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Sample records for affairs medical hospital

  1. Helping safeguard Veterans Affairs' hospital buildings by advanced earthquake monitoring

    USGS Publications Warehouse

    Kalkan, Erol; Banga, Krishna; Ulusoy, Hasan S.; Fletcher, Jon Peter B.; Leith, William S.; Blair, James L.

    2012-01-01

    In collaboration with the U.S. Department of Veterans Affairs (VA), the National Strong Motion Project of the U.S. Geological Survey has recently installed sophisticated seismic systems that will monitor the structural integrity of hospital buildings during earthquake shaking. The new systems have been installed at more than 20 VA medical campuses across the country. These monitoring systems, which combine sensitive accelerometers and real-time computer calculations, are capable of determining the structural health of each structure rapidly after an event, helping to ensure the safety of patients and staff.

  2. Surgery, Hospitals, and Medications

    MedlinePlus

    ... products that are not commonly stocked in hospital pharmacies. Examples include: Salagen ® , Evoxac ® , and Restasis ® Eye drops, ... prescription and OTC medications/products in their labeled pharmacy container or packaging. This is important in case ...

  3. Assessing Hospital Disaster Readiness Over Time at the US Department of Veterans Affairs.

    PubMed

    Der-Martirosian, Claudia; Radcliff, Tiffany A; Gable, Alicia R; Riopelle, Deborah; Hagigi, Farhad A; Brewster, Pete; Dobalian, Aram

    2017-02-01

    Introduction There have been numerous initiatives by government and private organizations to help hospitals become better prepared for major disasters and public health emergencies. This study reports on efforts by the US Department of Veterans Affairs (VA), Veterans Health Administration, Office of Emergency Management's (OEM) Comprehensive Emergency Management Program (CEMP) to assess the readiness of VA Medical Centers (VAMCs) across the nation. Hypothesis/Problem This study conducts descriptive analyses of preparedness assessments of VAMCs and examines change in hospital readiness over time.

  4. [Suggestions for buying medical equipment in hospitals].

    PubMed

    Trontzos, Christos

    2004-01-01

    TO THE EDITOR: Both in Greece and in other European countries there are plans to buy more medical equipment. If the whole procedure is not effective, it may result to a large deficit in the hospital budget. The total hospital deficit now in Greece is about 2.5 billion euros. It is suggested that in every hospital, the Authorized Committee for Medical Equipment Purchasing, should include the following: One Director of a Medical Department related to the equipment to be bought and another Director of a Medical Department, unrelated. One accountant. One legal advisor specialized in hospital affairs. One economical advisor specialized in banking who will be able to suggest leasing or other means of financing the purchase of the relevant equipment. A cost accounting analysis described by a detailed report, should be provided to secure that the equipment to be bought should be cost-effective and leaving a reasonable surplus after not more than 10 years from the time it is installed. Finally, the possibility of using one expensive equipment to cover the needs of more than one hospitals either by moving the equipment (i.e. the PET/CT camera by a large vehicle) or by transferring the patients to a central hospital, may be provided by the above Authorized Committee.

  5. Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center

    PubMed Central

    Detweiler, Mark B.; Pagadala, Bhuvaneshwar; Candelario, Joseph; Boyle, Jennifer S.; Detweiler, Jonna G.; Lutgens, Brian W.

    2016-01-01

    The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0–6.0 mg), clonidine (63%, 0.1–2.0 mg), quetiapine (50%, 12.5–800.0 mg), mirtazapine (50%; 7.5–30.0 mg), and terazosin (64%, 50.0–300.0 mg). Notably, olanzapine (2.5–10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares. PMID:27999253

  6. Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center.

    PubMed

    Detweiler, Mark B; Pagadala, Bhuvaneshwar; Candelario, Joseph; Boyle, Jennifer S; Detweiler, Jonna G; Lutgens, Brian W

    2016-12-16

    The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0-6.0 mg), clonidine (63%, 0.1-2.0 mg), quetiapine (50%, 12.5-800.0 mg), mirtazapine (50%; 7.5-30.0 mg), and terazosin (64%, 50.0-300.0 mg). Notably, olanzapine (2.5-10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares.

  7. Female genital mutilation. Council on Scientific Affairs, American Medical Association.

    PubMed

    1995-12-06

    Female genital mutilation is the medically unnecessary modification of female genitalia. Female genital mutilation typically occurs at about 7 years of age, but mutilated women suffer severe medical complications throughout their adult lives. Female genital mutilation most frequently occurs in Africa, the Middle East, and Muslim parts of Indonesia and Malaysia, and it is generally part of a ceremonial induction into adult society. Recent political and economic problems in these regions, however, have increased the numbers of students and refugees to the United States. Consequently, US physicians are treating an increasing number of mutilated patients. The Council on Scientific Affairs recommends that US physicians join the World Health Organization, the World Medical Association, and other major health care organizations in opposing all forms of medically unnecessary surgical modification of the female genitalia.

  8. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Hospital care and medical services in foreign countries. 17.35 Section 17.35 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries §...

  9. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Hospital care and medical services in foreign countries. 17.35 Section 17.35 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries §...

  10. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Hospital care and medical services in foreign countries. 17.35 Section 17.35 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries §...

  11. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Hospital care and medical services in foreign countries. 17.35 Section 17.35 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries §...

  12. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Hospital care and medical services in foreign countries. 17.35 Section 17.35 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries §...

  13. Status of Faculty Affairs and Faculty Development Offices in U.S. Medical Schools.

    ERIC Educational Resources Information Center

    Morahan, Page S.; Gold, Jennifer S.; Bickel, Janet

    2002-01-01

    Surveyed faculty affairs personnel at U.S. medical schools. Found that schools support over four times as many offices of faculty affairs as faculty development. Core functions of faculty affairs offices include administrative support for appointments, promotions, and tenure committees; faculty information and policies; faculty governance…

  14. Medication safety during your hospital stay

    MedlinePlus

    Five-rights - medication; Medication administration - hospital; Medical errors - medication; Patient safety - medication safety ... Medication safety means you get the right medicine, the right dose, at the right times. During your ...

  15. Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA): preauthorization of durable medical equipment. Final rule.

    PubMed

    2009-07-01

    This document amends the Department of Veterans Affairs (VA) medical regulations for the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) preauthorization section by increasing the dollar ceiling for purchase or rental of durable medical equipment (DME) from $300 to $2,000.

  16. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities...

  17. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities...

  18. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities...

  19. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities...

  20. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities...

  1. Measuring physicians' productivity in a Veterans' Affairs Medical Center.

    PubMed

    Coleman, David L; Moran, Eileen; Serfilippi, Delchi; Mulinski, Paul; Rosenthal, Ronnie; Gordon, Bruce; Mogielnicki, R Peter

    2003-07-01

    The mission of the Department of Veterans Affairs includes patient care, education, research, and backup to the Department of Defense. Because the measurement of physicians' productivity must reflect both institutional goals and market forces, the authors designed a productivity model that uses measures of clinical workload and academic activities commensurate with the VA's investments in these activities. The productivity model evaluates four domains of physicians' activity: clinical work, education, research, and administration. Examples of the application of the productivity model in the evaluation of VA-paid physician-staff and in the composition of contracts for clinical services are provided. The proposed model is a relatively simple strategy for measuring a broad range of the work of academic physicians in VA medical centers. The model provides incentives for documentation of resident supervision and participation in administrative activities required for effective and efficient clinical care. In addition, the model can aid in determining resource distribution among clinical services and permits comparison with non-VA health care systems. A strategy for modifying the model to incorporate measures of quality of clinical care, research, education, and administration is proposed. The model has been a useful part of the process to ensure the optimum use of resources and to meet clinical and academic institutional goals. The activities and accomplishments used to define physician productivity will have a substantial influence on the character of the medical profession, the vitality of medical education and research, and the cost and quality of health care.

  2. 78 FR 55671 - Hospital Care and Medical Services for Camp Lejeune Veterans

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AO78 Hospital Care and Medical Services for Camp Lejeune Veterans AGENCY...) proposes to amend its regulations to implement a statutory mandate that VA provide health care to certain... January 1, 1957, and ending on December 31, 1987. The law requires VA to furnish hospital care and...

  3. Relationships between Drug Company Representatives and Medical Students: Medical School Policies and Attitudes of Student Affairs Deans and Third-Year Medical Students

    ERIC Educational Resources Information Center

    Sierles, Frederick; Brodkey, Amy; Cleary, Lynn; McCurdy, Frederick A.; Mintz, Matthew; Frank, Julia; Lynn, Deborah Joanne; Chao, Jason; Morgenstern, Bruce; Shore, William; Woodard, John

    2009-01-01

    Objectives: The authors sought to ascertain the details of medical school policies about relationships between drug companies and medical students as well as student affairs deans' attitudes about these interactions. Methods: In 2005, the authors surveyed deans and student affairs deans at all U.S. medical schools and asked whether their schools…

  4. Medical practice, procedure manuals and the standardisation of hospital death.

    PubMed

    Hadders, Hans

    2009-03-01

    This paper examines how death is managed in a larger regional hospital within the Norwegian health-care. The central focus of my paper concerns variations in how healthcare personnel enact death and handle the dead patient. Over several decades, modern standardised hospital death has come under critique in the western world. Such critique has resulted in changes in the standardisation of hospital deaths within Norwegian health-care. In the wake of the hospice movement and with greater focus on palliative care, doors have gradually been opened and relatives of the deceased are now more often invited to participate. I explore how the medical practice around death along with the procedure manual of post-mortem care at Trondheim University Hospital has changed. I argue that in the late-modern context, standardisation of hospital death is a multidimensional affair, embedded in a far more comprehensive framework than the depersonalized medico-legal. In the late-modern Norwegian hospital, interdisciplinary negotiation and co-operation has allowed a number of different agendas to co-exist, without any ensuing loss of the medical power holder's authority to broker death. I follow Mol's notion of praxiographic orientation of the actor-network approach while exploring this medical practice.

