[Hospitalization period and nutritional status in hospitalized patients].

PubMed

Merhi, V A Leandro; de Oliveira, Ma R Marques; Caran, A L; Tristão, T Menuzzo Graupner; Ambo, R Miante; Tanner, M A; Vergna, C Marton

2007-01-01

With the objective of studying the nutritional status and its relationship with hospitalization period, a cross-sectional study was done with patients from a private hospital representing a population with a better socioeconomic condition. The anthropometric data of 267 patients, 46% males and 54% females ranging from 20 to 80 years of age, were assessed on the second day of hospitalization. Hospitalization period associated with nutritional status. The data were analyzed by the software Excel and Sigma Stat, using Fisher's exact test and the chi-square test. The studied population presented a body mass index of 25.9 +/- 5.3 and most patients lost weight during hospitalization. The longest hospitalization periods were found among patients with lung diseases (13 days), some being pre-obese (40%) with a small prevalence of undernutrition (4%). The percentage distribution of nutritional status among the groups according to diagnosis was different (P < 0.01) when assessed by the Fisher's exact test and the percentage distribution in weight variation between men and women was different (P < 0.02) when assessed by the chi-square test. When the population was segmented according to age, the percentage distribution of the nutritional status between > 60 and < or = 60 did not present a difference when assessed by the chi-square test. The results of this study show that the nutritional status in some diseases deserves special attention given the greater risk found in these situations, contributing to a longer hospitalization period.

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.

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

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.

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.

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.

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

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)

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.

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.

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.

The Status of the Teaching Profession 2011

ERIC Educational Resources Information Center

Bland, Jennifer; Sherer, David; Guha, Roneeta; Woodworth, Katrina; Shields, Patrick; Tiffany-Morales, Juliet; Campbell, Ashley

2011-01-01

This paper presents the Center for the Future of Teaching and Learning at WestEd's 13th annual report on the status of the teaching profession in California, focusing on the role of the principal in supporting teaching quality. More specifically, the report discusses fiscal and policy trends, the competing demands of the principalship,…

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)

An epidemiological study on the predictors of health status of food handlers in food establishments of teaching hospitals of North India.

PubMed

Singh, Arun; Katyal, Rashmi; Chaudhary, Varsha; Narula, Kusum; Upadhayay, Deepak; Singh, Shailendra Pratap

2015-01-01

The US Centers for Disease Control and Prevention (USDHHS-CDC 1996) revealed that the outbreaks of food borne diseases include inadequate cooking, heating, or re-heating of foods consumption of food from unsafe sources, cooling food inappropriately and allowing too much of a time lapse. As we all know that the food handlers have been working in various types of community kitchen and their health status can affect the status of food hygiene which can lead to contamination of foods attributing to acute gastroenteritis and food poisoning in various subgroups of the population e.g., medical/dental/nursing students. The background characteristics of these food handlers may have important role to affect health status of these handlers. The indexed study was carried out among the food handlers working in the food establishments the 5 teaching hospitals of Bareilly city in U.P. India during one year i.e., from August 2013 to July 2014. The survey method using schedule was conducted to get information about the background characteristics and food handlers and each food handler was examined clinically for assessing health status. Chi-Square test was used as test of significance and regression analysis was also done to nullifying the effect of confounders. The health status of the mess workers was found to be significantly associated with use of gloves, hand washing after toilet and hand washing before cooking and serving food. The rationale of this study was that though many studies have been carried out to show the health status of the food handlers and their background characteristics, no study has highlighted the association of these background characteristics and personal hygiene practices with the health status of food handlers.

[The legal status of medical students during practical training in hospitals (author's transl)].

PubMed

Liebhardt, E; Spann, W; Marx, B

1977-10-21

The most important change in the qualification regulations in force at the present time is the provision for the practical training of medical students, which occurs not only in university hospitals but also in "teaching hospitals" outside the university. The realization of the practical year is problematic according to the actual conditions because of the difficulties and financial investment necessarily associated with it. Furthermore, the legal status of the students during the practical activities differes from that of earlier medical assistants, because according to the present law the legal provisions for employment and social insurance such as the determination of division of labour, working hours and remuneration and also for third party and accident insurance do not apply.

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…

Socioeconomic status and length of hospital stay in children with vaso-occlusive crises of sickle cell disease.

PubMed Central

Ellison, Angela M.; Bauchner, Howard

2007-01-01

OBJECTIVE: To examine the association between socioeconomic status and length of hospital stay for vaso-occlusive crises in children with sickle cell disease. METHODS: 19,174 discharges (aged 1-20 years), with a primary diagnosis of sickle cell disease with crisis were analyzed from the Healthcare Cost and Utilization Project Kid Inpatient Database 2000. Socioeconomic status was assessed using an area-based measure, median household income by ZIP code and an individual-level measure, insurance status. We adjusted for age, gender, hospital location/teaching status, presence of pneumonia, number of diagnoses on record and number of procedures performed. Negative binomial regression models using generalized estimating equations (GEE) were used to assess length of stay. RESULTS: Socioeconomic status as measured by income was not associated with length of stay (incidence rate ratio (highest versus lowest category) = 1.04 (95% CI: 0.98, 1.11)). In contrast, socioeconomic status as measured by insurance was associated with length of stay [adjusted incidence rate ratio = 1.04 (95% CI: 1.01, 1.08)), although the magnitude of this difference is small and not likely to be clinically important. CONCLUSIONS: We found no evidence to suggest that socioeconomic status has any clinically important effect on length of hospital stay in children with vaso-occlusive crises in sickle cell disease. PMID:17393942

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)

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

Colorectal cancer in patients seen at the teaching hospitals of Guadeloupe and Martinique: discrepancies, similarities in clinicopathological features, and p53 status

PubMed Central

2014-01-01

Background In Guadeloupe and Martinique, two French Overseas Departments, colorectal cancer (CRC) has become an essential public health issue. However, little is known about CRC characteristics and the p53 status in these populations, particularly in Guadeloupe, whereas certification of a cancer registry has been recently validated. Methods This was a descriptive retrospective study of 201 patients who, between 1995 and 2000, underwent surgery for CRC in the Guadeloupe Teaching Hospital (GlpeTH; 83 patients) and in the Martinique Teaching Hospital (MqueTH; 118 patients). The clinicopathological features and the p53 expression, evaluated with immunohistochemistry, were compared at the time of diagnosis. A relationship between these parameters and the p53 expression was also studied. Data were analysed, using the SPSS computer software version 17.0. Results No statistical difference was found between the two groups of patients regarding age (p = 0.60), percentage of young patients (≤50 years; p = 0.94)), sex (p = 0.47), histological type (p = 0.073) and tumour sites (p = 0.65), although the GlpeTH patients were diagnosed with more distal colon cancers (54.2%) than the Mque TH patients (47.4%). By contrast, a significant difference was found regarding the tumour grade (p < 0.0001), the pTNM stage (p = 0.045) and the pT stage (p < 0.0001). Regarding p53 expression, solely for the MqueTH patients, nuclear expression was associated with pTNM, the percentage of p53 negative tumours increasing with the progression of the pTNM stages (p = 0.029). Conclusions For the first time, this study reveals discrepancies in clinicopathological features and in the p53 status between the two groups of patients. The GlpeTH patients were diagnosed with more moderated CRCs but with few CRCs at pTNM IV stage. By contrast, the MqueTH patients were diagnosed with more differentiated tumours, but with many more CRCs at pTNM IV stage. This paradox may be

Accounting For Patients' Socioeconomic Status Does Not Change Hospital Readmission Rates.

PubMed

Bernheim, Susannah M; Parzynski, Craig S; Horwitz, Leora; Lin, Zhenqiu; Araas, Michael J; Ross, Joseph S; Drye, Elizabeth E; Suter, Lisa G; Normand, Sharon-Lise T; Krumholz, Harlan M

2016-08-01

There is an active public debate about whether patients' socioeconomic status should be included in the readmission measures used to determine penalties in Medicare's Hospital Readmissions Reduction Program (HRRP). Using the current Centers for Medicare and Medicaid Services methodology, we compared risk-standardized readmission rates for hospitals caring for high and low proportions of patients of low socioeconomic status (as defined by their Medicaid status or neighborhood income). We then calculated risk-standardized readmission rates after additionally adjusting for patients' socioeconomic status. Our results demonstrate that hospitals caring for large proportions of patients of low socioeconomic status have readmission rates similar to those of other hospitals. Moreover, readmission rates calculated with and without adjustment for patients' socioeconomic status are highly correlated. Readmission rates of hospitals caring for patients of low socioeconomic status changed by approximately 0.1 percent with adjustment for patients' socioeconomic status, and only 3-4 percent fewer such hospitals reached the threshold for payment penalty in Medicare's HRRP. Overall, adjustment for socioeconomic status does not change hospital results in meaningful ways. Project HOPE—The People-to-People Health Foundation, Inc.

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.

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.

[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.

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.

The financial status of Catholic hospitals: 1982-1983.

PubMed

Choate, G M; Walker, W R; Unger, M

1986-01-01

Recently available figures for 1982 and 1983 show that Catholic hospitals as a whole attained positive ratios of net income to fund balances and that these gains exceeded inflation in both years. The financial picture varies, however, when data for specific categories of Catholic hospitals are examined. For example, smaller hospitals relied more on borrowed funds to finance assets and generate profits, and for many of them these profits still did not exceed the 1983 inflation rate. Hospitals particularly vulnerable to diagnosis-related group payment--that is, teaching hospitals, hospitals with negative operating income, and hospitals adding beds--possessed less liquidity than Catholic hospitals aggregately. Hospitals in each of these categories experienced less-than-average basic profitability as well.

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.

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...

Hospital Magnet Status, Unit Work Environment, and Pressure Ulcers.

PubMed

Ma, Chenjuan; Park, Shin Hye

2015-11-01

To identify how organizational nursing factors at different structural levels (i.e., unit-level work environment and hospital Magnet status) are associated with hospital-acquired pressure ulcers (HAPUs) in U.S. acute care hospitals. A cross-sectional observational study used data from the National Database of Nursing Quality Indicators®. Responses from 33,845 registered nurses (RNs) were used to measure unit work environments. The unit of analysis was the nursing unit, and there were 1,381 units in 373 hospitals in the United States. Unit work environment was measured by the Practice Environment Scale of Nurse Working Index (PES-NWI). Multilevel logistic regressions were used to estimate the effects of unit work environment and hospital Magnet status on HAPUs. All models were controlled for hospital and unit characteristics when considering clustering of units within hospitals. Magnet hospital units had 21% lower odds of having an HAPU than non-Magnet hospital units (95% confidence interval [CI], 0.64-0.98). With one unit increase of the PES-NWI score, units had 29% lower odds of having an HAPU (95% CI, 0.55-0.91). When including both hospital Magnet status and unit work environment in the model, hospital Magnet status no longer had a significant effect on HAPUs (odds ratio [OR] = 0.82; 95% CI, 0.66-1.02), whereas the significant effect of unit work environment persisted (OR = 0.73; 95% CI, 0.56-0.93). Both hospital and unit environments were significantly associated with HAPUs, and the unit-level work environment can be more influential in reducing HAPUs. Investment in the nurse work environments at both the hospital level and unit level has the potential to reduce HAPUs; and additional to hospital-level initiatives (e.g., Magnet recognition program), efforts targeting on-unit work environments deserve more attention. © 2015 Sigma Theta Tau International.

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

Anemia, nutritional status, and inflammation in hospitalized elderly.

PubMed

Ramel, Alfons; Jonsson, Palmi V; Bjornsson, Sigurbjorn; Thorsdottir, Inga

2008-01-01

Anemia (hemoglobin <120 g/L) in elderly patients is a health problem. The aim of this study was to investigate the prevalence of anemia and associations of anemia with nutritional status and inflammation in hospitalized elderly. Sixty patients from the Department of Geriatrics were randomly assigned to participate. Blood samples were drawn and analyzed at the laboratory of the University Hospital in Reykjavik. Nutritional status was assessed using anthropometric and hematologic parameters. The prevalence of anemia was 36.7%. Female participants were more frequently anemic than male participants (47.4% versus 18.2%, P = 0.024). Anemic patients had a lower albumin level (31.3 versus 33.4 g/L, P = 0.019) and a higher erythrocyte sedimentation rate (29.6 versus 16.0 mm/h, P = 0.005) and were more often malnourished (81.8% versus 44.7%, P = 0.005) than non-anemic patients. Hemoglobin correlated with prealbumin (rho = 0.338, P = 0.008) and albumin (rho = 0.250, P = 0.054) levels, but negatively with age (rho = -0.310, P = 0.016) and erythrocyte sedimentation rate (rho = -0.412, P < 0.001). In the multivariate analysis, erythrocyte sedimentation rate and nutritional status were significant predictors of hemoglobin (R(2) = 34.0%). This cross-sectional analysis provides evidence of anemia in 36.7% of patients hospitalized at the Landspitali-University Hospital in Reykjavik and shows an association among anemia, deteriorated nutritional status, and inflammation. Future prospective studies are needed to assess the efficacy of adjuvant nutritional support to stabilize or improve nutritional status including anemia in hospitalized elderly.

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)

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.

Hospital-level changes in adult ICU bed supply in the United States

PubMed Central

Wallace, David J.; Seymour, Christopher W.; Kahn, Jeremy M.

2017-01-01

Objective Although the number of intensive care beds in the United States is increasing, little is known about the hospitals responsible for this growth. We sought to better characterize national growth in intensive care beds by identifying hospital-level factors associated with increasing numbers of intensive care beds over time. Design We performed a repeated-measures time series analysis of hospital-level intensive care bed supply using data from Centers for Medicare and Medicaid Services. Setting All United States acute care hospitals with adult intensive care beds over the years 1996 to 2011. Measurements & Main Results We described the number of beds, teaching status, ownership, intensive care occupancy and urbanicity for each hospital in each year of the study. We then examined the relationship between increasing intensive care beds and these characteristics, controlling for other factors. The study included 4,457 hospitals and 55,865 hospital-years. Overall, the majority of intensive care bed growth occurred in teaching hospitals (net +13,471 beds, 72.1% of total growth), hospitals with 250 or more beds (net +18,327 beds, 91.8% of total growth) and hospitals in the highest quartile of occupancy (net +10,157 beds, 54.0% of total growth). In a longitudinal multivariable model, larger hospital size, teaching status, and high intensive care occupancy were associated with subsequent-year growth. Furthermore, the effects of hospital size and teaching status were modified by occupancy: the greatest odds of increasing intensive care unit beds were in hospitals with 500 or more beds in the highest quartile of occupancy (adjusted OR: 18.9; 95% CI: 14.0 – 25.5; p<0.01) and large teaching hospitals in the highest quartile of occupancy (adjusted OR: 7.3; 95% CI: 5.3 – 9.9; p<0.01). Conclusions Increasingly, intensive care bed expansion in the United States is occurring in larger hospitals and teaching centers, particularly following a year with high intensive care

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.

Social impact of HIV/AIDS on clients attending a teaching hospital in Southern Nigeria.

PubMed

Johnson, Ofonime E

2012-01-01

People living with human immunodeficiency virus and acquired immune deficiency syndrome (PLWHA) face numerous social challenges. The objectives of this study were to assess the level of self-disclosure of status by PLWHA, to describe the level and patterns of stigma and discrimination, if any, experienced by the PLWHA and to assess the effect of sero-positivity on the attitude of friends, family members, health workers, colleagues and community. This was a cross-sectional descriptive study carried out among PLWHA attending the University of Uyo Teaching Hospital, Uyo, Southern Nigeria. Information was obtained using an interviewer-administered semi-structured questionnaire, which was analysed using the Epi 6 software. A total of 331 respondents were interviewed. A majority, 256 (77.3%), of the respondents were within the age range of 25-44 years. A total of 121 (36.6%) PLWHA were single and 151 (46.6%) were married, while the rest were widowed, divorced or separated. A majority, 129 (85.4%), of the married respondents disclosed their status to their spouses and 65 (50.4%) were supportive. Apart from spouses, disclosure to mothers (39.9%) was highest. Most clients (57.7%) did not disclose their status to people outside their immediate families for fear of stigmatization. Up to 111 (80.4%) of the respondents working for others did not disclose their status to their employers. Among those whose status was known, discrimination was reported to be highest among friends (23.2%) and at the workplace (20.2%). Attitudes such as hostility (14.5%), withdrawal (11.7%) and neglect (6.8%) were reported from the private hospitals. Apart from disclosure to spouses, the level of disclosure to others was very low. Those whose status was known mainly received acceptance from their families but faced discriminatory attitudes such as hostility, neglect and withdrawal from friends, colleagues and hospital workers. There is a need for more enlightenment campaigns on HIV/AIDS by

[Current status of nurses' perceived professional benefits and influencing factors in 3A-level hospitals in Tianjin].

PubMed

Ma, H W; Dan, X; Xu, S H; Hou, R N; Zhao, N M

2017-06-20

Objective: To investigate the current status of nurses' perceived professional benefits in 3A-level hospitals in Tianjin, and analyze its influencing factors. Methods: A total of 421 clinical nurses from five 3A-level hospitals in Tianjin were recruited for investigation on perceived professional benefits by Nurses'Perceived Professional Benefits Scale. Results: The total score of nurses' perceived professional benefit was 110.50±14.24, the score index was 77.34%. Among five dimensions, the highest scores index was 84.80% for personal development, the lowest was 71.57% for identification by relatives and friends. Multiple linear regression analysis showed the three variables, such as department, teaching and cooperative relation between doctors and nurses entered the model, higher perceived professional benefits was observed in medical nurses, teaching nurses, and those with better cooperative relation between doctors and nurses ( P <0.05) . Conclusion: The investigated nurses in 3A-level hospitals in Tianjin show upper-moderate level of perceived professional benefits. Nursing managers should develop targeted interventions based on the factors affecting the perceived professional benefits of the nurses and further enhance their perceived professional benefits.

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 relationship between the Balanced Budget Act (BBA) and hospital profitability.

PubMed

Younis, Mustafa Z

2006-01-01

The Balanced Budget Act of 1997 (BBA) reduced the payment for fees for service providers and reduced the subsidy paid by the government for teaching hospitals. Since the passage of such cost containment measures, debates regarding their impact on hospitals, graduate medical education, and access to health care were raised. The need to examine the effect of such payment reduction on hospital profitability was widely ignored. We examined the relationship between the BBA and hospital profitability by using return on assets to measure profitability, by running an ordinary least squares regression for 1996 as pre-BBA and 1999 as post-BBA. We controlled for variables that were not included in previous literature, such as disproportionate share hospital status, critical access hospital status, and graduate medical education, measured by teaching hospitals to measure the effect of BBA cuts on teaching hospitals. Furthermore we incorporated several economic, financial, and utilization variables in the model. We used 1996 and 1999 data in our analysis to bridge potential effects of the BBA. To locate hospitals that changed ownership status we cross-matched the Medicare Cost Report data with the American Hospital Association Annual Survey. We found that overall hospital profitability declined as a result of the introduction of the BBA; however, small rural hospitals that converted to critical access status enjoyed improvement in financial status over the period of our study. Hospitals that converted to for-profit status did not improve in financial status, and showed a lower earning after the conversation. Our results show that the BBA had a negative effect on hospitals because of cuts in its reimbursement policy, except for critical access hospitals, which show improvement because of their exemption from the prospective payment system. Our study differs from others by using national comprehensive data for years that focus exclusively on the Balanced Budget Act period. We

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.

Pre-hospital physical activity status affects in-hospital course of elderly patients with acute myocardial infarction.

PubMed

Miyamoto, Takamichi; Obayashi, Tohru; Hattori, Eijirou; Yamauchi, Yasuteru; Niwa, Akihiro; Isobe, Mitsuaki

2010-03-01

The clinical course of elderly patients with acute myocardial infarction (AMI) can sometimes unexpectedly result in an adverse outcome even when therapy appears to be successful. We suspect that specific factors may characterize this worsening of status during hospitalization. This study examines whether the pre-hospital physical activity status of the elderly treated with percutaneous coronary intervention (PCI) for AMI affects their in-hospital course. We studied 110 consecutive patients, aged 80 or older, who had undergone emergent PCI for AMI. Patients were divided into two groups based on clinical presentation: Better Killip class (Killip classes I and II) and Worse Killip class (Killip classes III and IV). Patients were also divided into two groups based on pre-hospital physical activity status, determined retrospectively by review of medical records: Good physical activity (n=57) comprising those able to go out alone independently and Poor physical activity comprising those mainly confined to home (n=53). The overall in-hospital mortality rate was 9.1% for the study population. The Worse Killip class group had a higher in-hospital mortality rate than the Better Killip class group (27.8% vs 5.4%, respectively; p=0.0102). In addition, the Poor physical activity group had a higher in-hospital mortality rate than the Good physical activity group (15.1% vs. 3.5%, respectively; p=0.047). These data suggest that pre-hospital physical activity status in elderly patients with AMI may affect in-hospital mortality as well as Killip class.

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...

Is Profit Status of Inpatient Rehabilitation Facilities Independently Associated with 30-day Unplanned Hospital Readmission for Medicare Beneficiaries?

PubMed Central

Karmarkar, Amol; Lin, Yu-Li; Kuo, Yong-Fang; Ottenbacher, Kenneth J.; Graham, James E.

2017-01-01

Objective To investigate the effects of facility-level factors on 30-day unplanned risk-adjusted hospital readmission after Inpatient Rehabilitation Facilities (IRFs) discharge. Design We used the 100% Medicare claims data, covering 269,306 discharges from 1,094 IRFs between October 2010 and September 2011. We examined the association between hospital readmission and ten facility-level factors (number of discharges, disproportionate share percentage, profit status, teaching status, freestanding status, accreditation status, census region, stroke belt, location and median household income). Setting Discharge from IRFs. Participants Facilities (IRFs) serving Medicare fee-for-service beneficiaries. Intervention NA Main Outcome Measure(s) Risk Standardized Readmission Rate (RSRR) for 30-day hospital readmission. Results Profit status was the only IRF provider-level characteristic significantly associated with unplanned readmissions. For-profit IRFs had significantly higher RSRR (13.26 ± 0.51) as compared to non-profit IRFs (13.15 ± 0.47) (p<0.001). After controlling for all other facility characteristics (except for accreditation status due to collinearity), for-profit IRFs remained 0.1% point higher RSRR than non-profit IRFs, and census region was the only significant region-level characteristic, with the South showing the highest RSRR of all regions (p=0.005 for both, type III test). Conclusions Our findings support the inclusion of profit status on the IRF Compare website (a platform includes IRF comparators to indicate quality of services). For-profit IRFs had higher RSRR than non-profit IRFs for Medicare beneficiaries. The South had higher RSRR than other regions. The RSRR difference between for-profit and non-profit IRFs could be due to the combined effects of organizational and regional factors. PMID:28958606

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

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.

Prevalence and Associated Risk Factors of Asymptomatic Bacteriuria in Ante-Natal Clients in a Large Teaching Hospital in Ghana.

PubMed

Labi, A-K; Yawson, A E; Ganyaglo, G Y; Newman, M J

2015-09-01

Asymptomatic bacteriuria, the presence of bacteria in urine without symptoms of acute urinary tract infection, predisposes pregnant women to the development of urinary tract infections and pyelonephritis, with an attendant pregnancy related complications. To measure the prevalence of asymptomatic bacteriuria among ante-natal clients at the Korle-Bu Teaching Hospital in Ghana and its' associated risk factors. A cross-sectional study involving 274 antenatal clients was conducted over a period of 4 weeks. A face to face questionnaire was completed and midstream urine collected for culture and antimicrobial susceptibility testing. The prevalence of asymptomatic bacteriuria was 5.5%. It was associated with sexual activity during pregnancy (Fisher's Exact 5.871, p-value 0.0135), but not with sexual frequency. There were no significant associations with educational status, parity, gestational age, marital status and the number of foetuses carried. The commonest organism isolated was Enterococcus spp (26.7%) although the enterobacteriaceae formed the majority of isolated organisms (46.7%). Nitrofurantoin was the antibiotic with the highest sensitivity to all the isolated organisms. The prevalence of asymptomatic bacteriuria among ante-natal clients at this large teaching hospital in Ghana is 5.5%, which is lower than what has been found in other African settings. Enterococcus spp was the commonest causative organism. However, due to the complications associated with asymptomatic bacteriuria, a policy to screen and treat- all pregnant women attending the hospital, is worth considering.

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

[Nutritional status recording in hospitalized patient notes].

PubMed

Matos, L; Teixeira, M A; Henriques, A; Tavares, M M; Alvares, L; Antunes, A; Amaral, Teresa F

2007-01-01

The prevalence of disease-related malnutrition (DRM) is described to be of 30-60% on admission to hospital, and of 10% in the community. It has been associated with worse clinical outcomes, namely higher morbidity and mortality as well as higher frequency of health care and its associated costs. The lack of screening and monitoring of nutritional status have been said to be risk factors for the increased prevalence of DRM during hospital stay. The aims of this study were to evaluate the importance given by health care professionals to certain aspects related with nutritional status (weight, food intake) of hospital patients and to see if there were any differences between the under and non undernourished ones. A systematic sample of patients from six hospitals was collected. Pregnancy, paediatric age and critical illness were exclusion criteria as well as incapacity to fulfil nutritional risk screening protocol and length-of-stay less than 24h. Socio-demographic, anthropometric data and clinical notes (e.g. weight, food/nutrient intake) from medical records were collected and Nutritional Risk Screening 2002 protocol was applied. A total of 1152 patients were included in this study. The prevalence of nutritional risk varied between 28.5% and 47.3% while undernutrition classified by anthropometrical parameters was considerably lower (6.3% to 14.9%). Two thirds of the patients had their food intake monitored and registered in medical records but only one third were weighted. Undernourished patients had their food intake more frequently monitored but their weight was less frequently measured, than the well-nourished ones. DRM prevalence amongst hospital patients on admission is significantly high. Clinical notes regarding nutritional status is rather infrequent on medical records. This study showed that urges the need to empower health care providers of the importance of the screening and monitoring of weight and food intake, on admission and during hospital stay.

Current status and challenge of Human Parasitology teaching in China

PubMed Central

Peng, Hong-Juan; Zhang, Chao; Wang, Chun-Mei; Chen, Xiao-Guang

2012-01-01

Parasitic infection profile in China has been changed greatly with the rapid economic development in China since the 1980s, such as the tremendous decreased infection rate of the soil-borne helminthiasis, the elimination of filariasis, the control of malaria, and the initiation to eradicate malaria in 2020. Some food-borne parasitic infections have increased such as Clonorchiasis, Cysticercosis, and Echinococcosis, probably because of the increased chances of eating out. This trend directly affected the status of Human Parasitology teaching in medical universities, such as the shorten length of this course, re-adjusted contents structure and teaching manners, even the change of the name of this course. In this paper, we analyzed the current status and challenges of Human Parasitology teaching in medical universities, and discussed the requisite contents and manners in course delivery and measures to improve the quality of Human Parasitology teaching in China. PMID:23265609

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.

Differences in hospital casemix, and the relationship between casemix and hospital costs.

PubMed

Söderlund, N; Milne, R; Gray, A; Raftery, J

1995-03-01

The aim of the study was to examine the relationship between hospital costs and casemix, and after adjustment for casemix differences, between cost and institutional size, number of specialties, occupancy and teaching status. A retrospective analysis of all admissions to nine acute-care NHS hospitals in the Oxford region during the 1991-1992 financial year was undertaken. All episodes were assigned to a diagnosis-related group (DRG) and a cost weight assigned accordingly. Costs per finished consultant episode, before and after adjustment for casemix differences, were analysed at the hospital and specialty level. Casemix differences were significant, and accounted for approximately 77 per cent of the difference in costs between providers. Costs per casemix-adjusted episode were not significantly associated with differences in hospital size, scope, occupancy levels or teaching status, but sample size was insufficient to investigate these relationships adequately. Specialty costs were poorly correlated with specialty casemix. This was probably due to poor apportionment of specialty costs in hospital accounting returns. Casemix differences need to be taken into account when comparing providers for the purposes of contracting, as unadjusted unit costs may be misleading. Although the methods used may currently be applied to most NHS hospitals, widespread use would be greatly facilitated by the development of indigenous cost weights and better routine hospital data coding and collection.

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.

Assessing the nutritional status of hospitalized elderly.

