively. However, an affirmative attitude was recorded for face and organ transplant. More education on face and organ donations is needed.

Evaluation of chest and abdominal injuries in trauma patients hospitalized in the surgery ward of poursina teaching hospital, guilan, iran.

PubMed

Hemmati, Hossein; Kazemnezhad-Leili, Ehsan; Mohtasham-Amiri, Zahra; Darzi, Ali Asghar; Davoudi-Kiakalayeh, Ali; Dehnadi-Moghaddam, Anoush; Kouchakinejad-Eramsadati, Leila

2013-01-01

Trauma, especially chest and abdominal trauma are increasing due to the growing number of vehicles on the roads, which leads to an increased incidence of road accidents. Urbanization, industrialization and additional problems are the other associated factors which accelerate this phenomenon. A better understanding of the etiology and pattern of such injuries can help to improve the management and ultimate the outcomes of these patients. This study aimed to evaluate the patients with chest and abdominal trauma hospitalized in the surgery ward of Poursina teaching hospital, Guilan, Iran. In this cross-sectional study, the data of all chest and abdominal trauma patients hospitalized in the surgery ward of Poursina teaching hospital were collected from March 2011 to March 2012. Information about age, gender, injured areas, type of injury (penetrating or blunt), etiology of the injury, accident location (urban or rural) and patients' discharge outcomes were collected by a questionnaire. In total, 211 patients with a mean age of 34.1 ± 1.68 years was entered into the study. The most common cause of trauma was traffic accidents (51.7%). Among patients with chest trauma, 45 cases (35.4%) had penetrating injuries and 82 cases (64.6%) blunt lesions. The prevalence of chest injuries was 35.5% and rib fractures 26.5%. In chest injuries, the prevalence of hemothorax was 65.3%, pneumothorax 2.7%, lung contusion 4% and emphysema 1.3%, respectively. There were 24 cases (27.9%) with abdominal trauma which had penetrating lesions and 62 cases (72.1%) with blunt lesions. The most common lesions in patients with penetrating abdominal injuries were spleen (24.2%) and liver (12.1%) lesions. The outcomes of the patients were as follow: 95.7% recovery and 4.3% death. The majority of deaths were observed among road traffic victims (77.7%). Considering the fact that road-related accidents are quite predictable and controllable; therefore, the quality promotion of traumatic patients' care

Evaluation of Chest and Abdominal Injuries in Trauma Patients Hospitalized in the Surgery Ward of Poursina Teaching Hospital, Guilan, Iran

PubMed Central

Hemmati, Hossein; Kazemnezhad-Leili, Ehsan; Mohtasham-Amiri, Zahra; Darzi, Ali Asghar; Davoudi-Kiakalayeh, Ali; Dehnadi-Moghaddam, Anoush; Kouchakinejad-Eramsadati, Leila

2013-01-01

Background Trauma, especially chest and abdominal trauma are increasing due to the growing number of vehicles on the roads, which leads to an increased incidence of road accidents. Urbanization, industrialization and additional problems are the other associated factors which accelerate this phenomenon. A better understanding of the etiology and pattern of such injuries can help to improve the management and ultimate the outcomes of these patients. Objectives This study aimed to evaluate the patients with chest and abdominal trauma hospitalized in the surgery ward of Poursina teaching hospital, Guilan, Iran. Patients and Methods In this cross-sectional study, the data of all chest and abdominal trauma patients hospitalized in the surgery ward of Poursina teaching hospital were collected from March 2011 to March 2012. Information about age, gender, injured areas, type of injury (penetrating or blunt), etiology of the injury, accident location (urban or rural) and patients' discharge outcomes were collected by a questionnaire. Results In total, 211 patients with a mean age of 34.1 ± 1.68 years was entered into the study. The most common cause of trauma was traffic accidents (51.7%). Among patients with chest trauma, 45 cases (35.4%) had penetrating injuries and 82 cases (64.6%) blunt lesions. The prevalence of chest injuries was 35.5% and rib fractures 26.5%. In chest injuries, the prevalence of hemothorax was 65.3%, pneumothorax 2.7%, lung contusion 4% and emphysema 1.3%, respectively. There were 24 cases (27.9%) with abdominal trauma which had penetrating lesions and 62 cases (72.1%) with blunt lesions. The most common lesions in patients with penetrating abdominal injuries were spleen (24.2%) and liver (12.1%) lesions. The outcomes of the patients were as follow: 95.7% recovery and 4.3% death. The majority of deaths were observed among road traffic victims (77.7%). Conclusions Considering the fact that road-related accidents are quite predictable and controllable

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

PubMed

Lancman, B M

2016-05-01

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

Educational Technology-Related Performance of Teaching Faculty in Higher Education: Implications for eLearning Management

ERIC Educational Resources Information Center

Larbi-Apau, Josephine A.; Guerra-Lopez, Ingrid; Moseley, James L.; Spannaus, Timothy; Yaprak, Attila

2017-01-01

The study examined teaching faculty's educational technology-related performances (ETRP) as a measure for predicting eLearning management in Ghana. A total of valid data (n = 164) were collected and analyzed on applied ISTE-NETS-T Performance Standards using descriptive and ANOVA statistics. Results showed an overall moderate performance with the…

In-Service Science Teachers' and the Use of Multimedia as a Teaching Tool

ERIC Educational Resources Information Center

Ameyaw, Y.; Quansah, E.

2013-01-01

The study investigated the attitudes of in-service teachers' towards the use of multimedia as a tool for science teaching in Junior High Schools in the Greater Accra Region of Ghana. The population sample consisted of 100 Junior High School (JHS) science teachers made up of 60 urban teachers and 40 rural teachers from three selected districts…

VAGINAL BIRTH AFTER A PREVIOUS CAESAREAN SECTION: CURRENT TRENDS AND OUTLOOK IN GHANA.

PubMed

Seffah, J D; Adu-Bonsaffoh, K

2014-01-01

The optimal mode of subsequent delivery of women with prior caesarean birth remains a subject of intense research and debate in contemporary obstetric practice especially in low resource settings like West Africa where there are obvious systemic and management-related challenges associated with trial of scar. However, there is evidence that vaginal birth after caesarean section (VBAC) is safe in appropriately selected women in addition to adequate intrapartum monitoring and ready access to theatre when emergency CS is indicated. The primary objective of the study was to determine the current trends and performance of VBAC in Ghana after decades of practice of trial of labour after caesarean section (TOLAC) in the mist of inherent challenges in deciding the optimal mode of childbirth for women with a previous caesarean birth. The secondary objective was to relate evidence based practice of TOLAC to obstetric practice in low resource settings like Ghana and provide recommendations for improving maternal and newborn health among women with prior caesarean birth. This was a retrospective study of the records of patients who had had a prior caesarean delivery and who then proceeded to deliver the next babies at the Korle Bu Teaching Hospital (KBTH) between Jan 2010 and Dec 2014. The data on demography, antenatal care, labour and delivery and outcomes were collected from the Labour and Recovery wards and the Biostatistics unit of the Maternity unit of the Hospital. Excluded were women with a previous CS who had multiple pregnancies and those with incomplete notes as well as those whose delivery plans were not predetermined antenatally.. The data were analyzed using SPSS version 20. There were 53,581 deliveries during the study period. Vaginal delivery was obtained in 31,870 (59.5%) pregnancies and 21,711(40.5%) had CS. Also, 6261 (11.7%) had had a prior CS and 2472 (39.5%) of these were selected for TOLAC while 2119 (33.8) were scheduled for planned repeat CS. There was

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

PubMed Central

Ugwa, EA

2015-01-01

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

[Cost of nursing turnover in a Teaching Hospital].

PubMed

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

2016-02-01

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

Student Activism and Democratic Quality in Ghana's Fourth Republic

ERIC Educational Resources Information Center

Van Gyampo, Ransford Edward

2013-01-01

Student activism has been pivotal in Ghana's political and democratic history. Prior to Ghana's Fourth Republic, student activism was highly confrontational and entailed student support or opposition to the various regimes depending on the extent to which the regimes were accepted by all as being rightful or legitimate. After 23 years of…

Prevalence of alcohol among nonfatally injured road accident casualties in two level III trauma centers in northern Ghana.