  5. Medical tourism private hospitals: focus India.

    PubMed

    Brotman, Billie Ann

    2010-01-01

    This article examines demand factors for sophisticated medical treatments offered by private hospitals operating in India. Three types of medical tourism exist: Outbound, Inbound, and Intrabound. Increased profitability and positive growth trends by private hospital chains can be attributed to rising domestic income levels within India. Not all of the chains examined were financially solvent. Some of the hospital groups in this sample that advertised directly to potential Inbound medical tourists appear to be experiencing negative cash flows.

  6. Evaluation of Outpatient Parenteral Antimicrobial Therapy at a Veterans Affairs Hospital.

    PubMed

    Spivak, Emily Sydnor; Kendall, Brian; Orlando, Patricia; Perez, Christian; De Amorim, Marina; Samore, Matthew; Pavia, Andrew T; Hersh, Adam L

    2015-09-01

    We reviewed outpatient parenteral antimicrobial therapy at a Veterans Affairs Medical Center to identify opportunities for antimicrobial stewardship intervention. A definite or possible modification would have been recommended in 60% of courses. Forty-one percent of outpatient parenteral antimicrobial therapy courses were potentially avoidable, including 22% involving infectious diseases consultation.

  7. Strategic management of Public Hospitals' medical services.

    PubMed

    Hao, Aimin; Yi, Tao; Li, Xia; Wei, Lei; Huang, Pei; Xu, Xinzhou; Yi, Lihua

    2016-01-01

    Purpose: The quality of medical services provided by competing public hospitals is the primary consideration of the public in determining the selection of a specific hospital for treatment. The main objective of strategic planning is to improve the quality of public hospital medical services. This paper provides an introduction to the history, significance, principles and practices of public hospital medical service strategy, as well as advancing the opinion that public hospital service strategy must not merely aim to produce but actually result in the highest possible level of quality, convenience, efficiency and patient satisfaction.

  8. Hospital Contracts: Important Issues for Medical Groups.

    PubMed

    Rosolio, Charles E

    2016-01-01

    Relationships with hospitals and outpatient medical facilities have always been an important part of the business model for private medical practices. As healthcare delivery to patients has evolved in the United States (much of it driven by the new government mandates, regulations, and the Affordable Care Act), the delivery of such services is becoming more and more centered on the hospital or institutional setting, thus making contractual relationships with hospitals even more important for medical practices. As a natural outgrowth of this relationship, attention to hospital contracts is becoming more important.

  9. 38 CFR 17.95 - Outpatient medical services for Department of Veterans Affairs employees and others in emergencies.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Outpatient medical services for Department of Veterans Affairs employees and others in emergencies. Outpatient medical services for which charges shall be made as required by § 17.101 may be authorized for... services for Department of Veterans Affairs employees and others in emergencies. 17.95 Section...

  10. 38 CFR 17.95 - Outpatient medical services for Department of Veterans Affairs employees and others in emergencies.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Outpatient medical services for Department of Veterans Affairs employees and others in emergencies. Outpatient medical services for which charges shall be made as required by § 17.101 may be authorized for... services for Department of Veterans Affairs employees and others in emergencies. 17.95 Section...

  11. 38 CFR 17.95 - Outpatient medical services for Department of Veterans Affairs employees and others in emergencies.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Outpatient medical services for Department of Veterans Affairs employees and others in emergencies. Outpatient medical services for which charges shall be made as required by § 17.101 may be authorized for... services for Department of Veterans Affairs employees and others in emergencies. 17.95 Section...

  12. 38 CFR 17.95 - Outpatient medical services for Department of Veterans Affairs employees and others in emergencies.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Outpatient medical services for Department of Veterans Affairs employees and others in emergencies. Outpatient medical services for which charges shall be made as required by § 17.101 may be authorized for... services for Department of Veterans Affairs employees and others in emergencies. 17.95 Section...

  13. 38 CFR 17.95 - Outpatient medical services for Department of Veterans Affairs employees and others in emergencies.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Outpatient medical services for Department of Veterans Affairs employees and others in emergencies. Outpatient medical services for which charges shall be made as required by § 17.101 may be authorized for... services for Department of Veterans Affairs employees and others in emergencies. 17.95 Section...

  14. Veterans Affairs and Academic Medical Center Affiliations: The North Texas Experience

    ERIC Educational Resources Information Center

    Mohl, Paul Cecil; Hendrickse, William; Orsak, Catherine; Vermette, Heidi

    2009-01-01

    Objective: The authors review the more than 30-year history of the academic affiliation between the Department of Psychiatry at the University of Texas Southwestern Medical Center in Dallas and the Mental Health Service at the Veterans Affairs North Texas Health Care System. Methods: The authors interviewed individuals involved at various stages…

  15. Survival of patients with spinal cord injury after cardiac arrest in Department of Veterans Affairs hospital: Pilot study.

    PubMed

    Caruso, Deborah; Carter, William E; Cifu, David X; Carne, William

    2014-01-01

    Survivability characteristics after cardiopulmonary resuscitation in the population with spinal cord injury (SCI) are unclear but may be useful for advanced care planning discussions with patients. Retrospective evaluation from records of all SCI patients over 10 yr at a Department of Veterans Affairs medical center who experienced in-hospital cardiac arrest was performed. Demographic data and other common measurements were recorded. Thirty-six male subjects were identified, and only two patients survived to discharge (5.5% survival rate), both of whom were admitted for nonacute issues and were asymptomatic shortly before the cardiac arrest. The mean age at the time of cardiopulmonary arrest was 62.4 yr, with a mean time from cardiac arrest to death of 3.02 d. No significant demographic parameters were identified. Overall, SCI likely portends worse outcome for acutely ill patients in the situation of a cardiac arrest. Conclusions are limited by sample size.

  16. Implementing medical teaching policy in university hospitals.

    PubMed

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

    2016-11-16

    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 remained underexplored. Knowledge of these factors is needed to develop theory on the successful implementation of medical teaching policy in university hospitals. To explore factors that influence faculty in making use of teaching policy incentives and to develop a conceptual model for implementation of medical teaching policy in university hospitals. We used the grounded theory methodology. We applied constant comparative analysis to qualitative data obtained from 12 semi-structured interviews conducted at the Radboud University Medical Center. We used a constructivist approach, in which data and theories are co-created through interaction between the researcher and the field and its participants. We constructed a model for the implementation of medical teaching policy in university hospitals, including five factors that were perceived to promote or inhibit faculty in a university hospital to make use of teaching policy incentives: Executive Board Strategy, Departmental Strategy, Departmental Structure, Departmental Culture, and Individual Strategy. Most factors we found to affect individual teachers' strategies and their use of medical teaching policy lie at the departmental level. If an individual teacher's strategy is focused on medical teaching and a medical teaching career, and the departmental context offers support and opportunity for his/her development, this promotes faculty's use of teaching policy incentives.

  17. Conflict of interest issues pertinent to Veterans Affairs Medical Centers.

    PubMed

    Hanna, Jennifer; Simiele, Ernest; Lawson, D Curtis; Tyler, Douglas

    2011-09-01

    Conflicts of interest exist when an arrangement potentially exerts inappropriate influence on decision making or professional judgment, or is perceived to do so, and can thus damage the public trust and undermine the integrity of those decisions. Concerns regarding financial conflicts of interest in the medical arena have reached their height as of late, given that physicians now function in a milieu of complex and delicate relationships with pharmaceutical, biotechnology, and medical device industries. Even when such relationships do not correlate with actual compromise of judgment or patient care, it threatens the credibility of both the health care professional and the institution because of the social perception of the effect of these relationships. Although most institutions in the Western world set forth a code of ethics and conflict-of-interest policies to be followed under threat of termination, the Veterans Health Administration (VHA) presents itself as a unique environment in which conflicts of interest are subject to governmental laws, violation of which may not only result in employment-related discipline, but may be sanctioned by civil and criminal penalties. Moreover, these provisions are developed by a national authoritative organization rather than being institution-specific guidelines. Given that many academic physicians working within the VHA may also have a component of their practice in a University setting, it becomes important to understand the differences in policy between these contexts so as not to threaten the public trust in the veracity of decisions made and, therefore, maintain the integrity of the relationship between physician and patient. This article will review aspects of conflict-of-interest policies in the realm of research, financial relationships, foreign travel, and vendor contracting that are particular to the VHA and make it a unique environment to function in as a physician and scientist.

  18. [Medical clowns at hospitals and their effect on hospitalized children].

    PubMed

    Bornstein, Yossi

    2008-01-01

    Healing by the use of humor has become popular over the last few years and it is used not only in alternative medicine but also in conventional medicine in hospitals all over the world, particularly in the USA and Europe. This practice has been well implemented in pediatric wards. It is easier to make a child laugh than an adult. In the framework of healing by humor, use is made of a medical clown who is in fact a person who has undergone special training in acting and clowning, combined with medical knowledge and an understanding of patient behavior. Some medical clowns come from the world of entertainment, and are actors, clowns, and magicians. Some have a paramedical or medical background. Medical research demonstrates that medical clowns and humor have a positive effect on patients. The implementation of medical clowning has been increasing throughout the world from year to year and has, slowly but surely, started a movement to integrate it into formal frameworks in both pediatric and adult wards in hospitals. However, there is still a necessity to conduct larger, well controlled clinical trials regarding the influence of the different programs. Maybe the growing awareness in the world will fill the void that demands resources of both personnel and budgets, both of which are often missing from health budgets.