PubMed

Abd Aziz, Nur Adilah Shuhada; Teng, Nur Islami Mohd Fahmi; Abdul Hamid, Mohd Ramadan; Ismail, Nazrul Hadi

2017-01-01

The increasing number of elderly people worldwide throughout the years is concerning due to the health problems often faced by this population. This review aims to summarize the nutritional status among hospitalized elderly and the role of the nutritional assessment tools in this issue. A literature search was performed on six databases using the terms "malnutrition", "hospitalised elderly", "nutritional assessment", "Mini Nutritional Assessment (MNA)", "Geriatric Nutrition Risk Index (GNRI)", and "Subjective Global Assessment (SGA)". According to the previous studies, the prevalence of malnutrition among hospitalized elderly shows an increasing trend not only locally but also across the world. Under-recognition of malnutrition causes the number of malnourished hospitalized elderly to remain high throughout the years. Thus, the development of nutritional screening and assessment tools has been widely studied, and these tools are readily available nowadays. SGA, MNA, and GNRI are the nutritional assessment tools developed specifically for the elderly and are well validated in most countries. However, to date, there is no single tool that can be considered as the universal gold standard for the diagnosis of nutritional status in hospitalized patients. It is important to identify which nutritional assessment tool is suitable to be used in this group to ensure that a structured assessment and documentation of nutritional status can be established. An early and accurate identification of the appropriate treatment of malnutrition can be done as soon as possible, and thus, the malnutrition rate among this group can be minimized in the future.

Periodontal status and its association with self-reported hypertension in non-medical staff in a university teaching hospital in Nigeria.

PubMed

Umeizudike, K A; Ayanbadejo, P O; Onajole, A T; Umeizudike, T I; Alade, G O

2016-03-01

A growing body of evidence suggests a relationship between periodontal disease and non-communicable systemic diseases with rising prevalence in developing countries, Nigeria inclusive. To determine the periodontal status and its association with self-reported hypertension among non-medical staff in a university teaching hospital in Nigeria. A cross-sectional study was conducted among non-medical staff using self-administered questionnaires and periodontal clinical examination between July and August 2013. Multivariate analysis was explored to determine the independent variables associated with self-reported hypertension. P values < 0.05 were considered statistically significant. A total of 276 subjects were enrolled into the study. Shallow pockets (CPI code 3) constituted the predominant periodontal disease (46.7%), calculus (CPI code 2) 46%, bleeding gingiva (CPI code 1) in 3.3% and deep pockets ≥ 6mm (CPI code 4) in 2.2%. Self-reported hypertension was the most prevalent self-reported medical condition (18.1%) and found to be associated with periodontitis, increasing age, lower education, and a positive family history of hypertension. Periodontal disease was highly prevalent in this study. Self-reported hypertension was associated with periodontitis, older age, lower education and a positive family history. Periodic periodontal examination and regular blood pressure assessment for non-medical staff is recommended.

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.

"Top Performing" US Hospitals and the Health Status of Counties they Serve.

PubMed

Maraccini, Amber M; Yang, Wei; Slonim, Anthony D

2018-06-01

This study (a) examined the relationships between "top performing" US hospitals and the health status of counties they serve and (b) compared the health status of "top performing" US hospital counties versus that of remaining US counties. Statistical analyses considered US News and World Report Honor Roll ranking data, as a measure of hospital performance, and County Health Rankings (CHR) data, as a measure of county health status. "Top performing" hospital Honor Roll scores were correlated with measures of Clinical Care (p < 0.001). Counties with "top performing" US hospitals presented greater health status with regard to All Health Outcomes (p < 0.001), Length of Life (p < 0.001), Quality of Life (p < 0.001), All Health Factors (p < 0.001), Health Behaviors (p < 0.001), and Clinical Care (p < 0.001), than compared to remaining US counties. Hospital impact on county health status remains primarily recognized in clinical care and not in overall health. Also, counties that contain a "top performing" US hospital tend to present lower health risks to their citizens than compared to other US counties.

[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

Investigation of health promotion status in specialized hospitals associated with Hamadan University of Medical Sciences: health-promoting hospitals.

PubMed

Hamidi, Yadollah; Hazavehei, Seyed Mohammad Mahdi; Karimi-Shahanjarini, Akram; SeifRabiei, Mohamad Ali; Farhadian, Maryam; Alimohamadi, Shohreh; Kharghani Moghadam, Seyedeh Melika

2017-12-01

The prophecy of health promoting hospitals (HPH) is bringing about a change and transition from treatment-oriented to health-oriented attitudes. In Iran, hospitals usually play the traditional roles. The present study was aimed at the evaluation of the health promotion status in specialized hospitals associated with Hamadan University of Medical Sciences (HUMS). This applied study was conducted in two Hamadan specialized hospitals in the Hamadan city. The health promotion status was evaluated using a self-assessment checklist designed by the World Health Organization's HPH. The evaluation was done in five standards including management policy, patient assessment, patient information and intervention, promotion of a healthy workplace and continuity and cooperation. The results showed that both the hospitals studied had a poor status in terms of promoting a healthy workplace (average = 31.24%) and management policy standards (average = 35.29%) in comparison with the other relevant standards: patient assessment (53.12%), patient information and intervention (62.5%), continuity and cooperation (65.78%)). The results of the standards and sub-standards status displayed better performance in the cardiovascular hospital (53.67%) compared to the women and parturition hospital (42.64%). The findings indicated that HPH standards are very low in the studied hospitals. The reason behind this wide gap might be due to the fact that hospitals in Iran are more treatment-oriented and patient-oriented and they do not play an active part in health promoting. It was found that management policy and promoting healthy workplace standards had the worst status and must be improved.

A Decomposition of Hospital Profitability

PubMed Central

Broom, Kevin; Elliott, Michael; Lee, Jen-Fu

2015-01-01

Objectives: This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE) into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Methods: Profit margin, the efficiency with which services are rendered (total asset turnover), and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services’ Healthcare Cost Report Information System (CMS Form 2552). The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS) against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. Results: When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. Conclusion: The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of NFP and IO

[Analysis and outlook on teaching status of Molecular Pharmacognosy].

PubMed

Bi, Yu-xia; Xu, Hai-yu; Tong, Yan; Cui, Shu-zhen; Li, Hai-yan; Liu, Chang-xiao

2015-09-01

The teaching status of Molecular Pharmacognosy in 28 institutions in China was investigated by questionnaire and the survey data was analyzed by SPSS. Research contents included course beginning years, majors, class hours, characteristics of the course, teaching ways, the theory and practice contents, evaluation modes, selection of teaching material, teaching achievements, teachers and so on for undergraduates and graduates. Research results showed that with 20 years' development, Molecular Pharmacognosy had been offered for both undergraduate and graduate students in at least 20 colleges and universities and Molecular Pharmacognosy education in China showed good development momentum. At the same time, to promote the development of Molecular Pharmacognosy further, investment for it should be increased and practical teaching condition should be improved.

Factoring socioeconomic status into cardiac performance profiling for hospitals: does it matter?

PubMed

Alter, David A; Austin, Peter C; Naylor, C David; Tu, Jack V

2002-01-01

Critics of "scorecard medicine" often highlight the incompleteness of risk-adjustment methods used when accounting for baseline patient differences. Although socioeconomic status is a highly important determinant of adverse outcome for patients admitted to the hospital with acute myocardial infarction, it has not been used in most risk-adjustment models for cardiovascular report cards. To determine the incremental impact of socioeconomic status adjustments on age, sex, and illness severity for hospital-specific 30-day mortality rates after acute myocardial infarction. The authors compared the absolute and relative hospital-specific 30-day acute myocardial infarction mortality rates in 169 hospitals throughout Ontario between April 1, 1994 and March 31, 1997. Patient socioeconomic status was characterized by median neighborhood income using postal codes and 1996 Canadian census data. They examined two risk-adjustment models: the first adjusted for age, sex, and illness severity (standard), whereas the second adjusted for age, sex, illness severity, and median neighborhood income level (socioeconomic status). There was an extremely strong correlation between 'standard' and 'socioeconomic status' risk-adjusted mortality rates (r = 0.99). Absolute differences in 30-day risk-adjusted mortality rates between the socioeconomic status and standard risk-adjustment models were small (median, 0.1%; 25th-75th percentile, 0.1-0.2). The agreement in the quintile rankings of hospitals between the socioeconomic status and standard risk-adjustment models was high (weighted kappa = 0.93). Despite its importance as a determinant of patient outcomes, the effect of socioeconomic status on hospital-specific mortality rates over and above standard risk-adjustment methods for acute myocardial infarction hospital profiling in Ontario was negligible.

Functional Status in ICU Survivors and out of hospital outcomes: a cohort study

PubMed Central

Rydingsward, Jessica E.; Horkan, Clare M.; Mogensen, Kris M.; Quraishi, Sadeq A.; Amrein, Karin; Christopher, Kenneth B.

2016-01-01

Objective Functional status at hospital discharge may be a risk factor for adverse events among survivors of critical illness. We sought to examine the association between functional status at hospital discharge in survivors of critical care and risk of 90-day all-cause mortality after hospital discharge. Design Single center retrospective cohort study Setting Academic Medical Center Patients 10,343 adults who received critical care from 1997 to 2011 and survived hospitalization. Interventions None Measurements and Main Results The exposure of interest was functional status determined at hospital discharge by a licensed physical therapist and rated based on qualitative categories adapted from the Functional Independence Measure. The main outcome was 90-day post hospital discharge all-cause mortality. A categorical risk prediction score was derived and validated based on a logistic regression model of the function grades for each assessment. In an adjusted logistic regression model, the lowest quartile of functional status at hospital discharge was associated with an increased odds of 90-day post-discharge mortality compared to patients with independent functional status [OR=7.63 (95%CI 3.83, 15.22; P<0.001)]. In patients who had at least seven days of physical therapy treatment prior to hospital discharge (N=2,293), the adjusted odds of 90-day post-discharge mortality in patients with marked improvement in functional status at discharge was 64% less than patients with no change in functional status [OR 0.36 (95%CI 0.24–0.53); P<0.001]. Conclusions Lower functional status at hospital discharge in survivors of critical illness is associated with increased post-discharge mortality. Further, patients whose functional status improves before discharge have decreased odds of post-discharge mortality. PMID:26929191

Effectiveness of simple control measures on methicillin-resistant Staphylococcus aureus infection status and characteristics with susceptibility patterns in a teaching hospital in Peshawar.

PubMed

Rafiq, Muhammad Salman; Rafiq, Muhammad Imran; Khan, Taimur; Rafiq, Maria; Khan, Mah Muneer

2015-09-01

To determine the effectiveness of simple control measures on the infection status and characteristics of methicillin-resistant Staphylococcus aureus including susceptibility patterns among health professionals and patients in a teaching hospital. The cross-sectional study was conducted from September 2013 to January 2014, and comprised samples collected from healthcare personnel and patients in the various units of Khyber Teaching Hospital, Peshawar. The specimens were collected before and one month after the implementation of simple control measures for outbreak prevention of methicillin-resistant Staphylococcus aureus. These were tested for culture and antimicrobial susceptibility. Data about methicillin-sensitive and methicillin-resistant Staphylococcus aureus infection, wound characteristics and susceptibility patterns was collected and effectiveness of simple control measures was determined. SPSS 20 was used for statistical analysis. Of the total 390 isolates, 180(46.2%) were Staphylococcus aureus; 77(19.7%) from healthcare personnel and 103(26.4%) from patients. Of these, 164(42.1%) were methicillin-sensitive and 16(4.1%) were methicillin-resistant. Among the patients, 38(15.1%) methicillin-sensitive and 8(3.2%) methicillin-resistant isolates were recovered from wounds or skin and soft tissues. Pus with 33(13.1%) and 4(1.6%) cases respectively was the second most common source. Among methicillin-resistant isolates, resistance to Linezolid was 0%, all were resistant to Oxacillin, Cefoxitin, Amoxicillin, Cefotaxime and Cephradine, and resistance to both Co-Amoxiclav and Ciprofloxacin was 87.5%. After one month of implementation of simple control measures, the number of methicillin-resistant cases among healthcare professionals and patients dropped from 4(2.9%) and 7(10.8%) to 1(0.7%) and 5(2.7%), respectively. Methicillin-resistant and methicillin-sensitive Staphylococcus aureus differed in their anti-microbial susceptibility profiles. Selection of antibiotics

Assessing the nutritional status of hospitalized elderly

PubMed Central

Abd Aziz, Nur Adilah Shuhada; Teng, Nur Islami Mohd Fahmi; Abdul Hamid, Mohd Ramadan; Ismail, Nazrul Hadi

2017-01-01

Purpose The increasing number of elderly people worldwide throughout the years is concerning due to the health problems often faced by this population. This review aims to summarize the nutritional status among hospitalized elderly and the role of the nutritional assessment tools in this issue. Methods A literature search was performed on six databases using the terms “malnutrition”, “hospitalised elderly”, “nutritional assessment”, “Mini Nutritional Assessment (MNA)”, “Geriatric Nutrition Risk Index (GNRI)”, and “Subjective Global Assessment (SGA)”. Results According to the previous studies, the prevalence of malnutrition among hospitalized elderly shows an increasing trend not only locally but also across the world. Under-recognition of malnutrition causes the number of malnourished hospitalized elderly to remain high throughout the years. Thus, the development of nutritional screening and assessment tools has been widely studied, and these tools are readily available nowadays. SGA, MNA, and GNRI are the nutritional assessment tools developed specifically for the elderly and are well validated in most countries. However, to date, there is no single tool that can be considered as the universal gold standard for the diagnosis of nutritional status in hospitalized patients. Conclusion It is important to identify which nutritional assessment tool is suitable to be used in this group to ensure that a structured assessment and documentation of nutritional status can be established. An early and accurate identification of the appropriate treatment of malnutrition can be done as soon as possible, and thus, the malnutrition rate among this group can be minimized in the future. PMID:29042762

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.

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 influence of socioeconomic status on the hemoglobin level and anthropometry of sickle cell anemia patients in steady state at the Lagos University Teaching Hospital.

PubMed

Animasahun, B A; Temiye, E O; Ogunkunle, O O; Izuora, A N; Njokanma, O F

2011-01-01

Sickle cell anemia (SCA) has multisystemic manifestations and is associated with severe morbidity and high mortality. It commonly affects growth leading to wasting and stunting. This study aimed to determine the influence of socioeconomic status on the nutritional status using anthropometric measurements and steady-state hemoglobin, of children with homozygous SCA, aged 1 year to 10 years in steady state at the Lagos University Teaching Hospital. This is a cross-sectional study involving 100 children with SCA and 100 age-, sex-, and social class-matched controls that fulfilled the inclusion criteria. Social class was assessed using educational attainment and occupation of parents. Hemoglobin concentration was determined using the oxy-hemoglobin method. This study demonstrated a significantly lower mean weight and weight-for-height in the SCA patients than those of controls (P < 0.001). By contrast, this study did not demonstrate any statistical significant difference in the mean height and mean body mass index of SCA patients and controls (P = 0.06) and (P = 0.12), respectively. The mean weight, height, and body mass indices of the subjects and controls were consistently below those of the NCHS standards. The magnitude of the difference from the NCHS standard was also more pronounced in the subjects, increased with advancing age and affected male subjects more than females. Progressive declines in the anthropometric attainment and hemoglobin concentration were observed from social class 1 to 4; this was statistically significant in controls (P = 0.00) but not in subjects (P > 0.1). However, SCA patients had significantly lower values than controls in each of the social classes. Poor socioeconomic status has an adverse effect on the nutritional status and hemoglobin of SCA patients.

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.

The internal organization of hospitals: a descriptive study.

PubMed Central

Sloan, F A

1980-01-01

This study presents descriptive information on several dimensions of the internal organization of hospitals, with particular emphasis on medical staff, using data from two unique national surveys. Three alternative theories of hospital behavior by economists are described and evaluated with these data. The study also shows how standard bed size, teaching, and ownership categories relate to important features of hospital organization. In this way, understanding of these standard "control" variables is enhanced. For example, systematic organizational differences between proprietary and other hospitals are reported, holding bed size and teaching status constant. No single theory of hospital behavior emerges as dominant. The tables demonstrate the diversity of hospitals and the likelihood that no single model can adequately describe the behavior of all hospitals. PMID:7204062

Helicobacter pylori status and associated gastroscopic diagnoses in a tertiary hospital endoscopy population in Rwanda.

PubMed

Walker, Timothy D; Karemera, Martin; Ngabonziza, Francois; Kyamanywa, Patrick

2014-05-01

The study was undertaken to document the prevalence of Helicobacter pylori and endoscopic diagnoses in Rwandans presenting for gastroscopy. We studied an endoscopic database containing 961 consecutive gastroscopy patients at the University Teaching Hospital, Butare, over 12 months. Patient characteristics, endoscopic diagnoses and H. pylori status (by modified rapid urease testing) were analysed. The overall H. pylori positivity rate was 75% (n=825), similar to that found elsewhere in sub-Saharan Africa. Common endoscopic diagnoses included duodenal ulceration (20%), duodenitis (9%), benign gastric outlet obstruction (6%) and malignancy (5%). Duodenal ulceration was strongly associated with H. pylori infection (OR 6.2 [3.1-12.6]; p<0.001).

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.

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

Who Considers Teaching and Who Teaches? First-Time 2007-08 Bachelor's Degree Recipients by Teaching Status 1 Year after Graduation. Stats in Brief. NCES 2014-002

ERIC Educational Resources Information Center

Staklis, Sandra; Henke, Robin

2013-01-01

This Statistics in Brief examines the teaching status of 2007-08 first-time bachelor's degree recipients one year after graduation. The analysis compares four groups with respect to their teaching experiences or interest in teaching: those who taught either before or after receiving their bachelor's degree, those who prepared to teach but had not…

[Anesthesia practice in Catalan hospitals and other health care facilities].

PubMed

Villalonga, Antonio; Sabaté, Sergi; Campos, Juan Manuel; Fornaguera, Joan; Hernández, Carmen; Sistac, José María

2006-05-24

The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003. We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training. A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident

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...

Diagnosis-related group-adjusted hospital costs are higher in older medical patients with lower functional status.

PubMed

Chuang, Kenneth H; Covinsky, Kenneth E; Sands, Laura P; Fortinsky, Richard H; Palmer, Robert M; Landefeld, C Seth

2003-12-01

To determine whether hospital costs are higher in patients with lower functional status at admission, defined as dependence in one or more activities of daily living (ADLs), after adjustment for Medicare Diagnosis-Related Group (DRG) payments. Prospective study. General medical service at a teaching hospital. One thousand six hundred twelve patients aged 70 and older. The hospital cost of care for each patient was determined using a cost management information system, which allocates all hospital costs to individual patients. Hospital costs were higher in patients dependent in ADLs on admission than in patients independent in ADLs on admission ($5,300 vs $4,060, P<.01). Mean hospital costs remained higher in ADL-dependent patients than in ADL-independent patients in an analysis that adjusted for DRG weight ($5,240 vs $4,140, P<.01), and in multivariate analyses adjusting for age, race, sex, Charlson comorbidity score, acute physiology and chronic health evaluation score, and admission from a nursing home as well as for DRG weight ($5,200 vs $4,220, P<.01). This difference represents a 23% (95% confidence interval=15-32%) higher cost to take care of older dependent patients. Hospital cost is higher in patients with worse ADL function, even after adjusting for DRG payments. If this finding is true in other hospitals, DRG-based payments provide hospitals a financial incentive to avoid patients dependent in ADLs and disadvantage hospitals with more patients dependent in ADLs.

Nurses' Perspectives on the Geriatric Nursing Practice Environment and the Quality of Older People's Care in Ontario Acute Care Hospitals.

PubMed

Fox, Mary T; Sidani, Souraya; Butler, Jeffrey I; Tregunno, Deborah

2017-06-01

Background Cultivating hospital environments that support older people's care is a national priority. Evidence on geriatric nursing practice environments, obtained from studies of registered nurses (RNs) in American teaching hospitals, may have limited applicability to Canada, where RNs and registered practical nurses (RPNs) care for older people in predominantly nonteaching hospitals. Purpose This study describes nurses' perceptions of the overall quality of care for older people and the geriatric nursing practice environment (geriatric resources, interprofessional collaboration, and organizational value of older people's care) and examines if these perceptions differ by professional designation and hospital teaching status. Methods A cross-sectional survey, using Dillman's tailored design, that included Geriatric Institutional Assessment Profile subscales, was completed by 2005 Ontario RNs and registered practical nurses to assess their perceptions of the quality of care and geriatric nursing practice environment. Results Scores on the Geriatric Institutional Assessment Profile subscales averaged slightly above the midpoint except for geriatric resources which was slightly below. Registered practical nurses rated the quality of care and geriatric nursing practice environment higher than RNs; no significant differences were found by hospital teaching status. Conclusions Nurses' perceptions of older people's care and the geriatric nursing practice environment differ by professional designation but not hospital teaching status. Teaching and nonteaching hospitals should both be targeted for geriatric nursing practice environment improvement initiatives.

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.

The Status of Teaching as a Profession in South Africa

ERIC Educational Resources Information Center

de Wet, Corene

2016-01-01

Using ten universally accepted criteria for a profession and following the Structural-Functional Model of professionalism, this study evaluates the status of teaching as a profession in South Africa. The study found that policies and structures have been put in place since the beginning of the new millennium to enhance the professional status of…

Socioeconomic status and hospitalization in the very old: a retrospective study.

PubMed

Antonelli-Incalzi, Raffaele; Ancona, Carla; Forastiere, Francesco; Belleudi, Valeria; Corsonello, Andrea; Perucci, Carlo A

2007-08-31

Socioeconomic status could affect the demand for hospital care. The aim of the present study was to assess the role of age, socioeconomic status and comorbidity on acute hospital admissions among elderly. We retrospectively examined the discharge abstracts data of acute care hospital admissions of residents in Rome aged 75 or more years in the period 1997-2000. We used the Hospital Information System of Rome, the Tax Register, and the Population Register of Rome for socio-economic data. The rate of hospitalization, modified Charlson's index of comorbidity, and level of income in the census tract of residence were obtained. Rate ratios and 95% confidence limits were computed to assess the relationship between income deciles and rate of hospitalization. Cross-tabulation was used to explore the distribution of the index of comorbidity by deciles of income. Analyses were repeated for patients grouped according to selected diseases. Age was associated with a marginal increase in the rate of hospitalization. However, the hospitalization rate was inversely related to income in both sexes. Higher income was associated with lower comorbidity. The same associations were observed in patients admitted with a principal diagnosis of chronic condition (diabetes mellitus, heart failure, chronic obstructive pulmonary disease) or stroke, but not hip fracture. Lower social status and associated comorbidity, more than age per se, are associated with a higher rate of hospitalization in very old patients.

Processes of code status transitions in hospitalized patients with advanced cancer.

PubMed

El-Jawahri, Areej; Lau-Min, Kelsey; Nipp, Ryan D; Greer, Joseph A; Traeger, Lara N; Moran, Samantha M; D'Arpino, Sara M; Hochberg, Ephraim P; Jackson, Vicki A; Cashavelly, Barbara J; Martinson, Holly S; Ryan, David P; Temel, Jennifer S

2017-12-15

Although hospitalized patients with advanced cancer have a low chance of surviving cardiopulmonary resuscitation (CPR), the processes by which they change their code status from full code to do not resuscitate (DNR) are unknown. We conducted a mixed-methods study on a prospective cohort of hospitalized patients with advanced cancer. Two physicians used a consensus-driven medical record review to characterize processes that led to code status order transitions from full code to DNR. In total, 1047 hospitalizations were reviewed among 728 patients. Admitting clinicians did not address code status in 53% of hospitalizations, resulting in code status orders of "presumed full." In total, 275 patients (26.3%) transitioned from full code to DNR, and 48.7% (134 of 275 patients) of those had an order of "presumed full" at admission; however, upon further clarification, the patients expressed that they had wished to be DNR before the hospitalization. We identified 3 additional processes leading to order transition from full code to DNR acute clinical deterioration (15.3%), discontinuation of cancer-directed therapy (17.1%), and education about the potential harms/futility of CPR (15.3%). Compared with discontinuing therapy and education, transitions because of acute clinical deterioration were associated with less patient involvement (P = .002), a shorter time to death (P < .001), and a greater likelihood of inpatient death (P = .005). One-half of code status order changes among hospitalized patients with advanced cancer were because of full code orders in patients who had a preference for DNR before hospitalization. Transitions due of acute clinical deterioration were associated with less patient engagement and a higher likelihood of inpatient death. Cancer 2017;123:4895-902. © 2017 American Cancer Society. © 2017 American Cancer Society.

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.

Helicobacter pylori status and associated gastroscopic diagnoses in a tertiary hospital endoscopy population in Rwanda

PubMed Central

Walker, Timothy D.; Karemera, Martin; Ngabonziza, Francois; Kyamanywa, Patrick

2014-01-01

Background The study was undertaken to document the prevalence of Helicobacter pylori and endoscopic diagnoses in Rwandans presenting for gastroscopy. Methods We studied an endoscopic database containing 961 consecutive gastroscopy patients at the University Teaching Hospital, Butare, over 12 months. Patient characteristics, endoscopic diagnoses and H. pylori status (by modified rapid urease testing) were analysed. Results and conclusion The overall H. pylori positivity rate was 75% (n=825), similar to that found elsewhere in sub-Saharan Africa. Common endoscopic diagnoses included duodenal ulceration (20%), duodenitis (9%), benign gastric outlet obstruction (6%) and malignancy (5%). Duodenal ulceration was strongly associated with H. pylori infection (OR 6.2 [3.1–12.6]; p<0.001). PMID:24598794

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.

[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.

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

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.

Nutritional status of children hospitalized in Tabriz Paediatric Hospital, Islamic Republic of Iran, 2008.

PubMed

Mahdavi, A M; Ostadrahimi, A; Safaiyan, A

2011-01-01

This study aimed to evaluate the nutritional status of children consecutively admitted as inpatients to Tabriz Paediatric Hospital in the north-west of the Islamic Republic of Iran between June and August 2008. A total of 140 children aged 2-12 years were included. Patients' weight, height and triceps skinfold thickness (TSFT) were measured, and nutritional status was evaluated. Evaluation of weight-for-age, height-for-age, weight-for-height and TSFT showed that 48.6%, 30.7%, 32.2% and 14.3% of the patients, respectively, were malnourished. Malnutrition among hospitalized children is worthy of attention, and effective strategies for systematic screening and treatment of malnutrition need to be developed and implemented.

Assessing hand hygiene resources and practices at a large african teaching hospital.

PubMed

Owusu-Ofori, Alex; Jennings, Rebecca; Burgess, Jennifer; Prasad, Priya A; Acheampong, Faustina; Coffin, Susan E

2010-08-01

To gather baseline data on hand hygiene (HH) practices in an African hospital with a newly established infection prevention and control team. Cross-sectional, observational study. Setting. Komfo Anokye Teaching Hospital, a large teaching hospital in Ghana with approximately 1,000 beds. All hospital staff with patient contact were eligible for assessment of HH practices. HH observations were conducted using a standardized data collection tool and method based on the World Health Organization's "5 Moments of Hand Hygiene." Small-group interviews were conducted to gather additional information on perceptions of HH and barriers to its use. HH resource needs were also assessed using a standardized tool. HH was attempted in 12% of the opportunities and was performed appropriately in 4% of the opportunities. Most main wards (89%) had at least 1 functional HH station. The most commonly identified barriers to HH were limited resources and lack of knowledge on appropriate times to perform HH. We developed and applied tools to evaluate HH resources and practices in a large African hospital. These assessments were undertaken to guide future efforts to improve HH at this hospital but can also serve as a model of the way to perform a systematic assessment at acute care hospitals in developing countries.

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…

Handgrip strength and nutrition status in hospitalized pediatric patients.

PubMed

Silva, Catarina; Amaral, Teresa F; Silva, Diana; Oliveira, Bruno M P M; Guerra, António

2014-06-01

Handgrip strength (HGS) is a useful indicator of nutrition status in adults, but evidence is lacking in pediatric patients. The aim of this study was to describe the association between undernutrition and HGS in pediatric patients at hospital admission, quantifying the modifying effect of disease severity, anthropometrics, and other patient characteristics on HGS. Eighty-nine inpatients aged ≥6 years consecutively admitted were recruited in a longitudinal study. Nutrition status was evaluated using body mass index (BMI) z scores, and HGS was evaluated at admission and discharge. In the total sample, 30.3% of patients were undernourished at admission, and 64% lost HGS during the hospital stay. This study showed that HGS at admission was independently associated with undernutrition defined by BMI z scores (β = 0.256, P = .037). In this multivariate analysis, sex, age, height, and BMI z scores explained 67.1% of HGS at hospital admission. Lower HGS may be a potential marker of undernutrition in hospitalized pediatric patients, although HGS data should be interpreted according to sex, age, and height of the patient.

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.

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…

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

Measuring charitable contributions: implications for the nonprofit hospital's tax-exempt status.