PubMed

Damsere-Derry, James; Palk, Gavan; King, Mark

2018-02-17

Alcohol use is pervasive among motorists on the road in Ghana; however, we do not know the extent to which this behavior is implicated in road accidents in this country. The main objective of this research was to establish the prevalence of alcohol in the blood of nonfatally injured casualties in the emergency departments (EDs) in northern Ghana. Participants were injured road traffic crash victims, namely, pedestrians, cyclists, motorcyclists, and drivers seeking treatment at an ED. The study sites were 2 level III trauma centers located in Wa and Bolgatanga. Participants were screened for alcohol followed by breath tests for positive participants using breathalyzers. Two hundred and sixty-two accident victims visited EDs, 58% of whom were in Wa. Among the victims, 41% were hospitalized and 57% experienced slight injuries. The vast majority (76%) of the casualties were motorcyclists, 13% were pedestrians, 8% were cyclists, and 2% were drivers. Casualties who had detectable alcohol in their blood were predominantly vulnerable road users. In all, 34% of participants had detectable blood alcohol concentrations (BACs) and the mean BAC for all casualties who tested positive and could give definitive BACs was 0.2265 (226 mg/dl). The prevalence of alcohol use was 53% among cyclists, 34% among motorcyclists, 21% among pedestrians, and 17% among drivers. Male casualties were more likely to test positive for alcohol than females. In addition, the prevalence of alcohol was significantly higher among injured casualties in Bolgatanga compared to Wa. There was a high prevalence of alcohol use among nonfatally injured casualties in northern Ghana and injury severity increased with BAC. AUDIT screening in the hospital, alcohol consumption guideline, road safety education with an emphasis on minimizing or eliminating alcohol consumption, and enhanced enforcement of the BAC limit among motorists are recommended.

Socioeconomic factors affecting patients’ utilization of primary care services at a Tertiary Teaching Hospital in Riyadh, Saudi Arabia

PubMed Central

Alsubaie, Abdulaziz M.; Almohaimede, Khaled A.; Aljadoa, Abdulrahman F.; Jarallah, Osamah J.; Althnayan, Yasser I.; Alturki, Yousef A.

2016-01-01

Background: Primary care services utilization is dependent on socioeconomic factors. It is proven that variation in socioeconomic factors result in discrepancies in the use of such services. Admittedly, research is limited on the socioeconomic factors affecting the utilization of primary care services in Saudi Arabia. Objectives: The aim of this research was to study the effect of the main socioeconomic factors affecting patients' utilization of primary care services at a tertiary teaching hospital, Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted from January to February 2014 in a primary care clinic of a tertiary teaching hospital in Riyadh city; subjects selected using a random consecutive sampling technique. A self-administered questionnaire in Arabic was given to the participants to collect the data which comprised sociodemographic data, utilization measures, and health needs. The data were analyzed using SPSS version 21. Results: A total of 358 subjects participated in the study. The main factors that best determine the utilization of primary health care clinic in a tertiary teaching hospital were the possession of a health insurance (P = 0.046, odds ratio [OR] = 8.333), and bad self-health-perception (P < 0.014, OR: 2.088). Chronic illness was also associated with higher utilization (OR = 2.003). Conclusion: Our results reveal that chronic health problems, self-health-perception, and health insurance are the most significant socioeconomic factors affecting the utilization of primary care services. PMID:26929723

Budget impact analysis of pemetrexed introduction: case study from a teaching hospital perspective, Thailand.

PubMed

Chanjaruporn, Farsai; Roughead, Elizabeth E; Sooksriwong, Cha-oncin; Kaojarern, Sming

2011-09-01

Thailand does not currently require Budget Impact Analysis (BIA) assessment. The present study aimed to estimate the annual drug cost and the incremental impact on the hospital pharmaceutical budget of the introduction of pemetrexed to a Thai teaching hospital. The budget impact model was conducted in accordance with the Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee (PBAC). The model variables consisted of number of patients, growth rate of lung cancer, uptake rate of pemetrexed over time, unit prices of drugs, and the length and cost of treatment. Sensitivity analysis was performed to determine changes in budgetary impact due to variation of parameters or assumptions in the model. The introduction of pemetrexed was estimated to cause considerable costs for the teaching hospital. In the base-case analysis, the incremental costs were estimated at 8,553,984 Baht in the first year increasing to 12, 118, 144 Baht, 17,820,800 Baht and 17,820,800 Baht in the following years. The 4-year net budgetary impact was 20,154,480 Baht or approximately 127,560 Baht per patient. Sensitivity analyses found that number of treatment cycles andproportion of patients assumed to be treated with pemetrexed were the two most important influencing factors in the model. New costly innovative interventions should be evaluated using the BIA model to determine whether they are affordable. The Thai government should consider requiring the BIA study as one of the requirements for drug submission to assist in the determination of listing and subsidizing decision for medicines.

Antimicrobial susceptibility pattern of Klebsiella species from Ebonyi State University Teaching Hospital Abakaliki, Nigeria.

PubMed

Akujobi, C N

2005-12-01

Klesiella specie isolated from clinical specimens from Ebonyi State University Teaching Hospital (EBSUTH). Abakakliki were studied to determine the antimicrobial susceptibility pattern. Between January, 2003 and September 2004 a total of 3.600 specimens processed in the routine Medical Microbiology laboratory of EBSUTH, of which 245(6.8%) yielded Klebsiella species, with 84 from out - patients and 161 from in - patients. The number of isolates from various samples were: Urine 126, Sputum 37 Endocervical swab 13, Aspirates 8, High Vaginal Swab 7, Blood 3, Eye Swab, Ear Swab and Cerebrospinal fluid were 2 samples each. Organisms were identified by conventional methods. Antimicrobial susceptibility was done by the disk diffusion methods. The antimicrobial disk used include: Ceftazidime, Cefuroxime, Cefotaxine, Augmentin, Pefloxacin (30ug), Doxycyline (25ug) Genticin (10 ug) Ciprofloacin and Ofloxacin (5ug) each and Erythromycin (15ug). All were Oxoid products. Results were interpreted according to NCCLS criteria. Klebsilla species were isolated mostly from urine specimens (51.4%) followed by wound swabs (18.4%). Antimicrobial susceptibility to various groups drugs used was generally poor. The most sensitive antimicrobial was Ciprofloxacin with 121(49.4%) isolates susceptible to it, followed by Gentamicin with 95 (38.8%) and Ceftazidime with 90(36.7%). Seventeen isolates were multiresistant to all the antimicrobial agents used. The result of this study will help in the empiric therapy of infection caused by Klebsiella species in Ebonyi State University Teaching Hospital, Abakaliki, Nigeria but continuous surverillance of antimicrobial resistance of the organnisn is very necessary in the formulation of a sound antibiotic policy in the hospital.

A Diversity of Voices: Physical Education Teachers' Beliefs about Inclusion and Teaching Students with Disabilities

ERIC Educational Resources Information Center

Hodge, Samuel; Ammah, Jonathan O. A.; Casebolt, Kevin M.; LaMaster, Kathryn; Hersman, Bethany; Samalot-Rivera, Amaury; Sato, Takahiro

2009-01-01

The purpose of this study was to analyse the beliefs about inclusion and teaching students with disabilities of physical education teachers from various countries and cultures. The participants were 29 physical education teachers from Ghana (Africa), Japan, the US and Puerto Rico. The research method was explanatory multiple-case study situated in…

Basic School Leaders in Ghana: How Equipped Are They?

ERIC Educational Resources Information Center

Donkor, Anthony Kudjo

2015-01-01

This paper examines the leadership preparedness of institutional-level practice with focus on basic schools in Ghana. The analysis of documents on teacher training curriculum and, one-on-one and focus group interviews with teachers and school leaders revealed that in all the 38 teacher training institutions in Ghana where teachers are prepared for…

Tertiary Education Policy in Ghana. An Assessment: 1988-1998.

ERIC Educational Resources Information Center

Girdwood, Alison

This study was one of several activities conducted at the end of a 5-year World Bank/Government of Ghana project, the Tertiary Education Project (TEP). This project was designed to assist the government of Ghana with the restructuring and quality enhancement of its tertiary education sector. Although the government had prepared an ambitious reform…

Factors associated with the patient safety climate at a teaching hospital1

PubMed Central

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

2015-01-01

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

HEALTH WORKERS' PERCEPTIONON THE QUALITY OF SERVICE AND CORPORATE CULTURE OF A TEACHING HOSPITAL IN NIGERIA.