  19. Television documentaries lifting hospital, medical center profiles.

    PubMed

    Rees, T

    2001-01-01

    The nation's hospitals and medical centers are enjoying the legacy of TV audiences' addiction to medical dramas. Cable television has met the challenge with documentary coverage of real live hospitals. The medium offers many benefits and few disadvantages for those marketing managers with the courage to welcome camera crews. Lynn Hopkins Cantwell is director of public relations and marketing for Children's National Medical Center, Washington, D.C., which was covered in a seven-instrument "Lifeline" documentary for the Discovery Channel. James G. Gosky is director of communications for The MetroHealth System, Cleveland, which was the subject of two installments of "Trauma: Life in th ER," produced for the Learning Channel. These marketing pros describe the myriad details they faced when their respective hospitals went "on camera." Among the key factors were good communications with all constituents, attention to detail, and follow-up.

  20. Jackson Park Hospital Green Building Medical Center

    SciTech Connect

    Dorsey, William; Vasquez, Nelson

    2010-05-01

    Jackson Park Hospital completed the construction of a new Medical Office Building on its campus this spring. The new building construction has adopted the City of Chicago's recent focus on protecting the environment, and conserving energy and resources, with the introduction of green building codes. Located in a poor, inner city neighborhood on the South side of Chicago, Jackson Park Hospital has chosen green building strategies to help make the area a better place to live and work.

  1. [Use of medication among hospital workers].

    PubMed

    Luz, Tatiana Chama Borges; Luiza, Vera Lucia; Avelar, Fernando Genovez; Hökerberg, Yara Hahr Marques; Passos, Sonia Regina Lambert

    2012-02-01

    Although medication is acknowledged as a key element in treating health problems, there is little information available on the use of medication by hospital workers. To estimate the prevalence and describe the patterns of medication consumption by hospital workers and to identify the factors associated with such consumption in this population, data from the "PROSEC" baseline cohort were analyzed (n=417). The prevalence of overall medication consumption was 72.4%, most of which was for nervous complaints (25.4%), especially analgesics (17.8%). Use of any amount of medication was independently associated with gender, number of medically diagnosed conditions and health problem in the two weeks prior to the interview. Use of a drug was significantly associated with income whereas self-diagnosed health problems were independently related with the use of two or more pharmaceutical products. The high prevalence of medication usage in this population, with analgesics being the most consumed medication, should be seen as a cause for concern, since many consumers are unaware that these products are not exempt from risk. Women and individuals in poor health are the main candidates for intervention programs in order to promote adequate and proper use of these pharmaceutical products.

  2. [Medication errors and medication reconciliation from a hospital pharmacist's perspective].

    PubMed

    Amann, Steffen; Kantelhardt, Pamela

    2012-01-01

    To reduce medication errors and other drug-related problems, their systematic discovery, documentation and evaluation is essential. The web-based documentation database ADKA-DokuPIK enables both the documentation and the publication of annotated individual cases and, moreover, systematic errors or accumulations of risk drugs may be determined. Medication reconciliation is another important component to increase safety in drug therapy. Hospital pharmacists may support and significantly improve this process. In Germany some initial information from various projects is available. Medication reconciliation performed by hospital pharmacists may significantly increase the completeness and accuracy of medication regimens. Patient counselling together with the necessary drug supply at discharge improves patients' knowledge, closes supply gaps and improves the satisfaction of all parties.

  3. Metadata - National Hospital Ambulatory Medical Care Survey (NHAMCS)

    EPA Pesticide Factsheets

    The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect information on the services provided in hospital emergency and outpatient departments and in ambulatory surgery centers.

  4. [The coordination of the forensic medical service with the medical criminology subdivisions of internal affairs organs in the personal identification of unidentified corpses].

    PubMed

    Pashinian, G A; Tuchik, E S

    1997-01-01

    In order to improve the cooperation between medical criminology departments of the organs of home affairs and forensic medical service in personality identification of unidentified corpses, the authors propose amendments to the routine procedure regulated by documents of the Ministry of Home Affairs of the Russian Federation, for these documents are in need of serious correction and revision, so that they conform to the judicial legislation and other documents.

  5. Evaluation of hospital medication inventory policies.

    PubMed

    Gebicki, Marek; Mooney, Ed; Chen, Shi-Jie Gary; Mazur, Lukasz M

    2014-09-01

    As supply chain costs constitute a large portion of hospitals' operating expenses and with $27.7 billion spent by the US hospitals on drugs alone in 2009, improving medication inventory management provides a great opportunity to decrease the cost of healthcare. This study investigates different management approaches for a system consisting of one central storage location, the main pharmacy, and multiple dispensing machines located in each department. Each medication has a specific unit cost, availability from suppliers, criticality level, and expiration date. Event-driven simulation is used to evaluate the performance of several inventory policies based on the total cost and patient safety (service level) under various arrangements of the system defined by the number of drugs and departments, and drugs' criticality, availability, and expiration levels. Our results show that policies that incorporate drug characteristics in ordering decisions can address the tradeoff between patient safety and cost. Indeed, this study shows that such policies can result in higher patient safety and lower overall cost when compared to traditional approaches. Additional insights from this study allow for better understanding of the medication inventory system's dynamics and suggest several directions for future research in this topic. Findings of this study can be applied to help hospital pharmacies with managing their inventory.

  6. Jackson Park Hospital Green Building Medical Center

    SciTech Connect

    William Dorsey; Nelson Vasquez

    2010-03-31

    Jackson Park Hospital completed the construction of a new Medical Office Building on its campus this spring. The new building construction has adopted the City of Chicago's recent focus on protecting the environment, and conserving energy and resources, with the introduction of green building codes. Located in a poor, inner city neighborhood on the South side of Chicago, Jackson Park Hospital has chosen green building strategies to help make the area a better place to live and work. The new green building houses the hospital's Family Medicine Residency Program and Specialty Medical Offices. The residency program has been vital in attracting new, young physicians to this medically underserved area. The new outpatient center will also help to allure needed medical providers to the community. The facility also has areas designated to women's health and community education. The Community Education Conference Room will provide learning opportunities to area residents. Emphasis will be placed on conserving resources and protecting our environment, as well as providing information on healthcare access and preventive medicine. The new Medical Office Building was constructed with numerous energy saving features. The exterior cladding of the building is an innovative, locally-manufactured precast concrete panel system with integral insulation that achieves an R-value in excess of building code requirements. The roof is a 'green roof' covered by native plantings, lessening the impact solar heat gain on the building, and reducing air conditioning requirements. The windows are low-E, tinted, and insulated to reduce cooling requirements in summer and heating requirements in winter. The main entrance has an air lock to prevent unconditioned air from entering the building and impacting interior air temperatures. Since much of the traffic in and out of the office building comes from the adjacent Jackson Park Hospital, a pedestrian bridge connects the two buildings, further

  7. HIV rapid testing in a Veterans Affairs hospital ED setting: a 5-year sustainability evaluation.

    PubMed

    Knapp, Herschel; Hagedorn, Hildi; Anaya, Henry D

    2014-08-01

    Routine HIV testing in primary care settings is now recommended in the United States. The US Department of Veterans Affairs (VA) has increased the number of patients tested for HIV, but overall HIV testing rates in VA remain low. A proven strategy for increasing such testing involves nurse-initiated HIV rapid testing (HIV RT). The purpose of this work was to use a mixed methodology approach to evaluate the 5-year sustainability of an intervention that implemented HIV RT in a VA emergency department setting in a large, urban VA medical center to reduce missed diagnostic and treatment opportunities in this vulnerable patient population. In-person semistructured interviews were conducted with providers and stakeholders. Interview notes were qualitatively coded for emerging themes. Quarterly testing rates were evaluated for a 5-year time span starting from the launch in July 2008. Findings indicate that HIV RT was sustained by the enthusiasm of 2 clinical champions who oversaw the registered nurses responsible for conducting the testing. The departure of the clinical champions was correlated with a substantial drop-off in testing. Findings also indicate potential strategies for improving sustainability including engaging senior leadership in the project, engaging line staff in the implementation planning from the start to increase ownership over the innovation, incorporating information into initial training explaining the importance of the innovation to quality patient care, providing ongoing training to maintain skills, and providing routine progress reports to staff to demonstrate the ongoing impact of their efforts.

  8. Advanced earthquake monitoring system for U.S. Department of Veterans Affairs medical buildings--instrumentation

    USGS Publications Warehouse

    Kalkan, Erol; Banga, Krishna; Ulusoy, Hasan S.; Fletcher, Jon Peter B.; Leith, William S.; Reza, Shahneam; Cheng, Timothy

    2012-01-01

    In collaboration with the U.S. Department of Veterans Affairs (VA), the National Strong Motion Project (NSMP; http://nsmp.wr.usgs.gov/) of the U.S. Geological Survey has been installing sophisticated seismic systems that will monitor the structural integrity of 28 VA hospital buildings located in seismically active regions of the conterminous United States, Alaska, and Puerto Rico during earthquake shaking. These advanced monitoring systems, which combine the use of sensitive accelerometers and real-time computer calculations, are designed to determine the structural health of each hospital building rapidly after an event, helping the VA to ensure the safety of patients and staff. This report presents the instrumentation component of this project by providing details of each hospital building, including a summary of its structural, geotechnical, and seismic hazard information, as well as instrumentation objectives and design. The structural-health monitoring component of the project, including data retrieval and processing, damage detection and localization, automated alerting system, and finally data dissemination, will be presented in a separate report.