PubMed

Sanders, S M

1993-01-01

Since 1985, some nonprofit hospitals have tried to measure the magnitude of their charitable contributions in order to protect themselves from challenges to their nonprofit tax-exempt status. Using a sample of 562 Catholic nonprofit hospitals, this research shows that these charitable contributions may be defined and measured in several different ways, each having methodological advantages and disadvantages. The data indicate that charity care contributions vary widely, are unequally distributed across the sample of hospitals, and are influenced by the characteristics of the people in the local community and not by the characteristics of the health care delivery system. These findings suggest that legislators may be correct when questioning the rationale for the tax-exemption accorded to virtually all nonprofit hospitals. Further, it suggests that nonprofit hospital administrators can protect the tax-exempt status of their hospital by emphasizing the charitable contributions it makes by absorbing the unreimbursed costs from Medicare and Medicaid.

Analysis of the healthcare waste management status in Tehran hospitals.

PubMed

Malekahmadi, Fariba; Yunesian, Masud; Yaghmaeian, Kamyar; Nadafi, Kazem

2014-01-01

Considering the importance of healthcare waste management, following the ratification of the Waste Management law in 2005 and the subsequent approval of its executive bylaw in 2006 and finally the healthcare waste management criteria passing by the parliament in 2008, a review on the status of healthcare waste management is needed to implement the mentioned law properly. In this retrospective study during six months period all public hospitals in Iran's capital city, Tehran, were selected to conduct the survey. Data collected through an expert-standardized questionnaire was analyzed by using SPSS software. The results of the current status of healthcare waste management in Tehran hospitals showed 5.6% of hospitals were ranked excellent, 50.7% good, 26.4% medium, and the 13.9% of hospitals were ranked weak and 3.5% ranked very poor. The findings showed that appropriate technologies should be used to have better disposal stage. As the ratified criteria were not fully observed by all the selected hospitals, training courses and comprehensive program conducting by each hospital could be enjoyed as practical tools to implement the all stages of healthcare waste management properly.

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…

[Nutritional status and risk in hospitalized children].

PubMed

Hankard, R; Bloch, J; Martin, P; Randrianasolo, H; Bannier, M F; Machinot, S; Cézard, J P

2001-11-01

A few studies report malnutrition in hospitalized patients. This one-day cross-sectional survey performed in January 1999 assessed nutritional status and protein-energy intake in a pediatric population hospitalized in medicine or surgery units. Every child older than six months, hospitalized for more than 48 h and free of nutritional support (parenteral, enteral, or special regimens for metabolic diseases) was included. Fifty-eight children among the 183 present the day of the study met the inclusion criteria and were included in the statistical analysis. They were hospitalized in medicine (48%), psychiatry (31%) and surgery (21%). The body mass index (BMI) was below -2 standard deviations (DS) in 21% of them. Excluding patients with anorexia nervosa, BMI was < -2 SD, > +2 SD, or in between these limits in respectively 12, 14 and 74%. Energy intake measured at the hospital was below 75% of the recommended dietary allowances in two-thirds of the children whether malnourished or not. Fifty percent of the malnourished children had been referred to a dietician the day of the study. Malnutrition is frequent in a population of hospitalized children. Energy intake and referral to a dietician are insufficient.

[Intelligence, socio-economic status and hospital admissions of young adults].

PubMed

Bosma, H; Traag, T; Berger-van Sijl, M; van Eijk, J; Otten, F

2007-05-12

To determine whether socio-economic differences in hospital admissions of adolescents and young adults are related to differences in intelligence. . Retrospective cohort study. The data were derived from a group of 10,231 young adults and adolescents who were followed for a total of 47,212 person years with regard to their hospital admissions. Intelligence was measured in the first year of secondary school by 2 non-verbal intelligence tests for fluid intelligence. Data from hospital admissions were matched to a large-scale educational and occupational cohort. Data were analysed with Cox proportional hazards analysis. Intelligence was not found to be related to hospital admissions. However, a low occupational and educational level of the young adults or their parents, was strongly related to heightened risk for hospital admissions. In particular, the low socio-economic status of a respondent was associated with heightened risk for hospital admissions due to accidents (relative risk: 3.49; 95% confidence interval: 1.91-6.39). The small extent to which the socio-economic differences in hospital admissions seem to be based upon fluid intelligence, at least in adolescents and young adults, as well as the heightened risks of hospital admissions in lower socio-economic status groups and the associated high costs for health care legitimise further study of the determinants of these differences.

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.

[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.

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.

Increasing Ketamine Use for Refractory Status Epilepticus in US Pediatric Hospitals.

PubMed

Keros, Sotirios; Buraniqi, Ersida; Alex, Byron; Antonetty, Annalee; Fialho, Hugo; Hafeez, Baria; Jackson, Michele C; Jawahar, Rachel; Kjelleren, Stephanie; Stewart, Elizabeth; Morgan, Lindsey A; Wainwright, Mark S; Sogawa, Yoshimi; Patel, Anup D; Loddenkemper, Tobias; Grinspan, Zachary M

2017-06-01

Ketamine is an emerging therapy for pediatric refractory status epilepticus. The circumstances of its use, however, are understudied. The authors described pediatric refractory status epilepticus treated with ketamine from 2010 to 2014 at 45 centers using the Pediatric Hospital Inpatient System database. For comparison, they described children treated with pentobarbital. The authors estimated that 48 children received ketamine and pentobarbital for refractory status epilepticus, and 630 pentobarbital without ketamine. Those receiving only pentobarbital were median age 3 [interquartile range 0-10], and spent 30 [18-52] days in-hospital, including 17 [9-28] intensive care unit (ICU) days; 17% died. Median cost was $148 000 [81 000-241 000]. The pentobarbital-ketamine group was older (7 [2-11]) with longer hospital stays (51 [30-93]) and more ICU days (29 [20-56]); 29% died. Median cost was $298 000 [176 000-607 000]. For 71%, ketamine was given ≥1 day after pentobarbital. Ketamine cases per half-year increased from 2 to 9 ( P < .05). Ketamine is increasingly used for severe pediatric refractory status epilepticus, typically after pentobarbital. Research on its effectiveness is indicated.

A national analysis of the relationship between hospital factors and post-cardiac arrest mortality.

PubMed

Carr, Brendan G; Goyal, Munish; Band, Roger A; Gaieski, David F; Abella, Benjamin S; Merchant, Raina M; Branas, Charles C; Becker, Lance B; Neumar, Robert W

2009-03-01

We sought to generate national estimates for post-cardiac arrest mortality, to assess trends, and to identify hospital factors associated with survival. We used a national sample of US hospitals to identify patients resuscitated after cardiac arrest from 2000 to 2004 to describe the association between hospital factors (teaching status, location, size) and mortality, length of stay, and hospital charges. Analyses were performed using logistic regression. A total of 109,739 patients were identified. In-hospital mortality was 70.6%. A 2% decrease in unadjusted mortality from 71.6% in 2000 to 69.6% in 2004 (OR 0.96, P < 0.001) was observed. Mortality was lower at teaching hospitals (OR 0.58, P = 0.001), urban hospitals (OR 0.63, P = 0.004), and large hospitals (OR 0.55, P < 0.001). Mortality after in-hospital cardiac arrest decreased over 5 years. Mortality was lower at urban, teaching, and large hospitals. There are implications for dissemination of best practices or regionalization of post-cardiac arrest care.

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

Sleep disorder status of nurses in general hospitals and its influencing factors.

PubMed

Han, Yanjie; Yuan, Yingzi; Zhang, Li; Fu, Yanru

2016-06-01

This study aimed to evaluate the current sleep disorder status of nurses in general hospitals and analyze its influencing factors. A total of 2,033 nurses who have worked for 6 months in 3 general hospitals, namely, The First Affiliated Hospital of Harbin Medical University, The Second Affiliated Hospital of Harbin Medical University, and The Third Affiliated Hospital of Harbin Medical University, were selected by random sampling from April 2015 to November 2015 and investigated. The Effort-Reward Imbalance Questionnaire (ERI) and Job Content Questionnaire (JCQ) were applied to evaluate occupational stress. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep disorder status of the research subjects. Logistic regression analysis was adopted to determine the influencing factors of nurses' sleep disorders. The average PSQI score of 2,003 research subjects is 7.26±3.56, including 860 subjects with PSQI ≥8, accounting for 42.9%. The female research subjects in the department of gynecology and obstetrics, emergency department, and ICU show high risks of sleep disorders (i.e., many years of working; job title: registered nurse; many times of night shift per month; no frequent exercise; many efforts and few rewards; high decision-making autonomy). Educational background and marital status did not exhibit statistical relevance with sleep disorders. The sleep disorder status of nurses in general hospitals is closely related to occupational stress. As such, nurse managers should focus more attention to the influencing factors of nurses' sleep disorders and relieve their occupational stress to reduce the occurrence rate of sleep disorders.

Effect of Regional Hospital Competition and Hospital Financial Status on the Use of Robotic-Assisted Surgery.

PubMed

Wright, Jason D; Tergas, Ana I; Hou, June Y; Burke, William M; Chen, Ling; Hu, Jim C; Neugut, Alfred I; Ananth, Cande V; Hershman, Dawn L

2016-07-01

Despite the lack of efficacy data, robotic-assisted surgery has diffused rapidly into practice. Marketing to physicians, hospitals, and patients has been widespread, but how this marketing has contributed to the diffusion of the technology remains unknown. To examine the effect of regional hospital competition and hospital financial status on the use of robotic-assisted surgery for 5 commonly performed procedures. A cohort study of 221 637 patients who underwent radical prostatectomy, total nephrectomy, partial nephrectomy, hysterectomy, or oophorectomy at 1370 hospitals in the United States from January 1, 2010, to December 31, 2011, was conducted. The association between hospital competition, hospital financial status, and performance of robotic-assisted surgery was examined. The association between hospital competition was measured with the Herfindahl-Hirschman Index (HHI), hospital financial status was estimated as operating margin, and performance of robotic-assisted surgery was examined using multivariate mixed-effects regression models. We identified 221 637 patients who underwent one of the procedures of interest. The cohort included 30 345 patients who underwent radical prostatectomy; 20 802, total nephrectomy; 8060, partial nephrectomy; 134 985, hysterectomy; and 27 445, oophorectomy. Robotic-assisted operations were performed for 20 500 (67.6%) radical prostatectomies, 1405 (6.8%) total nephrectomies, 2759 (34.2%) partial nephrectomies, 14 047 (10.4%) hysterectomies, and 1782 (6.5%) oophorectomies. Use of robotic-assisted surgery increased for each procedure from January 2010 through December 2011. For all 5 operations, increased market competition (as measured by the HHI) was associated with increased use of robotic-assisted surgery. For prostatectomy, the risk ratios (95% CIs) for undergoing a robotic-assisted procedure were 2.20 (1.50-3.24) at hospitals in moderately competitive markets and 2.64 (1.84-3.78) for highly competitive markets

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)

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.

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

Current status of teaching on spirituality in UK medical schools.

PubMed

Neely, David; Minford, Eunice J

2008-02-01

To investigate the current status of teaching on spirituality in medicine in UK medical schools and to establish if and how medical schools are preparing future doctors to identify patients' spiritual needs. We carried out a national questionnaire survey using a 2-part questionnaire. Section A contained questions relating to the quantity of teaching on spirituality and the topics covered. Section B contained questions relating to teaching on alternative health practices. Medical educators from each of the 32 medical schools in the UK were invited to participate. A response rate of 53% (n = 17) was achieved. A total of 59% (n = 10) of respondents stated that there is teaching on spirituality in medicine in their curricula. On extrapolation, at least 31% and a maximum of 78% of UK medical schools currently provide some form of teaching on spirituality. Of the respondents that teach spirituality, 50% (n = 5) stated that their schools include compulsory teaching on spirituality in medicine, 80% (n = 8) include optional components, and 88% stated that teaching on complementary and alternative medicine is included in the curriculum. Although 59% (n = 10) of respondent medical schools (the actual UK figure lies between 31% and 78%) currently provide some form of teaching on spirituality, there is significant room for improvement. There is little uniformity between medical schools with regard to content, form, amount or type of staff member delivering the teaching. It would be beneficial to introduce a standardised curriculum on spirituality across all UK medical schools.

Reflection into China's Business English Teaching Practices Based on GDUFS Graduates' Employment Status

ERIC Educational Resources Information Center

Zhu, Wenzhong; Wu, Si; Guo, Tingting

2009-01-01

GDUFS, as one of China's top three foreign language universities with the longest history in business English teaching, has accumulated over 20-year experiences in this discipline. This research reflects into its business English teaching practices based on its graduates' employment status in recent years, and concludes that the students of…

Clinical utility of EMSE and STESS in predicting hospital mortality for status epilepticus.

PubMed

Zhang, Yu; Chen, Deng; Xu, Da; Tan, Ge; Liu, Ling

2018-05-25

To explore the applicability of the epidemiology-based mortality score in status epilepticus (EMSE) and the status epilepticus severity score (STESS) in predicting hospital mortality in patients with status epilepticus (SE) in western China. Furthermore, we sought to compare the abilities of the two scales to predict mortality from convulsive status epilepticus (CSE) and non-convulsive status epilepticus (NCSE). Patients with epilepsy (n = 253) were recruited from the West China Hospital of Sichuan University from January 2012 to January 2016. The EMSE and STESS for all patients were calculated immediately after admission. The main outcome was in-hospital death. The predicted values were analysed using SPSS 22.0 receiver operating characteristic (ROC) curves. Of the 253 patients with SE who were included in the study, 39 (15.4%) died in the hospital. Using STESS ≥4 points to predict SE mortality, the area under the ROC curve (AUC) was 0.724 (P < 0.05). Using EMSE ≥79 points, the AUC was 0.776 (P < 0.05). To predict mortality in NCSE, STESS ≥2 points was used and resulted in an AUC of 0.632 (P > 0.05), while EMSE ≥90 points gave an AUC of 0.666 (P > 0.05). The hospital mortality rate from SE in this study was 15.4%. Those with STESS ≥4 points or EMSE ≥79 points had higher rates of SE mortality. Both STESS and EMSE are less useful predicting in-hospital mortality in NCSE compared to CSE. Furthermore, the EMSE has some advantages over the STESS. Copyright © 2018 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Evaluation of Health Status of Type 2 Diabetes Outpatients Receiving Care in a Tertiary Hospital in Nigeria.

PubMed

Adibe, Maxwell Ogochukwu; Anosike, Chibueze; Nduka, Sunday Odunke; Isah, Abdulmuminu

2017-09-07

The aim of this study was to determine the health status of type 2 diabetes patients in a Nigerian tertiary hospital, and examine the sociodemographic and clinical variables that predicted the health status of type 2 diabetes patients in terms of utility valuations and EuroQol Visual Analogue Scale (EQ-VAS) score. This was a cross-sectional study of 147 diabetes patients attending the University of Nigeria Teaching Hospital, Enugu State, Nigeria. The EQ-5D-5L instrument, version 2.1, was used to evaluate patients' self-reported health status, and patients who gave informed consent completed the questionnaire while waiting to see a doctor. Descriptive and multiple linear regression analyses were performed using SPSS version 20. Overall, 147 patients participated in this study, with a mean age (± standard deviation) of 56.7 years (± 10.33). Over half of the respondents were females (55.1%) and more than half were older than 60 years of age. The mean EQ-VAS and utility valuations of respondents were 72.59 ± 10.51 and 0.72 ± 0.13, respectively. The age of respondents independently and significantly predicted EQ-VAS by -2.659 per year, while the age of respondents, level of education, duration of diabetes, and presence of other illnesses independently and significantly predicted utility valuations by -0.020 per year, +0.029 per level of education, -0.008 per year, and -0.044 per illness, respectively. Less than 39% of patients experienced no problems for each of the dimensions, except self-care (68%). The results of this study revealed a relatively low health status among type 2 diabetic patients in Nigeria. Old age, duration of diabetes and the presence of other illnesses were major contributors to the negative impact on health status, while a higher level of education contributed positively to health status. Adequate family support, as well as regular and effective patient counseling and education, may be worthwhile.

The structural configuration of U.S. hospital medical staffs.

PubMed

Shortell, S M; Evashwick, C

1981-04-01

Using data from the 1973 American Hospital Association national survey of hospital medical staff organization, six factors of medical staff organization structure are examined in relation to each other and to hospital ownership, size, teaching status, geographic region and size of Standard Metropolitan Statistical Area (SMSA). The six factors include 1) Resource Capability; 2) Generalist Physician Contractual Orientation; 3) Communication and Control; 4) Local Staff Orientation; 5) Physician Participation in Decision Making; and 6) Hospital-Based Contractual Orientation. Several relatively distinct patterns emerged related to hospital ownership, size, teaching activity and region of the country, as well as interrelationships among the factors themselves. Differences between smaller and larger hospitals clearly emerged as well as a distinctive pattern for for-profit hospitals. All of the factors are subject to manipulation through administrative and/or public policy interventions and the findings suggest dimensions for future investigation of important policy issues related to the medical staff's role in cost containment, utilization, quality assurance and technology adoption.

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.

The impact of hospital volume, residency, and fellowship training on perioperative outcomes after radical prostatectomy.

PubMed

Trinh, Quoc-Dien; Sun, Maxine; Kim, Simon P; Sammon, Jesse; Kowalczyk, Keith J; Friedman, Ariella A; Sukumar, Shyam; Ravi, Praful; Muhletaler, Fred; Agarwal, Piyush K; Shariat, Shahrokh F; Hu, Jim C; Menon, Mani; Karakiewicz, Pierre I

2014-01-01

Although high-volume hospitals have been associated with improved outcomes for radical prostatectomy (RP), the association of residency or fellowship teaching institutions or both and this volume-outcome relationship remains poorly described. We examine the effect of teaching status and hospital volume on perioperative RP outcomes. Within the Nationwide Inpatient Sample, we focused on RPs performed between 2003 and 2007. We tested the rates of prolonged length of stay beyond the median of 3 days, in-hospital mortality, and intraoperative and postoperative complications, stratified according to teaching status. Multivariable logistic regression analyses further adjusted for confounding factors. Overall, 47,100 eligible RPs were identified. Of these, 19,193 cases were performed at non-teaching institutions, 24,006 at residency teaching institutions, and 3,901 at fellowship teaching institutions. Relative to patients treated at non-teaching institutions, patients treated at fellowship teaching institutions were healthier and more likely to hold private insurance. In multivariable analyses, patients treated at residency (OR = 0.92, P = 0.015) and fellowship (OR = 0.82, P = 0.011) teaching institutions were less likely to experience a postoperative complication than patients treated at non-teaching institutions. Patients treated at residency (OR = 0.73, P<0.001) and fellowship (OR = 0.91, P = 0.045) teaching institutions were less likely to experience a prolonged length of stay. More favorable postoperative complication profile and shorter length of stay should be expected at residency and fellowship teaching institutions following RP. Moreover, postoperative complication rates were lower at fellowship teaching than at residency teaching institutions, despite adjustment for potential confounders. Copyright © 2014 Elsevier Inc. All rights reserved.

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.

The mental health of nurses in acute teaching hospital settings: a cross-sectional survey.

PubMed

Perry, Lin; Lamont, Scott; Brunero, Scott; Gallagher, Robyn; Duffield, Christine

2015-01-01

Nursing is an emotionally demanding profession and deficiencies in nurses' mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses' health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals. A cross sectional survey design was used. The Registered and Enrolled Nurse workforce, employed on any form of contract, at two teaching hospitals in Sydney Australia were invited to participate. The survey tool was compiled of validated tools and questions. Family and medical history and health risk-related characteristics, current psycho-active medications, smoking status, alcohol intake, eating disorders, self-perceived general health, mental health and vitality, demographic, social and occupational details were collected. A total of 1215 surveys were distributed with a usable response rate of 382 (31.4%). Altogether 53 nurses (14%) reported a history of mental health disorders, of which n = 49 (13%) listed diagnoses of anxiety and/or depression; 22 (6%) were currently taking psychoactive medication. Symptoms that could potentially indicate a mental health issue were more common, with 248 (65.1%) reporting they had experienced symptoms sometimes or often in the last 12 month. Nurses had better mental health if they had better general health, lived with a spouse/ partner rather than alone, had fewer symptoms, sleep problems or disordered eating behaviours, were not an informal carer and did not work nights. Nurses had greater vitality if they were male, had better general health, fewer sleep problems or symptoms generally and lived with a spouse/ partner rather than alone; less vitality if they were an informal carer or had disordered eating. Nurses and their managers should strive to create workplaces where working practices promote nurses' health

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.

Distinguishing in-hospital and out-of-hospital status epilepticus: clinical implications from a 10-year cohort study.

PubMed

Sutter, R; Semmlack, S; Spiegel, R; Tisljar, K; Rüegg, S; Marsch, S

2017-09-01

The aim was to determine differences of clinical, treatment and outcome characteristics between patients with in-hospital and out-of-hospital status epilepticus (SE). From 2005 to 2014, clinical data were assessed in adults with SE treated in an academic medical care centre. Clinical characteristics, treatment and outcomes were compared between patients with in-hospital and out-of-hospital SE. Amongst 352 patients, 213 were admitted with SE and 139 developed in-hospital SE. Patients with in-hospital SE had more acute/fatal aetiologies (60% vs. 35%, P < 0.001), fewer previous seizures (33% vs. 50%, P = 0.002), a higher median Charlson Comorbidity Index (3 vs. 2, P < 0.001), longer median SE duration (1 vs. 0.5 days, P = 0.001), more refractory SE (52% vs. 39%, P = 0.022), less return to functional baseline (38% vs. 54%, P = 0.006) and increased mortality (29% vs. 19%, P = 0.001). Whilst in multivariable analyses an increasing Status Epilepticus Severity Score (STESS) was an independent predictor for death in both groups, increased Charlson Comorbidity Index and treatment refractory SE were associated with death only in patients with in-hospital SE. Continuous anaesthesia for refractory SE was associated with increased mortality only in patients with out-of-hospital SE. The area under the receiver operating curve was 0.717 for prediction of death by STESS in patients with in-hospital SE and 0.811 in patients with out-of-hospital SE. Patients with in-hospital SE had more fatal aetiologies and comorbidities, refractory SE, less return to functional baseline, and increased mortality compared to patients with out-of-hospital SE. Whilst the STESS was a robust predictor for death in both groups, the association between continuous anaesthesia and death was limited to out-of-hospital SE. © 2017 EAN.

Bilingual teaching in nursing education in China: evolution, status, and future directions.

PubMed

He, Wei; Xu, Yu; Zhu, Jianhua

2011-09-01

Based on Chinese published literature and personal observations, this article reviews the history of bilingual teaching in nursing education in China, describes its current status and challenges, and predicts its future directions. Bilingual teaching in nursing education enjoys increasing popularity in China. The major factors that affect bilingual teaching are bilingual educators, students' English-language levels, bilingual teaching materials, and teaching models. Based on surveys of nursing schools, the English-language proficiency of the nursing educators varies greatly. The main issues with the teaching methods lie in over-translation, cramming, and limited interaction between the students and the teachers. Despite relatively inadequate English-language proficiency among Chinese nursing students, their interest can be strengthened greatly if international exchanges are available and promoted. Bilingual textbooks are more suitable in China's national context because of pricing and relevance. Although immersive bilingual teaching is the ideal, it is more feasible to begin with infiltrative bilingual teaching and move progressively towards increased English-language penetration. Future directions for improving bilingual teaching include training teaching faculty members, strengthening international exchanges, providing better bilingual study atmospheres, and gradually implementing bilingual textbooks. © 2011 Blackwell Publishing Asia Pty Ltd.

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.

Survey of Cancer Patient Safety Culture: A Comparison of Chemotherapy and Oncology Departments of Teaching Hospitals of Tehran

PubMed Central

Raeissi, Pouran; Sharifi, Marziye; Khosravizadeh, Omid; Heidari, Mohammad

2017-01-01

Background: Patient safety culture plays an important role in healthcare systems, especially in chemotherapy and oncology departments (CODs), and its assessment can help to improve quality of services and hospital care. Objective: This study aimed to evaluate and compare items and dimensions of patient safety culture in the CODs of selected teaching hospitals of Iran and Tehran University of Medical Sciences. Materials and Methods: This descriptive-analytical cross-sectional survey was conducted during a six-month period on 270 people from chemotherapy and oncology departments selected through a cluster sampling method. All participants answered the standard questionnaire for “Hospital Survey of Patient Safety Culture” (HSOPSC). Statistical analyses were performed using SPSS/18 software. Results: The average score for patient safety culture was three for the majority of the studied CODs. Statistically significant differences were observed for supervisor actions, teamwork within various units, feedback and communications about errors, and the level of hospital management support. (p<0.05). Relationships between studied hospitals and patient safety culture were not statistically significant (p>0.05). Conclusion: Our results showed that the overall status of patient safety culture is not good in the studied CODs. In particular, teamwork across different units and organizational learning with continuous improvement were the only two properly operating items among 12 dimensions of patient safety culture. Therefore, systematic interventions are strongly required to promote communication. PMID:29072411

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.

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.

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.

Achievement of guideline-concordant care and in-hospital outcomes in patients with coronary artery disease in teaching and nonteaching hospitals: results from the Get With The Guidelines-Coronary Artery Disease program.

PubMed

Tam, Lori M; Fonarow, Gregg C; Bhatt, Deepak L; Grau-Sepulveda, Maria V; Hernandez, Adrian F; Peterson, Eric D; Schwamm, Lee H; Giugliano, Robert P

2013-01-01

Secondary prevention therapies improve longitudinal outcomes in patients with coronary artery disease. Previous studies showed that teaching hospitals (THs) more consistently use evidence-based secondary prevention therapies than non-THs (NTHs). It is unclear whether these differences persist after initiation of a national quality improvement system. We analyzed 270902 patients across 361 hospitals in the Get With The Guidelines-Coronary Artery Disease program from June 2000 to September 2009. The primary outcome was guideline-concordant care, defined as compliance with all Get With The Guidelines-Coronary Artery Disease quality measures: (1) aspirin within 24 hours, (2) aspirin at discharge, (3) angiotensin-converting enzyme inhibitor/angiotensin receptor blockers for systolic dysfunction, (4) β-blockers at discharge, (5) lipid therapy if low-density lipoprotein >100 mg/dL, and (6) smoking cessation. We used multivariate modeling to compare the relationship between TH and NTH status on quality measures, in-hospital mortality, and length of stay. Guideline-concordant care was higher at THs (78.4% versus 73.3%; P<0.01). The adjusted odds ratio between 2000 and 2009 for guideline-concordant care at THs compared with NTHs was 2.78 (confidence interval, 1.28-6.06; P=0.01). Guideline-concordant care increased from 2000 to 2009 at THs (n=176; 65.3%→88.3%; adjusted odds ratio for year increase, 1.24 [confidence interval, 1.16-1.30; P<0.01]) and NTHs (n=185; 61.0%→93.9%; adjusted odds ratio for year increase, 1.35 [confidence interval, 1.26-1.45]; P<0.01). THs had shorter length of stay (adjusted odds ratio, 0.74 for length of stay >4 days; confidence interval, 0.58-0.94) from 2000 to 2009. Lower in-hospital mortality was observed at THs (3.7% versus 4.4% at NTHs; P<0.01), but this was not significant after adjustment. Adherence to guideline-recommended therapies increased over time with participation in the Get With The Guidelines-Coronary Artery Disease program

Mobbing in Schools and Hospitals in Uruguay: Prevalence and Relation to Loss of Status.

PubMed

Buunk, Abraham P; Franco, Silvia; Dijkstra, Pieternel; Zurriaga, Rosario

2016-01-19

In the present study in secondary schools and hospitals in Uruguay (N = 187), we examined the relationship between feeling the victim of mobbing and a perceived loss of status. Nearly all forms of mobbing were more prevalent among hospital employees than among school employees. Among hospital employees, 40.4%, and among school employees, 23.9% reported being the victim of mobbing at least once a week. Being the victim of mobbing was, in both hospitals and schools, more prevalent among older employees, and in hospitals, among employees who were more highly educated and who had been employed for a longer time. Men and women did not differ in reporting that one was a victim of mobbing, but men reported more perceived loss of status than women. However, among women, being the victim of mobbing was much more strongly related to experiencing a loss of status than among men. Several explanations for this gender difference and the practical and theoretical implications of the results are discussed. © The Author(s) 2016.

[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…

Anesthesia Capacity in Ghana: A Teaching Hospital's Resources, and the National Workforce and Education.