PubMed

Akpan, Etukumana Etiobong; Bassey, Orie Jacob

2015-01-01

Quality of service delivery remains the most important issue in hospitals since patients expect higher standard care and services. This quality service is rooted in the culture of the health care organization. Therefore,this study seeks to determine health workers' perception on the quality of service and corporate culture at University of Uyo Teaching hospital, Uyo, Nigeria. A cross-sectional descriptive study was carried out. Using structured questionnaire and convenient sampling technique, data were collected from 250 hospital workers.The responses on questions to elicit the hospital's quality of service and corporate culture were rated on a five-point Likert Scale as follows; Strongly Agree (SA), Agree (A), Neutral(N), Disagree (D) and Strongly Disagree (SD). Data entry and analysis were performed using Epi Info 3.2.2 (CDC, Atlanta, Georgia, USA). The minimum and maximum ages of the respondents were 21 years and 60 years respectively. The mean, median and mode ages in the respondents were 34.6 (± 7.88) years, 33 years, and 30 years respectively. Majority of the study respondents were in the age group of 31-40 years (30%), female (56.8%) and Doctors (36%). The respondents' positive perception on quality of service offered by the hospital was 69.2% (OR 5.05, 95% CI 3.39-7.52, P < 0.00001). The subjects' positive perception on the organization values for the individual worker was 54.4% (OR 1.42, 95% CI 0.99- 2.06, P = 0.049). However, only 43.2% of the subjects accepted that the management of the hospital was flexible and understands the important of balancing their work/personal life (OR 0.58, 95%CI 0.40-0.84), P = 0.002).Thirty-eight percentages (38%) accepted that top management of the hospital communicates changes in decisions that affect employees (OR 0.38, 95% CI 0.26-0.55), P < 0.00001). Majority of the workers in the various professions accepted that the hospital offer quality services as obtained in other hospitals. Majority of the workers in all the

Determinants of parents' decisions on childhood immunisations at Kumasi Metropolis in Ghana.

PubMed

Hagan, Doris; Phethlu, Deliwe R

2016-07-29

To describe factors that influence parents' decisions on childhood immunisations at Kumasi Metropolis in Ghana. Quantitative cross-sectional survey. A sample of 303 parents was obtained from a monthly accessible population of 1420 individuals from the five district hospitals through convenience sampling of respondents at immunisation sessions in Kumasi. Data obtained from the survey were analysed with SPSS version 21 software. Most parents were aware of child immunisations, but they had limited knowledge on vaccines and immunisation schedules. Antenatal nurses constituted the most accessible source of vaccine information. The study established a high percentage of complete immunisation, influenced by parents' fear of their children contracting vaccine-preventable diseases. Remarkably, some parents indicated that they immunised their children because they wanted to know the weight of their children. Forgetfulness and lack of personnel or vaccine at the centres were the reasons given by the few parents who could not complete immunisation schedules for their children, whereas the socio-demographic variables considered did not influence parents' decision on immunisation. Knowledge on immunisation could not influence immunisation decisions but parents' fear of vaccine-preventable diseases, awareness on the benefits of immunisations and sources of vaccine information were the main factors that influenced immunisation decision at Kumasi in Ghana.

Health and vulnerability to poverty in Ghana: evidence from the Ghana Living Standards Survey Round 5

PubMed Central

2012-01-01

Background An understanding of the complex relationship between health status and welfare is crucial for critical policy interventions. However, the focus of most policies in developing regions has been on current welfare to the neglect of forward-looking welfare analysis. The absence of adequate research in the area of future poverty or vulnerability to poverty has also contributed to the focus on current welfare. The objectives of this study were to estimate vulnerability to poverty among households in Ghana and examine the relationship between health status and vulnerability to poverty. Method The study used cross section data from the Fifth Round of the Ghana Living Standards Survey (GLSS 5) with a nationally representative sample of 8,687 households from all administrative regions in Ghana. A three-step Feasible Generalized Least Squares (FGLS) estimation procedure was employed to estimate vulnerability to poverty and to model the effect of health status on expected future consumption and variations in future consumption. Vulnerability to poverty estimates were also examined against various household characteristics. Results Using an upper poverty line, the estimates of vulnerability show that about 56% of households in Ghana are vulnerable to poverty in the future and this is higher than the currently observed poverty level of about 29%. Households with ill members were vulnerable to poverty. Moreover, households with poor hygiene conditions were also vulnerable to future poverty. The vulnerability to poverty estimates were, however, sensitive to the poverty line used and varied with household characteristics. Conclusion The results imply that policies directed towards poverty reduction need to take into account the vulnerability of households to future poverty. Also, hygienic conditions and health status of households need not be overlooked in poverty reduction strategies. PMID:22827954

Needs assessment of science teachers in secondary schools in Kumasi, Ghana: A basis for in-service education training programs at the Science Resource Centers

NASA Astrophysics Data System (ADS)

Gyamfi, Alexander

The purpose of this study was twofold. First, it identified the priority needs common to all science teachers in secondary schools in Kumasi, Ghana. Second, it investigated the relationship existing between the identified priority needs and the teacher demographic variables (type of school, teacher qualification, teaching experience, subject discipline, and sex of teacher) to be used as a basis for implementing in-service education training programs at the Science Resource Centers in Kumasi Ghana. An adapted version of the Moore Assessment Profile (MAP) survey instrument and a set of open-ended questions were used to collect data from the science teachers. The researcher handed out one hundred and fifty questionnaire packets, and all one hundred and fifty (100%) were collected within a period of six weeks. The data were analyzed using descriptive statistics, content analysis, and inferential statistics. The descriptive statistics reported the frequency of responses, and it was used to calculate the Need Index (N) of the identified needs of teachers. Sixteen top-priority needs were identified, and the needs were arranged in a hierarchical order according to the magnitude of the Need Index (0.000 ≤ N ≤ 1.000). Content analysis was used to analyze the responses to the open-ended questions. One-way analysis of variance (ANOVA) was used to test the null hypotheses of the study on each of the sixteen identified top-priority needs and the teacher demographic variables. The findings of this study were as follows: (1) The science teachers identified needs related to "more effective use of instructional materials" as a crucial area for in-service training. (2) Host and Satellite schools exhibited significant difference on procuring supplementary science books for students. Subject discipline of teachers exhibited significant differences on utilizing the library and its facilities by students, obtaining information on where to get help on effective science teaching

A comparative analysis of fertility differentials in Ghana and Nigeria.

PubMed

Olatoregun, Oluwaseun; Fagbamigbe, Adeniyi Francis; Akinyemi, Odunayo Joshua; Yusuf, Oyindamola Bidemi; Bamgboye, Elijah Afolabi

2014-09-01

Nigeria and Ghana are the most densely populated countries in the West African sub-region with fertility levels above world average. Our study compared the two countries' fertility levels and their determinants as well as the differentials in the effect of these factors across the two countries. We carried out a retrospective analysis of data from the Nigeria and Ghana Demographic Health Surveys, 2008. The sample of 33,385 and 4,916 women aged 15-49 years obtained in Nigeria and Ghana respectively was stratified into low, medium and high fertility using reported children ever born. Data was summarized using appropriate descriptive statistics. Factors influencing fertility were identified using ordinal logistic regression at 5% significance level. While unemployment significantly lowers fertility in Nigeria, it wasn't significant in Ghana. In both countries, education, age at first marriage, marital status, urban-rural residence, wealth index and use of oral contraception were the main factors influencing high fertility levels.

Knowledge and power necessary to reconstruct nursing after management changes at a teaching hospital.

PubMed

Bernardino, Elizabeth; Felli, Vanda Elisa Andres

2008-01-01

This study was carried out at a teaching hospital in Southern Brazil, which adopted a management model that provoked the dismantling of the nursing service and the disbandment of nursing professionals. Its general goal was to promote changes that would be implemented in the re-organization of nursing work. It is a case study with a historical-dialectic approach, whose data were collected in March and April 2005 through the focal group technique. The study subjects were eight nurses, two technicians and two nursing auxiliaries. Data were analyzed through thematic content analysis. Results evidenced that the greatest challenges nursing faced at this hospital were: to construct a new identity, carry out teamwork while maintaining its professional identity, acquire visibility in the institution, change care and expand management.

Case series of child sexual abuse: Abia State University Teaching Hospital experience.

PubMed

Okoronkwo, N C; Ejike, O

2014-01-01

Child sexual abuse remains a serious infringement on the rights of the child. Though it appears to be viewed less seriously among adolescents, the consequences may be more severe and less obvious for the younger child. Age of the child appears notto be a deterrent. There is paucity of local data in the sub-region on this important social problem. The circumstance surrounding child sexual abuse in our environment needs to be reviewed. This study sets out to evaluate the characteristics of victims of child sexual abuse and to proffer solutions on how to stem the tide of the crime. To examine the characteristics of sexually abused children presenting to the paediatrics department of Abia State UniversityTeaching hospital, Aba. The case records of 10 consecutive cases of sexually abused children that presented to the Children Outpatient Department of Abia State University Teaching Hospital (ABSUTH) Aba, from January to June 2006 were prospectively reviewed and the parents/child/abuser interviewed where possible. All the victims were females aged 3-11 yrs, while all the abusers were males 14-29 yrs. Both parties were of low socio-economic class. 50% of the victims reported the incident. Mental and psychological state of the perpetrators appears to be a factor. Physical injuries to the vulva-vaginal areas were common. This study shows that child sexual abuse may not be uncommon in our environment. The exact prevalence remains unknown.The perpetrators of child sexual abuse should be prosecuted as a deterrent and rehabilitated whenever possible.