  9. To name the Department of Veterans Affairs medical center in Spokane, Washington, as the "Mann-Grandstaff Department of Veterans Affairs Medical Center".

    THOMAS, 112th Congress

    Rep. McMorris Rodgers, Cathy [R-WA-5

    2011-10-13

    12/21/2012 Received in the Senate and Read twice and referred to the Committee on Veterans' Affairs. (All Actions) Tracker: This bill has the status Passed HouseHere are the steps for Status of Legislation:

  10. Health Care Practices for Medical Textiles in Government Hospitals

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  11. [The Medical Collections of Milan major hospital].

    PubMed

    Galimberti, Paolo M

    2009-01-01

    This essay shows the uncommon occurrence of collections developed in a Hospital. In the past centuries the obstetrical gynaecological (since 18th Century) and anatomical collections (since 1829) were oriented to medical education, while the Pharmacy had a rich equipment. In the first half of 20th century, a Museum open to the public was planned, but the second World War and the absence of interest induce the loss of a large part of the materials. Since 2002 we had censed, collected, and listed the historical instruments, and in 2005 we realized a permanent exhibition. The collections combine about 1500 items. We have especial care to save also modern objects and equipments, after they are disused. At last we hope to realize a real Museum, and we search to assume peculiarities, goals, strength, potentials users, custom.

  12. A bill to name the Department of Veterans Affairs medical center in Waco, Texas, as the "Doris Miller Department of Veterans Affairs Medical Center".

    THOMAS, 113th Congress

    Sen. Cornyn, John [R-TX

    2014-03-13

    03/13/2014 Read twice and referred to the Committee on Veterans' Affairs. (text of measure as introduced: CR S1656) (All Actions) Notes: For further action, see H.R.4199, which became Public Law 113-256 on 12/18/2014. Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  13. 33 CFR 5.59 - Medical treatment and hospitalization.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Medical treatment and hospitalization. 5.59 Section 5.59 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY GENERAL COAST GUARD AUXILIARY § 5.59 Medical treatment and hospitalization. When any member of...

  14. 33 CFR 5.59 - Medical treatment and hospitalization.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Medical treatment and hospitalization. 5.59 Section 5.59 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY GENERAL COAST GUARD AUXILIARY § 5.59 Medical treatment and hospitalization. When any member of...

  15. Public Hospital Reform and the Principal Roles of Medical Staff.

    PubMed

    Zhang, Peiying

    2015-05-01

    During the reform of public hospitals, medical staff's enthusiasm and participation must be mobilized. In the positive factors, such as benefit, power, reputation, humanistic concern and satisfaction evaluation, benefit stands at the core position, power and reputation guides the medical staff's enthusiasm, and humanistic concern and satisfaction evaluation guarantees the enthusiasm of medical staff. By the institutionalized settings of benefit, power, reputation, and other factors, medical staffs of Xuzhou Central Hospital have been effectively mobilized, the development of hospital operates well, and the function of ensuring people health level regionally is further developed.

  16. Comparison of advance medical directive inquiry and documentation for hospital inpatients in three medical services: implications for policy changes.

    PubMed

    Anunobi, Echezona; Detweiler, Mark B; Sethi, Roopa; Thomas, Reena; Lutgens, Brian; Detweiler, Jonna G

    2015-01-01

    Following the introduction of the Patient Self-Determination Act of 1990, the Veterans Health Administration developed its own advance medical directive (AMD) policy, which most recently states that documentation is mandatory for all hospital patients in all settings. The object of this study was to assess the effectiveness of AMD documentation at a local Veterans Affairs Medical Center. AMD documentation was compared among three inpatient services: surgery, medicine, and psychiatry. Retrospective in nature, 594 inpatient cases were compared. Results revealed that, overall, the rate of AMD documentation was 37.7%. AMD documentation on surgery was statistically more frequent (45.6%) than for either medicine (33.2%) or psychiatry (34.5%). The difference between the numbers of days to AMD documentation for all three services was not statistically significant. While there was no statistically significant difference across gender, Caucasians had AMDs documented more frequently than African Americans (p < .001). Logistic regression reveals that social worker and physician intervention, not patient-specific variables, are the primary predictors of AMD incidence. Policy makers may need to consider the realities of hospital care, especially in emergency settings, and be more specific in the steps of implementation of the policy in the evenings, weekends, and holidays. True adherence to policy implementation may require hospital administrators to increase staff and educational efforts so that the concept of AMD communication and documentation is completely explained to all staff and patients. Policy should include an electronic record reminder that is renewed every 3 years and provisions for accommodating patients who arrive on weekends and holidays, with special awareness of the particular communication needs of minority groups. The study conclusions are that further inquiry is needed to understand these policy nuances to enable the Veterans Affairs Administration to

  17. A Medication Safety Model: A Case Study in Thai Hospital

    PubMed Central

    Rattanarojsakul, Phichai; Thawesaengskulthai, Natcha

    2013-01-01

    Reaching zero defects is vital in medication service. Medication error can be reduced if the causes are recognized. The purpose of this study is to search for a conceptual framework of the causes of medication error in Thailand and to examine relationship between these factors and its importance. The study was carried out upon an in-depth case study and survey of hospital personals who were involved in the drug use process. The structured survey was based on Emergency Care Research Institute (ECRI) (2008) questionnaires focusing on the important factors that affect the medication safety. Additional questionnaires included content to the context of Thailand's private hospital, validated by five-hospital qualified experts. By correlation Pearson analysis, the result revealed 14 important factors showing a linear relationship with drug administration error except the medication reconciliation. By independent sample t-test, the administration error in the hospital was significantly related to external impact. The multiple regression analysis of the detail of medication administration also indicated the patient identification before administration of medication, detection of the risk of medication adverse effects and assurance of medication administration at the right time, dosage and route were statistically significant at 0.05 level. The major implication of the study is to propose a medication safety model in a Thai private hospital. PMID:23985110

  18. Unit Cost of Medical Services at Different Hospitals in India

    PubMed Central

    Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

    2013-01-01

    Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates

  19. Knowledge of healthcare professionals about medication errors in hospitals

    PubMed Central

    Abdel-Latif, Mohamed M. M.

    2016-01-01

    Context: Medication errors are the most common types of medical errors in hospitals and leading cause of morbidity and mortality among patients. Aims: The aim of the present study was to assess the knowledge of healthcare professionals about medication errors in hospitals. Settings and Design: A self-administered questionnaire was distributed to randomly selected healthcare professionals in eight hospitals in Madinah, Saudi Arabia. Subjects and Methods: An 18-item survey was designed and comprised questions on demographic data, knowledge of medication errors, availability of reporting systems in hospitals, attitudes toward error reporting, causes of medication errors. Statistical Analysis Used: Data were analyzed with Statistical Package for the Social Sciences software Version 17. Results: A total of 323 of healthcare professionals completed the questionnaire with 64.6% response rate of 138 (42.72%) physicians, 34 (10.53%) pharmacists, and 151 (46.75%) nurses. A majority of the participants had a good knowledge about medication errors concept and their dangers on patients. Only 68.7% of them were aware of reporting systems in hospitals. Healthcare professionals revealed that there was no clear mechanism available for reporting of errors in most hospitals. Prescribing (46.5%) and administration (29%) errors were the main causes of errors. The most frequently encountered medication errors were anti-hypertensives, antidiabetics, antibiotics, digoxin, and insulin. Conclusions: This study revealed differences in the awareness among healthcare professionals toward medication errors in hospitals. The poor knowledge about medication errors emphasized the urgent necessity to adopt appropriate measures to raise awareness about medication errors in Saudi hospitals. PMID:27330261

  20. Hospital and medical staff strategic planning: developing an integrated approach.

    PubMed

    Zuckerman, A M

    1994-08-01

    The physician as the principal customer of the hospital is a relatively new concept, indicative of the shift to a more complete market orientation in strategic planning. Although medical staff and medical community dynamics receive increasing attention in strategic planning, much more sophistication is now needed to involve physicians constructively in strategic planning for the hospital and medical staff. While full consonance of physician and hospital plans may be achievable only in a completely integrated delivery system, there is considerable room for improvement in current organizational models.

  1. The contribution of hospital library services to continuing medical education.

    PubMed

    Gluck, Jeannine Cyr

    2004-01-01

    Much of the literature relating to continuing medical education programs laments the lack of effectiveness of traditional lecture-based format, the most often used method of presentation in hospitals. A gap exists between the content taught in lectures and the application of that knowledge in actual patient care. The services of the medical librarian, already employed in most hospitals, can help ameliorate this problem. Further, libraries help to support quality improvement efforts. These three functions (library services, continuing medical education, and quality improvement) are interdependent. Each lends strength to the other, and, ideally, all are coordinated within the hospital structure.