PubMed

Brouillette, Mark A; Aidoo, Alfred J; Hondras, Maria A; Boateng, Nana A; Antwi-Kusi, Akwasi; Addison, William; Hermanson, Alec R

2017-12-01

Quality anesthetic care is lacking in low- and middle-income countries (LMICs). Global health leaders call for perioperative capacity reports in limited-resource settings to guide improved health care initiatives. We describe a teaching hospital's resources and the national workforce and education in this LMIC capacity report. A prospective observational study was conducted at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, during 4 weeks in August 2016. Teaching hospital data were generated from observations of hospital facilities and patient care, review of archival records, and interviews with KATH personnel. National data were obtained from interviews with KATH personnel, correspondence with Ghana's anesthesia society, and review of public records. The practice of anesthesia at KATH incorporated preanesthesia clinics, intraoperative management, and critical care. However, there were not enough physicians to consistently supervise care, especially in postanesthesia care units (PACUs) and the critical care unit (CCU). Clean water and electricity were usually reliable in all 16 operating rooms (ORs) and throughout the hospital. Equipment and drugs were inventoried in detail. While much basic infrastructure, equipment, and medications were present in ORs, patient safety was hindered by hospital-wide oxygen supply failures and shortage of vital signs monitors and working ventilators in PACUs and the CCU. In 2015, there were 10,319 anesthetics administered, with obstetric and gynecologic, general, and orthopedic procedures comprising 62% of surgeries. From 2011 to 2015, all-cause perioperative mortality rate in ORs and PACUs was 0.65% or 1 death per 154 anesthetics, with 99% of deaths occurring in PACUs. Workforce and education data at KATH revealed 10 anesthesia attending physicians, 61 nurse anesthetists (NAs), and 7 anesthesia resident physicians in training. At the national level, 70 anesthesia attending physicians and 565 NAs cared for Ghana's population

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

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.

Impact of Nutritional Status and Sleep Quality on Hospital Utilisation in the Oldest Old with Heart Failure.

PubMed

Selan, S; Hellström, A; Fagerström, C

2016-02-01

To describe three-year trends in nutritional status and sleep quality and their impact on hospital utilisation in the oldest old (80 +) with heart failure (HF). Single-centred longitudinal observational study. South-eastern Sweden. 90 elderly (80+) with objectively verified HF. Baseline data from the Mini Nutritional Assessment (MNA) and on sleep quality were collected through structured interviews following the HF diagnosis (n=90) and at a three-year follow-up (n=41). Data on hospital utilisation during the three years following the HF diagnosis were also collected. Nineteen percent of the participants were found to have impaired nutritional status, a condition that increased hospital utilisation by four bed days per year. A majority (85%) had impaired sleep quality, but no impact on hospital utilisation was found. Nutritional status and sleep quality were stable over the three-year period. In the oldest old with HF, impaired nutritional status and impaired sleep quality are already common at HF diagnosis. Impaired nutritional status increases hospital utilisation significantly. Therefore, it is of supreme importance to systematically evaluate nutritional status and sleep quality in the oldest old when they are diagnosed with HF, as well as to take action if impairments are present.

The effect of hospital organizational characteristics on postoperative complications.

PubMed

Knight, Margaret

2013-12-01

To determine if there is a relationship between the risk of postoperative complications and the nonclinical hospital characteristics of bed size, ownership structure, relative urbanicity, regional location, teaching status, and area income status. This study involved a secondary analysis of 2006 administrative hospital data from a number of U.S. states. This data, gathered annually by the Agency for Healthcare Research and Quality (AHRQ) via the National Inpatient Sample (NIS) Healthcare Utilization Project (HCUP), was analyzed using probit regressions to measure the effects of several nonclinical hospital categories on seven diagnostic groupings. The study model included postoperative complications as well as additional potentially confounding variables. The results showed mixed outcomes for each of the hospital characteristic groupings. Subdividing these groupings to correspond with the HCUP data analysis allowed a greater understanding of how hospital characteristics' may affect postoperative outcomes. Nonclinical hospital characteristics do affect the various postoperative complications, but they do so inconsistently.

Service mix in the hospital outpatient department: implications for Medicare payment reform.

PubMed Central

Miller, M E; Sulvetta, M B; Englert, E

1995-01-01

OBJECTIVE. To determine if implementation of a PPS for Medicare hospital outpatient department (HOPD) services will have distributional consequences across hospital types and regions, this analysis assesses variation in service mix and the provision of high-technology services in the HOPD. DATA. HCFA's 1990 claims file for a 5 percent random sample of Medicare beneficiaries using the HOPD was merged, by hospital provider number, with various HCFA hospital characteristic files. STUDY DESIGN. Hospital characteristics examined are urban/rural location, teaching status, disproportionate-share status, and bed size. Two analyses of HOPD services are presented: mix of services provided and the provision of high-technology services. The mix of services is measured by the percentage of services in each of 14 type-of-service categories (e.g., medical visits, advanced imaging services, diagnostic testing services). Technology provision is measured by the percentage of hospitals providing selected high-technology services. FINDINGS/CONCLUSIONS. The findings suggest that the role hospital types play in providing HOPD services warrants consideration in establishing a PPS. HOPDs in major teaching hospitals and hospitals serving a disproportionate share of the poor play an important role in providing routine visits. HOPDs in both major and minor teaching hospitals are important providers of high-technology services. Other findings have implications for the structure of an HOPD PPS as well. First, over half of the services provided in the HOPD are laboratory tests and HOPDs may have limited control over these services since they are often for patients referred from local physician offices. Second, service mix and technology provision vary markedly among regions, suggesting the need for a transition to prospective payment. Third, the organization of service supply in a region may affect service provision in the HOPD suggesting that an HOPD PPS needs to be coordinated with payment

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.

Determining the status quo of infection prevention and control standards in the hospitals of iran: a case study in 23 hospitals.

PubMed

Shojaee, Jalil; Moosazadeh, Mahmood

2014-02-01

Applying Prevention and Control of Infection (PCI) standards in hospitals reduces probable risks to patients, staff and visitors; it also increases efficiency, and ultimately improves productivity of hospitals. The current study aimed to determine the status quo of international standards of PCI in hospitals located in the north of Iran. This cross-sectional study was conducted in 23 hospitals. Data collection tool was a questionnaire with confirmed validity and reliability. . In this regard, 260 managers, section supervisors and infection control nurses participated in the study according to census basis. SPSS software version 16 was employed to analyze the data through descriptive and analytical statistics. Among the studied hospitals, 18 hospitals were public. Hospitals enjoyed 77.2% of leadership and programming, 80.8% of focus of programs, 67.4% of isolating methods, 88.2% of hand health and protection techniques, 78.8% of improving patient's safety and quality, 90.3% of training personnel, and 78.7% of the average status quo of PCI standards. This study revealed that PCI standards were significantly observed in the studied hospitals and that there were necessary conditions for full deployment of nosocomial infection surveillance.

Vitamin D Status in Hospitalized Chronically Ill Patients.

PubMed

Botros, Raef Malak; AbdElsalam Besibes, Mona Mohamed; Bahaaeldin, Ahmed Mohamed; Abo Elyazed, Sherihan

2018-04-13

Vitamin D deficiency is rarely considered or treated in critically ill patients. Deficiency of 25-hydroxy vitamin D [25(OH)D] prior to hospital admission might be a significant predictor of short- and long-term all cause patient mortality in a critically ill patient. The aim of this work is to investigate the prevalence of vitamin D deficiency in hospitalized patients and its relation to the length of stay and outcome of hospitalization. Prospective cohort study performed on 80 patients admitted with acute deterioration of their chronic illness. Four groups of diseases were included, namely, chronic liver diseases (CLD), chronic obstructive pulmonary diseases (COPD), cerebrovascular stroke (CVS), and heart failure (HF). The patients were followed up until their discharge, or transfer, or death. Patients were sampled for their vitamin D level on admission and were divided according to their vitamin D status into sufficient, insufficient, and deficient. Statistical methods and analysis of the present study were conducted using the SPSS V17 program. Vitamin D level had a significant inverse correlation with length of hospital stay (r = -0.648) (p < 0.001). In vitamin D-deficient and -insufficient groups, there was a significant difference between survivors and nonsurvivors as regards vitamin D levels and an inverse correlation between vitamin D level and outcome of hospital admission. Vitamin D deficiency and insufficiency are significantly associated with a longer hospital stay and a poor outcome of hospital admission in comparison to control.

Factors affecting the informal payments in public and teaching hospitals.

PubMed

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

2016-01-01

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

Human immuno-deficiency virus antibody seroprevalence among pregnant women at booking at a university teaching hospital in South-Eastern Nigeria.

PubMed

Okeudo, C; Ezem, B U; Ojiyi, E C

2012-01-01

In Africa, human immuno-deficiency virus (HIV) infection continues to be progressively feminized. This has led to an increase in the number of paediatric HIV infections reported due to increased risk of mother-to-child transmission (MTCT) of HIV during pregnancy, labour and breastfeeding. The objective of the study was to determine the HIV positive sero-prevalence at booking among pregnant women at the Imo State University Teaching Hospital, Orlu. A retrospective analysis of the case records of women who booked and were screened for Human Immune-deficiency Virus at the Imo State University Teaching Hospital (IMSUTH), Orlu from 1st March 2008 to 28th February 2010 was done. Data on age, parity, educational status, gestational age at booking, and retroviral status were collected and analysed using spss version 13. Nine hundred and twenty one pregnant women were screened for the presence of HIV 1 & 2 antibodies in their serum. One hundred and six of them were positive, giving a sero-prevalence rate at booking of 11.5%. The highest sero prevalence rate of 45.2% occurred in the age group of 26-30 years. Petty traders contributed 97 (91.5%) of the HIV positive women, while multiparous (para 2-4) women contributed 50% of the positive pregnant women. Only 32 (30.2%) of the HIV positive women booked within the first trimester for antenatal care. Majority 53 (59.4%) of the HIV positive women had secondary education, while those that had no formal education contributed only 6 (5.7%) of the HIV positive women. There was a high HIV seroprevalence at booking among pregnant women at IMSUTH, Orlu. A lot more needs to be done in order to reduce vertical transmission of HIV in our environment.

Hospice Agencies’ Hospital Contract Status and Differing Levels of Hospice Care

PubMed Central

Chung, Kyusuk; Richards, Nicole; Burke, Sloane C.

2014-01-01

In response to a 2011 finding that approximately 27% of Medicare-certified hospices do not provide a single day of general inpatient (GIP) level of care, the authors explored the extent to which hospices have contracts with hospitals for GIP. Using the 2007 National Home and Hospice Care Survey (NHHCS), we estimated that 1,119 agencies (32%) had no contract with any hospitals in 2007 and half of those with no contract did not have a contract with a skilled nursing facility (SNF) either. As a result, these hospices were unable to provide GIP patient referrals for those in need of inpatient care for acute pain and symptom management. More importantly, not having a contract with a hospital was just one of the factors influencing GIP provision. In the multivariate logistic model, after controlling for contract status with a hospital and other hospice characteristics, agencies in the second quartile of hospice patient census (12 to 29 vs. 73 or more, Adjusted OR=14.10; 95% CI: 4.26–46.62) were independently related to providing only routine home care. These hospices are more likely to rely solely on scatter beds for GIP provision. Given that a significant portion of hospices do not have a contract with a hospital, policy makers need to understand barriers to contracts with a hospital/SNF for GIP and consider a hospice’s contract status as one of the standards for hospice certification. In addition, further research is necessary to understand why hospices that do have a contract with a hospital do not make GIP referral. PMID:24576832

Hospice agencies' hospital contract status and differing levels of hospice care.

PubMed

Chung, Kyusuk; Richards, Nicole; Burke, Sloane

2015-05-01

In response to a 2011 finding that approximately 27% of Medicare-certified hospices do not provide a single day of general inpatient care (GIP), the authors explored the extent to which hospices have contracts with hospitals for GIP. Using the 2007 National Home and Hospice Care Survey, we estimated that 1119 (32%) agencies had no contract with any hospitals in 2007 and half of those with no contract did not have a contract with a skilled nursing facility (SNF) either. As a result, these hospices were unable to provide GIP referrals for those in need of inpatient care for acute pain and symptom management. More importantly, not having a contract with a hospital was just one of the factors influencing GIP provision. In the multivariate logistic model, after controlling for contract status with a hospital and other hospice characteristics, agencies in the second quartile of hospice patient census (12-29 vs 73 or more, adjusted odds ratio = 14.10; 95% confidence interval 4.26-46.62) were independently related to providing only routine home care. These hospices are more likely to rely solely on scatter beds for GIP provision. Given that a significant portion of hospices do not have a contract with a hospital, policy makers need to understand barriers to contracts with a hospital/SNF for GIP and consider a hospice's contract status as one of the standards for hospice certification. In addition, further research is necessary to understand why hospices that do have a contract with a hospital do not make GIP referral. © The Author(s) 2014.

Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Hospital Readmission Rates Following Hip and Knee Arthroplasty.

PubMed

Martsolf, Grant R; Barrett, Marguerite L; Weiss, Audrey J; Kandrack, Ryan; Washington, Raynard; Steiner, Claudia A; Mehrotra, Ateev; SooHoo, Nelson F; Coffey, Rosanna

2016-08-17

Readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly used to measure hospital performance. Readmission rates that are not adjusted for race/ethnicity and socioeconomic status, patient risk factors beyond a hospital's control, may not accurately reflect a hospital's performance. In this study, we examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following THA and TKA. We calculated 2 sets of risk-adjusted readmission rates by (1) using the Centers for Medicare & Medicaid Services standard risk-adjustment algorithm that incorporates patient age, sex, comorbidities, and hospital effects and (2) adding race/ethnicity and socioeconomic status to the model. Using data from the Healthcare Cost and Utilization Project, 2011 State Inpatient Databases, we compared the relative performances of 1,194 hospitals across the 2 methods. Addition of race/ethnicity and socioeconomic status to the risk-adjustment algorithm resulted in (1) little or no change in the risk-adjusted readmission rates at nearly all hospitals; (2) no change in the designation of the readmission rate as better, worse, or not different from the population mean at >99% of the hospitals; and (3) no change in the excess readmission ratio at >97% of the hospitals. Inclusion of race/ethnicity and socioeconomic status in the risk-adjustment algorithm led to a relative-performance change in readmission rates following THA and TKA at <3% of the hospitals. We believe that policymakers and payers should consider this result when deciding whether to include race/ethnicity and socioeconomic status in risk-adjusted THA and TKA readmission rates used for hospital accountability, payment, and public reporting. Prognostic Level III. See instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery

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...

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.

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

Tetanus remains a formidable health challenge in Nigeria: The experience from a single Teaching Hospital in Osun State, Nigeria.

PubMed

Mustapha, A F; Eegunranti, B A; Fawale, Mb B

2015-01-01

Tetanus, though an eminently preventable disease still ranks as a leading cause of death in Nigeria as well as in other developing countries. Reported mortality for severe tetanus varies from 20-60% and depends on the availability and quality of intensive care. Farmers and artisans are mostly affected. This retrospective study was carried out to determine the pattern of clinical presentation of tetanus, the immunization status, case fatality rate and factors influencing mortality. Case notes of patients (age > 10 and above) managed for tetanus from 2004-2008 at LAUTECH Teaching Hospital Osogbo were retrieved. Demographic, clinical data, laboratory investigation results and response to treatment were collated. The data obtained were analysed using the SPSS version 15 Statistical package. Over the 5-year period,80 cases of tetanus were managed in the medical wards of LAUTECH Hospital Teaching Osogbo. However, the medical records of 12 of them could not be retrieved, leaving 68(85%) for analysis. This comprised of 45 males and 23 females. Tetanus was highest in the third decade of life. The commonest portal of entry was the lower limb (n = 43). Only one subject was fully vaccinated and received booster dose of vaccine. Thirty-one (31)out of the 68 patients died giving a case fatality rate of 51.5%. The mortality of tetanus is still very high from this retrospective study. The rate of immunization against tetanus was dismally low. Active immunization should be given to all Nigerians particularly those in the vulnerable group.

[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

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.

Current status of nutritional support for hospitalized children: a nationwide hospital-based survey in South Korea.

PubMed

Kim, Seung; Lee, Eun Hye; Yang, Hye Ran

2018-06-01

The prevalence of malnutrition among hospitalized children ranges between 12% and 24%. Although the consequences of hospital malnutrition are enormous, it is often unrecognized and untreated. The aim of this study was to identify the current status of in-hospital nutrition support for children in South Korea by carrying out a nationwide hospital-based survey. Out of 345 general and tertiary hospitals in South Korea, a total of 53 institutes with pediatric gastroenterologists and more than 10 pediatric inpatients were selected. A questionnaire was developed by the nutrition committee of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition. The questionnaires were sent to pediatric gastroenterologists in each hospital. Survey was performed by e-mails. Forty hospitals (75.5%) responded to the survey; 23 of them were tertiary hospitals, and 17 of them were general hospitals. Only 21 hospitals (52.5%) had all the required nutritional support personnel (including pediatrician, nutritionist, pharmacist, and nurse) assigned to pediatric patients. Routine nutritional screening was performed in 22 (55.0%) hospitals on admission, which was lower than that in adult patients (65.8%). Nutritional screening tools varied among hospitals; 33 of 40 (82.5%) hospitals used their own screening tools. The most frequently used nutritional assessment parameters were weight, height, hemoglobin, and serum albumin levels. In our nationwide hospital-based survey, the most frequently reported main barriers of nutritional support in hospitals were lack of manpower and excessive workload, followed by insufficient knowledge and experience. Although this nationwide hospital-based survey targeted general and tertiary hospitals with pediatric gastroenterologists, manpower and medical resources for nutritional support were still insufficient for hospitalized children, and nutritional screening was not routinely performed in many hospitals. More attention to hospital malnutrition

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.

THE IMPACT OF MEASURES OF SOCIOECONOMIC STATUS ON HOSPITAL PROFILING IN NEW YORK CITY

PubMed Central

Blum, Alexander B.; Egorova, Natalia N.; Sosunov, Eugene A.; Gelijns, Annetine C.; DuPree, Erin; Moskowitz, Alan J.; Federman, Alex D.; Ascheim, Deborah D.; Keyhani, Salomeh

2014-01-01

Background Current 30-day readmission models used by the Center for Medicare and Medicaid Services for the purpose of hospital-level comparisons lack measures of socioeconomic status (SES). We examined whether the inclusion of a SES measure in 30-day congestive heart failure (CHF) readmission models changed hospital risk standardized readmission rates (RSRR) in New York City (NYC) hospitals. Methods and Results Using a Centers for Medicare & Medicaid Services (CMS)-like model we estimated 30-day hospital-level RSRR by adjusting for age, gender and comorbid conditions. Next, we examined how hospital RSRRs changed relative to the New York City mean with inclusion of the Agency for Healthcare Research and Quality (AHRQ) validated SES index score. In a secondary analysis, we examined whether inclusion of the AHRQ SES Index score in 30-day readmission models disproportionately impacted the RSRR of minority-serving hospitals. Higher AHRQ SES scores, indicators of higher socioeconomic status, were associated with lower odds, 0.99, of 30-day readmission (p< 0.019). The addition of the AHRQ SES index did not change the model’s C statistic (0.63). After adjustment for the AHRQ SES index, one hospital changed status from “worse than the NYC average” to “no different than the NYC average”. After adjustment for the AHRQ SES index, one NYC minority-serving hospital was re-classified from “worse” to “no different than average”. Conclusions While patients with higher SES were less likely to be admitted, the impact of SES on readmission was very small. In NYC, inclusion of the AHRQ SES score in a CMS based model did not impact hospital-level profiling based on 30-day readmission. PMID:24823956

Gaps in patient care practices to prevent hospital-acquired delirium.

PubMed

Alagiakrishnan, Kannayiram; Marrie, Thomas; Rolfson, Darryl; Coke, William; Camicioli, Richard; Duggan, D'Arcy; Launhardt, Bonnie; Fisher, Bruce; Gordon, Debbie; Hervas-Malo, Marilou; Magee, Bernice; Wiens, Cheryl

2009-10-01

To evaluate the current patient care practices that address the predisposing and precipitating factors contributing to the prevention of hospital-acquired delirium in the elderly. Prospective cohort (observational) study. Patients 65 years of age and older who were admitted to medical teaching units at the University of Alberta Hospital in Edmonton over a period of 7 months and who were at risk of delirium. Medical teaching units at the University of Alberta. Demographic data and information on predisposing factors for hospital-acquired delirium were obtained for all patients. Documented clinical practices that likely prevent common precipitants of delirium were also recorded. Of the 132 patients enrolled, 20 (15.2%) developed hospital-acquired delirium. At the time of admission several predisposing factors were not documented (eg, possible cognitive impairment 16 [12%], visual impairment 52 [39.4%], and functional status of activities of daily living 99 [75.0%]). Recorded precipitating factors included catheter use, screening for dehydration, and medications. Catheters were used in 35 (26.5%) patients, and fluid intake-and-output charting assessed dehydration in 57 (43.2%) patients. At the time of admission there was no documentation of hearing status in 69 (52.3%) patients and aspiration risk in 104 (78.8%) patients. After admission, reorientation measures were documented in only 16 (12.1%) patients. Although all patients had brief mental status evaluations performed once daily, this was not noted to occur twice daily (which would provide important information about fluctuation of mental status) and there was no formal attention span testing. In this study, hospital-acquired delirium was also associated with increased mortality (P < .004), increased length of stay (P < .007), and increased institutionalization (P < .027). Gaps were noted in patient care practices that might contribute to hospital-acquired delirium and also in measures to identify the development

The diffusion of Magnet hospital recognition.

PubMed

Abraham, Jean; Jerome-D'Emilia, Bonnie; Begun, James W

2011-01-01

Magnet recognition is promoted by many in the practice community as the gold standard of nursing care quality. The Magnet hospital population has exploded in recent years, with about 8% of U.S. general hospitals now recognized. The purpose of this study was to identify the characteristics that distinguish Magnet-recognized hospitals from other hospitals within the framework of diffusion theory. We conceptualize Magnet recognition as an organizational innovation and Magnet-recognized hospitals as adopters of the innovation. We hypothesize that adoption is associated with selected characteristics of hospitals and their markets. The study population consists of the 3,657 general hospitals in the United States in 2008 located in metropolitan or micropolitan areas. We used logistic regression analysis to estimate the association of Magnet recognition with organizational and market characteristics. Empirical results support hypotheses that adoption is positively associated with hospital complexity and specialization, as measured by teaching affiliation, and with hospital size, slack resources, and not-for-profit or public ownership (vs. for-profit). Adopters also are more likely to be located in markets that are experiencing population growth and are more likely to have competitor hospitals within the market that also have adopted Magnet status. A positive association of adoption with baccalaureate nursing school supply is contrary to the hypothesized relationship. Because of its rapid recent growth, consideration of Magnet program recognition should be on the strategic planning agenda of hospitals and hospital systems. Hospital administrators, particularly in smaller, for-profit hospitals, may expect more of their larger not-for-profit competitors, particularly teaching hospitals, to adopt Magnet recognition, increasing competition for baccalaureate-prepared registered nurses in the labor market.

Physical activity, health status and risk of hospitalization in patients with severe chronic obstructive pulmonary disease.

PubMed

Benzo, Roberto P; Chang, Chung-Chou H; Farrell, Max H; Kaplan, Robert; Ries, Andrew; Martinez, Fernando J; Wise, Robert; Make, Barry; Sciurba, Frank

2010-01-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of death and 70% of the cost of COPD is due to hospitalizations. Self-reported daily physical activity and health status have been reported as predictors of a hospitalization in COPD but are not routinely assessed. We tested the hypothesis that self-reported daily physical activity and health status assessed by a simple question were predictors of a hospitalization in a well-characterized cohort of patients with severe emphysema. Investigators gathered daily physical activity and health status data assessed by a simple question in 597 patients with severe emphysema and tested the association of those patient-reported outcomes to the occurrence of a hospitalization in the following year. Multiple logistic regression analyses were used to determine predictors of hospitalization during the first 12 months after randomization. The two variables tested in the hypothesis were significant predictors of a hospitalization after adjusting for all univariable significant predictors: >2 h of physical activity per week had a protective effect [odds ratio (OR) 0.60; 95% confidence interval (95% CI) 0.41-0.88] and self-reported health status as fair or poor had a deleterious effect (OR 1.57; 95% CI 1.10-2.23). In addition, two other variables became significant in the multivariate model: total lung capacity (every 10% increase) had a protective effect (OR 0.88; 95% CI 0.78-0.99) and self-reported anxiety had a deleterious effect (OR 1.75; 95% CI 1.13-2.70). Self-reported daily physical activity and health status are independently associated with COPD hospitalizations. Our findings, assessed by simple questions, suggest the value of patient-reported outcomes in developing risk assessment tools that are easy to use.

A Decomposition of Hospital Profitability: An Application of DuPont Analysis to the US Market.

PubMed

Turner, Jason; Broom, Kevin; Elliott, Michael; Lee, Jen-Fu

2015-01-01

This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE) into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Profit margin, the efficiency with which services are rendered (total asset turnover), and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services' Healthcare Cost Report Information System (CMS Form 2552). The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS) against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of NFP and IO hospitals, significant financial differences remain

Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Non-Target Conditions

PubMed Central

Desai, Nihar R.; Ross, Joseph S.; Kwon, Ji Young; Herrin, Jeph; Dharmarajan, Kumar; Bernheim, Susannah M.; Krumholz, Harlan M.; Horwitz, Leora I.

2017-01-01

Importance Readmission rates declined after announcement of the Hospital Readmission Reduction Program (HRRP), which penalizes hospitals for excess readmissions for acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Objective To compare trends in readmission rates for target and non-target conditions, stratified by hospital penalty status. Design, Setting, Participants Retrospective cohort study of 48,137,102 hospitalizations of 20,351,161 Medicare fee-for-service beneficiaries over 64 years discharged between January 1, 2008 and June 30, 2015 from 3,497 hospitals. Difference interrupted time series models were used to compare trends in readmission rates by condition and penalty status. Exposure Hospital penalty status or target condition under the HRRP. Outcome 30-day risk adjusted, all-cause unplanned readmission rates for target and non-target conditions. Results In January 2008, the mean readmission rates for AMI, HF, pneumonia and non-target conditions were 21.9%, 27.5%, 20.1%, and 18.4% respectively at hospitals later subject to financial penalties (n=2,189) and 18.7%, 24.2%, 17.4%, and 15.7% at hospitals not subject to penalties (n=1,283). Between January 2008 and March 2010, prior to HRRP announcement, readmission rates were stable across hospitals (except AMI at non-penalty hospitals). Following announcement of HRRP (March 2010), readmission rates for both target and non-target conditions declined significantly faster for patients at hospitals later subject to financial penalties compared with those at non-penalized hospitals (AMI, additional decrease of −1.24 (95% CI, −1.84, −0.65) percentage points per year relative to non-penalty discharges; HF, −1.25 (−1.64, −0.65); pneumonia, −1.37 (−0.95, −1.80); non-target, −0.27 (−0.38, −0.17); p<0.001 for all). For penalty hospitals, readmission rates for target conditions declined significantly faster compared with non-target conditions (AMI: additional decline of −0

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.

The effect of marital status on the presentation and outcomes of elderly male veterans hospitalized for pneumonia.

PubMed

Metersky, Mark L; Fine, Michael J; Mortensen, Eric M

2012-10-01

Although marital status has been shown to affect the outcomes of many conditions, there are limited data on the relationships between marital status and the presentation and outcomes of pneumonia. We used Veterans Affairs administrative databases to identify a retrospective cohort of male veterans age ≥ 65 years hospitalized for pneumonia between 2002 and 2007. We assessed unadjusted and adjusted associations between marital status and mortality, hospital length of stay, and readmission to the hospital using generalized linear mixed-effect models with admitting hospital as a random effect and adjusted for baseline patient characteristics. There were 48,635 patients (26,558 married and 22,077 unmarried) in the study. Married men had a slightly higher Charlson comorbidity score (3.0 vs 2.8, P < .0001) but were less likely to require ICU admission, ventilator support, and vasopressor treatment during the first 48 h of hospitalization. Married patients had significantly lower crude and adjusted in-hospital mortality (9.4% vs 10.6%; adjusted OR, 0.87; 95% CI, 0.81-0.93) and mortality during the 90 days after hospital discharge (14.7% vs 16.0%; adjusted OR, 0.92; 95% CI, 0.88-0.98). Their adjusted incidence rate ratio length of stay was also lower (0.92; 95% CI, 0.91-0.92). Unmarried elderly men admitted to the hospital with pneumonia have a higher risk of in-hospital and postdischarge mortality, despite having a lower degree of comorbidity. Although marital status may be a surrogate marker for other predictors, it is an easily identifiable one. These results should be considered by those responsible for care-transition decisions for patients hospitalized with pneumonia.

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.