The performance implications of pharmacy information system at the university teaching hospitals of Shiraz, Iran: Cluster approach

PubMed Central

Bayati, Saeede; Bastani, Peivand; Sagheb, Zahra Mahmoodzade; Jamalabadi, Sara; Samadbeik, Mahnaz

2017-01-01

Pharmacy information system (PIS) is becoming vital in assisting pharmacists to do their responsibilities. The aim of this study was to identify the current PIS implications in teaching hospitals affiliated with Shiraz University of Medical Science. This cross-sectional study was conducted in teaching hospitals affiliated with Shiraz University of Medical Science over the year 2016. Data were collected by observing the PIS as well as interviewing its users based on the researcher-made checklist. The checklist was prepared based on reviewing the Persian and English literature and its content validity was approved by the experts. To determine the reliability of the checklist, inter-rater reliability was used. Data were analyzed using SPSS16, and hospitals were clustered using SK-means method. In this study, the least conformity to the standards was shown in smart clinical features (4.54%), pharmaceutical companies' relationship (32.6%), and optimization of drug therapy (34.6%). In contrast, the highest conformity to the standards was shown in reporting capabilities (77.3%) and entry information and input (70.4%). Medication stock checking and optimization of drug therapy were effective features that have made a distinction between hospitals and lead to 95% variance between clusters. Based on the results, the current PIS design pays less attention to clinical features. Besides, clinical information for pharmacists and outside organization relationship were not provided by the current system. Thus, emphasis should be placed on the implementation of corrective actions to eliminate the current system's deficiencies. PMID:29184843

Outcome of a ceftriaxone/cefotaxime interchange programme in a major teaching hospital.

PubMed

Gutensohn, A; Bunz, D; Frighetto, L; Jewesson, P

1991-01-01

A two-stage intervention programme was performed to enable the effective substitution of ceftriaxone for cefotaxime in a teaching hospital with large numbers of transient prescribers. One hundred and sixteen patients with a variety of bacterial infections were randomized to an open, historical control comparative study to determine if ceftriaxone was an acceptable replacement for cefotaxime. For 6 months prior to the intervention, both cephalosporins were available on formulary. Following an initial informational stage, a therapeutic interchange programme was implemented to convert prescriptions for cefotaxime to ceftriaxone. Ceftriaxone and cefotaxime were equivalent in terms of microbiological and clinical efficacy and patient tolerance in 77 evaluable patients. No changes in prescriber service occurred after the changeover. Post-intervention treatment courses required a ceftriaxone/cefotaxime interchange in 28% of the cases. Ceftriaxone appeared to be a suitable and cost-effective alternative to cefotaxime in this hospital. The intervention programme successfully invoked the formulary change with minimal expense and prescriber opposition.

Historical evidence for the origin of teaching hospital, medical school and the rise of academic medicine.

PubMed

Modanlou, H D

2011-04-01

Historical progression and the development of current teaching hospitals, 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.

The Determinants of Girls' Educational Enrollment in Ghana. Working Paper.

ERIC Educational Resources Information Center

Johnson, Rebecca; Kyle, Steven

This study examined the determinants of school enrollment in Ghana, considering historical and social information to formulate an econometric model of school enrollment patterns for households. Data came from a 1989 survey of households in Ghana. The survey collected basic information about community characteristics, health and school facilities,…

Children with Intellectual Disabilities and Special School Education in Ghana

ERIC Educational Resources Information Center

Kassah, Bente Lilljan Lind; Kassah, Alexander Kwesi; Phillips, Deborah

2018-01-01

Even though Ghana has embraced international calls for mainstream education, many children with intellectual disabilities still receive education in segregated special schools. This article discusses the views of seven informants on the importance of special schools in Ghana. After securing the consent of our informants, we conducted in-depth…

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

PubMed

Nyathi, T; Chirwa, Tf; van der Merwe, Dg

2010-01-01

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

Historical versus contemporary medicinal plant uses in Ghana.

PubMed

Soelberg, J; Asase, A; Akwetey, G; Jäger, A K

2015-02-03

Three extraordinary, historical documents stemming from observations made in 1697, 1803 and 1817 quote medicinal plant uses among the Fante, Ga and Ashanti people of present-day Ghana, and can be linked to original botanical specimens in European herbaria. This provides a unique opportunity to gain insight to the historical materia medica of Ghana and compare this to contemporary medicinal plant uses. By critical literary and taxonomic review, the present study (re-)establishes the earliest known history of many important Ghanaian medicinal plants, and assesses the scale of change and loss of medicinal plant knowledge in Ghana over time. The study provides the foundation to reconstruct lost or discontinued Ghanaian plant uses in local or ethnopharmacological contexts. Historical botanical specimens were located in the herbaria of University of Copenhagen Herbarium (C) and British Museum of Natural History (BM). The classification and synonymy of the specimens were updated for the study, and the historical vernacular names and medicinal uses of the plants compared with 20th/21st century literature. The plants of the historical Ga materia medica were (re-)collected to aid in semi-structured interviews. The interviews aimed to document the contemporary uses and names of the plants among the Ga, and to determine to what extent the historical medicinal uses and names are extant. The study identified 100 species in historical medicinal use in Ghana, which could be linked to 134 unique uses and 105 vernacular names in Twi (Ashanti/Fante) and Ga. Most of the plants are common in Ghana. At least 52% of the historical vernacular names appear to still be in use today. Of the specific historical uses, 41 (31%) were traced among contemporary medicinal plant uses in Ghana and represent some of the most important Ghanaian medicinal plant species. However, 93 (69%) of the historical uses could not be traced and appears to be discontinued or forgotten. Among the Ga, two medicinal

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

PubMed

Adibi, Hossein; Khalesi, Nader; Ravaghi, Hamid; Jafari, Mahdi; Jeddian, Ali Reza

2012-09-21

Unsafe health care provision is a main cause of increased mortality rate amongst hospitalized patients all over the world. A system approach to medical error and its reduction is crucial that is defined by clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury. The aim of this study was to develop and implement a risk management system in a large teaching hospital in Iran, especially of the basis of WHO guidelines and patient safety context. 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. 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. 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

Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: evidence from Kumasi, Ghana.

PubMed

VanDeusen, Adam; Paintsil, Elijah; Agyarko-Poku, Thomas; Long, Elisa F

2015-03-18

Achieving the goal of eliminating mother-to-child HIV transmission (MTCT) necessitates increased access to antiretroviral therapy (ART) for HIV-infected pregnant women. Option B provides ART through pregnancy and breastfeeding, whereas Option B+ recommends continuous ART regardless of CD4 count, thus potentially reducing MTCT during future pregnancies. Our objective was to compare maternal and pediatric health outcomes and cost-effectiveness of Option B+ versus Option B in Ghana. A decision-analytic model was developed to simulate HIV progression in mothers and transmission (in utero, during birth, or through breastfeeding) to current and all future children. Clinical parameters, including antenatal care access and fertility rates, were estimated from a retrospective review of 817 medical records at two hospitals in Ghana. Additional parameters were obtained from published literature. Modeled outcomes include HIV infections averted among newborn children, quality-adjusted life-years (QALYs), and cost-effectiveness ratios. HIV-infected women in Ghana have a lifetime average of 2.3 children (SD 1.3). Projected maternal life expectancy under Option B+ is 16.1 years, versus 16.0 years with Option B, yielding a gain of 0.1 maternal QALYs and 3.2 additional QALYs per child. Despite higher initial ART costs, Option B+ costs $785/QALY gained, a value considered very cost-effective by World Health Organization benchmarks. Widespread implementation of Option B+ in Ghana could theoretically prevent up to 668 HIV infections among children annually. Cost-effectiveness estimates remained favorable over robust sensitivity analyses. Although more expensive than Option B, Option B+ substantially reduces MTCT in future pregnancies, increases both maternal and pediatric QALYs, and is a cost-effective use of limited resources in Ghana.

Health Policy, Health Systems Research and Analysis Capacity Assessment of the School of Public Health, University of Ghana.