  2. Medical staff appointment and delineation of pediatric privileges in hospitals.

    PubMed

    Rauch, Daniel A

    2012-04-01

    The review and verification of credentials and the granting of clinical privileges are required of every hospital to ensure that members of the medical staff are competent and qualified to provide specified levels of patient care. The credentialing process involves the following: (1) assessment of the professional and personal background of each practitioner seeking privileges; (2) assignment of privileges appropriate for the clinician's training and experience; (3) ongoing monitoring of the professional activities of each staff member; and (4) periodic reappointment to the medical staff on the basis of objectively measured performance. We examine the essential elements of a credentials review for initial and renewed medical staff appointments along with suggested criteria for the delineation of clinical privileges. Sample forms for the delineation of privileges can be found on the American Academy of Pediatrics Committee on Hospital Care Web site (http://www.aap.org/visit/cmte19.htm). Because of differences among individual hospitals, no 1 method for credentialing is universally applicable. The medical staff of each hospital must, therefore, establish its own process based on the general principles reviewed in this report. The issues of medical staff membership and credentialing have become very complex, and institutions and medical staffs are vulnerable to legal action. Consequently, it is advisable for hospitals and medical staffs to obtain expert legal advice when medical staff bylaws are constructed or revised.

  3. Prevention of venous thromboembolism in the hospitalized medical patient.

    PubMed

    Jaffer, Amir K; Amin, Alpesh N; Brotman, Daniel J; Deitelzweig, Steven B; McKean, Sylvia C; Spyropoulos, Alex C

    2008-04-01

    Hospitalized acutely ill medical patients are at high risk for venous thromboembolism (VTE), and clinical trials clearly demonstrate that pharmacologic prophylaxis of VTE for up to 14 days significantly reduces the incidence of VTE in this population. Guidelines recommend use of low-molecular-weight heparin (LMWH) or unfractionated heparin (5,000 U three times daily) for VTE prophylaxis in hospitalized medical patients with risk factors for VTE; in patients with contraindications to anticoagulants, mechanical prophylaxis is recommended. All hospitalized medical patients should be assessed for their risk of VTE at admission and daily thereafter, and those with reduced mobility and one or more other VTE risk factors are candidates for aggressive VTE prophylaxis. Based on results from the recently reported EXCLAIM trial, extended postdischarge prophylaxis with LMWH for 28 days should be considered for hospitalized medical patients with reduced mobility who are older than age 75 or have a cancer diagnosis or a history of VTE.

  4. International travel as medical research: architecture and the modern hospital.

    PubMed

    Logan, Cameron; Willis, Julie

    2010-01-01

    The design and development of the modern hospital in Australia had a profound impact on medical practice and research at a variety of levels. Between the late 1920s and the 1950s hospital architects, administrators, and politicians travelled widely in order to review the latest international developments in the hospital field They were motivated by Australia's geographic isolation and a growing concern with how to govern the population at the level of physical health. While not 'medical research' in the conventional sense of the term, this travel was a powerful generator of medical thinking in Australia and has left a rich archival legacy. This paper draws on that archive to demonstrate the ways in which architectural research and international networks of hospital specialists profoundly shaped the provision of medical infrastructure in Australia.

  5. A qualitative framework to assess hospital / medical websites.

    PubMed

    Rafe, Vahid; Monfaredzadeh, Maryam

    2012-10-01

    Nowadays, there are many peoples who access to the internet to search for a proper hospital with their desired medical services. Hence, the website quality of hospitals or medical centers is very important to help patients/users. However, to design high qualitative medical websites, we should first know the medical quality metrics. Then, we should try to find a way to assess different medical websites based on the quality metrics. In fact, medical websites may have a significant role to increase the society's knowledge about people health, provided services for patients etc. Thus, it is necessary to design a framework to evaluate the quality of these websites. Even though there are many medical websites, unfortunately, there are a few studies about quality analysis of medical/hospital websites. In this paper, we propose a qualitative framework to assess different medical websites. The proposed framework consists of 7 main categories, each having different metrics. Finally, to show how these metrics can help designers to assess the websites quality, we have considered 3 different hospitals as case studies. We asked different people including doctors, website designers, and usual peoples to evaluate our defined metrics on each case study. At the end, the results are shown through different charts.

  6. Hospital medical waste management in Shandong Province, China.

    PubMed

    Gai, Ruoyan; Kuroiwa, Chushi; Xu, Lingzhong; Wang, Xingzhou; Zhang, Yufei; Li, Huijuan; Zhou, Chengchao; He, Jiangjian; Tang, Wei

    2009-06-01

    Medical waste refers to those hazardous waste materials generated by healthcare activities, including a broad range of materials, and remains as an issue on both public health and environment. In China, there was inadequate information on the implementation of management systems in hospitals based on the national regulatory framework. The objectives of this study were to assess the current situation of medical waste management and to identify factors determining the implementation of a management system based on the national regulatory framework in hospitals. We investigated 23 general hospitals in both urban and rural areas of Shandong Province, China, by both quantitative and qualitative approaches. The medical waste generation rate was 0.744, 0.558 and 1.534 kg bed(-1) day(-1) in tertiary hospitals, urban secondary hospitals and county hospitals, respectively. There is a wide disparity between implementation in tertiary, secondary and county hospitals. With increasing financial, technological, and materials investment, a management system has been established in tertiary and secondary hospitals. Financial support and administrative monitoring by the government is urgently needed to build a sound management system in hospitals located at remote and less-developed areas. In those areas issues in the financial, administrative and technical aspects should be further examined.

  7. Nurses' medication administration practices at two Singaporean acute care hospitals.

    PubMed

    Choo, Janet; Johnston, Linda; Manias, Elizabeth

    2013-03-01

    This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design.

  8. Maximizing Financial Resources in Veterinary Medical Teaching Hospitals.

    ERIC Educational Resources Information Center

    Walker, Terry S.

    1979-01-01

    The University of California at Davis Veterinary Medical Teaching Hospital created a healthier environment with inexpensive business procedures. Reported are: removal of billing responsibilities from faculty, separation of discharge functions from receptionist's functions, billing system/medical records system, and use of credit cards and…

  9. [University teaching hospitals hold primacy in graduate medical education].

    PubMed

    Jaspers, Fr C A

    2006-07-01

    The university teaching hospitals are legally commissioned for the development and implementation of the initial medical training for doctors and for the training of specialist registrars, i.e. graduate medical education. They are able to carry out this task partly due to the professionals' collective sense of ambition and a strongly focussed organization that has the necessary critical mass at its disposal.

  10. An academic hospitalist model to improve healthcare worker communication and learner education: Results from a quasi-experimental study at a veterans affairs medical center

    PubMed Central

    Saint, Sanjay; Fowler, Karen E; Krein, Sarah L; Flanders, Scott A; Bodnar, Timothy W; Young, Eric; Moseley, Richard H

    2013-01-01

    BACKGROUND Although hospitalists may improve efficiency and quality of inpatient care, their effect on healthcare-worker communication and education has been less well-studied. OBJECTIVE To test various approaches to improving healthcare-worker communication and learner education within the context of a newly designed academic hospital medicine program. DESIGN Before-and-after design with concurrent control group. SETTING A Midwestern Veterans Affairs medical center. INTERVENTION Multimodal systems redesign of 1 of 4 medical teams (Gold team) that included clinical modifications (change in rounding structure, with inclusion of nurses, a Clinical Care Coordinator, and a pharmacist) and educational interventions (providing explicit expectations of learners and providing a reading list for both learners and attending physicians). MEASUREMENTS Number of admissions, length of stay, readmissions, house officer and medical student ratings of attendings' teaching, medical student internal medicine National Board of Medical Examiners Subject Examination (“shelf” exam) scores, and clinical staff surveys. RESULTS Length of stay was reduced by about 0.3 days on all teams after the initiative began (P = 0.004), with no significant differences between Gold and non-Gold teams. The majority of physicians (83%) and nurses (68%) felt that including nurses during rounds improved healthcare-worker communication; significantly more nurses were satisfied with communication with the Gold team than with the other teams (71% vs 53%; P = 0.02). Gold attendings generally received higher teaching scores compared with non-Gold attendings, and third-year medical students on the Gold team scored significantly higher on the shelf exam compared with non–Gold team students (84 vs 82; P = 0.006). CONCLUSIONS Academic hospitalists working within a systems redesign intervention were able to improve healthcare-worker communication and enhance learner education without increasing

  11. Medical waste production at hospitals and associated factors.

    PubMed

    Cheng, Y W; Sung, F C; Yang, Y; Lo, Y H; Chung, Y T; Li, K-C

    2009-01-01

    This study was conducted to evaluate the quantities of medical waste generated and the factors associated with the generation rate at medical establishments in Taiwan. Data on medical waste generation at 150 health care establishments were collected for analysis in 2003. General medical waste and infectious waste production at these establishments were examined statistically with the potential associated factors. These factors included the types of hospital and clinic, reimbursement payment by National Health Insurance, total number of beds, bed occupancy, number of infectious disease beds and outpatients per day. The average waste generation rates ranged from 2.41 to 3.26kg/bed/day for general medical wastes, and 0.19-0.88kg/bed/day for infectious wastes. The total average quantity of infectious wastes generated was the highest from medical centers, or 3.8 times higher than that from regional hospitals (267.8 vs. 70.3Tons/yr). The multivariate regression analysis was able to explain 92% of infectious wastes and 64% of general medical wastes, with the amount of insurance reimbursement and number of beds as significant prediction factors. This study suggests that large hospitals are the major source of medical waste in Taiwan. The fractions of medical waste treated as infectious at all levels of healthcare establishments are much greater than that recommended by the USCDC guidelines.