Teaching surgery takes time: the impact of surgical education on time in the operating room

PubMed Central

Vinden, Christopher; Malthaner, Richard; McGee, Jacob; McClure, J. Andrew; Winick-Ng, Jennifer; Liu, Kuan; Nash, Danielle M.; Welk, Blayne; Dubois, Luc

2016-01-01

Background It is generally accepted that surgical training is associated with increased surgical duration. The purpose of this study was to determine the magnitude of this increase for common surgical procedures by comparing surgery duration in teaching and nonteaching hospitals. Methods This retrospective population-based cohort study included all adult residents of Ontario, Canada, who underwent 1 of 14 surgical procedures between 2002 and 2012. We used several linked administrative databases to identify the study cohort in addition to patient-, surgeon- and procedure-related variables. We determined surgery duration using anesthesiology billing records. Negative binomial regression was used to model the association between teaching versus nonteaching hospital status and surgery duration. Results Of the 713 573 surgical cases included in this study, 20.8% were performed in a teaching hospital. For each procedure, the mean surgery duration was significantly longer for teaching hospitals, with differences ranging from 5 to 62 minutes across individual procedures in unadjusted analyses (all p < 0.001). In regression analysis, procedures performed in teaching hospitals were associated with an overall 22% (95% confidence interval 20%–24%) increase in surgery duration, adjusting for patient-, surgeon- and procedure-related variables as well as the clustering of patients within surgeons and hospitals. Conclusion Our results show that a wide range of surgical procedures require significantly more time to perform in teaching than nonteaching hospitals. Given the magnitude of this difference, the impact of surgical training on health care costs and clinical outcomes should be a priority for future studies. PMID:27007088

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.

Motorcycle-related injuries at a university teaching hospital in north central Nigeria

PubMed Central

Elachi, Itodo C.; Okunola, Benjamin B.; Yongu, Williams T.; Onyemaechi, Ndubuisi OC; Odatuwa-Omagbemi, Odoyoh D.; Ahachi, Chukwukadibia N.; Mue, Daniel D.

2014-01-01

Background: Motorcycle-related injuries lead to considerable morbidity and mortality. The aim of this study is to determine the pattern and outcome of motorcycle-related injuries at Benue State University Teaching Hospital, Makurdi, Nigeria. Patients and Methods: Case records of all patients who presented to the accident and emergency department with motorcycle-related injuries between July 2012 and June 2013 were analysed for age, gender, injury host status (i.e. rider, pillion or pedestrian), nature of collision (motorcycle versus other vehicles, motorcycle versus motorcycle, motorcycle versus pedestrian or lone riders), body region injured, injury severity score (ISS) at arrival, length of hospital stay (LOS) and mortality. Results: Seventy - nine patients with motorcycle-related injuries were included in the study. They consisted of 63 males (61.8%) and 16 females (15.7%). The age range was 5-65 years with a mean of 32.4 ± 14.0. Motorcycle versus vehicle collisions were the most common mechanism of injury (n = 46, 58.2%). Musculoskeletal injuries constituted the most common injuries sustained (n = 50, 47.6%) and the tibia was the most frequently fractured bone (n = 14, 35.9%). The majority of patients (57.0%) sustained mild/moderate injuries (ISS ≤ 15). There was no statistically significant difference between the sexes for sustaining mild/moderate injuries or severe/profound injuries (P > 0.05). Mortality rate was 6.3% with head injuries being involved in all cases. Conclusion: Young males were mostly injured in motorcycle-related trauma. Musculoskeletal injuries were the most common injuries sustained and head injuries were involved in all the deaths. Enforcement of motorcycle crash bars and helmet usage is recommended. PMID:25538360

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.

Have procompetitive changes altered hospital provision of indigent care?

PubMed

Campbell, E S; Ahern, M W

1993-10-01

In the past decade alone there have been numerous changes in the financial and competitive environment of hospitals in the United States. Some examples include the advent of Medicare's Prospective Payment System, growth in managed care options, relaxation of states' Certificate of Need (CON) regulations, and court cases questioning the tax-exempt status of nonprofit hospitals. In this paper we attempt to reveal how hospitals alter their provision of care to the poor in a more cost conscious and competitive environment. Using hospital data from the State of California for the fiscal years ending in 1983 and 1987, estimates explaining uncompensated care commitments are presented. In particular, this study illustrates how hospitals under different ownership control varied their provision of uncompensated care over the period studied on average and by profitability level. Other factors, such as hospital location, teaching status, medicare patient load, and contractual adjustments, are also included in the analysis. A number of interesting trends are detected. Moreover, the results are found to be compatible with a quid pro quo hypothesis which states that hospital regulators reward large uncompensated care providers with profitable CON licenses.

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

Costs, charges, and revenues for hospital diagnostic imaging procedures: differences by modality and hospital characteristics.

PubMed

Sistrom, Christopher Lee; McKay, Niccie L

2005-06-01

This study examined financial data reported by Florida hospitals concerning costs, charges, and revenues related to imaging services. Financial reports to the Florida Hospital Uniform Reporting System by all licensed acute care facilities for fiscal year 2002 were used to calculate four financial indices on a per procedure basis. These included charge, net revenue, operating expense (variable cost), and contribution margin. Analysis, stratified by cost center (imaging modality), tested the effects of bed size, ownership, teaching status, and urban or rural status on the four indices. The mean operating expense and charge per procedure were as follows: computed tomography (CT): $51 and $1565; x-ray and ultrasound: $55 and $410; nuclear medicine (NM): $135 and $1138; and magnetic resonance imaging (MRI): $165 and $2048. With all four modalities, for-profit hospitals had higher charges than not-for-profit and public facilities. Excepting NM, however, the difference by ownership disappeared when considering net revenue. Operating expense did not differ by ownership type or bed size. Operating expense (variable cost) per procedure is considerably lower for CT than for MRI. Consequently, when diagnostically equivalent, CT is preferable to MRI in terms of costs for hospitals. If the cost structure of nonhospital imaging is at all similar to hospitals, the profit potential for performing CT and MRI seems to be substantial, which has relevance to the issue of imaging self-referral.

Under-coding of secondary conditions in coded hospital health data: Impact of co-existing conditions, death status and number of codes in a record.

PubMed

Peng, Mingkai; Southern, Danielle A; Williamson, Tyler; Quan, Hude

2017-12-01

This study examined the coding validity of hypertension, diabetes, obesity and depression related to the presence of their co-existing conditions, death status and the number of diagnosis codes in hospital discharge abstract database. We randomly selected 4007 discharge abstract database records from four teaching hospitals in Alberta, Canada and reviewed their charts to extract 31 conditions listed in Charlson and Elixhauser comorbidity indices. Conditions associated with the four study conditions were identified through multivariable logistic regression. Coding validity (i.e. sensitivity, positive predictive value) of the four conditions was related to the presence of their associated conditions. Sensitivity increased with increasing number of diagnosis code. Impact of death on coding validity is minimal. Coding validity of conditions is closely related to its clinical importance and complexity of patients' case mix. We recommend mandatory coding of certain secondary diagnosis to meet the need of health research based on administrative health data.

For-Profit Hospital Ownership Status and Use of Brachytherapy after Breast-Conserving Surgery

PubMed Central

Sen, Sounok; Soulos, Pamela R.; Herrin, Jeph; Roberts, Kenneth B.; Yu, James B.; Lesnikoski, Beth-Ann; Ross, Joseph S.; Krumholz, Harlan M.; Gross, Cary P.

2014-01-01

BACKGROUND Little is known about the relation between surgical care for breast cancer at for-profit hospitals and subsequent use of adjuvant radiation therapy (RT). Among Medicare beneficiaries, we examined whether hospital ownership status is associated with the use of breast brachytherapy – a newer and more expensive modality – as well as overall RT. METHODS We conducted a retrospective study of female Medicare beneficiaries receiving breast-conserving surgery for invasive breast cancer in 2008 and 2009. We assessed the relationship between hospital ownership and receipt of brachytherapy or overall RT using hierarchical generalized linear models. RESULTS The sample consisted of 35,118 women, 8.0% of whom had surgery at for-profit hospitals. Among patients who received RT, those who underwent surgery at for-profit hospitals were significantly more likely to receive brachytherapy (20.2%) than patients treated at not-for-profit hospitals (15.2%; OR for for-profit vs. not-for-profit: 1.50; 95%CI: 1.23–1.84; p<0.001). Among women aged 66–79, there was no relation between hospital ownership status and overall RT use. Among women aged 80–94 years old – the group least likely to benefit from RT due to shorter life expectancy – receipt of surgery at a for-profit hospital was significantly associated with higher overall RT use (OR: 1.22; 95%CI: 1.03–1.45, p=0.03) and brachytherapy use (OR: 1.66; 95%CI: 1.18–2.34, p=0.003). CONCLUSIONS Surgical care at for-profit hospitals was associated with increased use of the newer and more expensive RT modality, brachytherapy. Among the oldest women, who are least likely to benefit from RT, surgical care at a for-profit hospital was associated with higher overall RT use, with this difference largely driven by the use of brachytherapy. PMID:24787104

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.

Immunization Status of NICU Graduates at a Tertiary Care Children's Hospital.

PubMed

Macintosh, Janelle L B; Huggins, Leslie J; Eden, Lacey M; Merrill, Katreena Collette; Luthy, Karlen E Beth

2017-04-01

Approximately 500,000 infants are born prematurely each year in the United States. Immunization of infants in a neonatal intensive care unit (NICU) set a precedence for future immunizations. The objectives of this study were to determine the current rates of immunization and identify variables associated with immunizations of NICU graduates who were aged 60 days or older at time of discharge. This descriptive pilot study utilized retrospective paper medical record review in one tertiary children's hospital. The relationships between immunization status and study variables were examined using t tests and logistic regression. Of 43 infants discharged at least 60 days of age or older from the NICU, 74.4% were fully immunized in accordance with American Academy of Pediatrics (AAP) recommendations. Significant predictors were age at discharge for immunization and steroid use for nonimmunization. Immunization needs to be a priority in order to give NICU infants every advantage regarding their future health status. Nurses need to implement hospital policies ensuring immunizations of NICU graduates. Future studies should focus on samples from diverse hospitals and levels of NICUs. Qualitative studies exploring and describing parent and provider knowledge of current AAP guidelines will strengthen our understanding of potential barriers to immunization.

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.

[Investigation and analysis of status in simulation education of anesthesiology of China].

PubMed

Wang, Tian-long; Xue, Ji-xiu; Xiao, Wei; Wu, Xin-min

2010-03-09

To investigate the status of simulation education of anesthesiology in China. Five hundreds questionnaires were mailed to chairmen of department of anesthesiology in teaching hospitals in 29 provinces and autonomous regions in China. The retrieved questionnaires and data were processed and analyzed with statistics. Sixty one questionnaires were retrieved, and retrieved rate is 12.2%. The result indicated that the theory and knowledge of anesthesiology was adopted for the training of medical students and residents in 2% teaching hospitals, theory and knowledge of anesthesiology combined with problem-based learning discussion in 52% teaching hospitals, theory and knowledge of anesthesiology combined with problem-based learning discussion and simulation training in 46% teaching hospitals. The order of simulation devices possessed was as follows: Basic Life Support (BLS) (79.6%), training model for clinical anesthesia techniques (53.1%) and Advances Life Support (ALS) (51.0%). There were only six teaching hospitals utilized Human Patient Simulator for anesthesia training. The result of evaluation of simulation education showed that 91.2% anesthesiologists recognized it as applicable, 90.1% anesthesiologists recognized it as medical ethic requirement and 86.0% anesthesiologists recognized it as partly close to clinical situation. The degree of cognition of anesthesiologists to simulation education was ordered as follows: manipulation correcting ability (92.6%), procedure controllability (87.0%), training adjustability (76.0%) and patients safety (68.5%). The simulation education of anesthesiology in China is still in the preliminary period. The executive departments of education should enhance supports to the simulation education in both hard ware and in soft ware.

The nutritional status of hospitalized children: Has this subject been overlooked?

PubMed

Kapçı, Nermin; Akçam, Mustafa; Koca, Tuğba; Dereci, Selim; Kapcı, Mücahit

2015-07-01

To determine the nutritional status of hospitalized children at the time of admission and to investigate the relationship between diagnosis and nutritional status. Body weight, height, triceps skinfold thickness, and mid-arm circumference were measured on admission and percentages of weight-for-age, weight-for-height, body mass index, mid-arm circumference, and triceps skinfold thickness were calculated. The nutritional status was evaluated using the Waterlow, Gomez, and other anthropometric assessments. A total of 511 patients were included in the study with a mean age of 5.8±4.9 years. Malnutrition was determined in 52.7% of patients according to the Waterlow classification. Mild malnutrition was determined in 39%, moderate in 12%, and severe in 1.7%, with the characteristics of acute malnutrition in 23.9%, acute-chronic in 7.3%, and chronic in 21.5%. The highest rate of malnutrition was in the 0-2 years age group (62.3%). According to the Gomez classification, malnutrition rate was determined as 46.8%. The rates of malnutrition in malignant, gastrointestinal, and infectious diseases were 60%, 59.8%, and 54.5%, respectively. The prevalence of malnutrition in hospitalized children was noticeably high. The nutritional evaluation of all patients and an early start to nutritional support could provide a significant positive contribution.

Preoperative teaching and hysterectomy outcomes.

PubMed

Oetker-Black, Sharon L; Jones, Susan; Estok, Patricia; Ryan, Marian; Gale, Nancy; Parker, Carla

2003-06-01

This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies.

Waiting time of inpatients before elective surgical procedures at a State Government Teaching Hospital in India.

PubMed

Ray, Shreyasi; Kirtania, Jyotirmay

2017-01-01

Abundant published literature exists addressing the issues of outpatient waiting lists before surgery. However, there is no published literature on inpatient waiting time before elective surgical procedures. This study aims to measure the inpatient waiting time, identify the factors that affect the inpatient waiting time, and recommend the ways of reducing the waiting time of inpatients before elective surgical procedures, at a state government teaching hospital in India. Descriptive research methods and quality control tools were used for this prospective observational study. Descriptive statistics, Shapiro-Wilk test of normality, Wilcoxon-Mann-Whitney Test, and Kruskal-Wallis test were used. Pareto charts were used to highlight the most important modifiable factors among the set of factors causing increased waiting time. We also applied the M/M/c model (Erlang - A model) of queue theory to analyze the traffic intensity and system congestion. The median waiting time of inpatients before elective surgery was 12 days (interquartile range = 11.5 days). The waiting time was influenced significantly (P < 0.05) by the patient's age, physical status, and the financial status. The surgical specialty, blood product booking and procurement, cross-specialty consultation before surgery, and Intensive Care Unit booking were the other important factors. Modifiable and nonmodifiable factors affecting the inpatient waiting time of surgical patients were identified. Control measures that can reduce the waiting time of inpatients before elective surgery were identified.

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

Food intake and nutritional status influence outcomes in hospitalized hematology-oncology patients.

PubMed

Calleja Fernández, Alicia; Pintor de la Maza, Begoña; Vidal Casariego, Alfonso; Villar Taibo, Rocío; López Gómez, Juan José; Cano Rodríguez, Isidoro; Ballesteros Pomar, María D

2015-06-01

Malnutrition in oncology and hematology-oncology patients is important due to its prevalence and associated mortality and morbidity. The aims of the study were to assess the prevalence of malnutrition in oncology and hematology patients and determine if intake or malnutrition influences hospitalization outcomes. A cohort study was performed in all patients admitted to the oncology and hematology wards in a 30-day period. Nutritional assessment was performed within 24-hours of admission and repeated after 7 days of hospitalization, including Subjective Global Assessment, anthropometry, dietary assessment (24-hour recall) and estimation of caloric and protein needs. Medical records were reviewed 30 days after discharge. Seventy-three patients were evaluated on admission and 29 on day 7 of hospitalization. The prevalence of malnutrition was 47.7%. On admission, patients consumed 71.6 (SD 22.0)% of the prescribed dietary calories and 68.2 (SD 23.5)% of prescribed proteins. The death rate was 2.8% among patients who ate ≥75% and 17.9% among those who ate <75% (p = 0.040). No significant differences were observed between the intake of calories (p = 0.124) and protein (p = 0.126) on admission and on day 7 of hospitalization. Nutritional status was related to readmission rate, being 35.1% for malnourished vs. 8% for well-nourished (p = 0.014). Nutritional status and food intake were not related to the rest of the studied outcomes (length of stay and mechanical, metabolic or infectious complications). Intake did not decrease during hospitalization. There was an upward trend between reduced intake and mortality. Malnutrition was related to hospital readmission. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Gaps in patient care practices to prevent hospital-acquired delirium

PubMed Central

Alagiakrishnan, Kannayiram; Marrie, Thomas; Rolfson, Darryl; Coke, William; Camicioli, Richard; Duggan, D’Arcy; Launhardt, Bonnie; Fisher, Bruce; Gordon, Debbie; Hervas-Malo, Marilou; Magee, Bernice; Wiens, Cheryl

2009-01-01

ABSTRACT OBJECTIVE To evaluate the current patient care practices that address the predisposing and precipitating factors contributing to the prevention of hospital-acquired delirium in the elderly. DESIGN Prospective cohort (observational) study. PARTICIPANTS Patients 65 years of age and older who were admitted to medical teaching units at the University of Alberta Hospital in Edmonton over a period of 7 months and who were at risk of delirium. SETTING Medical teaching units at the University of Alberta. MAIN OUTCOME MEASURES Demographic data and information on predisposing factors for hospital-acquired delirium were obtained for all patients. Documented clinical practices that likely prevent common precipitants of delirium were also recorded. RESULTS Of the 132 patients enrolled, 20 (15.2%) developed hospital-acquired delirium. At the time of admission several predisposing factors were not documented (eg, possible cognitive impairment 16 [12%], visual impairment 52 [39.4%], and functional status of activities of daily living 99 [75.0%]). Recorded precipitating factors included catheter use, screening for dehydration, and medications. Catheters were used in 35 (26.5%) patients, and fluid intake-and-output charting assessed dehydration in 57 (43.2%) patients. At the time of admission there was no documentation of hearing status in 69 (52.3%) patients and aspiration risk in 104 (78.8%) patients. After admission, reorientation measures were documented in only 16 (12.1%) patients. Although all patients had brief mental status evaluations performed once daily, this was not noted to occur twice daily (which would provide important information about fluctuation of mental status) and there was no formal attention span testing. In this study, hospital-acquired delirium was also associated with increased mortality (P < .004), increased length of stay (P < .007), and increased institutionalization (P < .027). CONCLUSION Gaps were noted in patient care practices that might

A ten-year study of measles admissions in a Nigerian teaching hospital.

PubMed

Fetuga, M B; Jokanma, O F N; Ogunfowora, O B; Abiodun, Runsewe

2007-03-01

Measles remains a major cause of childhood morbidity and mortality in Nigeria despite the availability of safe and effective vaccines. The last report on measles from our center was about 15 years ago. A review of the current status is necessary in order to strengthen interventional strategies. To study the burden and epidemiological correlates of measles admissions in a Nigerian teaching hospital. Retrospective. Children admitted with measles infection and/or complications. A review of medical records of measles admissions over the 10-year period, May 1994 and April 2004. One hundred and sixty four children (6.1% of paediatric admissions) aged 4 months to 12 years (28.4 + 28.82 months) were admitted with measles. Sixty-three infants (< or = 12 months old) accounted for 39.4% of patients with about half of them younger than nine months. History of vaccination against measles was obtained in 43 (29.5%) subjects. Forty- eight (32.9%) children were underweight weighing between 60-80% of the expected weight for age and six (4.1%) of them were marasmic weighing below 60% of expected weight for age. None of the patients had oedema. The commonest complication was bronchopneumonia (55.5%). Major complications were less commonly associated with children who weighed more than 80% of expected weight (p = 0.011). The case fatality rate was 7.5 % accounting for 0.4% of childhood mortality. Children without prior measles vaccination, those of low socio-economic status and those weighing less than 80% of expected for age all had significantly higher mortality rates. (p< 0.05 in each case). Measles incidence has risen in the last ten years in Sagamu and its environs but it is still largely a disease of young children. Therefore routine immunization and disease surveillance should be strengthened. Supplemental immunization activities should also be considered.

Factors influencing the use of registered nurse overtime in hospitals, 1995-2000.

PubMed

Berney, Barbara; Needleman, Jack; Kovner, Christine

2005-01-01

To assess nurse overtime in acute care general hospitals and the factors that influence overtime among various hospitals and in the same hospitals from year to year. Staffing data from 1995 to 2000 from 193 acute general hospitals in New York State were used to examine hospital characteristics (size, location, RN unionization, hospital ownership, and teaching status) to determine whether they were associated with nurse overtime. The average weekly overtime RNs worked was 4.5% of total hours, varying from almost none to 16.6%. At mean overtime levels, nurses were working less overtime than the mean for manufacturing workers, but, at the extreme, nurses were working more than 6 hours overtime per week. Significant differences were observed in the use of overtime by hospital ownership and by union status. Nurses in government hospitals worked less overtime than did those in nongovernment hospitals. Nurses in unionized hospitals worked slightly more overtime than did nurses in nonunionized hospitals. Hospitals varied dramatically in their overtime use. That some categories of hospitals (e.g., government-owned) used little overtime indicates that hospital management can find substitutes for overtime to meet fluctuating staffing needs. The finding that hospitals with similar characteristics varied greatly in their number of overtime hours also supported this conclusion.

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.

Characteristics and determinants of adult patients with acute poisoning attending the accident and emergency department of a teaching hospital in Qatar.

PubMed

Khudair, I F; Jassim, Z; Hanssens, Y; Alsaad, W A

2013-09-01

Data about etiologic and demographic characteristics of acute poisoning in adults in Qatar are lacking. This prospective observational study was undertaken to analyze characteristics and possible determinants of acute poisoning in adults in Qatar. During 2010, 18,073 patients attended the emergency department of Hamad General Hospital, a teaching hospital in Qatar. Out of them, 599 (3.3%) patients were diagnosed as "poisoning case" with either chemical or pharmaceutical substances. The prevalence rate of poisoning incidence was 35.3/100,000 population. Seven patients died, corresponding with a case-fatality rate of 0.39/1000. The majority were male (65%) and the mean age was 34 years. The poisons involved were mainly chemicals (61.6%) and pharmaceuticals (38.4%). Female, mainly single, suffered more intentional poisoning compared to male. Of the patients aged 60 years and above (7.2%), the majority (95.3%) suffered unintentional poisoning with pharmaceuticals; 56% with warfarin, 12% with digoxin and 7% with insulin. Multivariate analysis shows that female gender, single status, younger than 35 years of age, being poisoned by pharmaceutical products, and the need for hospitalization are significant determinants for acute intentional poisoning after adjusting all other possible covariates. The findings of this study can be used to establish awareness and prophylactic campaigns in Qatar.

Factors Affecting Code Status in a University Hospital Intensive Care Unit

ERIC Educational Resources Information Center

Van Scoy, Lauren Jodi; Sherman, Michael

2013-01-01

The authors collected data on diagnosis, hospital course, and end-of-life preparedness in patients who died in the intensive care unit (ICU) with "full code" status (defined as receiving cardiopulmonary resuscitation), compared with those who didn't. Differences were analyzed using binary and stepwise logistic regression. They found no…

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)

[Status of health psychology teaching in Chilean schools of medicine].

PubMed

Santander, Jaime T; Pinedo, José P; Repetto, Paula L

2012-07-01

Physicians should be exposed, during their training to basic concepts in psychology. To describe the current status of the formal teaching of health psychology or medical psychology in Chilean medical schools. We reviewed the programs of the courses including topics of Medical Psychology, Health Psychology and Behavioral Medicine at 18 medical schools in Chile, using a focused coding method. The contents and the time spent on these courses were considered and analyzed. Eighty three percent of medical schools have a Medical Psychology or related program, 56.3% are carried out during the first year of medical School teaching and the weekly load has an average of 4 hours. The contents are mixed and predominantly concerning general and developmental psychology, but also address specific issues of Medical Psychology in most cases. There is little clarity about the training issues to be addressed in medical psychology for medical students in Chile. It is necessary to define the minimum content that all medical graduates should learn.

Hospital Variation in Functional Recovery After Stroke.

PubMed

Bettger, Janet Prvu; Thomas, Laine; Liang, Li; Xian, Ying; Bushnell, Cheryl D; Saver, Jeffrey L; Fonarow, Gregg C; Peterson, Eric D

2017-01-01

Functional status is a key patient-centric outcome, but there are little data on whether functional recovery post-stroke varies among hospitals. This study examined the distribution of functional status 3 months after stroke, determined whether these outcomes vary among hospitals, and identified hospital characteristics associated with better (or worse) functional outcomes. Observational analysis of the AVAIL study (Adherence Evaluation After Ischemic Stroke-Longitudinal) included 2083 ischemic stroke patients enrolled from 82 US hospitals participating in Get With The Guidelines-Stroke and AVAIL. The primary outcome was dependence or death at 3 months (modified Rankin Scale [mRS] score of 3-6). Secondary outcomes included functional dependence (mRS score of 3-5), disabled (mRS score of 2-5), and mRS evaluated as a continuous score. By 3 months post-discharge, 36.5% of patients were functionally dependent or dead. Rates of dependence or death varied widely by discharging hospitals (range: 0%-67%). After risk adjustment, patients had lower rates of 3-month dependence or death when treated at teaching hospitals (odds ratio, 0.72; 95% confidence interval, 0.54-0.96) and certified primary stroke centers (odds ratio, 0.69; 95% confidence interval, 0.53-0.91). In contrast, a composite measure of hospital-level adherence to acute stroke care performance metrics, stroke volume, and bed size was not associated with downstream patient functional status. Findings were robust across mRS end points and sensitivity analyses. One third of acute ischemic stroke patients were functionally dependent or dead 3 months postacute stroke; functional recovery rates varied considerably among hospitals, supporting the need to better determine which care processes can maximize functional outcomes. © 2017 American Heart Association, Inc.

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).

Evaluation of health literacy status among patients in a tertiary care hospital in coastal karnataka, India.

PubMed

U P, Rathnakar; Belman, Madhuri; Kamath, Ashwin; B, Unnikrishnan; Shenoy K, Ashok; A L, Udupa

2013-11-01

People with limited health literacy are more likely to make medication errors, and they have less health knowledge, worse health status, more hospitalizations, and higher healthcare costs than people with adequate literacy. The objective of this study is to assess the health literacy status among patients who are able to read and understand English attending a tertiary care hospital by using Rapid Estimate of Adult Literacy in Medicine [REALM] technique and to compare the health literacy levels to educational status and other baseline characteristics. A widely used word recognition method [REALM] was used to assess the HL status of 200 patients attending a tertiary care hospital in Southern India. The number of correctly pronounced words was used to assign a grade-equivalent reading level. Scores 0 to 44 indicate reading skills at or below the 6th grade level, scores from 45 to 60 represent skills at the 7th or 8th grade level, and scores above 60 indicate skills at the high-school level or higher. HL status was found below adequate level in more than 50% of the patients. Younger age group showed better HL scores compared to those aged more than 25 years. General education level or the medium of education does not truly reflect HL levels as brought out in the study. Even those with postgraduate qualification had poor HL skills. The study was carried out to find out the HL levels among patients attending a tertiary care hospital. It was assumed that the general education levels may not reflect true HL status. In view of the results of this study it can be concluded that patient's HL skills should not be taken for granted and adequate attention should be paid in educating and briefing patients whenever patients are required to interpret and understand health care related documents.

Epidemiological profiling of methicillin-resistant Staphylococcus aureus-positive dogs arriving at a veterinary teaching hospital.

PubMed

Hoet, Armando E; van Balen, Joany; Nava-Hoet, Rocio C; Bateman, Shane; Hillier, Andrew; Dyce, Jonathan; Wittum, Thomas E

2013-06-01

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important zoonotic and nosocomial pathogen in veterinary settings. Even though human risk factors for MRSA infection and colonization are well known, this information in animals is lacking. The objective of this study was to identify risk factors associated with MRSA carrier dogs on their arrival at a veterinary teaching hospital. A total of 435 dogs were enrolled in the MRSA active surveillance program at The Ohio State University-Veterinary Medical Center over a 1-year period. Dogs were screened for MRSA on arrival, regardless of health status, sex, breed, or age. In addition, an epidemiological survey and medical history were obtained for each dog to identify potential risk factors up to 1 year prior to the appointment. Of 435 dogs included in the study, 25 (5.7%) were MRSA positive, with 86.5% of the isolates classified staphylococcal chromosome cassette mec (SCCmec) type II and USA100. Four of the 25 MRSA carrier dogs were healthy, 20 had health issues unrelated to MRSA, and 1 had an active MRSA infection. MRSA was detected in the nares (72%, 18/25), skin lesions (24%, 6/25), and the perianal area (16%, 4/25). Except for previous surgery <90 days (odds ratio [OR]=4.9; 95% confidence interval [CI] 1.4-17.6; p value 0.01), none of the variables related to the previous medical history, dog's management, home environment, and other potential exposures were associated with the MRSA carrier status. However, the profession of the owner was significantly associated, and dogs owned by veterinary students were 20.5 times (95% CI 4.5-93.6; p value≤0.01) more likely to be MRSA positive than dogs owned by clients with different occupations. MRSA-positive dogs were dispersed in different categories, preventing the creation of an epidemiological profile that would allow their early recognition upon arrival to a veterinary hospital. However, the association between veterinary students with MRSA

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

Review article: Paediatric status epilepticus in the pre-hospital setting: An update.