PubMed

Agyepong, I A; Anniah, K; Aikins, M; Akweongo, P; Esena, R; Mirzoev, T

2015-09-01

Health Policy and Systems Research and Analysis (HPSR&A) is an applied science that deals with complexity as it tries to provide lessons, tools and methods to understand and improve health systems and health policy. It is defined by the kinds of questions asked rather than a particular methodology. Our objective was to assess capacity and capacity strengthening needs for HPSR&A conduct and teaching in the University of Ghana School of Public Health (UG-SPH). We conceptualized dynamically inter-related levels of capacity as contextual, institutional and individual. The study had a cross sectional, mixed methods design. Data collection involved desk review, ,an in-depth interview, focus group discussions (FGD) and an interviewer administered questionnaire with closed and open ended items. Netmap was used as a tool in the FGD. At all levels, HPSR&A capacity exists in Ghana but is somewhat fragile. The fragility reflects in part contextual challenges related to national income and priorities as well as the fact that globally HPSR&A remains an emerging field. At the contextual level, Institutions involved in some way or other in HPSR&A were part of larger organizations with broader mandates. Only a handful of SPH staff indicated that they specifically do teaching and /or research related to HPSR&A. There is a need to raise awareness of the field of HPSR&A and its potential contributions to health sector development; build upon already existing contextual, institutional and individual capacity; and also attract and develop the next generation of researchers and teachers.

Determinants of unprotected casual heterosexual sex in Ghana.

PubMed

Kumi-Kyereme, Akwasi; Tuoyire, Derek A; Darteh, Eugene K M

2014-05-01

Casual heterosexual sex remains a significant contributor to HIV transmissions in Ghana. The study used data from the 2008 Ghana Demographic and Health Survey (GDHS) to assess the socio-demographic, economic and spatial factors influencing unprotected casual heterosexual sex among men and women. The results of the binary logistic regression models revealed that women aged 35-44 had significantly higher odds of engaging in unprotected casual heterosexual sex than those aged 15-24, unlike the men. There were significantly lower odds of unprotected casual heterosexual sex for women and men with exposure to print media compared with those without exposure. Compared with men residing in the Western Region, unprotected casual heterosexual sex was significantly less likely among those in the Upper East Region. There is the need for behavioural change campaigns in Ghana that take into consideration the multiplicity of factors that determine unprotected casual heterosexual sex.

An assessment of the competence and experience of dentists with the management of medical emergencies in a Nigerian teaching hospital.

PubMed

Adewole, Richard Ayodeji; Sote, Elizabeth Obalowu; Oke, David Adewale; Agbelusi, Adewumi Gbemisola

2009-01-01

Previous reports show that medical emergency events have ocurred in Teaching Hospital Dental centres, with attendant mortality and morbidity. (1) To study the pattern of medical emergencies encountered by clinical dental staff of Lagos University Teaching Hospital (2) To evaluate their training, perception of their training and competence as undergraduates and postgraduates to manage such events. All the clinical staff viz: Dental surgeons of different cadres--consultants, registrars, house surgeons and dental nurses of Lagos University Teaching Hospital. A structured questionnaire requesting to know demographic data, respondents attendance of life support training viz: Basic life support (BLS), advanced trauma life support (ATLS), intensive care support (ICS). A self rating in the competence of management of medical emergencies and previous personal encounter with medical emergencies with success/failure in the management with/or without medical colleage assistance were sought. In addition adequacy of their dental clinic/centres for drugs, equipments and their perceived readiness to deal with emergencies were enquired. Among the dental surgeons, 20 (26.6%) were consultants, 40 (53.3%) were registrars and 35 (46.6%) were house-officers. Thirty five (43.7%) had previous knowledge of basic life support (BLS) training, while 45 (56.2%) denied such knowledge. The figures for other trainings such as advanced trauma life Support (ATLS) was 8 (10%) and intensive care support (ICS) 2 (2.5% 73.3% of the respondents felt inadequate in the management of cardiovascular emergencies, while only 15.4% felt adequately prepared. Similar ratings for respiratory emergencies are 63.1% inadequacy, 16.9% adequacy, and only 3.3% felt very adequate. The availability of oxygen extension tubing and ambu bag was nil in all departments. Emergency drugs were claimed to be present by 28.5% oral surgery respondents and, 34.7% Child Dental Health respondents. Most of the respondents felt their

Quality of life among dentists in teaching hospitals in South Canara, India.

PubMed

Doshi, Dolar; Jain, Animesh; Vinaya, K; Kotian, Shashidhar

2011-01-01

This paper reports on the quality of life among dentists using World Health Organization Abbreviated Instrument for Quality of Life Assessment, comprising 26 items which measure the following broad domains: Physical health, psychological health, social relationships, and environment. The instrument was self-administered among dentists in four teaching dental institutions. A total of 191 questionnaires were given out. Of those, 187 were consented and answered, making up a response rate of 97.9%. The internal consistency of the questionnaire, measured by Cronbach's alpha was estimated at 0.75. Highest mean score was seen for Domain 3 (Social relationships) (16.15 + 2.38) and the least score was for Domain 4 (Environment) (14.72 + 2.12). Higher proportions of respondents rated their quality of life as good (65.1 percent), and also majority of dentists (63.5 percent) were satisfied with their health. Quality of life recognizes the value of an individual's health in the broader psychologic and social aspects of his/her life. In this study, the overall rating of quality of life among dentists in teaching hospitals is good.

Veterinary teaching hospitals: current challenges and pathways for the future.

PubMed

Hubbell, John A E

2008-01-01

University-based veterinary teaching hospitals must change to maintain their viability. A number of factors both internal and external to universities and the veterinary profession have contributed to the need for change. A task force formed by the Association of American Veterinary Medical Colleges and the American Association of Veterinary Clinicians was convened to identify the issues and propose individual and collective strategies for the future. Primary issues include a shortage of faculty and staff, the nature of the case load, the need for fiscal management strategies, and the need to manage stakeholder expectations. The majority of the proposed strategies for the future will be managed individually by the colleges. Proposed collective strategies center on increasing the number of specialists and improving recruitment and retention of faculty and staff.

Medication Administration Errors in an Adult Emergency Department of a Tertiary Health Care Facility in Ghana.

PubMed

Acheampong, Franklin; Tetteh, Ashalley Raymond; Anto, Berko Panyin

2016-12-01

This study determined the incidence, types, clinical significance, and potential causes of medication administration errors (MAEs) at the emergency department (ED) of a tertiary health care facility in Ghana. This study used a cross-sectional nonparticipant observational technique. Study participants (nurses) were observed preparing and administering medication at the ED of a 2000-bed tertiary care hospital in Accra, Ghana. The observations were then compared with patients' medication charts, and identified errors were clarified with staff for possible causes. Of the 1332 observations made, involving 338 patients and 49 nurses, 362 had errors, representing 27.2%. However, the error rate excluding "lack of drug availability" fell to 12.8%. Without wrong time error, the error rate was 22.8%. The 2 most frequent error types were omission (n = 281, 77.6%) and wrong time (n = 58, 16%) errors. Omission error was mainly due to unavailability of medicine, 48.9% (n = 177). Although only one of the errors was potentially fatal, 26.7% were definitely clinically severe. The common themes that dominated the probable causes of MAEs were unavailability, staff factors, patient factors, prescription, and communication problems. This study gives credence to similar studies in different settings that MAEs occur frequently in the ED of hospitals. Most of the errors identified were not potentially fatal; however, preventive strategies need to be used to make life-saving processes such as drug administration in such specialized units error-free.

Educational status and beliefs regarding non-communicable diseases among children in Ghana.