  12. Medical museum, 2nd surgical hospital.

    PubMed

    Hawk, Alan J

    2013-12-01

    When his unit, the 2nd Surgical Hospital (MA), was established at An Khe in January 1966, MAJ Rich began collecting retrieved foreign bodies along with documentation of the wound. A museum displaying these objects was established at one end of the operating room Quonset hut. During Rich's tour of duty, there were 324 cases where the patient was wounded by a punji stick, representing 38% wounds because of hostile action.

  13. [Improvement of medical equipment setting for the hospital link of the medical service during wartime].

    PubMed

    Miroshnichenko, Yu V; Goryachev, A B; Popov, A A; Rodionov, E O

    2016-04-01

    One of the priorities of the military health care is to improve the system of rationing medical equipment for the hospital unit of the medical service of the Armed Forces in wartime. This is determined the fact that the effectiveness of measures to provide military field hospitals with medical supplies depends on the quality of medical care for the wounded and sick, as well as the level of their return to duty. The article presents the characteristics of modern standards medical supplies procurement of military field hospitals included in the new regulatory legal act of the Russian Federation Ministry of Defence--"Standards of supplies medical supplies medical and pharmaceutical organizations (units) of the Russian Federation on the wartime armed forces", approved and put into effect in 2015 by order of the Minister of Defence of the Russian Federation.

  14. Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress

    PubMed Central

    Mayer, Stephanie B.; Levy, James R.; Farrell-Carnahan, Leah; Nichols, Michelle G.; Raman, Shekar

    2016-01-01

    Study Objectives: This cross-sectional study aimed to characterize sleep patterns, the quality and duration of sleep, and estimate the prevalence of common sleep disorders and posttraumatic stress disorder (PTSD) in a hospital-based Veterans Affairs MOVE! (Managing Overweight Veterans Everywhere) clinic. Methods: Participants completed five instruments: the Pittsburgh Sleep Quality Index (PSQI), Smith's Measure of Morningness/Eveningness, Restless Legs Syndrome Rating Scale, the STOP Questionnaire, and the Posttraumatic Stress Disorder (PTSD) Checklist – Civilian Version (PCL-C). Results: Enrolled Veterans (n = 96) were mostly male (78%), African American (49%), mean age 58 (standard deviation [SD] 10.6) years, and mean body mass index (BMI) 38.4 kg/m2 (SD 8.4). By PSQI, 89% rated sleep quality as “poor” (mean = 11.1, SD = 5.1), consistent with severely impaired sleep. Most were at high risk for sleep disorders including restless leg syndrome (53%), obstructive sleep apnea (66%), and circadian sleep disorders (72%). Forty-seven percent endorsed clinically significant symptoms of PTSD. Hypotheses-generating regression models suggest sleep latency (minutes before falling asleep) was associated with BMI (p = 0.018). Bedtime, getting up time, hours of sleep, waking up in the middle of the night or early morning, having to get up to use the bathroom, inability to breathe comfortably, cough or snore loudly, feeling too cold or too hot, having bad dreams, pain, and frequency of having trouble sleeping, were not significantly associated with BMI. Conclusions: Our cross-sectional study suggests that sleep difficulties are common among Veterans referred to a weight loss program at a Veterans Affairs Hospital. Controlled studies are needed to investigate whether the results are generalizable and whether obesity among veterans is a risk factor for sleep disorders and PTSD. Commentary: A commentary on this article appears in this issue on page 943. Citation: Mayer SB

  15. Hospital care and medical services for Camp Lejeune veterans. Final rule.

    PubMed

    2014-09-24

    This document amends Department of Veterans Affairs (VA) regulations in order to implement a statutory mandate that VA provide health care to certain veterans who served at Camp Lejeune, North Carolina, for at least 30 days during the period beginning on January 1, 1957, and ending on December 31, 1987. The law requires VA to furnish hospital care and medical services for these veterans for certain illnesses and conditions that may be attributed to exposure to toxins in the water system at Camp Lejeune. This rule does not implement the statutory provision requiring VA to provide health care to these veterans' family members; regulations applicable to such family members will be promulgated through a separate notice.

  16. Medication Reconciliation in Patients Hospitalized in a Cardiology Unit

    PubMed Central

    Magalhães, Gabriella Fernandes; Santos, Gláucia Beisl Noblat de Carvalho; Rosa, Mário Borges; Noblat, Lúcia de Araújo Costa Beisl

    2014-01-01

    Objectives To compare drugs prescribed on hospital admission with the list of drugs taken prior to admission for adult patients admitted to a cardiology unit and to identify the role of a pharmacist in identifying and resolving medication discrepancies. Method This study was conducted in a 300 bed university hospital in Brazil. Clinical pharmacists taking medication histories and reconciling medications prescribed on admission with a list of drugs used prior to admission. Discrepancies were classified as justified (e.g., based on the pharmacotherapeutic guidelines of the hospital studied) or unintentional. Treatments were reviewed within 48 hours following hospitalization. Unintentional discrepancies were further classified according to the categorization of medication error severity. Pharmacists verbally contacted the prescriber to recommend actions to resolve the discrepancies. Results A total of 181 discrepancies were found in 50 patients (86%). Of these discrepancies, 149 (82.3%) were justified changes to the patient's home medication regimen; however, 32 (17.7%) discrepancies found in 24 patients were unintentional. Pharmacists made 31 interventions and 23 (74.2%) were accepted. Among unintentional discrepancies, the most common was a different medication dose on admission (42%). Of the unintentional discrepancies 13 (40.6%) were classified as error without harm, 11 (34.4%) were classified as error without harm but which could affect the patient and require monitoring, 3 (9.4%) as errors could have resulted in harm and 5 (15.6%) were classified as circumstances or events that have the capacity to cause harm. Conclusion The results revealed a high number of unintentional discrepancies and the pharmacist can play an important role by intervening and correcting medication errors at a hospital cardiology unit. PMID:25531902

  17. The Impact of Medical Tourism on Thai Private Hospital Management: Informing Hospital Policy

    PubMed Central

    James, Paul TJ

    2012-01-01

    Background: The purpose of this paper is to help consolidate and understand management perceptions and experiences of a targeted group (n=7) of Vice-Presidents of international Private Thai hospitals in Bangkok regarding medical tourism impacts. Methods: The method adopted uses a small-scale qualitative inquiry. Examines the on-going development and service management factors which contribute to the establishment and strengthening of relationships between international patients and hospital medical services provision. Develops a qualitative model that attempts to conceptualise the findings from a diverse range of management views into a framework of main (8) - Hospital Management; Hospital Processes; Hospital Technology; Quality Related; Communications; Personnel; Financial; and Patients; and consequent sub-themes (22). Results: Outcomes from small-scale qualitative inquiries cannot by design be taken outside of its topical arena. This inevitably indicates that more research of this kind needs to be carried out to understand this field more effectively. The evidence suggests that Private Thai hospital management have established views about what constitutes the impact of medical tourism on hospital policies and practices when hospital staff interact with international patients. Conclusions: As the private health service sector in Thailand continues to grow, future research is needed to help hospitals provide appropriate service patterns and appropriate medical products/services that meet international patient needs and aspirations. Highlights the increasing importance of the international consumer in Thailand’s health industry. This study provides insights of private health service providers in Bangkok by helping to understand more effectively health service quality environments, subsequent service provision, and the integrated development and impacts of new medical technology. PMID:22980119

  18. Medical Image distribution and visualization in a hospital using CORBA.

    PubMed

    Moreno, Ramon Alfredo; do Santos, Marcelo; Bertozzo, Nivaldo; de Sa Rebelo, Marina; Furuie, Sergio S; Gutierrez, Marco A

    2008-01-01

    In this work it is presented the solution adopted by the Heart Institute (InCor) of Sao Paulo for medical image distribution and visualization inside the hospital's intranet as part of the PACS system. A CORBA-based image server was developed to distribute DICOM images across the hospital together with the images' report. The solution adopted allows the decoupling of the server implementation and the client. This gives the advantage of reusing the same solution in different implementation sites. Currently, the PACS system is being used on two different hospitals each one with three different environments: development, prototype and production.

  19. THE HOSPITAL MEDICAL ADVISORY COMMITTEE--THE CABINET OF THE MEDICAL STAFF.

    PubMed

    WILLIAMS, K J; OSBALDESTON, J B

    1965-05-22

    Before a hospital medical staff can realistically accept responsibility for the professional practices of its members, a principle initially fostered by the American College of Surgeons and adopted by both the Canadian and American accreditation programs, it must have an effectively functioning medical staff organization. The medical advisory committee is the most important committee of the medical staff organization. A representative composition, adherence to sound administrative principles, and recognition of its prime functions of co-ordination, supervision and jurisdiction will permit this committee-and the total medical staff organization-to discharge adequately the very important responsibilities delegated to them by the governing board of the hospital. Properly structured medical staff bylaws with clearly defined terms of reference assist the smooth functioning of the "cabinet" of the medical staff and safeguard the prerogatives of the individual members of the staff.

  20. The Impact of VA and Navy Hospital Collaboration on Medical School Education

    ERIC Educational Resources Information Center

    Atre-Vaidya, Nutan; Ross, Arthur, III; Sandu, Ioana C.; Hassan, Tariq

    2009-01-01

    Objective: The U.S. Department of Veterans Affairs (VA) is the largest single provider of medical education in the United States and is often the preferred training site for medical students and residents. However, changing priorities of patients and the marketplace are forcing medical schools and the VA to consider new ways of practicing medicine…

  1. Costs of Venous Thromboembolism Associated with Hospitalization for Medical Illness

    PubMed Central

    Cohoon, Kevin P.; Leibson, Cynthia L.; Ransom, Jeanine E.; Ashrani, Aneel A.; Petterson, Tanya M.; Long, Kirsten Hall; Bailey, Kent R.; Heit, John A.