PubMed

Furyk, Jeremy; Watt, Kerriane; Emeto, Theophilus I; Dalziel, Stuart; Bodnar, Daniel; Riney, Kate; Babl, Franz E

2017-08-01

Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Survey of tuberculosis hospitals in China: current status and challenges.

PubMed

Du, Jian; Pang, Yu; Liu, Yuhong; Mi, Fengling; Xu, Shaofa; Li, Liang

2014-01-01

Hospitals will play an increasingly important role in delivering TB services in China, however little is known in terms of the current landscape of the hospital system that delivers TB care. In order to examine the status of TB hospitals we performed a study in which a total of 203 TB hospitals, with 30 beds or more, were enrolled from 31 provinces and Xinjiang Production and Construction Corps. Of the 203 hospitals, 93 (45.8%) were located in the eastern region of China, 84 (41.4%) in the central region, and 26 (12.8%) in the western region, while there were 34.6 million TB patients in western China, accounting for 34.6% of the TB burden nationwide. The total number of staff in these 203 hospitals was 83,011, of which 18,899 (22.8%) provided health services for TB patients, (physicians, nurses, lab technicians, etc). Although both the overall number of the health care workers and TB staff in the 203 hospitals increased from the year 1999 to 2009, the former increased by 52%, while the latter increased only by 34%, showing that the percentage of TB staff declined significantly (χ2 = 181.7, P<0.01). The total annual income of the 203 hospitals increased 5.5 fold from 1999 to 2009, while that from TB care increased 3.8 fold during the same period. TB care and control experienced a relatively slower development during this period as shown by the lower percentage of TB staff and the lesser increase in income from TB care in the hospitals. In conclusion, our findings demonstrated that hospital resources are scarcer in western China as compared with eastern China. In view of the current findings, policymakers are urged to address the uneven distribution of medical resources between the underdeveloped west and the more affluent eastern provinces.

For-profit hospital ownership status and use of brachytherapy after breast-conserving surgery.

PubMed

Sen, Sounok; Soulos, Pamela R; Herrin, Jeph; Roberts, Kenneth B; Yu, James B; Lesnikoski, Beth-Ann; Ross, Joseph S; Krumholz, Harlan M; Gross, Cary P

2014-05-01

Little is known about the relationship between operative care for breast cancer at for-profit hospitals and subsequent use of adjuvant radiation therapy (RT). Among Medicare beneficiaries, we examined whether hospital ownership status is associated with the use of breast brachytherapy--a newer and more expensive modality--as well as overall RT. We conducted a retrospective study of female Medicare beneficiaries who received breast-conserving surgery for invasive breast cancer in 2008 and 2009. We assessed the relationship between hospital ownership and receipt of brachytherapy or overall RT by using hierarchical generalized linear models. The sample consisted of 35,118 women, 8.0% of whom had breast-conserving operations at for-profit hospitals. Among patients who received RT, those who underwent operation at for-profit hospitals were more likely to receive brachytherapy (20.2%) than patients treated at not-for-profit hospitals (15.2%; odds ratio [OR] for for-profit versus not-for-profit: 1.50; 95% confidence interval [95% CI] 1.23-1.84; P < .001). Among women aged 66-79 years, there was no relationship between hospital ownership status and overall use of RT. Among women ages 80-94 years of age--the group least likely to benefit from RT due to shorter life expectancy--undergoing breast-conserving operations at a for-profit hospital was associated with greater overall use of RT (OR 1.22; 95% CI 1.03-1.45, P = .03) and brachytherapy use (OR 1.66; 95% CI 1.18-2.34, P = .003). Operative care at for-profit hospitals was associated with increased use of the newer and more expensive RT modality, brachytherapy. Among the oldest women who are least likely to benefit from RT, operative care at a for-profit hospital was associated with greater overall use of RT, with this difference largely driven by the use of brachytherapy. Copyright © 2014 Mosby, Inc. All rights reserved.

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.

Depression and associated factors in hospitalized elderly: a cross-sectional study in a Saudi teaching hospital.

PubMed

Alamri, Sultan Hassan; Bari, Abdulaziz Ihsan; Ali, Abdulrahman Talal

2017-01-01

Depression in the elderly is a serious and often underdiagnosed psychiatric disorder that has been linked to adverse outcomes in the hospital setting. To determine the prevalence of depression and possible associated factors among hospitalized elderly. An analytical cross-sectional study. Medical and surgical wards of King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The study included 200 consecutively hospitalized patients aged 60 years and older. Participants were evaluated within 48 hours of admission using an interviewer-administered question-naire to provide basic demographic and clinical information. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9) screening method and the Structured Clinical Interview for the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) mood disorder module. According to PHQ-9, 17% and 10.5% of the hospitalized patients were diagnosed with a major depressive disorder and other depressive disorders, respectively. The DSM-5 criteria identified 12% of elderly with major depression. Overall, the number of comorbidities associated with depression was signifi-cantly higher in the major depressive disorder group than in the no depression group (post hoc P=.022). Depression was also associated with female gender, unmarried status, lower income, and polypharmacy. In addition, cardiovascular disease and cancer were the most prevalent medical illnesses associated with depression among hospitalized elderly. Major depressive disorder was prevalent among hospitalized elderly, especially among those with comorbid conditions. Hospital physicians must, therefore, maintain a high index of suspicion to identify early and manage depressive symptoms in these patients. The small size of certain subgroups limits the statistical power to examine for associations of depression with particular conditions.

Increased risk of alteration of nutritional status in hospitalized elderly patients with advanced cancer.

PubMed

Paillaud, E; Caillet, P; Campillo, B; Bories, P N

2006-01-01

Malnutrition is common in patients with advanced cancer and is associated with worse prognosis. The aim of this study was to follow-up the nutritional status of elderly patients with advanced cancer in comparison with that of younger ones, in the course of hospitalization. Eighty-eight (44 males and 44 females) patients with advanced cancer entered the study. Two groups were defined according to age : superior 70 y (n = 45) and < 70 y (n = 43). Nutritional status by means of anthropometric variables and daily intake were assessed on Day 0, Day 30 and Day 60. A blood sample was collected on Day 0 for determination of serum proteins. The two groups of patients did not differ in terms of anthropometry and biological variables on admission to our department ; only bicipital skinfold thickness and energy intake were lower in the elderly patients. After one month hospitalization, tricipital skinfold thickness and fat mass decreased in these patients. After two months, mid-arm circumference also decreased. Unlike the older group, the younger patients increased their daily energy and protein intakes. During hospitalization, older persons with advanced cancer cannot improve their energy intake and therefore, are at particular risk of aggravating their nutritional status.

[The two-year post graduate training program for nurses: implementation status and personal perspectives].

PubMed

Yin, Yu-Chun

2013-06-01

The Taiwan Joint Commission on Hospital Accreditation (TJCHA) authorized the Teaching Quality Improvement Program for Teaching Hospitals as a way for the Department of Health to plan and implement improvements. The program assists medical and paramedical professionals to establish a postgraduate clinical training system. The two-year postgraduate training program for nurses is one of the program's regular activities, divided into three phases that include location-based curriculum training (3 months), core curriculum training (9 months), and professional courses training (12 months). This paper describes the origin, current implementation status, and efficacy / key problems of this two-year post graduate training program, Information regarding the opinions of new nurses, preceptors, and nursing managers on the three aspects is drawn from the author's relevant professional experience, interactions with nurses, and a review of the literature. Findings include: (1) nursing departments should operate in accordance with TJCHA guidelines; (2) department training should be adequate to promote the ability and willingness of nurses to train a new generation of clinical preceptors; and (3) participant opinions on project execution progress and difficulties. Findings may be referenced to better achieve Teaching Quality Improvement Program for Teaching Hospital objectives.

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.

The status of bedside teaching in the United Kingdom: the student perspective

PubMed Central

Jones, Patrick; Rai, Bhavan Prasad

2015-01-01

Purpose Bedside teaching holds a strong tradition as a key-learning platform for clinical examination in the basic medical clerkship. There is a growing body of literature expressing concern for its witnessed decline in medical school curricula. However, the views of students toward this patient-centered cornerstone in surgical education remain under-reported. The purpose of this study was to gain a nationwide perspective on bedside teaching according to medical students in the United Kingdom. Materials and methods An adapted Delphi method was employed to formulate the question series as part of a multi-step process including a pilot study, which was used to construct this survey. The target population was medical undergraduates in the United Kingdom and participants were recruited via social media. Outcomes assessed included exposure to bedside teaching, perceived benefits of clinical simulation, and junior doctors as clinical teachers. Barriers to clinical examination were also evaluated. Results Overall, 368 completed surveys were received (completion rate 98.9%). Final year students were significantly more likely to report receiving insufficient bedside teaching (P<0.01). Seventy-eight percent of the study group agreed that clinical simulation is a good learning tool for clinical examination. Seventy percent of students felt junior doctors were as able as senior doctors to teach. Lack of confidence was identified as the commonest barrier to overcome when examining patients and two-thirds of students felt they burdened patients during bedside teaching. Conclusion This prospective study confirms the exposure deficit, which medical students experience in bedside teaching. The junior doctor represents a dynamic clinical teacher in the face of working time directives. Peer learning is a novel solution to such pressures. Work is needed to re-establish the hospital wards as a supportive environment for student learning. PMID:26082672

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.

Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition

PubMed Central

Timmons, Suzanne; Manning, Edmund; Barrett, Aoife; Brady, Noeleen M.; Browne, Vanessa; O’Shea, Emma; Molloy, David William; O'Regan, Niamh A.; Trawley, Steven; Cahill, Suzanne; O'Sullivan, Kathleen; Woods, Noel; Meagher, David; Ni Chorcorain, Aoife M.; Linehan, John G.

2015-01-01

Background: previous studies have indicated a prevalence of dementia in older admissions of ∼42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups. Objective: to determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland. Methods: six hundred and six patients aged ≥70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for delirium and depression, and assessed for co-morbidity, functional ability and nutritional status. Results: of 598 older patients admitted to acute hospitals, 25% overall had dementia; with 29% in public hospitals. Prevalence varied between hospitals (P < 0.001); most common in rural hospitals and acute medical admissions. Only 35.6% of patients with dementia had a previous diagnosis. Patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status (P < 0.001). Delirium was commonly superimposed on dementia (57%) on admission. Conclusion: dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available. Most dementia is not previously diagnosed, emphasising the necessity for cognitive assessment in older people on presentation to hospital. PMID:26420638

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.

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.

Pediatric pain: prevalence, assessment, and management in a teaching hospital

PubMed Central

Linhares, M.B.M.; Doca, F.N.P.; Martinez, F.E.; Carlotti, A.P.P.; Cassiano, R.G.M.; Pfeifer, L.I.; Funayama, C.A.; Rossi, L.R.G.; Finley, G.A.

2012-01-01

The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients' pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28%) answered the questionnaire and for the other 72% (unable to communicate), the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49%) had observed their child's pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals. PMID:22983181

Socioeconomic status and utilization of amblyopia services at a tertiary pediatric hospital in Canada.

PubMed

Sharma, Abhishek; Wong, Agnes M F; Colpa, Linda; Chow, Amy H Y; Jin, Ya-Ping

2016-12-01

To evaluate whether socioeconomic status is associated with equal utilization of amblyopia services at The Hospital for Sick Children (SickKids), a pediatric tertiary hospital in Canada. This is a retrospective, cross-sectional study. The medical records of children aged under 7 years diagnosed with amblyopia at SickKids from 2007 to 2009 were reviewed. Socioeconomic status was derived from patients' residential postal codes through linking with income data in the 2006 Canadian census report. Patients were divided into 5 income quintiles to compare with amblyopia service utilization. The main outcome measure was the observed distribution of amblyopia patients by socioeconomic status versus the expected distribution of 20% for each quintile. The analyses included 336 patients. Children with amblyopia at SickKids were more likely to come from the richest neighbourhood (32.5%), whereas children from each of the 3 lowest quintiles (14.6%-15.5%) were less likely to present at SickKids. These results differed significantly from the expected 20% for each quintile (p < 0.0001). All types of amblyopia were significantly under-represented for children from the lower socioeconomic groups. When analyses were stratified by travel distance to the hospital, a significant inequality between the lower and higher income quintiles remained for nonmetropolitan Toronto patients, but not for metropolitan Toronto patients. Despite a publicly funded health-care system in Canada, children from lower socioeconomic neighbourhoods in distant areas utilize the amblyopia services in a tertiary pediatric centre less often than those from higher socioeconomic status. Copyright © 2016 Canadian Ophthalmological Society. All rights reserved.

Scores of nutritional risk and parameters of nutritional status assessment as predictors of in-hospital mortality and readmissions in the general hospital population.

PubMed

Budzyński, Jacek; Tojek, Krzysztof; Czerniak, Beata; Banaszkiewicz, Zbigniew

2016-12-01

We have no "gold standard" for the diagnosis of malnutrition. The aim of this study was to determine the importance of many of the parameters used in nutritional status screening and assessment among inpatients for the prediction of in-hospital mortality, readmission and length of hospitalization. On the base of the medical documentation a retrospective analysis was performed of nutritional status screening and assessment parameters for all 20,237 non-selected, consecutive hospitalizations in 15,013 patients over 18 years of age treated in one hospital during the course of one year. The risk of malnutrition expressed as a Nutritional Risk Screening (NRS)-2002 score ≥ 3 concerned 6.4% hospitalizations. The greater risk of in-hospital death, as well as readmission within 14 days and 30 days, was related to an NRS-2002 score ≥3, age >65 years, male gender, urgent admission, body mass deficit calculated as the difference between actual body mass and ideal weight determined according to the Lorentz formula, higher degree of Instant Nutritional Assessment (INA), greater value of a C-reactive protein (CRP)/albumin ratio, and plasma glucose concentration. Whereas, greater blood concentration of albumin, hemoglobin, cholesterol and triglycerides, as well as a greater blood lymphocyte count, were associated with reduced risk of the measured outcomes. NRS-2002 score, blood albumin, CRP/albumin ratio, and INA seem to be good predictors of in-hospital mortality, readmission rate and length of hospital stay. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

The impact of Medicaid payer status on hospitalizations in nursing homes

PubMed Central

Cai, Shubing; Miller, Susan C.; Nelson, Dallas L.; Mukamel, Dana B.

2015-01-01

Objectives To examine the association between payer status (Medicaid versus private-pay) and the risk of hospitalizations among long-term stay nursing home (NH) residents who reside in the same facility. Data and study population The 2007–2010 national Medicare Claims and the Minimum Data Set were linked. We identified newly admitted NH residents who became long-stayers and then followed them for 180 days. Analyses Three dichotomous outcomes – all-cause, discretionary and nondiscretionary hospitalizations during the follow-up period – were defined. Linear probability model with facility fixed-effects and robust standard errors were used to examine the within-facility difference in hospitalizations between Medicaid and private-pay residents. A set of sensitivity analyses were performed to examine the robustness of the findings. Results The prevalence of all-cause hospitalization during a 180-day follow-up period was 23.3% among Medicaid residents compared to 21.6% among private-pay residents. After accounting for individual characteristics and facility effects, the probability of any all-cause hospitalization was 1.8 percentage point (P<0.01) higher for Medicaid residents than for private-pay residents within the same facility. We also found Medicaid residents were more likely to be hospitalized for discretionary conditions (5% increase in the likelihood of discretionary hospitalizations), but not for non-discretionary conditions. The findings from the sensitivity analyses were consistent with the main analyses. Conclusion Observed higher hospitalization rates for Medicaid NH residents are at least in part driven by the financial incentive NHs have to hospitalize Medicaid residents. PMID:26067881

In-hospital mortality of generalized convulsive status epilepticus: a large US sample.

PubMed

Koubeissi, Mohamad; Alshekhlee, Amer

2007-08-28

To evaluate the in-hospital mortality associated with generalized convulsive status epilepticus (GCSE), and predictors of death in a large US cohort. We identified our cohort from the National Inpatient Sample for the years 2000 through 2004 by searching the International Classification of Diseases, Ninth Revision, code for GCSE. We excluded patients with partial status epilepticus, and assessed whether associated diagnoses including brain tumors, CNS infections, stroke, hypoxic-ischemic brain injury, metabolic derangements, and respiratory failure predicted mortality. We used logistic regression models to identify predictors of death. Eleven thousand five hundred eighty patients were included in this analysis. The mean age of the patients was 39 +/- 25.6 years, and the median duration of stay was 3 days. Male sex (53.4%) and white race (42.4%) were predominant. Overall in-hospital mortality was 399 in 11,580 (3.45%). Age was a significant predictor of death. Mortality tripled in those who received mechanical ventilation compared with those who did not (7.43% vs 2.22%, odds ratio [OR] 2.79, 95% CI 2.18 to 3.59). Other predictors of mortality included hypoxic-ischemic brain injury (OR 9.85, 95% CI 6.63 to 14.6), cerebrovascular diseases (OR 2.08, 95% CI 1.13 to 3.82), female sex (OR 1.34, 95% CI 1.04 to 1.73), and higher comorbidity index (OR 6.79, 95% CI 4.27 to 10.8). Overall in-hospital mortality from generalized convulsive status epilepticus is low, but remarkably increases in those treated with mechanical ventilation. Other predictors of mortality include older age, female sex, hypoxic-ischemic brain injury, and higher comorbidity index.

Investigation and Analysis of the Status Quo of the Practical Teaching Ability of English Normal Students in the Higher Vocational College in China

ERIC Educational Resources Information Center

Zhou, Zhen

2017-01-01

The teaching ability is the key factor to decide the quality of teaching. How to train and improve the teaching ability of teachers has become a widespread concern of experts and scholars in the field of education and linguistics. The research investigates the status of students' practical teaching ability in the higher vocational college,…

Will Hospital Peer Grouping by Patient Socioeconomic Status Fix the Medicare Hospital Readmission Reduction Program or Create New Problems?

PubMed

Fuller, Richard L; Hughes, John S; Goldfield, Norbert I; Averill, Richard F

2018-04-01

In 2016 the U.S. Congress directed the Centers for Medicare & Medicaid Services (CMS) to implement the 21st Century Cures Act to fix a flaw in the Hospital Readmissions Reduction Program (HRRP). One section of the Act is intended to remove bias in calculating penalties for hospitals treating large percentages of low socioeconomic status (SES) patients. A study was conducted to analyze the effect of the introduction of SES hospital peer groups on the number and distribution of the hospitals being penalized. The CMS analysis files for the fiscal year 2017 HRRP final rule and Disproportionate Share Hospital adjustments were used to assign hospital peer groups. The median excess readmission ratios for hospital peer groups were calculated, and the resulting pattern of hospital penalties within peer groups was analyzed. The findings suggest that because CMS assigns individual HRRP penalties on six clinical conditions but proposes to assign hospitals to a single SES peer group based on all admissions, it will ignore substantial differences in the distribution of peer group medians across these conditions. For surgical cases, as expected, hospitals with fewer patients had higher readmission rates, while for medical cases, hospitals with fewer patients had fewer readmissions. These findings may result in distortion of the peer group adjustment intended to correct for SES. Hospital peer groups may create unintended redistributions of penalties through distortion of peer group medians. An observed relationship between lower-volume hospitals and fewer readmissions for medical conditions requires additional research to establish its basis. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

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.

The necessity of sociodemographic status adjustment in hospital value rankings for perforated appendicitis in children.

PubMed

Tian, Yao; Sweeney, John F; Wulkan, Mark L; Heiss, Kurt F; Raval, Mehul V

2016-06-01

Hospitals are increasingly focused on demonstration of high-value care for common surgical procedures. Although sociodemographic status (SDS) factors have been tied to various surgical outcomes, the impact of SDS factors on hospital value rankings has not been well explored. Our objective was to examine effects of SDS factors on high-value surgical care at the patient level, and to illustrate the importance of SDS adjustment when evaluating hospital-level performance. Perforated appendicitis hospitalizations were identified from the 2012 Kids' Inpatient Database. The primary outcome of interest was high-value care as defined by evaluation of duration of stay and cost. SDS factors included race, health insurance type, median household income, and patient location. The impact of SDS on high-value care was estimated using regression models after accounting for hospital-level variation. Risk-adjusted value rankings were compared before and after adjustment for SDS. From 9,986 hospitalizations, 998 high-value encounters were identified. African Americans were less likely to experience high-value care compared with white patients after adjusting for all SDS variables. Although private insurance and living in nonmetro counties were associated independently with high-value care, the effects were attenuated in the fully adjusted models. For the 136 hospitals ranked according to risk-adjusted value status, 59 hospitals' rankings improved after adjustment and 53 hospitals' rankings declined. After adjustment for patient and hospital factors, SDS has a small but significant impact on risk-adjusted hospital performance ranking for pediatric appendicitis. Adjustment for SDS should be considered in future comparative performance assessment. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of Health Literacy Status Among Patients in a Tertiary Care Hospital in Coastal Karnataka, India

PubMed Central

U.P, Rathnakar; Belman, Madhuri; Kamath, Ashwin; B, Unnikrishnan; Shenoy K, Ashok; A.L, Udupa

2013-01-01

Introduction: People with limited health literacy are more likely to make medication errors, and they have less health knowledge, worse health status, more hospitalizations, and higher healthcare costs than people with adequate literacy. The objective of this study is to assess the health literacy status among patients who are able to read and understand English attending a tertiary care hospital by using Rapid Estimate of Adult Literacy in Medicine [REALM] technique and to compare the health literacy levels to educational status and other baseline characteristics. Material and Methods: A widely used word recognition method [REALM] was used to assess the HL status of 200 patients attending a tertiary care hospital in Southern India. The number of correctly pronounced words was used to assign a grade-equivalent reading level. Scores 0 to 44 indicate reading skills at or below the 6th grade level, scores from 45 to 60 represent skills at the 7th or 8th grade level, and scores above 60 indicate skills at the high-school level or higher. Results: HL status was found below adequate level in more than 50% of the patients. Younger age group showed better HL scores compared to those aged more than 25 years. General education level or the medium of education does not truly reflect HL levels as brought out in the study. Even those with postgraduate qualification had poor HL skills. Conclusion: The study was carried out to find out the HL levels among patients attending a tertiary care hospital. It was assumed that the general education levels may not reflect true HL status. In view of the results of this study it can be concluded that patient’s HL skills should not be taken for granted and adequate attention should be paid in educating and briefing patients whenever patients are required to interpret and understand health care related documents. PMID:24392398

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.

Compensation of chief executive officers at nonprofit US hospitals.

PubMed

Joynt, Karen E; Le, Sidney T; Orav, E John; Jha, Ashish K

2014-01-01

Hospital chief executive officers (CEOs) can shape the priorities and performance of their organizations. The degree to which their compensation is based on their hospitals' quality performance is not well known. To characterize CEO compensation and examine its relation with quality metrics. Retrospective observational study. Participants included 1877 CEOs at 2681 private, nonprofit US hospitals. We used linear regression to identify hospital structural characteristics associated with CEO pay. We then determined the degree to which a hospital's performance on financial metrics, technologic metrics, quality metrics, and community benefit in 2008 was associated with CEO pay in 2009. The CEOs in our sample had a mean compensation of $595,781 (median, $404,938) in 2009. In multivariate analyses, CEO pay was associated with the number of hospital beds overseen ($550 for each additional bed; 95% CI, 429-671; P < .001), teaching status ($425,078 more at major teaching vs nonteaching hospitals; 95% CI, 315,238-534,918; P < .001), and urban location. Hospitals with high levels of advanced technologic capabilities compensated their CEOs $135,862 more (95% CI, 80,744-190,990; P < .001) than did hospitals with low levels of technology. Hospitals with high performance on patient satisfaction compensated their CEOs $51,706 more than did those with low performance on patient satisfaction (95% CI, 15,166-88,247; P = .006). We found no association between CEO pay and hospitals' margins, liquidity, capitalization, occupancy rates, process quality performance, mortality rates, readmission rates, or measures of community benefit. Compensation of CEOs at nonprofit hospitals was highly variable across the country. Compensation was associated with technology and patient satisfaction but not with processes of care, patient outcomes, or community benefit.

Hospital nurse job attitudes and performance: the impact of employment status.

PubMed

Chu, Cheng-I; Hsu, Yao-Feng

2011-03-01

According to the 2007 Taiwan Labor Front Human Resources Report, as much as 47.6% of nurses at some public hospitals were contracted rather than full time. Furthermore, turnover rates for contract nurses were found to be as high as five to eight times of those for full-time nurses. Because high turnover rates are likely to induce negative impacts on the stability of care provided in the absence of staffing continuity, the association between nursing employment arrangement and nursing care quality is attracting greater attention. This study was designed to investigate the work status of contract versus full-time nurses at a public hospital in Taiwan and to examine the impact of such on work-related attitudes, organizational citizenship behavior, and job performance. Samples were recruited from a public hospital in Taiwan. In addition to self-rated items, researchers used supervisor-rated structured questionnaires for job performance to attenuate the possible effect of common method bias. The study investigated the impact of hospital nurse employment status on work-related attitudes, organizational citizenship behavior, and job performance using a regression model that included the critical work-related attitudes variables of job satisfaction and organizational commitment. Study findings included the following: (a) organizational commitment, job satisfaction, organizational citizenship behavior, and job performance correlate positively with one another. (b) No significant difference between contract and full-time nurses was found in terms of organizational commitment, job satisfaction, organizational citizenship behavior, and self-rated job performance. However, when rated by supervisors, reported job performance levels for full-time nurses were significantly higher than those of contract nurses. (c) Organizational citizenship behavior exhibited a mediating effect between job satisfaction, organizational commitment, and job performance. In this study, supervisors

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.

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

ERIC Educational Resources Information Center

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

2016-01-01

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

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.

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.

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.

NUTRITIONAL STATUS AND PERIOPERATIVE FASTING TIME VERSUS COMPLICATIONS AND HOSPITAL STAY OF SURGICAL PATIENTS.

PubMed

de Amorim, Ana Carolina Ribeiro; Costa, Milena Damasceno de Souza; Nunes, Francisca Leide da Silva; da Silva, Maria da Guia Bezerra; de Souza Leão, Cristiano; Gadelha, Patrícia Calado Ferreira Pinheiro

2015-08-01

many factors can have a negative influence over surgical results, such as a compromised nutritional status and the extension of the perioperative fasting time. to evaluate the influence of the nutritional status and the perioperative fasting time over the occurrence of surgical complications and over hospital stay, in patients who have undergone surgery of the gastrointestinal tract and/or abdominal wall, and who were subjected to a nutritional care protocol. cohort study, conducted with 84 patients, from June to November 2014. Data collection was performed by applying a structured questionnaire, search over the records and medical and/or nutritional prescription. Statistical analysis was performed using STATA/SE 12.0 and significance level of 5%. nutritional risk was present in 26.2%, and from these 45.4% carried out preoperative nutritional therapy, having an average of 6.6 ± 2.79 days. The preoperative fasting was 4.5 (3.66; 5.50) hours and the postoperative fasting 5.1 (2.5; 20.5) hours. No associations were found between the parameters for assessing body composition and the presence of complications. A negative correlation was observed between the length of hospital stay and the BMI (p = 0.017),while a positive correlation was observed between weight loss and the length of hospital stay (p = 0.036). Patients with higher postoperative fasting time had a higher occurrence of complications (p = 0.021). the compromised nutritional status and the extension of perioperative fasting time are associated with the occurrence of surgical complications and increased length of hospital stay. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

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

Malnutrition in Hospitalized Pediatric Patients: Assessment, Prevalence, and Association to Adverse Outcomes.

PubMed

Daskalou, Efstratia; Galli-Tsinopoulou, Assimina; Karagiozoglou-Lampoudi, Thomais; Augoustides-Savvopoulou, Persefone

2016-01-01

Malnutrition is a frequent finding in pediatric health care settings in the form of undernutrition or excess body weight. Its increasing prevalence and impact on overall health status, which is reflected in the adverse outcomes, renders imperative the application of commonly accepted and evidence-based practices and tools by health care providers. Nutrition risk screening on admission and nutrition status evaluation are key points during clinical management of hospitalized pediatric patients, in order to prevent health deterioration that can lead to serious complications and growth consequences. In addition, anthropometric data based on commonly accepted universal growth standards can give accurate results for nutrition status. Both nutrition risk screening and nutrition status assessment are techniques that should be routinely implemented, based on commonly accepted growth standards and methodology, and linked to clinical outcomes. The aim of the present review was to address the issue of hospital malnutrition in pediatric settings in terms of prevalence, outline nutrition status evaluation and nutrition screening process using different criteria and available tools, and present its relationship with outcome measures. Key teaching points • Malnutrition-underweight or excess body weight-is a frequent imbalance in pediatric settings that affects physical growth and results in undesirable clinical outcomes. • Anthropometry interpretation through growth charts and nutrition screening are cornerstones for the assessment of malnutrition.To date no commonly accepted anthropometric criteria or nutrition screening tools are used in hospitalized pediatric patients. • Commonly accepted nutrition status and screening processes based on the World Health Organization's growth standards can contribute to the overall hospital nutrition care of pediatric patients.