PubMed

Badasu, Delali M; Abuosi, Aaron A; Adzei, Francis A; Anarfi, John K; Yawson, Alfred E; Atobrah, Deborah A

2018-03-05

Increasing prevalence of non-communicable diseases (NCDs) has been observed in Ghana as in other developing countries. Past research focused on NCDs among adults. Recent researches, however, provide evidence on NCDs among children in many countries, including Ghana. Beliefs about the cause of NCDs among children may be determined by the socioeconomic status of parents and care givers. This paper examines the relationship between educational status of parents and/or care givers of children with NCDs on admission and their beliefs regarding NCDs among children. A total of 225 parents and/or care givers of children with NCDS hospitalized in seven hospitals in three regions (Greater Accra, Ashanti and Volta) were selected for the study. Statistical techniques, including the chi-square and multinomial logistic regression, were used for the data analysis. Educational status is a predictor of care giver's belief about whether enemies can cause NCDs among children or not. This is the only belief with which all the educational categories have significant relationship. Also, post-secondary/polytechnic (p-value =0.029) and university (p-value = 0.009) levels of education are both predictors of care givers being undecided about the belief that NCDs among children can be caused by enemies, when background characteristics are controlled for. Significant relationship is found between only some educational categories regarding the other types of beliefs and NCDs among children. For example, those with Middle/Juniour Secondary School (JSS)/Juniour High School (JHS) education are significantly undecided about the belief that the sin of parents can cause NCDs among children. Education is more of a predictor of the belief that enemies can cause NCDs among children than the other types of beliefs. Some categories of ethnicity, residential status and age have significant relationship with the beliefs when background characteristics of the parents and/or care givers were controlled

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

PubMed

Bahrami, Mohammad Amin; Barati, Omid; Ghoroghchian, Malake-Sadat; Montazer-Alfaraj, Razieh; Ranjbar Ezzatabadi, Mohammad

2016-04-01

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

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

PubMed Central

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

2015-01-01

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

Knowledge Practice and Outcome of Quality Nursing Care among Nurses in University of Calabar Teaching Hospital (UCTH)

ERIC Educational Resources Information Center

Oyira, Emilia James; Ella, R. E.; Chukwudi, Usochukwu Easter; Paulina, Akpan Idiok

2016-01-01

Objectives: The main purpose of this study was to determine knowledge practice and outcome of quality nursing care among nurses in University of Calabar Teaching Hospital (UCTH). Three research questions and one hypothesis were formulated to guide this study. Literature related to the variables under study was reviewed according to the research…

[Scientific output of orthopaedic hospitals in the Netherlands: not all hospitals meet the requirements of the Dutch orthopaedic residency programme].

PubMed

Eshuis, Rienk; Verheyen, Cees C P M; de Gast, Arthur

2011-01-01

To evaluate the feasibility of the requirements for scientific participation in the Dutch orthopaedic residency programme by assessing the numbers of articles published by orthopaedic teaching hospitals. Descriptive. All 29 orthopaedic teaching hospitals in the Netherlands were asked to draw up a list of articles published from 2004 to 2009. The publications were subdivided into papers indexed in PubMed and papers published in the Nederlands Tijdschrift voor Orthopedie (NTvO, Netherlands Journal of Orthopaedics) and the Nederlands Tijdschrift voor Traumatologie (NTvT, Netherlands Journal of Traumatology). There was an overall response rate of 72% (21/29). For the 8 non-responders a search of PubMed and the NTvO-NTvT journal databases was used to compile a list of their publications. The university teaching hospitals (n = 8) published 1150 articles, 1118 of which were indexed in PubMed, 19 published in the NTvO and 13 in the NTvT. Peripheral teaching hospitals (n = 21) published 689 articles: 590 indexed in PubMed, 77 published in the NTvO and 22 in the NTvT. In the peripheral teaching hospitals there was a positive correlation between the number of orthopaedic surgeons and PhD students and the number of published articles. Of the 29 teaching hospitals, 9 (31%) did not meet the requirements for publication specified in the Dutch orthopaedic residency programme guidelines. The number of published articles is related to the numbers of orthopaedic surgeons and PhD students in peripheral teaching hospitals. The requirements for the minimum number of publications could therefore be revised to reflect the proportion of orthopaedic surgeons in each teaching hospital. The introduction of a weighting factor that accounts for the quality of the publications would also result in a more balanced assessment.

Associations between teaching effectiveness scores and characteristics of presentations in hospital medicine continuing education.

PubMed

Ratelle, John T; Wittich, Christopher M; Yu, Roger C; Newman, James S; Jenkins, Sarah M; Beckman, Thomas J

2015-09-01

There is little research regarding characteristics of effective continuing medical education (CME) presentations in hospital medicine (HM). Therefore, we sought to identify associations between validated CME teaching effectiveness scores and characteristics of CME presentations in the field of HM. This was a cross-sectional study of participants and didactic presentations from a national HM CME course in 2014. Participants provided CME teaching effectiveness (CMETE) ratings using an instrument with known validity evidence. Overall CMETE scores (5-point scale: 1 = strongly disagree; 5 = strongly agree) were averaged for each presentation, and associations between scores and presentation characteristics were determined using the Kruskal-Wallis test. The threshold for statistical significance was set at P < 0.05. A total of 277 out of 368 participants (75.3%) completed evaluations for the 32 presentations. CMETE scores (mean [standard deviation]) were significantly associated with the use of audience response (4.64 [0.16]) versus no audience response (4.49 [0.16]; P = 0.01), longer presentations (≥30 minutes: 4.67 [0.13] vs <30 minutes: 4.51 [0.18]; P = 0.02), and larger number of slides (≥50: 4.66 [0.17] vs <50: 4.55 [0.17]; P = 0.04). There were no significant associations between CMETE scores and use of clinical cases, defined goals, or summary slides. To our knowledge, this is the first study regarding associations between validated teaching effectiveness scores and characteristics of effective CME presentations in HM. Our findings, which support previous research in other fields, indicate that CME presentations may be improved by increasing interactivity through the use of audience response systems and allowing longer presentations. © 2015 Society of Hospital Medicine.

Ghana: Disability and Spirituality

ERIC Educational Resources Information Center

Botts, Betsy H.; Evans, William H.

2010-01-01

This descriptive study explores the educational system and attitudes toward disability in the Volta Region of Ghana. Traditional, Christian, and Islamic beliefs toward disability are explored. Educators from Accra and three families from the Volta Region with children with special needs are interviewed in an effort to explore the connection…

Predicting future staffing needs at teaching hospitals: use of an analytical program with multiple variables.

PubMed

Mitchell, Christine C; Ashley, Stanley W; Zinner, Michael J; Moore, Francis D

2007-04-01

To develop a model to predict future staffing for the surgery service at a teaching hospital. Tertiary hospital. A computer model with potential future variables was constructed. Some of the variables were distribution of resident staff, fellows, and physician extenders; salary/wages; work hours; educational value of rotations; work units, inpatient wards, and clinics; future volume growth; and efficiency savings. Outcomes Number of staff to be hired, staffing expense, and educational impact. On a busy general surgery service, we estimated the impact of changes in resident work hours, service growth, and workflow efficiency in the next 5 years. Projecting a reduction in resident duty hours to 60 hours per week will require the hiring of 10 physician assistants at a cost of $1 134 000, a cost that is increased by $441 000 when hiring hospitalists instead. Implementing a day of didactic and simulator time (10 hours) will further increase the costs by $568 000. A 10% improvement in the efficiency of floor care, as might be gained by advanced information technology capability or by regionalization of patients, can mitigate these expenses by as much as 21%. On the other hand, a modest annual growth of 2% will increase the costs by $715 000 to $2 417 000. To simply replace residents with alternative providers requires large amounts of human and fiscal capital. The potential for simple efficiencies to mitigate some of this expense suggests that traditional patterns of care in teaching hospitals will have to change in response to educational mandates.

Analysis of the Financial Cost of Diabetes Mellitus in Four Cocoa Clinics of Ghana.

PubMed

Quaye, Ernest Attuquaye; Amporful, Edward O; Akweongo, Patricia; Aikins, Moses K

2015-09-01

To estimate the financial cost of managing diabetes mellitus in four Cocoa clinics of Ghana. A descriptive cross-sectional study of diabetes management was carried out in the four Cocoa clinics of Ghana from January to December 2009. The "cost-of-illness" approach from the institutional perspective was used. A pretested data extraction form was used to review the medical records of 304 randomly selected diabetic patients. The patients' mean age was 55.4 ± 9.4 years. The mean annual financial cost of managing one diabetic case at the clinics was estimated to be Ghana cedi (GHS) 540.35 (US $372.65). Service cost constituted 22% of the cost, whereas direct medical cost constituted 78% of the cost. Drug cost was 71% of the financial cost. The cost of hospitalization per patient-day at Cocoa clinics was estimated at GHS 32.78 (US $22.61). The total financial cost of diabetes management was estimated at GHS 420,087.67 (US $289,715.63). This accounted for 8% of the total expenditure for the clinics in the year 2009. The study showed that facility type, type of diabetes, and presence of complication are associated with the cost of diabetes management to Cocoa clinics. The mean age of detection suggests delay in diagnosis of diabetes mellitus and accompanying complications, which has cost implications. Policy that enhances early detection of diabetes in clinical practice would therefore improve management and reduce costs. The financial cost of managing diabetes can be used to forecast the economic burden of the disease in the area. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Candiduria in hospitalized patients in teaching hospitals of Ahvaz.