    2015-01-01

    Objective To determine population-based estimates of medical costs attributable to venous thromboembolism (VTE) among patients currently or recently hospitalized for acute medical illness. Study Design Population-based cohort study conducted in Olmsted County, Minn. Methods Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County, MN residents with objectively-diagnosed incident VTE within 92 days of hospitalization for acute medical illness over the 18-year period, 1988–2005 (n=286). One Olmsted County resident hospitalized for medical illness without VTE was matched to each case on event date (± 1 year), duration of prior medical history and active cancer status. Subjects were followed forward in REP provider-linked billing data for standardized, inflation-adjusted direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before their respective event or index date to the earliest of death, emigration from Olmsted County, or 12/31/2011 (study end date). We censored follow-up such that each case and match control had similar periods of observation. We also controlled for length of follow-up from index to up to 5-years post-index. We used generalized linear modeling (controlling for age, sex, pre-existing conditions and costs 1 year before index) to predict costs for cases and controls. Results Adjusted mean predicted costs were 2.5-fold higher for cases ($62,838) than for controls ($24,464) (P=<0.001) from index to up to 5-years post-index. Cost differences between cases and controls were greatest within the first 3 months after the event date (mean difference=$16,897) but costs remained significantly higher for cases compared to controls for up to 3 years. Conclusions VTE during or after recent hospitalization for medical illness contributes a substantial economic burden. PMID:26244788

  2. Medical Information Management System (MIMS): An automated hospital information system

    NASA Technical Reports Server (NTRS)

    Alterescu, S.; Simmons, P. B.; Schwartz, R. A.

    1971-01-01

    An automated hospital information system that handles all data related to patient-care activities is described. The description is designed to serve as a manual for potential users, nontechnical medical personnel who may use the system. Examples of the system's operation, commentary on the examples, and a complete listing of the system program are included.

  3. [Integration of activities of regional hospitals and territorial medical institutions].

    PubMed

    Murtazin, Z Ia; Blokhin, A B

    2000-01-01

    Medical and economic efficiency of regional therapeutic and prophylactic institutions is to develop in integration with therapeutic and prophylactic institutions of administrative territories of a subject of the federation, which necessitates modifications in the functions and organizational structure of organization and methodology departments of regional, central, and municipal hospitals.

  4. Characterization of medical waste from hospitals in Tabriz, Iran.

    PubMed

    Taghipour, Hassan; Mosaferi, Mohammad

    2009-02-15

    Medical waste has not received enough attention in recent decades in Iran, as is the case in most economically developing countries. Medical waste is still handled and disposed of together with domestic waste, creating great health risks to health-care stuff, municipal workers, the public, and the environment. A fundamental prerequisite for the successful implementation of any medical waste management plan is the availability of sufficient and accurate information about the quantities and composition of the waste generated. The objectives of this study were to determine the quantity, generation rate, quality, and composition of medial waste generated in the major city northwest of Iran in Tabriz. Among the 25 active hospitals in the city, 10 hospitals of different size, specializations, and categories (i.e., governmental, educational, university, private, non-governmental organization (NGO), and military) were selected to participate in the survey. Each hospital was analyzed for a week to capture the daily variations of quantity and quality. The results indicated that the average (weighted mean) of total medical waste, hazardous-infectious waste, and general waste generation rates in Tabriz city is 3.48, 1.039 and, 2.439 kg/bed-day, respectively. In the hospital waste studied, 70.11% consisted of general waste, 29.44% of hazardous-infectious waste, and 0.45% of sharps waste (total hazardous-infectious waste 29.89%). Of the maximum average daily medical waste, hazardous-infectious waste, and general waste were associated with N.G.O and private hospitals, respectively. The average composition of hazardous-infectious waste was determined to be 35.72% plastics, 20.84% textiles, 16.70% liquids, 11.36% paper/cardboard, 7.17% glass, 1.35% sharps, and 6.86% others. The average composition of general waste was determined to be 46.87% food waste, 16.40% plastics, 13.33% paper/cardboard, 7.65% liquids, 6.05% textiles, 2.60% glass, 0.92% metals, and 6.18% others. The average

  5. Post-hospital medical respite care and hospital readmission of homeless persons.

    PubMed

    Kertesz, Stefan G; Posner, Michael A; O'Connell, James J; Swain, Stacy; Mullins, Ashley N; Shwartz, Michael; Ash, Arlene S

    2009-01-01

    Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This article examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital.

  6. [Hospital response and medical management in toxic chemical substance disasters].

    PubMed

    Yeh, I-Jeng; Lin, Tzeng-Jih

    2010-06-01

    A hazardous material is defined as any item or agent which has the potential to cause harm to humans, animals, or the environment, either by itself or through interaction with other factors. Toxic chemical substance events are increasingly common events in our modern world. The numerous variables and special equipment involved make effective response to toxic chemical events an especially critical test of hospital emergency response and patient rescue mechanisms. Inadequacies in management could result in disaster - even when only a simple event and minimal error are involved. This article introduces the general medical management algorithm for toxic chemical substance injury and the hospital incident command systems (HICS) developed and currently used by Taiwanese hospitals. Important steps and frequent mistakes made during medical management procedures are further described. The goal of medical care response and emergency units is to prevent catastrophic disasters in the emergency room and their subsequent results. This article further emphasizes correct patient management not only in terms of medical unit effort, but also in terms of cooperation between various relevant organizations including factory-based industrial health and safety systems, multi-factory union defense systems, coordination centers, fire protection and disaster rescue systems, the Environmental Protection Administration and national defense system in order to achieve the most appropriate management. Such coordination, in particular, requires reinforcement in order to ensure readiness for future response needs.

  7. 38 CFR 17.45 - Hospital care for research purposes.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... research purposes. 17.45 Section 17.45 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes... of Veterans Affairs research project and there are insufficient veteran-patients suitable for...

  8. 38 CFR 17.45 - Hospital care for research purposes.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... research purposes. 17.45 Section 17.45 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes... of Veterans Affairs research project and there are insufficient veteran-patients suitable for...

  9. 38 CFR 17.45 - Hospital care for research purposes.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... research purposes. 17.45 Section 17.45 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes... of Veterans Affairs research project and there are insufficient veteran-patients suitable for...

  10. 38 CFR 17.45 - Hospital care for research purposes.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... research purposes. 17.45 Section 17.45 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes... of Veterans Affairs research project and there are insufficient veteran-patients suitable for...

  11. Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

    PubMed

    Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

    2016-01-01

    The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

  12. 78 FR 54766 - Federal Plan Requirements for Hospital/Medical/Infectious Waste Incinerators Constructed On or...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-06

    .../Medical/Infectious Waste Incinerators Constructed On or Before December 1, 2008, and Standards of Performance for New Stationary Sources: Hospital/Medical/Infectious Waste Incinerators Correction In...

  13. 38 CFR 1.514 - Disclosure to private physicians and hospitals other than Department of Veterans Affairs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., or treatment as is requested, including the loan of original X-ray films, whether Department of Veterans Affairs clinical X-rays or service department entrance and separation X-rays, provided there...

  14. 38 CFR 1.514 - Disclosure to private physicians and hospitals other than Department of Veterans Affairs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., or treatment as is requested, including the loan of original X-ray films, whether Department of Veterans Affairs clinical X-rays or service department entrance and separation X-rays, provided there...

  15. 38 CFR 1.514 - Disclosure to private physicians and hospitals other than Department of Veterans Affairs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., or treatment as is requested, including the loan of original X-ray films, whether Department of Veterans Affairs clinical X-rays or service department entrance and separation X-rays, provided there...

  16. 38 CFR 1.514 - Disclosure to private physicians and hospitals other than Department of Veterans Affairs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., or treatment as is requested, including the loan of original X-ray films, whether Department of Veterans Affairs clinical X-rays or service department entrance and separation X-rays, provided there...

  17. 38 CFR 1.514 - Disclosure to private physicians and hospitals other than Department of Veterans Affairs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., or treatment as is requested, including the loan of original X-ray films, whether Department of Veterans Affairs clinical X-rays or service department entrance and separation X-rays, provided there...

  18. Pharmacist Staffing, Technology Use, and Implementation of Medication Safety Practices in Rural Hospitals

    ERIC Educational Resources Information Center

    Casey, Michelle M.; Moscovice, Ira S.; Davidson, Gestur

    2006-01-01

    Context: Medication safety is clearly an important quality issue for rural hospitals. However, rural hospitals face special challenges implementing medication safety practices in terms of their staffing and financial and technical resources. Purpose: This study assessed the capacity of small rural hospitals to implement medication safety…

  19. 78 FR 72581 - Direct Final Approval of Hospital/Medical/Infectious Waste Incinerator Negative Declaration for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-03

    ... AGENCY 40 CFR Part 62 Direct Final Approval of Hospital/Medical/Infectious Waste Incinerator Negative... negative declarations from Michigan and Wisconsin regarding Hospital/Medical/ Infectious Waste Incinerator... combusts any amount of hospital waste and/or medical/infectious waste. The designated facilities to...