[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.

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.

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

Stress at work and mental health status among female hospital workers.

PubMed Central

Estryn-Behar, M; Kaminski, M; Peigne, E; Bonnet, N; Vaichere, E; Gozlan, C; Azoulay, S; Giorgi, M

1990-01-01

Relations between working conditions and mental health status of female hospital workers were studied in a sample of 1505 women: 43% were nurses, 32% auxiliaries, and 7% ancillary staff; 13% were other qualified health care staff, mainly head nurses; 5% had occupations other than direct health care; 63% worked on the morning, 20% on the afternoon, and 17% on the night shift. Data were collected at the annual routine medical visit by the occupational health practitioner, using self administered questionnaires and clinical assessments. Five health indicators were considered: a high score to the general health questionnaire (GHQ); fatigue; sleep impairment; use of antidepressants, sleeping pills, or sedatives; and diagnosis of psychiatric morbidity at clinical assessment. Four indices of stress at work were defined: job stress, mental load, insufficiency in internal training and discussion, and strain caused by schedule. The analysis was conducted by multiple logistic regression, controlling for type of occupation, shift, number of years of work in hospital, daily travel time to work, age, marital status, number of children, and wish to move house. Sleep impairment was mostly linked to shift and strain due to schedule. For all other indicators of mental health impairment and especially high GHQ scores, the adjusted odds ratios increased significantly with the levels of job stress, mental load, and strain due to schedule. This evidence of association between work involving an excessive cumulation of stress factors and mental wellbeing should be considered in interventions aimed at improving the working conditions of hospital workers. PMID:2310704

Status of eye lens radiation dose monitoring in European hospitals.

PubMed

Carinou, Eleftheria; Ginjaume, Merce; O'Connor, Una; Kopec, Renata; Sans Merce, Marta

2014-12-01

A questionnaire was developed by the members of WG12 of EURADOS in order to establish an overview of the current status of eye lens radiation dose monitoring in hospitals. The questionnaire was sent to medical physicists and radiation protection officers in hospitals across Europe. Specific topics were addressed in the questionnaire such as: knowledge of the proposed eye lens dose limit; monitoring and dosimetry issues; training and radiation protection measures. The results of the survey highlighted that the new eye lens dose limit can be exceeded in interventional radiology procedures and that eye lens protection is crucial. Personnel should be properly trained in how to use protective equipment in order to keep eye lens doses as low as reasonably achievable. Finally, the results also highlighted the need to improve the design of eye dosemeters in order to ensure satisfactory use by workers.

Uniforms, status and professional boundaries in hospital.

PubMed

Timmons, Stephen; East, Linda

2011-11-01

Despite their comparative neglect analytically, uniforms play a key role in the delineation of occupational boundaries and the formation of professional identity in healthcare. This paper analyses a change to the system of uniforms in one UK hospital, where management have required all professions (with the exception of doctors) to wear the same 'corporate' uniform. Focus groups were conducted with the professionals and patients. We analyse this initiative as a kind of McDonaldisation, seeking to create a new 'corporate' worker whose allegiance is principally to the organisation, rather than a profession. Our findings show how important uniforms are to their wearers, both in terms of the defence of professional boundaries and status, as well as the construction of professional identity. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Predictors of Outcome of Convulsive Status Epilepticus Among an Egyptian Pediatric Tertiary Hospital.

PubMed

Halawa, Eman F; Draz, Iman; Ahmed, Dalia; Shaheen, Hala A

2015-11-01

Convulsive status epilepticus is a common neurologic emergency in pediatrics. We aimed to study the etiology, clinical features, and prognostic factors among pediatric patients with convulsive status epilepticus. Seventy patients were included in this cohort study from pediatric emergency department of the specialized Children Hospital of Cairo University. The outcome was evaluated using the Glasgow Outcome Score. Acute symptomatic etiology was the most common cause of convulsive status epilepticus. Refractory convulsive status epilepticus was observed more significantly in cases caused by acute symptomatic etiologies. The outcome was mortality in 26 (37.1%) patients, severe disability in 15 (21.4%), moderate disability in 17 (24.3%), and good recovery in 12 (17.1%) patients. The significant predictor of mortality was lower modified Glasgow Coma Scale score on admission, whereas lower modified Glasgow Coma Scale score on admission and refractory convulsive status epilepticus were the significant predictors for disability and mortality. © The Author(s) 2015.

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.

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.

Multidrug-resistant gram-negative bacterial infections in a teaching hospital in Ghana.

PubMed

Agyepong, Nicholas; Govinden, Usha; Owusu-Ofori, Alex; Essack, Sabiha Yusuf

2018-01-01

Multidrug-resistant Gram-negative bacteria have emerged as major clinical and therapeutic dilemma in hospitals in Ghana.To describe the prevalence and profile of infections attributable to multidrug-resistant Gram-negative bacteria among patients at the Komfo Anokye Teaching Hospital in the Ashanti region of Ghana. Bacterial cultures were randomly selected from the microbiology laboratory from February to August, 2015. Bacterial identification and minimum inhibitory concentrations were conducted using standard microbiological techniques and the Vitek-2 automated system. Patient information was retrieved from the hospital data. Of the 200 isolates, consisting of K. pneumoniae , A. baumannii , P. aeruginosa , Enterobacter spp. , E. coli , Yersinia spp. , Proteus mirabilis , Pasteurella spp., Chromobacterium violaceum, Salmomella enterica , Vibrio spp. , Citrobacter koseri , Pantoea spp. , Serratia spp. , Providencia rettgeri Burkholderia cepacia , Aeromonas spp. , Cadecea lapagei and Sphingomonas paucimobilis , 101 (50.5%) and 99 (49.5%) recovered from male and female patients respectively The largest proportion of patients were from age-group ≥60 years (24.5%) followed by < 10 years (24.0%) and least 10-19 years (9.5%) with a mean patient age of 35.95 ± 27.11 (0.2-91) years. The decreasing order of specimen source was urine 97 (48.5%), wound swabs 47 (23.5%), sputum 22 (11.0%) bronchial lavage, nasal and pleural swabs 1 (0.50%). Urinary tract infection was diagnosed in 34.5% of patients, sepsis in 14.5%, wound infections (surgical and chronic wounds) in 11.0%, pulmonary tuberculosis in 9.0% and appendicitis, bacteremia and cystitis in 0.50%. The isolates showed high resistance to ampicillin (94.4%), trimethoprim/sulfamethoxazole (84.5%), cefuroxime (79.0%) and cefotaxime (71.3%) but low resistance to ertapenem (1.5%), meropenem (3%) and amikacin (11%). The average multi-drug resistance was 89.5%, and ranged from 53.8% in Enterobacter spp. to 100.0% in

A survey of perceived stress, intimidation, harassment and well-being of resident doctors in a Nigerian Teaching Hospital.

PubMed

Ogunsemi, O O; Alebiosu, O C; Shorunmu, O T

2010-06-01

Stress levels of residency are under-reported in Nigeria despite the importance of well-being during residency training. We investigated the level of perceived stress, intimidation/harassment, mental health and well being among resident doctors. This was a cross sectional questionnaire survey of all residents in training in a Nigerian teaching hospital located in south western part ofNigeria. The response rate was 80.6% (58 out of 72). Forty three (74.1%) of the respondents were males. The mean age was 35.7 +/- 2.8 years (range = 31-43 yeas). The mean number of working hours was 8.8/ hours/week. Fifty percent of residents reported their life was stressful. There were gender differences in conditions like work situation, residency programme, employment status, personal and family safety, caring for children and discrimination in favour of men. Some residents resorted to the use of alcohol (5.2%), cigarette (1.7%), drugs and medications (8.6%) to handle stress. A greater majority of the residents (61.4%) would pursue another career if they had to do it all over, while 34.5% would consider changing to another teaching hospital for their residency. Many residents reported experiencing intimidation and harassment. Eighteen (31%) of the residents admitted to have had emotional or mental health problems during the residency program. About 29% will require further screening for depression, 21.6% for panic disorder, 15.8% for generalized anxiety, 9.3% for social phobia and 8.8% for agoraphobia. The study design however did not allow prediction of proportion of individuals who had mental challenges, nor allow comparison of such rates to the normal population in the country. Many residents experience significant stressors and intimidation/harassment, some of which differ among gender. This study can serve as a pilot for future research, resource application and advocacy for overall improvements of the well-being of residents in training.

[Nutritional status at the time of admission among patients admitted to a tertiary-care paediatric hospital].

PubMed

Durá Travé, Teodoro; San Martín García, Isabel; González Benavides, Aida; Vaquero Iñigo, Ibone; Herranz Aguirre, Mercedes; Iceta Elízaga, Ainhoa

2015-06-01

To analyze the nutrition status of the pediatric patients at the time of hospital admission throughout a calendar year in a tertiary level hospital and to identify those patients and/or groups of pathologies with a higher risk of malnutrition. Retrospective evaluation of nutrition status of 852 patients hospitalized in 2013 in a pediatric hospital (462 males and 390 females). Sex, age, body mass index at the moment of admission and days of hospitalization and diagnosis codified according to the International Classification of Diseases were registered. The prevalence of malnutrition patients registered at the moment of admission was 8.2%. Excess body weight (overweight and obesity) was detected in 18% of the patients. The diseases of the nervous system (22.9%), together with the diseases of the respiratory system, the infectious diseases (18.6%), the congenital malformations (11.4%) and the diseases of the genitorurinary system (8.6%) account for 84.4% of the cases with malnutrition. The overall prevalence rate for malnutrition in pediatric patients at the moment of admission in our hospital was 8.2%, being this figure similar to those published in occidental countries. It should be mandatory to accomplish an initial screening and follow up during hospitalization of younger patients and those suffering from diseases of the nervous and/or respiratory system and, especially, from congenital diseases. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

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

Adoption of medication alert systems in hospital outpatient departments in Taiwan.

PubMed

Kuo, Yu-Chun; Cheng, Shou-Hsia

2017-06-01

The adoption of medication alert systems in the health care sector varies among regions. In Taiwan, the health authority introduced policies in 2005 to encourage the adoption of medication alert systems in hospitals. This study aimed to understand the adoption of medication alert systems in the outpatient departments of hospitals in Taiwan using a nationwide survey. A questionnaire was developed and mailed to 380 accredited general hospitals in Taiwan in 2013. The information collected from the questionnaire concerning the outpatient department included (1) the time of adoption of a medication alert system; (2) the operation of individual alert functions: availability, management, and stability; and (3) hospital characteristics: accreditation level, teaching status, ownership, and number of beds. A total of 216 hospitals completed and returned the questionnaire, corresponding to a response rate of 56.8%. The adoption rate of medication alert systems in hospital outpatient departments increased from less than 10% in 1997-95.83% in 2012. Approximately two-thirds of the hospitals developed and maintained the alert systems independently or collaboratively with vendors. Teaching and large hospitals tended to develop more advanced alert functions such as drug-drug interaction functions. Improving the safety and quality of pharmaceutical services and meeting the policy requirements are reasons for hospitals to establish medication alert systems. The adoption rate of medication alert systems reached 95% in accredited general hospitals in Taiwan. Government policy and available health information professionals and vendors may somewhat contribute to the high adoption rate. Copyright © 2017 Elsevier B.V. All rights reserved.

Strategic planning, implementation, and evaluation processes in hospital systems: a survey from Iran.

PubMed

Sadeghifar, Jamil; Jafari, Mehdi; Tofighi, Shahram; Ravaghi, Hamid; Maleki, Mohammad Reza

2014-09-28

Strategic planning has been presented as an important management practice. However, evidence of its deployment in healthcare systems in low-income and middle-income countries (LMICs) is limited. This study investigated the strategic management process in Iranian hospitals. The present study was accomplished in 24 teaching hospitals in Tehran, Iran from September 2012 to March 2013. The data collection instrument was a questionnaire including 130 items. This questionnaire measured the situation of formulation, implementation, and evaluation of strategic plan as well as the requirements, facilitators, and its benefits in the studied hospitals. All the investigated hospitals had a strategic plan. The obtained percentages for the items "the rate of the compliance to requirements" and "the quantity of planning facilitators" (68.75%), attention to the stakeholder participation in the planning (55.74%), attention to the planning components (62.22%), the status of evaluating strategic plan (59.94%) and the benefits of strategic planning for hospitals (65.15%) were in the medium limit. However, the status of implementation of the strategic plan (53.71%) was found to be weak. Significant statistical correlations were observed between the incentive for developing strategic plan and status of evaluating phase (P=0.04), and between status of implementation phase and having a documented strategic plan (P=0.03). According to the results, it seems that absence of appropriate internal incentive for formulating and implementing strategies led more hospitals to start formulation strategic planning in accordance with the legal requirements of Ministry of Health. Consequently, even though all the investigated hospital had the documented strategic plan, the plan has not been implemented efficiently and valid evaluation of results is yet to be achieved.

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.

Evaluation of the effect of an intervention on the nutritional status of hospitalized patients.

PubMed

Miguel Montoya, Isabel; Ortí Lucas, Rafael; Ferrer Ferrándiz, Esperanza; Martín Baena, David; Montejano Lozoya, Raimunda

2017-04-07

To compare the nutritional status of a population of hospitalized patients, divided into 2 different groups, both at admission and hospital discharge, and to assess the influence of nutritional alteration during the hospital stay. Quasi-experimental study comprising 2 groups of patients (N=581); an intervention group (n=303), in which nurses received specific training on managing care methodology, and a control group (n=278), in which nurses continued their usual dynamics. Each group was made up of 2 care units with patients from both surgical and medical specialties. patients admitted to the selected units with a minimum stay of 5 days. The sample selection was performed prospectively and consecutively after implementing the training. Of the 581 patients studied, 49.4% were women and 50.6% were men. Mean patient age was 68.29 (SD 16.23) years. In the intervention group, the odds ratio (OR) associated with good nutritional status was multiplied by 1.7 (OR=1.67) compared to the control group in the first evaluation and by 1.4 times (OR=1.43) at hospital discharge. The average stay in days was higher in the control group (13.71, SD 10.19) than in the intervention group (10.89, SD 7.49) (P<.001). The systematic methodology-based intervention in the chosen units was positive. Patients admitted to the intervention units had a lower nutritional alteration and a shorter hospital stay than those admitted to the control units. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Factors influencing residents' evaluations of clinical faculty member teaching qualities and role model status.

PubMed

Arah, Onyebuchi A; Heineman, Maas J; Lombarts, Kiki M J M H

2012-04-01

  Evaluations of faculty members are widely used to identify excellent or substandard teaching performance. In order to enable such evaluations to be properly interpreted and used in faculty development, it is essential to understand the factors that influence resident doctors' (residents) evaluations of the teaching qualities of faculty members and their perceptions of faculty members as role-model specialists.   We carried out a cross-sectional survey within a longitudinal study of the System for Evaluation of Teaching Qualities (SETQ) of clinical teachers. The study sample included 889 residents and 1014 faculty members in 61 teaching programmes spanning 22 specialties in 20 hospitals in the Netherlands. Main outcome measures included residents' (i) global and (ii) specific ratings of faculty member teaching qualities, and (iii) global ratings of faculty members as role-model specialists. Statistical analysis was conducted using adjusted multivariable logistic generalised estimating equations.   In total, 690 residents (77.6%) completed 6485 evaluations of 962 faculty members, 848 (83.6%) of whom also self-evaluated. More recently certified faculty members, those who had attended a teacher training programme, and those who spent more time teaching than seeing patients or conducting research were more likely to score highly on most teaching qualities. However, faculty members who had undergone teacher training were less likely to be seen as role models (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.59-0.88). In addition, faculty members were evaluated slightly higher by male than female residents on core teaching domains and overall teaching quality, but were less likely to be seen as role models by male residents (OR 0.80, 95% CI 0.67-0.97). Lastly, faculty members had higher odds of receiving top scores in specific teaching domains from residents in the first 4 years of residency and were less likely to be considered as role models by more

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

Insurance status and admission to hospital for head injuries: are we part of a two-tiered medical system?

PubMed

Svenson, J E; Spurlock, C W

2001-01-01

Previous studies have shown an association between insurance status and use of resources for inpatient care. We sought to assess whether insurance status influences decisions regarding the evaluation and treatment of head injured patients in the emergency department (ED). Head injured patients were identified from ED data from 4 hospitals reporting to the Kentucky Emergency Medical Services Information System. Multiple regression analysis using admission, ED length of stay, and ED charges as outcome variables was then performed. From 216,137 ED visits there were 8,591 (4%) head injured patients identified from the database. Eliminating those with revisits, transfers to another hospital in the database, and isolated facial lacerations, there were 3,821 cases. Controlling for age, hospital, race, primary diagnosis, and indicators of severity of the injury, insurance status was significantly associated with hospital admission. Those uninsured were the least likely to be admitted (OR 0.41; 95% CI (0.31, 0.50), whereas those with public insurance had an intermediate probability (OR 0.50 95% CI (0.37, 0.68) as compared with those with private insurance. Similarly, ED charges were lower for Medicaid patients than insured patients ($880) and tended to be slightly lower for uninsured patients ($1,043) than insured patients ($1,141) (P =.001). Length of stay in the ED was shorter for publicly insured patients (179 minutes) than uninsured (186 minutes) and privately insured patients (192 minutes) (P =.001). The extent of evaluation and admission for head injured patients is associated with insurance status. This creates a dual standard of care for patients. Practitioners should work to standardize the evaluation of patients independent of paying status.

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

Hepatitis B vaccination status among healthcare workers in a tertiary care hospital in Tripoli, Libya.

PubMed

Ziglam, Hisham; El-Hattab, Mabrouk; Shingheer, Noura; Zorgani, Abdulaziz; Elahmer, Omar

2013-08-01

The prevalence of hepatitis B virus (HBV) among healthcare workers (HCWs) in hospitals in developing countries is high. However, the vaccination status of these workers and its relationship with occupational factors are not well documented. The aim of this study was to evaluate the susceptibility of HCWs to HBV infection in the representative Tripoli Central Hospital in Libya and prepare a practical guideline to protect HCWs from occupational exposure. In this cross-sectional study, a questionnaire survey was administered to 2705 healthcare workers of a university hospital in Tripoli. The questionnaire included vaccination status. Compliance with preventive practices against HBV infection was also assessed. The overall vaccination coverage (anti-HBs) was 78.1%. Furthermore, 82.6% of HCWs had received at least one dose of vaccine, but only 72% reported that they were fully vaccinated. The prevalence of hepatitis B surface antigen was 1.1%. The mean prevalence of hepatitis B core antibody (anti-HBc) was 17.3%. HCWs at hospitals are frequently exposed to blood-borne infections. Vaccines should be more readily available for Libyan HCWs, and current vaccination programs should be enforced. Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Health status after cancer: does it matter which hospital you belong to?

PubMed

Fiva, Jon H; Haegeland, Torbjørn; Rønning, Marte

2010-07-13

Survival rates are widely used to compare the quality of cancer care. However, the extent to which cancer survivors regain full physical or cognitive functioning is not captured by this statistic. To address this concern we introduce post-diagnosis employment as a supplemental measure of the quality of cancer care. This study is based on individual level data from the Norwegian Cancer Registry (n = 46,720) linked with data on labor market outcomes and socioeconomic status from Statistics Norway. We study variation across Norwegian hospital catchment areas (n = 55) with respect to survival and employment five years after cancer diagnosis. To handle the selection problem, we exploit the fact that cancer patients in Norway (until 2001) have been allocated to local hospitals based on their place of residence. We document substantial differences across catchment areas with respect to patients' post-diagnosis employment rates. Conventional quality indicators based on survival rates indicate smaller differences. The two sets of indicators are only moderately correlated. This analysis shows that indicators based on survival and post-diagnosis employment may capture different parts of the health status distribution, and that using only one of them to capture quality of care may be insufficient.

Medicaid payer status is associated with in-hospital morbidity and resource utilization following primary total joint arthroplasty.

PubMed

Browne, James A; Novicoff, Wendy M; D'Apuzzo, Michele R

2014-11-05

Previous reports suggest that there are major disparities in outcomes following total joint arthroplasty among patients with different payer statuses. The explanation for these differences is largely unknown and may result from confounding variables. The Affordable Care Act expansion of Medicaid coverage in 2014 makes the examination of these disparities particularly relevant. The Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database was used to identify patients who had undergone primary hip or knee arthroplasty from 2002 through 2011. Complications, costs, and length of hospital stay for patients with Medicaid were compared with those for non-Medicaid patients. Each Medicaid patient was matched to a non-Medicaid patient according to age, sex, race, type of total joint arthroplasty, procedure year, hospital characteristics, smoking status, and all twenty-nine comorbidities defined in the NIS-modified Elixhauser comorbidity measure. It was determined that 191,911 patients who underwent total joint arthroplasty had Medicaid payer status (2.8% of the entire total joint arthroplasty population), and 107,335 (56%) of these Medicaid patients were matched one to one to a non-Medicaid patient for all variables for the adjusted analysis. After matching, Medicaid patients were found to have a higher prevalence of postoperative in-hospital infection (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.3 to 2.1), wound dehiscence (OR, 2.2; 95% CI, 1.4 to 3.4), and hematoma or seroma (OR, 1.3; 95% CI, 1.2 to 1.4) but a lower risk of cardiac complications (OR, 0.7; CI, 0.6 to 0.9). The length of the hospital stay was longer, total cost was higher, and discharge to an inpatient facility was more frequent for patients with Medicaid status (p < 0.01). Compared with non-Medicaid patients, Medicaid patients have a significantly higher risk for certain postoperative in-hospital complications and consume more resources following total joint

Trends and Characteristics of United States Out-of-Hospital Births 2004-2014: New Information on Risk Status and Access to Care.

PubMed

MacDorman, Marian F; Declercq, Eugene

2016-06-01

Out-of-hospital births are increasing in the United States. Our purpose was to examine trends in out-of-hospital births from 2004 to 2014, and to analyze newly available data on risk status and access to care. Newly available data from the revised birth certificate for 47 states and Washington, DC, were used to examine out-of-hospital births by characteristics and to compare them with hospital births. Trends from 2004 to 2014 were also examined. Out-of-hospital births increased by 72 percent, from 0.87 percent of United States births in 2004 to 1.50 percent in 2014. Compared with mothers who had hospital births, those with out-of-hospital births had lower prepregnancy obesity (12.5% vs 25.0%) and smoking (2.8% vs 8.5%) rates, and higher college graduation (39.3% vs 30.0%) and breastfeeding initiation (94.3% vs 80.8%) rates. Among planned home births, 67.1 percent were self-paid, compared with 31.9 percent of birth center and 3.4 percent of hospital births. Vaginal births after cesarean (VBACs) comprised 4.6 percent of planned home births and 1.6 percent of hospital and birth center births. Sociodemographic and medical risk status of out-of-hospital births improved substantially from 2004 to 2014. Improvements in risk status of out-of-hospital births from 2004 to 2014 suggest that appropriate selection of low-risk women is improving. High rates of self-pay for the costs of out-of-hospital birth suggest serious gaps in insurance coverage, whereas higher-than-average rates of VBAC could reflect lack of access to hospital VBACs. Mandating private insurance and Medicaid coverage could substantially improve access to out-of-hospital births. Improving access to hospital VBACs might reduce the number of out-of-hospital VBACs. © 2016 Wiley Periodicals, Inc.

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.

Nutritional status and nutrition risk screening in hospitalized children in New Zealand.

PubMed

Moeeni, Vesal; Walls, Tony; Day, Andrew S

2013-09-01

Children requiring hospitalization are at risk of malnutrition. This study aimed to define the nutritional status of paediatric inpatients in comparison with healthy children and to compare and contrast the feasibility and validity of three nutritional risk screening (NRS) tools in the hospitalized children. A total of 162 children admitted to Christchurch Hospital were assessed along with a similar group of healthy children. Their nutritional state was assessed and classified using standard criteria. The NRS tools were applied, and patients were classified into low-, medium- and high-risk groups. The feasibility and validity of the tools were assessed. Under-nutrition was more frequent in the inpatient group (9.9% vs. 3.7%; p = 0.04), whereas both groups had similar rates of overweight/obesity. NRS tools were able to identify between 81% and 100% of the malnourished patients in the medium- to high-risk groups. Undernourished patients had longer hospital stay than well-nourished patients. Hospitalized children have higher rates of under-nutrition than healthy children in NZ. The three NRS tools were able to identify children at nutritional risk with differing utility. In this setting, STRONGkids was the most reliable tool. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

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

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.

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.

[Current status of disinfection and sterilization for dental handpieces in the hospitals].

PubMed

Deng, Xiao-hong; Sun, Zheng; Su, Jing

2004-11-01

To understand current status of the uses of dental handpieces, methods of disinfection and sterilization and their effectiveness in dental-care hospitals and out-patient departments of stomatology in general hospitals. Ten dental-care hospitals and departments of stomatology in general hospitals at varied levels were randomly sampled during 2000 to 2001 to investigate the uses of dental handpieces and means of their disinfection and sterilization. One used dental handpiece from each hospital or department of stomatology in general hospital selected was detected for possible contamination of bacteria by aerobic bacterial count and Coliform bacterial examinations and hepatitis B surface antigen (HBsAg) on it, based on "The Technical Standards for Disinfection" set by the Ministry of Health of China, and the effectiveness of its disinfection and sterilization was evaluated as well. Anti-suction handpieces were used only in 5.9% of the hospitals or departments, 94.1% of them without anti-suction devices. Cleansing disinfection was applied for used dental handpieces in 62.9% of the dental-care hospitals and the departments of stomatology, with an effective rate of 26.17%, immersing disinfection in 10.0%, with an effective rate of 55.88%, and autoclave in 27.1%, with an effective rate of 80.43%. Used dental handpieces in the hospitals and departments of stomatology in general hospitals were all contaminated by bacteria and HBsAg could be detected in 1.67% of them. Dental handpieces without anti-suction should be replaced soon by those with it or comprehensive dental unit with anti-suction device should be used. Used dental handpieces must be sterilized effectively before next use. Awareness on prevention from cross-infection should be improved for dental-care professional staff and operation of sterilization should be standardized.

Has Health Care Reform Legislation Reduced the Economic Burden of Hospital Readmissions Following Primary Total Joint Arthroplasty?

PubMed

Kurtz, Steven M; Lau, Edmund C; Ong, Kevin L; Adler, Edward M; Kolisek, Frank R; Manley, Michael T

2017-11-01

The purpose of this study was to determine whether the cost of readmissions after primary total hip and knee arthroplasty (THA and TKA) has decreased since the introduction of health care reform legislation and what patient, clinical, and hospital factors drive such costs. The 100% Medicare inpatient dataset was used to identify 1,654,602 primary THA and TKA procedures between 2010 and 2014. The per-patient cost of readmissions was evaluated in general linear models in which the year of surgery and patient, clinical, and hospital factors were treated as covariates in separate models for THA and TKA. The year-to-year risk of 90-day readmission was reduced by 2% and 4% (P < .001) for THA and TKA, respectively. By contrast, the cost of readmissions did not change significantly over time. The 5 most important variables associated with the cost of 90-day THA readmissions (in rank order) were the nature of the readmission (ie, due to medical or procedure-related reasons), the length of stay, hospital's teaching status, discharge disposition, and hospital's overall total joint arthroplasty volume. The top 5 factors associated with the cost of 90-day TKA readmissions were (in rank order) the length of stay, hospital's teaching status, discharge disposition, patient's gender, and age. Although readmission rates declined slightly, the results of this study do not support the hypothesis that readmission costs have decreased since the introduction of health care reform legislation. Instead, we found that clinical and hospital factors were among the most important cost drivers. Copyright © 2017 Elsevier Inc. All rights reserved.

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

Patients discharged against medical advice from a psychiatric hospital in Iran: a prospective study.

PubMed

Sheikhmoonesi, Fatemeh; Khademloo, Mohammad; Pazhuheshgar, Samaneh

2014-03-30

Self- discharged patients are at high risk for readmission and ultimately higher cost for care.We intended to find the proportion of patients who leave hospital against medical advice and explore some of their characteristics. This prospective study of discharge against medical advice was conducted in psychiatric wards of Zare hospital in Iran, 2011. A psychologist recorded some information on a checklist based on the documented information about the patient who wanted to leave against medical advice. The psychologist interviewed these patients and recorded the reasons for discharge against medical advice. Descriptive statistics were calculated for the variables. The rate of premature discharge was 34.4%. Compared to patients with regular discharges, patients with premature discharge were significantly more likely to be male, self-employed, to have co morbid substance abuse and first admission and positive family history of psychiatric disorder. Disappearance of symptoms was the most frequent reason for premature discharge. The 34.4% rate of premature discharge observed in our study is higher than rate reported in other studies. One possible explanation is our teaching hospital serves a low-income urban area and most patients had low socioeconomic status. Further studies are needed to compare teaching and non-teaching hospital about the rate of premature discharge and the reasons of patients who want to leave against medical advice.