PubMed

Zarei-Mahmoudabadi, A; Zarrin, M; Ghanatir, F; Vazirianzadeh, B

2012-12-01

Nosocomial infections are usually acquired during hospitalization. Fungal infection of the urinary tract is increasing due to predisposing factors such as; antibacterial agents, indwelling urinary catheters, diabetes mellitus, long hospitalization, immunosuppressive agents, use of IV catheters, radiation therapy, malignancy. The aim of our study was to determine the prevalence of candiduria and urinary tract infection in patients admitted in Golestan and Emam Khomeini hospitals of Ahvaz, Iran. During 14 months, a total of 744 urine samples were collected and transferred to medical mycology laboratory immediately. Ten µl of uncentrifuged sample was cultured on CHROM agar Candida plates and incubated at 37°C for 24-48h aerobically. Candida species were identified based on colony morphology on CHROM agar Candida, germ tube production and micro-morphology on corn meal agar including 1% Tween 80. In the present study, 744 hospitalized patients were sampled (49.5%, female; 50.5%, male). The prevalence of candiduria in subjects was 16.5% that included 65.1% female and 34.9% male. The most common isolates were C. albicans (53.3%), followed by C. glabrata (24.4%), C. tropicalis (3.7%), C. krusei (2.2%), and Geotrichum spp. (0.7%) Urine cultures yielded more than 10,000 yeast colonies in 34.1% of cases, and the major predisposing factor associated with candiduria was antibiotic therapy (69.1%). Candiduria is relatively common in hospitalized patients in educational hospitals of Ahvaz. In addition, there is a strong correlation between the incidence of candiduria in hospitalized patients and broad-spectrum antibiotics therapy.

Management of a severe thoracoabdominal injury from motorized sawing machine in a temporary semi-urban university teaching hospital: a case report.

PubMed

Fente, B G; Nwagwu, C C; Ogulu, B N; Orukari, G I B; Okere, E O; Miss Ouserigha, O E

2012-01-01

Report of our experience and outcome of a case of severe thoracoabdominal injuries by motorized sawing machine (a rare cause) in a Semi-Urban temporary University Teaching Hospital. Literature review on the topic was done using Pubmed. Relevant journals and topics were also reviewed. Textbooks on relevant topics were also searched. A 25 year old male timber-cutter was traumatized by motorized sawing machine injuring the left half of the chest, upper abdomen, the left shoulder and left hand. It is an unusual presentation of penetrating thoracoabdominal injury. There was open pneumotharax, 3th-8th ribs fractures, diaphragmatic laceration, and eviscerations of abdominal contents without affecting other thoraco-abdominal organs. Urgent surgical intervention done was the only option. The challenges posed by severe motorized sawing machine thoraco-abdominal injuries in a Semi-Urban temporary University Teaching Hospital were successfully managed due to rapid pre-hospital transfer and co-ordinated team effort.

Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care?

PubMed

Fenny, Ama Pokuaa; Asante, Felix A; Enemark, Ulrika; Hansen, Kristian S

2015-04-12

Malaria is Ghana's most endemic disease; occurring across most parts of the country with a significant impact on individuals and the health system as whole. Treatment seeking for malaria care takes various forms. The National Health Insurance Scheme (NHIS) was introduced in 2004 to promote access to health services to mitigate the negative impact of the user fee regime. Ten years on, national coverage is less than 40% of the total population and patients continue to make direct payments for health services. This paper analyses the care-seeking behaviour of households for treatment of malaria in Ghana under the NHI policy. Using a cross-sectional survey of household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah, a multinomial logit model is estimated. The sample consists of 365 adults and children reporting being ill with malaria in the last four weeks prior to the study. Out of the total, 58% were insured and 71% of them sought care from a formal health facility. Among the insured, 15% chose informal care compared to 48% among the uninsured. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. The results show that the insured are 6 times more likely to choose regional/district hospitals: 5 times more likely to choose health centres/clinics and 7 times more likely to choose private hospitals/clinics over informal care when compared with the uninsured. Individual characteristics such as age, education and wealth status were significant determinants of health care provider choice for specific categories of health facilities. Overall, for malaria care the uninsured are more likely to choose informal care compared to the insured for the treatment of malaria.

Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran.

PubMed

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

2016-04-21

In 1995, teaching and public hospitals that are affiliated with the ministry of health and medical education (MOHME) in Iran were granted financial self-sufficiency to practice contract-based relations with insurance organizations. The so-called "hospital autonomy" policy involved giving authority to the insurance organizations to purchase health services. The policy aimed at improving hospitals' performance, hoping to reduce government's costs. However, the policy was never implemented as intended. This was because most participating hospitals gave up to implement autonomous financing and took other financing pathways. This paper analyses the reasons for the gap between the intended policy and its execution. The lessons learned from this analysis can inform, we envisage, the implementation of similar initiatives in other settings. We conducted semi-structured interviews with 28 national and 13 regional health policy experts. We also gathered a comprehensive and purposeful set of related documents and analyzed their content. The qualitative data were analyzed by thematic inductive-deductive approach. We found a number of prerequisites and requirements that were not prepared prior to the implementing hospital autonomy policy and categorized them into policy content (sources of funds for the policy), implementation context (organization of insurance organizations, medical tariffs, hospitals' organization, feasibility of policy implementation, actors and stakeholders' support), and implementation approach (implementation method, blanket approach to the implementation and timing of implementation). These characteristics resulted in unsuitable platform for policy implementation and eventually led to policy failure. Autonomy of teaching hospitals and their exclusive financing through insurance organizations did not achieve the desired goals of purchaser-provider split in Iran. Unless contextual preparations are in place, hospital autonomy will not succeed and problematic

Effect of timely initiation of breastfeeding on child health in Ghana.

PubMed

Fosu-Brefo, Rita; Arthur, Eric

2015-01-01

Early initiation of breastfeeding and exclusive breastfeeding practices have been argued to be one of the important ways of ensuring child health. Unfortunately, owing to modernization, most nursing mothers fail to adhere to such practices. This is believed to be a factor contributory to poor child health in Ghana. Thus, this study investigated the effect of timely initiation of breastfeeding on child health in Ghana. Cross sectional data using secondary data based on the positivism approach to research was employed. The Ordinary least squares and the Instrumental variables approach were used in estimating the effect of breastfeeding and other socio demographic indicators on the health of the child. Data for the study was sourced from the 2008 round of the Ghana Demographic and Health Survey. The results indicate that timely initiation of breastfeeding, both immediately and hours after birth are important factors that influence the child's health. Additionally, factors such as the wealth of the household, mother's education, age and size of the child at birth and age of the mother are important factors that also influence the health of the child in Ghana. The findings imply that efforts should be made on encouraging appropriate breastfeeding practices among nursing mothers to ensure proper child development and growth in Ghana.

Between moral infraction and existential crisis: Exploring physicians and nurses' attitudes to suicide and the suicidal patient in Ghana.

PubMed

Osafo, Joseph; Akotia, Charity S; Boakye, Kofi E; Dickson, Erica

2018-05-26

Negative attitudes of health professionals towards suicide may hamper their willingness and skills to work with attempt survivors. The purpose of this study was to explore the attitudes of physicians and nurses towards suicide and the suicidal patient. A semi-structured qualitative interview was conducted on Twenty five (25) health professionals: (15 physicians and 10 casualty nurses) from five hospitals in Accra, the capital of Ghana. Findings showed that while majority of physicians viewed suicide as an existential crisis, most of the nurses viewed it as a moral infraction. Three key attitudes towards suicide and the suicidal patient were observed: stable, dissonant and transitioned. The findings are discussed under three main themes: Contexts, Theorizing suicide, and Shades of attitudes. Nurses and Physicians are key gatekeepers in suicide prevention in Ghana. Training is however, needed to improve both attitudes (especially for nurses) and competence towards suicide prevention in the country. Copyright © 2018 Elsevier Ltd. All rights reserved.

Rethinking Christian Religious Education in Ghana: History, Challenges and Prospects

ERIC Educational Resources Information Center

Addai-Mununkum, Richardson

2014-01-01

This scholarly essay employs an African philosophical and symbolic construct--Sank?fa--to examine religious education in Ghana. Sank?fa implores the need to examine the past in order to understand the present and to plan for the future. In line with this frame, I recount the history of religious education in Ghana, examine the present challenges,…

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

PubMed

Nwankwo, Okechukwu Emmanuel

2008-04-01

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

Technical efficiency of teaching hospitals in Iran: the use of Stochastic Frontier Analysis, 1999–2011

PubMed Central

Goudarzi, Reza; Pourreza, Abolghasem; Shokoohi, Mostafa; Askari, Roohollah; Mahdavi, Mahdi; Moghri, Javad

2014-01-01

Background: Hospitals are highly resource-dependent settings, which spend a large proportion of healthcare financial resources. The analysis of hospital efficiency can provide insight into how scarce resources are used to create health values. This study examines the Technical Efficiency (TE) of 12 teaching hospitals affiliated with Tehran University of Medical Sciences (TUMS) between 1999 and 2011. Methods: The Stochastic Frontier Analysis (SFA) method was applied to estimate the efficiency of TUMS hospitals. A best function, referred to as output and input parameters, was calculated for the hospitals. Number of medical doctors, nurses, and other personnel, active beds, and outpatient admissions were considered as the input variables and number of inpatient admissions as an output variable. Results: The mean level of TE was 59% (ranging from 22 to 81%). During the study period the efficiency increased from 61 to 71%. Outpatient admission, other personnel and medical doctors significantly and positively affected the production (P< 0.05). Concerning the Constant Return to Scale (CRS), an optimal production scale was found, implying that the productions of the hospitals were approximately constant. Conclusion: Findings of this study show a remarkable waste of resources in the TUMS hospital during the decade considered. This warrants policy-makers and top management in TUMS to consider steps to improve the financial management of the university hospitals. PMID:25114947

Management of perforated peptic ulcer in patients at a teaching hospital.

PubMed

Bin-Taleb, Ali K; Razzaq, Riyadh A; Al-Kathiri, Zaki O

2008-02-01

To explore and analyze the current status in management of patients with perforated peptic ulcers (PPU). A retrospective study carried out at the Surgical Department, Al-Gamhouria Teaching Hospital, Aden, Yemen. Patients admitted with perforated benign peptic ulcers from January 1997 to December 2006 were included in the study. A total of 156 patients, 138 (88.5%) male and 18 (11.5%) female, with an overall mean age of 39.08 years (range 14-75 years) and a higher frequency of PPU was noted in patients 21-40 years (58.3%). The perforated duodenal ulcer and perforated gastric ulcer ratio was 4.38:1. The mean time of presentation was 16.5 hours, and operative intervention after admission was 5.25 hours. Simple perforation closure was used in 91.7% of the patients. Postoperative complication rate was 41% (statistically significant in cases admitted later than 12 hours), wound sepsis making the majority at 55.2%, 6 deaths (3.9%), the correlation with presentation time was not significant. The overall mean post-operative hospitalization period was 12.76 days; 14.7% of the patients stayed more than 3 weeks. Younger patients (21-40 years) were frequently affected. Emphasis should be placed on shortening the time to surgery. Simple closure remains the selected treatment in the majority of patients. Overall post-operative mortality was low (3.9%). Improving the surgical skills, wound care, administrative regulations, hospital environment, and equipment are needed to reduce the high rate of complications.

A retrospective study of daptomycin use in a Paris teaching-hospital.

PubMed

Marc, F; Esquirol, C; Papy, E; Longuet, P; Armand-Lefevre, L; Rioux, C; Diamantis, S; Dumortier, C; Bourgeois-Nicolaos, N; Lucet, J-C; Wolff, M; Arnaud, P

2014-01-01

We retrospectively studied daptomycin use during 2010 at the Bichat-Claude-Bernard teaching-hospital (Paris) to observe the evolution of daptomycin prescriptions. Twenty-one patients were included and several parameters were documented: site of infection, bacterial species involved, reason for daptomycin use, dose and clinical outcome. Ninety-five percent of daptomycin prescritions were off-label and most did not comply with local guidelines. Fifteen of the 21 patients were cured (71%), including 9 patients of the 12 with off-label and off-local recommendation prescriptions (75%). Osteitis and Enterococcus spp endocarditis were the new indications. Daptomycin was increasingly used at higher doses: 52% of our patients were given doses above 6mg/kg. Staphylococcus spp. was the most frequent pathogen responsible for infection is our patients, followed by Enterococcus spp. Daptomycin use is likely to evolve because of its effectiveness in the treatment of osteitis, left-sided and Enterococcus spp. infective endocarditis. It is generally used at higher doses, which are well tolerated. However, therapeutic monitoring needs to be developed. The antibiotic commission of our hospital gave new recommendations for daptomycin use in 2011. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The impact of household wealth on child survival in Ghana.

PubMed

Lartey, Stella T; Khanam, Rasheda; Takahashi, Shingo

2016-11-22

Improving child health is one of the major policy agendas for most of the governments, especially in the developing countries. These governments have been implementing various strategies such as improving healthcare financing, improving access to health, increasing educational level, and income level of the household to improve child health. Despite all these efforts, under-five and infant mortality rates remain high in many developing nations. Some previous studies examined how economic development or household's economic condition contributes to child survival in developing countries. In Ghana, the question as to what extent does economic circumstances of households reduces infant and child mortality still remain largely unanswered. Thus, the purpose of this study is to investigate the extent to which wealth affects the survival of under-five children, using data from the Demographic and Health Survey (DHS) of Ghana. In this study, we use four waves of data from Demographic and Health Surveys (DHS) of Ghana from 1993 to 2008. The DHS is a detailed data set that provides comprehensive information on households and their demographic characteristics in Ghana. Data was obtained by distributing questionnaires to women (from 6000 households) of reproductive age between 15 and 49 years, which asked, among other things, their birth history information. The Weibull hazard model with gamma frailty was used to estimate wealth effect, as well as the trend of wealth effect on child's survival probability. We find that household wealth status has a significant effect on the child survival in Ghana. A child is more likely to survive when he/she is from a household with high wealth status. Among other factors, birth spacing and parental education were found to be highly significant to increase a child's survival probability. Our findings offer plausible mechanisms for the association of household wealth and child survival. We therefore suggest that the Government of Ghana

Prevalence and correlates of contraceptive use among female adolescents in Ghana.

PubMed

Nyarko, Samuel H

2015-08-19

Adolescence is a critical stage in the life course and evidence suggests that even though contraceptive use has been steadily increasing among women in Ghana over the past years, contraceptive prevalence and determinants among female adolescents is quite lacking. This paper examines the prevalence and correlates of contraceptive use among female adolescents in Ghana. The paper used data from the 2008 Ghana Demographic and Health survey. Bivariate analysis was carried out to determine the contraceptive prevalence among female adolescents while logistic regression analysis was applied to examine the correlates of female adolescent contraceptive use. The study founded that female adolescent contraceptive use was significantly determined by age of adolescent, education, work status, knowledge of ovulatory cycle, visit of health facility and marital status. This has implications for adolescent sexual and reproductive health programmes in Ghana. It is therefore essential to intensify girl child education and strengthen the provision of family planning information and services for female adolescents in the country.

Salmonella enterica serovar Oranienburg outbreak in a veterinary medical teaching hospital with evidence of nosocomial and on-farm transmission.

PubMed

Cummings, Kevin J; Rodriguez-Rivera, Lorraine D; Mitchell, Katharyn J; Hoelzer, Karin; Wiedmann, Martin; McDonough, Patrick L; Altier, Craig; Warnick, Lorin D; Perkins, Gillian A

2014-07-01

Nosocomial salmonellosis continues to pose an important threat to veterinary medical teaching hospitals. The objectives of this study were to describe an outbreak of salmonellosis caused by Salmonella enterica serovar Oranienburg within our hospital and to highlight its unique features, which can be used to help mitigate or prevent nosocomial outbreaks in the future. We retrospectively analyzed data from patients that were fecal culture-positive for Salmonella Oranienburg between January 1, 2006, and June 1, 2011, including historical, clinical, and pulsed-field gel electrophoresis (PFGE) data. Salmonella Oranienburg was identified in 20 horses, five alpacas, and three cows during this time frame, with dates of admission spanning the period from August, 2006, through January, 2008. We consider most of these patients to have become infected through either nosocomial or on-farm transmission, as evidenced by molecular subtyping results and supportive epidemiologic data. Interpretation of PFGE results in this outbreak was challenging because of the identification of several closely related Salmonella Oranienburg subtypes. Furthermore, a high percentage of cases were fecal culture-positive for Salmonella Oranienburg within 24 h of admission. These patients initially appeared to represent new introductions of Salmonella into the hospital, but closer inspection of their medical records revealed epidemiologic links to the hospital following the index case. Cessation of this outbreak was observed following efforts to further heighten biosecurity efforts, with no known cases or positive environmental samples after January, 2008. This study demonstrates that a Salmonella-positive culture result within 24 h of admission does not exclude the hospital as the source of infection, and it underscores the important role played by veterinary medical teaching hospitals as nodes of Salmonella infection that can promote transmission outside of the hospital setting.