The Status of Hospital Information Systems in Iranian Hospitals

PubMed Central

Jahanbakhsh, Maryam; Sharifi, Mohammed; Ayat, Masar

2014-01-01

Background: The area of e-Health is broad and has an excellent growth potential. An increasing number of experts believe that e-Health will fuel the next breakthroughs in health system improvements throughout the world, but there is frequent evidence of unsustainable use of e-Health systems in medical centres, particularly hospitals, for different reasons in different countries. Iran is also a developing country which is presently adopting this promising technology for its traditional healthcare delivery but there is not much information about the use of e-Health systems in its hospitals, and the weakness and opportunities of utilization of such Hospital Information Systems (HIS). Methods: For this research, a number of Hospitals from Isfahan, Iran, are selected using convenient sampling. E-health research professionals went there to observe their HIS and collect required data as a qualitative survey. The design of interview questions was based on the researchers’ experiences and knowledge in this area along with elementary interviews with experts on HIS utilization in hospitals. Results: Efficient administration of e-health implementation improves the quality of healthcare, reduces costs and medical errors, makes healthcare resources available to rural areas, etc. However, there are numerous issues affecting the successful utilization of e-health in Hospitals, such as a lack of a perfect HIS implementation plan and well-defined strategy, inadequate IT-security for the protection of e-health-related data, improper training and educational issues, legal challenges, privacy concerns, improper documentation of lessons learned, resistance to the application of new technologies, and finally a lack of recovery plan and disaster management. These results along with some informative stories are extracted from interview sessions to uncover associated challenges of HIS utilization in Iranian hospitals. Conclusion: The utilization of e-health in Iranian hospitals

Accelerating Improvement and Narrowing Gaps: Trends in Patients' Experiences with Hospital Care Reflected in HCAHPS Public Reporting.

PubMed

Elliott, Marc N; Cohea, Christopher W; Lehrman, William G; Goldstein, Elizabeth H; Cleary, Paul D; Giordano, Laura A; Beckett, Megan K; Zaslavsky, Alan M

2015-12-01

Measure HCAHPS improvement in hospitals participating in the second and fifth years of HCAHPS public reporting; determine whether change is greater for some hospital types. Surveys from 4,822,960 adult inpatients discharged July 2007-June 2008 or July 2010-June 2011 from 3,541 U.S. hospitals. Linear mixed-effect regression models with fixed effects for time, patient mix, and hospital characteristics (bedsize, ownership, Census division, teaching status, Critical Access status); random effects for hospitals and hospital-time interactions; fixed-effect interactions of hospital characteristics and patient characteristics (gender, health, education) with time predicted HCAHPS measures correcting for regression-to-the-mean biases. National probability sample of adult inpatients in any of four approved survey modes. HCAHPS scores increased by 2.8 percentage points from 2008 to 2011 in the most positive response category. Among the middle 95 percent of hospitals, changes ranged from a 5.1 percent decrease to a 10.2 percent gain overall. The greatest improvement was in for-profit and larger (200 or more beds) hospitals. Five years after HCAHPS public reporting began, meaningful improvement of patients' hospital care experiences continues, especially among initially low-scoring hospitals, reducing some gaps among hospitals. © Health Research and Educational Trust.

Oral nutritional supplements intake and nutritional status among inpatients admitted in a tertiary hospital.

PubMed

Lammel Ricardi, Juliana; Marcadenti, Aline; Perocchin de Souza, Simone; Siviero Ribeiro, Anelise

2013-01-01

Malnutrition is very common in hospitals and inpatients with prescription of oral nutritional supplementation have improvement of the nutritional status. To detect the total acceptance rate and a possible association between oral nutritional supplements intake and nutritional status. A cross-sectional study was carried out among 398 inpatients. Fifteen types of supplements were analyzed and nutritional status was detected by Subjective Global Assessment (SGA). Rest-ingestion index (RI) was obtained and Modified Poisson's regression was used to detect associations between nutritional status and intake of nutritional supplements. The prevalence of malnutrition was 43.7% and overall acceptance of supplements was around 75%. Industrialized supplements have better acceptance among well-nourished inpatients and patients who ate less than 80% of the supplement offered (industrialized or homemade) had higher risk for malnutrition (48%). There was an association between oral nutritional supplements intake and nutritional status, despite the good acceptance rate. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.

Antipsychotic Use and Hospitalization Among Older Assisted Living Residents: Does Risk Vary by Frailty Status?

PubMed

Stock, Kathryn J; Hogan, David B; Lapane, Kate; Amuah, Joseph E; Tyas, Suzanne L; Bronskill, Susan E; Morris, Andrew M; Bell, Chaim M; Jeffs, Lianne; Maxwell, Colleen J

2017-07-01

To examine associations between baseline frailty measures, antipsychotic use, and hospitalization over 1 year and whether hospitalization risk associated with antipsychotic use varies by frailty level. In this prospective cohort study of 1,066 residents (mean age: 85 years; 77% women) from the Alberta Continuing Care Epidemiological Studies, trained research nurses conducted comprehensive resident assessments at baseline (2006-2007) for sociodemographic characteristics, health conditions, frailty status, behavioral problems, and all medications consumed during the past 3 days. Two separate measures of frailty were assessed, the Cardiovascular Health Study (CHS) phenotype and an 86-item Frailty Index (FI). Time to first hospitalization during follow-up was determined via linkage with the Alberta Inpatient Discharge Abstract Database. Baseline frailty status (both measures), but not antipsychotic use, was significantly associated with hospitalization over 1 year. When stratified by frailty, FI-defined frail residents using antipsychotics showed a significantly increased risk for hospitalization (adjusted HR: 1.54; 95% CI: 1.01-2.36) compared with frail nonusers. CHS-defined frail antipsychotic users versus frail nonusers also showed an elevated risk (adjusted HR: 1.67; 95% CI: 0.96-2.88). Nonfrail residents using antipsychotics were significantly less likely to be hospitalized compared with nonfrail nonusers whether defined by the FI (adjusted HR: 0.62; 95% CI: 0.39-0.99) or CHS criteria (adjusted HR: 0.62; 95% CI: 0.40-0.96). Frailty measures may be helpful in identifying those who are particularly vulnerable to adverse effects and those who may experience benefit with treatment. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

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.

Strategic Planning, Implementation, and Evaluation Processes in Hospital Systems: A Survey From Iran

PubMed Central

Sadeghifar, Jamil; Jafari, Mehdi; Tofighi, Shahram; Ravaghi, Hamid; Maleki, Mohammad Reza

2015-01-01

Aim & Background: Strategic planning has been presented as an important management practice. However, evidence of its deployment in healthcare systems in low-income and middle-income countries (LMICs) is limited. This study investigated the strategic management process in Iranian hospitals. Methods: The present study was accomplished in 24 teaching hospitals in Tehran, Iran from September 2012 to March 2013. The data collection instrument was a questionnaire including 130 items. This questionnaire measured the situation of formulation, implementation, and evaluation of strategic plan as well as the requirements, facilitators, and its benefits in the studied hospitals. Results: All the investigated hospitals had a strategic plan. The obtained percentages for the items “the rate of the compliance to requirements” and “the quantity of planning facilitators” (68.75%), attention to the stakeholder participation in the planning (55.74%), attention to the planning components (62.22%), the status of evaluating strategic plan (59.94%) and the benefits of strategic planning for hospitals (65.15%) were in the medium limit. However, the status of implementation of the strategic plan (53.71%) was found to be weak. Significant statistical correlations were observed between the incentive for developing strategic plan and status of evaluating phase (P=0.04), and between status of implementation phase and having a documented strategic plan (P=0.03). Conclusion: According to the results, it seems that absence of appropriate internal incentive for formulating and implementing strategies led more hospitals to start formulation strategic planning in accordance with the legal requirements of Ministry of Health. Consequently, even though all the investigated hospital had the documented strategic plan, the plan has not been implemented efficiently and valid evaluation of results is yet to be achieved. PMID:25716385

A Survey on Clinical Research Training Status and Needs in Public Hospitals from Shenzhen

ERIC Educational Resources Information Center

Ji, Ping; Wang, Haibo; Zhang, Chao; Liu, Min; Zhou, Liping; Xiao, Ping; Wang, Yanfang; Wu, Yangfeng

2017-01-01

Objective: To obtain information on the current clinical research training status and evaluate the training needs comprehensively for medical staff in hospitals. Methods: This survey was initiated and conducted by the Health and Family Planning Commission of Shenzhen in conjunction with the Peking University Clinical Research Institute (Shenzhen)…

[Instruments of management accounting in german hospitals - potentials for competitive advantage and status quo].

PubMed

Berens, W; Lachmann, M; Wömpener, A

2011-03-01

The aim of this study is to provide an analysis of the status quo for the usage of instruments of management accounting in German hospitals. 600 managing directors of German hospitals were asked to answer a questionnaire about the usage of management accounting instruments in their hospitals. We obtained 121 usable datasets, which are evaluated in this study. A significant increase in the usage of management accounting instruments can be observed over time. The respondents have an overall positive perception of the usage of these instruments. Cost accounting and information systems are among the most widely used instruments, while widely discussed concepts like the balanced scorecard or clinical pathways show surprisingly low usage rates. © Georg Thieme Verlag KG Stuttgart · New York.

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.

Status of the Usage of Active Learning and Teaching Method and Techniques by Social Studies Teachers

ERIC Educational Resources Information Center

Akman, Özkan

2016-01-01

The purpose of this study was to determine the active learning and teaching methods and techniques which are employed by the social studies teachers working in state schools of Turkey. This usage status was assessed using different variables. This was a case study, wherein the research was limited to 241 social studies teachers. These teachers…

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.

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.

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.

Gestational diabetes mellitus among women attending prenatal care at Korle-Bu Teaching Hospital, Accra, Ghana.

PubMed

Oppong, Samuel A; Ntumy, Michael Y; Amoakoh-Coleman, Mary; Ogum-Alangea, Deda; Modey-Amoah, Emefa

2015-12-01

To determine the burden of gestational diabetes mellitus (GDM) among pregnant women in Accra, Ghana. The present cross-sectional study enrolled women at 20-24 weeks of pregnancy attending their first prenatal clinic at Korle-Bu Teaching Hospital, Accra, between March and November 2013. Participants underwent a 2-hour, 75-g oral glucose tolerance test between 24 and 28 weeks. The odds of GDM among different body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) groupings were calculated in a multiple logistic regression model. Among 399 women screened, 37 (9.3%) had GDM. Compared with women with a BMI in the normal range (18.50-24.99), obese women (BMI >30.0) had an increased risk of GDM (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.08-8.20; P=0.034]; overweight women (BMI 25.00-29.99) had a slightly elevated risk (OR 1.20, 95% CI 0.41-3.55; P=0.742). Maternal age, parity, education, employment status, place of residence, and previous pregnancy complications did not affect the risk of GDM. GDM was found in 10% of pregnant women in Accra. Women who were obese by 20-24 weeks of pregnancy had a significantly increased risk of GDM. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Health Status After Cancer: Does It Matter Which Hospital You Belong To?

PubMed Central

2010-01-01

Background Survival rates are widely used to compare the quality of cancer care. However, the extent to which cancer survivors regain full physical or cognitive functioning is not captured by this statistic. To address this concern we introduce post-diagnosis employment as a supplemental measure of the quality of cancer care. Methods This study is based on individual level data from the Norwegian Cancer Registry (n = 46,720) linked with data on labor market outcomes and socioeconomic status from Statistics Norway. We study variation across Norwegian hospital catchment areas (n = 55) with respect to survival and employment five years after cancer diagnosis. To handle the selection problem, we exploit the fact that cancer patients in Norway (until 2001) have been allocated to local hospitals based on their place of residence. Results We document substantial differences across catchment areas with respect to patients' post-diagnosis employment rates. Conventional quality indicators based on survival rates indicate smaller differences. The two sets of indicators are only moderately correlated. Conclusions This analysis shows that indicators based on survival and post-diagnosis employment may capture different parts of the health status distribution, and that using only one of them to capture quality of care may be insufficient. PMID:20626866

[Status of subjective well-being for medical staff in a tertiary hospital].

PubMed

Deng, Yunlong; Liu, Yan; Xu, Shaorong; Zhao, Min; Li, Junping; Xiong, Yan

2016-06-28

To investigate the status of subjective well-being (SWB) for medical staffs who contact with patients directly in a tertiary hospital.
 Staffs from a tertiary hospital in Hunan province were investigated the SWB Scale (SWBS-cc20) from 2012 to 2014.
 The scores of SWB for medical staffs are high (81.67±12.33). Among the 10 sub-dimensions of SWB, medical staffs performed the best in family atmosphere, personal growth, and interpersonal adaptation, while performed the worst in physical health, mental health and material contentment. Title, job nature, education and occupation significantly affected the status of SWB. Staffs who directly connected with patients have less scores of SWB than those who do not (t=-4.80, P<0.001). Moreover, they perform better in contentment (OR=0.079, 95% CI 1.278 to 2.214, P<0.001), but worse in mental health (OR=1.315, 95% CI 1.023 to 1.690, P<0.05) and physical health (OR=1.313, 95% CI 1.029 to 1.677, P<0.05).
 Medical staffs have high scores of SWB. Staffs who directly connected with patients have less scores of SWB than those who do not. Moreover, they perform better in contentment, but worse in mental health and physical health.

Comparison of stress and burnout among anesthesia and surgical residents in a tertiary care teaching hospital in North India.

PubMed

Gandhi, K; Sahni, N; Padhy, S K; Mathew, P J

2017-10-23

The residents undergoing training at hospitals in our country face challenges in terms of infrastructure and high workload with undefined working hours. The aim of the study was to compare the stress and burnout levels in trainee doctors doing residency in surgical fields and anesthesia at a tertiary care academic center in North India. A comparative, observational study was conducted in a tertiary care teaching hospital in North India. After Ethics Committee approval, 200 residents (100 each from surgical branches and anesthesia) were required to fill a questionnaire with information about age, sex, year of residency, marital status, and the Perceived Stress Scale-10, and Burnout Clinical Subtype Questionnaire-12. Burnout and perceived stress were compared between residents of anesthesia and surgical specialties. Residents of both surgical and anesthesia branches scored high in perceived stress, namely 21 and 18, respectively. The score was significantly higher in surgical residents (P = 0.03) and increased progressively with the year of residency. The majority of residents (90% surgical, 80% anesthesia) felt that they were being overloaded with work. However, only 20%-30% of respondents felt that there was lack of development of individual skills and still fewer (<10%) reported giving up in view of difficulties. There is high level of stress and overload dimension of burnout among the residents of anesthesia and surgical branches at our tertiary care academic institution and the surgical residents score marginally higher than anesthesia residents.

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.

A population pharmacokinetic analysis of the influence of nutritional status of digoxin in hospitalized Korean patients.

PubMed

Choi, Soo An; Yun, Hwi-yeol; Lee, Eun Sook; Shin, Wan Gyoon

2014-03-01

Safe and effective use of digoxin in hospitalized populations requires information about the drug's pharmacokinetics and the influence of various factors on drug disposition. However, no attempts have been made to link an individual's digoxin requirements with nutritional status. The main goal of this study was to estimate the population pharmacokinetics of digoxin and to identify the nutritional status that explains pharmacokinetic variability in hospitalized Korean patients. Routine therapeutic drug-monitoring data from 106 patients who received oral digoxin at Seoul National University Bundang Hospital were retrospectively collected. The pharmacokinetics of digoxin were analyzed with a 1-compartment, open-label pharmacokinetic model by using a nonlinear mixed-effects modeling tool (NONMEM) and a multiple trough screening approach. The effect of demographic characteristics and biochemical and nutritional indices were explored. Estimates generated by using NONMEM indicated that the CL/F of digoxin was influenced by renal function, serum potassium, age, and percentage of ideal body weight (PIBW). These influences could be modeled by following the equation CL/F (L/h) = 1.36 × (creatinine clearance/50)(1.580) × K(0.835) × 0.055 × (age/65) × (PIBW/100)(0.403). The interindividual %CV for CL/F was 34.3%, and the residual variability (SD) between observed and predicted concentrations was 0.225 μg/L. The median estimates from a bootstrap procedure were comparable and within 5% of the estimates from NONMEM. Correlation analysis with the validation group showed a linear correlation between observed and predicted values. The use of this model in routine therapeutic drug monitoring requires that certain conditions be met which are consistent with the conditions of the subpopulations in the present study. Therefore, further studies are needed to clarify the effects of nutritional status on digoxin pharmacokinetics. The present study established important sources of

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus.

PubMed

Aragona, Elena; El-Magbri, Eussra; Wang, Justin; Scheckelhoff, Tessa; Scheckelhoff, Trevor; Hyacinthe, Assata; Nair, Suja; Khan, Amina; Nino, Gustavo; Pillai, Dinesh K

2016-04-01

The prevalence of both childhood asthma and obesity remain at historically high levels and disproportionately affect urban children. Asthma is a common and costly cause for pediatric hospitalization. Our objective was to determine the effect of obesity on outcomes among urban children hospitalized with status asthmaticus. A retrospective cohort study was performed by using billing system data and chart review to evaluate urban children admitted for asthma. Demographics, asthma severity, reported comorbidities, and outcomes were assessed. Obesity was defined by BMI percentile (lean<85%, overweight 85%-95%, obese≥95%). Outcomes were length of stay, hospitalization charges, ICU stay, repeat admissions, and subsequent emergency department (ED) visits. Bivariate analysis assessed for differences between overweight/obese and lean children. Multivariable regression assessed the relationship between overweight status and primary outcomes while controlling for other variables. Post hoc age-stratified analysis was also performed. The study included 333 subjects; 38% were overweight/obese. Overweight/obese children admitted with asthma were more likely than lean children to have subsequent ED visits (odds ratio 1.6, 95% confidence interval 1.0-2.6). When stratified by age, overweight/obese preschool-age children (<5 years) were >2 times as likely to have repeat ED visits than lean preschool-age children (odds ratio 2.3, 95% confidence interval 1.0-5.6). There were no differences in the other outcomes between overweight/obese and lean individuals within the entire cohort or within other age groups. Copyright © 2016 by the American Academy of Pediatrics.

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

Estimates of hospitalization attributable to influenza and RSV in the US during 1997-2009, by age and risk status.

PubMed

Matias, Gonçalo; Taylor, Robert; Haguinet, François; Schuck-Paim, Cynthia; Lustig, Roger; Shinde, Vivek

2017-03-21

Estimates of influenza and respiratory syncytial virus (RSV) burden must be periodically updated to inform public health strategies. We estimated seasonal influenza- and RSV-attributable hospitalizations in the US from 1997 to 2009 according to age and risk status (NCT01599390). Multiple linear regression modelling was used to attribute hospitalizations to influenza or RSV using virological surveillance and hospitalization data. Hospitalization data were obtained from the US Nationwide Inpatient Sample and virology data were obtained from FluView (Centers for Disease Control and Prevention). Outcomes included any mention of ICD-coded respiratory disease and cardiorespiratory disease diagnoses. We also explored a broader definition of respiratory disease that included mention of relevant respiratory sign/symptoms and viral infection ("respiratory broad"). Applying the respiratory broad outcome, our model attributed ~300,000 and ~200,000 hospitalizations to influenza and RSV, respectively. Influenza A/H3N2 was the predominant cause of influenza-related hospitalizations in most seasons, except in three seasons when influenza B was dominant; likewise, A/H3N2 caused most influenza-related hospitalizations in all age segments, except in children <18 years where the relative contribution of A/H3N2 and B was similar. Most influenza A- and B-related hospitalizations occurred in seniors while approximately one half and one third of all RSV-related events occurred in children 0-4 years and seniors 65+ years, respectively. High-risk status was associated with higher risk of both influenza- and RSV-attributable hospitalizations in adults, but not in children. Our study assessed the burden of influenza and RSV, information that is important for both cost effectiveness studies and for prioritization of the development of antivirals and vaccines. For seniors, we found that the burdens of influenza and RSV were both substantial. Among children <18 years, about half of all

Comparison of ischemic stroke outcomes and patient and hospital characteristics by race/ethnicity and socioeconomic status.

PubMed

Hanchate, Amresh D; Schwamm, Lee H; Huang, Wei; Hylek, Elaine M

2013-02-01

Current literature provides mixed evidence on disparities by race/ethnicity and socioeconomic status in discharge outcomes after hospitalization for acute ischemic stroke. Using comprehensive data from 8 states, we sought to compare inpatient mortality and length of stay by race/ethnicity and socioeconomic status. We examined all 2007 hospitalizations for acute ischemic stroke in all nonfederal acute care hospitals in Arizona, California, Florida, Maine, New Jersey, New York, Pennsylvania, and Texas. Population was stratified by race/ethnicity (non-Hispanic whites, non-Hispanic blacks, and Hispanics) and socioeconomic status, measured by median income of patient zip code. For each stratum, we estimated risk-adjusted rates of inpatient mortality and longer length of stay (greater than median length of stay). We also compared the hospitals where these subpopulations received care. Hispanic and black patients accounted for 14% and 12% of all ischemic stroke admissions (N=147 780), respectively, and had lower crude inpatient mortality rates (Hispanic=4.5%, blacks=4.4%; all P<0.001) compared with white patients (5.8%). Hispanic and black patients were younger and fewer had any form of atrial fibrillation. Adjusted for patient risk, inpatient mortality was similar by race/ethnicity, but was significantly higher for low-income area patients than that for high-income area patients (odds ratio, 1.08; 95% confidence interval, 1.02-1.15). Risk-adjusted rates of longer length of stay were higher among minority and low-income area populations. Risk-adjusted inpatient mortality was similar among patients by race/ethnicity but higher among patients from lower income areas. However, this pattern was not evident in sensitivity analyses, including the use of mechanical ventilation as a partial surrogate for stroke severity.

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.

Hospital mergers and market overlap.

PubMed Central

Brooks, G R; Jones, V G

1997-01-01

OBJECTIVE: To address two questions: What are the characteristics of hospitals that affect the likelihood of their being involved in a merger? What characteristics of particular pairs of hospitals affect the likelihood of the pair engaging in a merger? DATA SOURCES/STUDY SETTING: Hospitals in the 12 county region surrounding the San Francisco Bay during the period 1983 to 1992 were the focus of the study. Data were drawn from secondary sources, including the Lexis/Nexis database, the American Hospital Association, and the Office of Statewide Health Planning and Development of the State of California. STUDY DESIGN: Seventeen hospital mergers during the study period were identified. A random sample of pairs of hospitals that did not merge was drawn to establish a statistically efficient control set. Models constructed from hypotheses regarding hospital and market characteristics believed to be related to merger likelihood were tested using logistic regression analysis. DATA COLLECTION: See Data Sources/Study Setting. PRINCIPAL FINDINGS: The analysis shows that the likelihood of a merger between a particular pair of hospitals is positively related to the degree of market overlap that exists between them. Furthermore, market overlap and performance difference interact in their effect on merger likelihood. In an analysis of individual hospitals, conditions of rivalry, hospital market share, and hospital size were not found to influence the likelihood that a hospital will engage in a merger. CONCLUSIONS: Mergers between hospitals are not driven directly by considerations of market power or efficiency as much as by the existence of specific merger opportunities in the hospitals' local markets. Market overlap is a condition that enables a merger to occur, but other factors, such as the relative performance levels of the hospitals in question and their ownership and teaching status, also play a role in influencing the likelihood that a merger will in fact take place. PMID

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

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 relationship between nutritional status and physical function, admission frequency, length of hospital stay, and mortality in old people living in long-term care facilities.

PubMed

Lin, Sin-Jie; Hwang, Shinn-Jang; Liu, Chieh-Yu; Lin, Hung-Ru

2012-06-01

Nutrition is an important issue for elderly residents of long-term care facilities (LTCFs). About 20% of elderly LTCF residents in Taiwan are malnourished. This study investigated correlations between nutritional status and physical function, admission frequency, hospitalstay duration, and mortality in elderly LTCF residents. Researchers used a retrospective study design and convenient sampling to enroll 174 subjects aged 67 to 105 years (average, 82.5 years) who were living in legally registered LTCFs in Beitou District, Taipei City, Taiwan. A review of LTCF resident files provided data on subjects' demographics, physical examination laboratory results for the most recent 1-year period, anthropometry, physical function, admission frequency, hospital stay duration, and causes of admissions. Subjects had lived in their LTCF for more than 1 year before their enrollment date. Subjects who died during and after the study period were also included in analysis. Results showed significant changes over the study year in subjects' nutritional status, physical function, and calf circumference. Physical function was found significantly correlated with calf circumference, hospitalization status was found correlated with nasal-gastric tube feeding status, and eating pattern was found correlated with calf circumference and levels of both serum albumin and cholesterol. Nutritional status, calf circumference, albumin level, and cholesterol level also correlated significantly with hospitalization status. In this study, the likelihood of hospitalization increased with age and nasal-gastric tube feeding use. Hospital stay duration for subjects receiving nasal-gastric tube feeding was longer than that for those receiving oral feeding. Also, weak nutritional status scores for calf circumference and hemoglobin levels were factors associated with increased mortality risk. Findings recommend that greater attention should be paid to the nutritional status of elderly persons living in LTCFs

[Changes in nutritional status of patients with different diseases during hospitalization].

PubMed

Cui, H Y; Zhu, M W; Wei, J M; Chen, W; Yang, X; Zhu, S N

2017-04-01

Objective: To evaluate changes in nutritional status of hospitalized patients with different diseases by subjective global assessment (SGA) and nutritional risk screening (NRS-2002). Methods: A prospective and parallel research done by multi-center collaboration from 34 hospitals in China from June to September 2014. Hospitalized patients with the following diseases were investigated: malignant tumor (2 487 cases), benign disease of the digestive system (1 358 cases), benign disease of the nervous system (1 043 cases), benign bone disease (451 cases), benign disease of the respiratory system(395 cases), cardiovascular disease (227 cases), benign thyroid and breast disease (179 cases), and endocrine disease (149 cases). Patients above the age of 18 and hospitalization time between 7-30 days were included. Physical indexes were measured, the NRS-2002 and SGA scores were recorded, the nutritional support were recorded during hospitalization and 24 hours after discharge from hospital. Measurement data between groups were analyzed using t test or Wilcoxon rank sum test, enumeration data and ranked data between groups were analyzed using chi-square test or Fisher exact test. Results: There were 6 638 cases of hospitalized patients, 3 861 cases were males and 2 777 were females, the male/female ratio was 1.4∶1.0; the median age was 60 years; the median height was 1.66 m; the median weight was 62 kg; the median body mass index (BMI)was 22.89 kg/m(2). At discharge, compared with that of admission, the body weight, BMI, grip strength, upper arm and calf circumferences of patients with malignant tumor were significantly decreased ( t =20.15-259.67, all P <0.01); the body weight and calf circumference were significantly decreased ( t =35.27, 60.40, P <0.01)of patients with digestive benign disease; the body weight of patients with benign bone diseases was decreased ( t =2.12, P =0.033); the body weight, grip strength and upper arm circumference were decreased in patients

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.

Hospitalization patterns associated with Appalachian coal mining.

PubMed

Hendryx, Michael; Ahern, Melissa M; Nurkiewicz, Timothy R

2007-12-01

The goal of this study was to test whether the volume of coal mining was related to population hospitalization risk for diseases postulated to be sensitive or insensitive to coal mining by-products. The study was a retrospective analysis of 2001 adult hospitalization data (n = 93,952) for West Virginia, Kentucky, and Pennsylvania, merged with county-level coal production figures. Hospitalization data were obtained from the Health Care Utilization Project National Inpatient Sample. Diagnoses postulated to be sensitive to coal mining by-product exposure were contrasted with diagnoses postulated to be insensitive to exposure. Data were analyzed using hierarchical nonlinear models, controlling for patient age, gender, insurance, comorbidities, hospital teaching status, county poverty, and county social capital. Controlling for covariates, the volume of coal mining was significantly related to hospitalization risk for two conditions postulated to be sensitive to exposure: hypertension and chronic obstructive pulmonary disease (COPD). The odds for a COPD hospitalization increased 1% for each 1462 tons of coal, and the odds for a hypertension hospitalization increased 1% for each 1873 tons of coal. Other conditions were not related to mining volume. Exposure to particulates or other pollutants generated by coal mining activities may be linked to increased risk of COPD and hypertension hospitalizations. Limitations in the data likely result in an underestimate of associations.