  20. Harnessing Protocolized Adaptation in Dissemination: Successful Implementation and Sustainment of the Veterans Affairs Coordinated-Transitional Care (C-TraC) Program in a Non- Veterans Affairs Hospital

    PubMed Central

    Kind, Amy J.H.; Brenny-Fitzpatrick, Maria; Leahy-Gross, Kris; Mirr, Jacquelyn; Chapman, Elizabeth; Frey, Brooke; Houlahan, Beth

    2015-01-01

    The low-cost, primarily phone-based Coordinated-Transitional Care (C-TraC) program reduced 30-day rehospitalizations by 1/3, leading to significant cost savings at one VA hospital. Non-VA hospitals have expressed interest in launching C-TraC, but non-VA hospitals differ in important ways from VA hospitals, particularly in terms of context, culture and resources. The objective of this project was to successfully adapt C-TraC to the specific context of one non-VA setting using a modified Replicating Effective Programs (REP) implementation theory model, and to test the feasibility of this protocolized implementation approach. The modified-REP model 1) uses a mentored phased-based implementation with intensive pre-implementation activities, and 2) harnesses local key stakeholders to adapt processes and goals to local context. Using this protocolized implementation approach, an adapted C-TraC protocol was created and launched at the non-VA hospital in July 2013. In its first 16 months, C-TraC successfully enrolled 1,247 patients with 3.2 full-time nurse case managers, achieving good fidelity for core protocol steps. C-TraC patients experienced a 30-day rehospitalization rate of 10.8%, as compared to 16.6% for a contemporary comparison group of similar patients for whom C-TraC was not available (n=1,307) [p-value < 0.001]. The new C-TraC program continues in operation to this day. In conclusion, use of a modified REP model to guide protocolized adaptation to local context resulted in a C-TraC program that was feasible and sustained in a real-world non-VA setting. A modified-REP implementation framework may be an appropriate foundational step for other clinical programs seeking to harness protocolized adaptation in mentored dissemination activities. PMID:26804896

  1. [The early medical textbooks in Korea: medical textbooks published at Je Joong Won-Severance Hospital Medical School].

    PubMed

    Park, H W

    1998-01-01

    Kwang Hye Won(Je Joong Won), the first western hospital in Korea, was founded in 1885. The first western Medical School in Korea was open in 1886 under the hospital management. Dr. O. R. Avison, who came to Korea in 1893, resumed the medical education there, which was interrupted for some time before his arrival in Korea. He inaugurated translating and publishing medical textbooks with the help of Kim Pil Soon who later became one of the first seven graduates in Severance Hospital Medical School. The first western medical textbook translated into Korean was Henry Gray's Anatomy. However, these twice-translated manuscripts were never to be published on account of being lost and burnt down. The existing early anatomy textbooks, the editions of 1906 and 1909, are not the translation of Gray's Anatomy, but that of Japanese anatomy textbook of Gonda. The remaining oldest medical textbook in Korean is Inorganic Materia Medica published in 1905. This book is unique among its kind that O. R. Avison is the only translator of the book and it contains the prefaces of O. R. Avison and Kim Pil Soon. The publication of medical textbook was animated by the participation of other medical students, such as Hong Suk Hoo and Hong Jong Eun. The list of medical textbooks published includes almost all the field of medicine. The medical textbooks in actual existence are as follows: Inorganic Materia Medica (1905), Inorganic Chemistry (1906), Anatomy I (1906), Physiology (1906), Diagnostics I (1906), Diagnostics II (1907), Obstetrics (1908), Organic Chemistry (1909), Anatomy (1909), and Surgery (1910).

  2. Food safety. Federal inspection programs. Council on Scientific Affairs, American Medical Association.

    PubMed

    1993-02-01

    Concern about the safety of the US food supply has stimulated criticism of the present system for assuring safe food in American markets. This report was prepared in response to resolutions introduced at the American Medical Association House of Delegates' December 1990 Interim Meeting. The resolutions requested the AMA to study the plans and procedures needed to improve the federal inspection of meat, poultry, and shellfish. To put these issues into perspective, an overview of food safety is presented. This report is not intended, however, to be a broad review of the Food and Drug Administration's and the US Department of Agriculture's responsibilities for food safety.

  3. Medical Eschatologies: The Christian Spirit of Hospital Protocol.

    PubMed

    Langford, Jean M

    2016-01-01

    If much has been written of the forms of bodiliness reinforced by hospitals, less attention has been paid to the medicalization of the soul. The medical management of death institutionalizes divisions between body and soul, and matter and spirit, infusing end-of-life care with latent Christian theological presumptions. The invisibility of these presumptions is partly sustained by projecting religiosity on those who endorse other cosmologies, while retaining for medicine a mask of secular science. Stories of conflict with non-Christian patients force these presumptions into visibility, suggesting alternative ethics of care and mourning rooted in other understandings. In this article, I explore one such story. Considering the story as an allegory for how matter and spirit figure in contemporary postmortem disciplines, I suggest that it exposes both the operation of a taboo against mixing material and spiritual agendas, and an assumption that appropriate mourning is oriented toward symbolic homage, rather than concern for the material welfare of the dead.

  4. Military to civilian questionnaire: a measure of postdeployment community reintegration difficulty among veterans using Department of Veterans Affairs medical care.

    PubMed

    Sayer, Nina A; Frazier, Patricia; Orazem, Robert J; Murdoch, Maureen; Gravely, Amy; Carlson, Kathleen F; Hintz, Samuel; Noorbaloochi, Siamak

    2011-12-01

    The primary objective of this study was to describe the development, reliability, and construct validity of scores on the Military to Civilian Questionnaire (M2C-Q), a 16-item self-report measure of postdeployment community reintegration difficulty. We surveyed a national, stratified sample of 1,226 Iraq and Afghanistan veterans who used U.S. Department of Veterans Affairs (VA) medical care; 745 completed the M2C-Q and validated mental health screening measures. All analyses were based on weighted estimates. The internal consistency of the M2C-Q was .95 in this sample. Factor analyses indicated a single total score was the best-fitting model. Total scores were associated with measures theoretically related to reintegration difficulties including perception of overall difficulty readjusting back into civilian life (R(2) = .49), probable PTSD (d = 1.07), probable problem drug or alcohol use (d = 0.34), and overall mental health (r = -.83). Subgroup analyses revealed a similar pattern of findings in those who screened negative for PTSD. Nonwhite and unemployed veterans reported greater community reintegration difficulty (d = 0.20 and 0.45, respectively). Findings offer preliminary support for the reliability and construct validity of M2C-Q scores.

  5. Medical affairs in the Far East after V-J day. A personal view.

    PubMed

    Girdwood, R H

    1995-06-01

    The invasion of Singapore and Malaya was delayed because of the reduction in the period of service in the Far East. The atom bombs were then dropped and plans for all services including medical ones had to be altered, their main aim becoming the treatment and repatriation of surviving prisoners of war. The ending of the war did not occur abruptly on V-J day; many Japanese troops had to be convinced that the war was over. Meantime the treatment of diseases in British and other service men continued; reference is made to some experiences in Rangoon. The morale of personnel who now were anxious to return to their homes was low and efforts were made to raise their spirits. In India it was accepted that the days of British rule were over.

  6. Fiscal strain and access to opiate substitution therapy at Department of Veterans Affairs Medical Centers.

    PubMed

    Rosenheck, Robert; Leslie, Douglas; Woody, George

    2003-01-01

    This study examines the relationship between institutional fiscal strain and the availability of opiate substitution therapy (eg, methadone maintenance), an effective but relatively expensive treatment for heroin addiction. An observational design was used to examine the association of changes in funding and changes in provision for treating opiate addiction at 29 VA Medical Centers (VAMCs). We hypothesized that VAMCs experiencing greater fiscal strain would show reduced availability of opiate substitution treatment. Administrative records from each of 29 VAMCs that provided opiate substitution therapy in both Fiscal Year (FY) 1995 and FY 1999 were used to measure changes in the availability of this service, ie, the percent change in total patients treated, annual visits per patient, and total services delivered. Institutional fiscal strain was measured by the percent decline in per capita funding at four levels at each VAMC: the entire medical center, all mental health programs, all substance abuse programs (inpatient and outpatient), and outpatient substance abuse programs alone. The total number of patients receiving opiate substitution increased from 5,549 in FY 1995 to 6,884 in FY 1999 (24%), annual visits per patient decreased by 16%, and the total number of units of services increased by 4%. There were no significant relationships between changes in the delivery of opiate substitution services and changes in per capita funding at any of the four institutional levels. No new programs were started during these years. Although no new programs were started, the availability of opiate substitution therapy at VA facilities with existing programs was maintained over a five-year period regardless of local funding changes, although at somewhat reduced intensity.

  7. Framework for preventing accidental falls in hospitals - management plan for ADL, medication and medical conditions.

    PubMed

    Kato, Shogo; Tsuru, Satoko; Iizuka, Yoshinori

    2009-01-01

    Prevention and reduction of medical accidents is essential. Among medical accidents, accidental falls remain a serious problem. While "assessment score sheets" have already been used in hospitals to prevent accidental falls, satisfactory results have not actually been achieved. In this study, we aim to establish a methodology for preventing accidental falls. We consider that the 'management plan' for each patient includes three factors. A plan of instructions for patients on actions they can take for safety in their ADL (Activities of Daily Living) is essential as a base. Second, a plan to keep up with any short term change in a patient's state is needed, because the state of a hospitalized patient will usually be temporarily affected by medication and changing medical conditions. We develop a model for preventing accidental falls, which enable us to design appropriate management plan for each patient. Then, we develop a prototype system based on the designed model. Finally, we address the result of verification of the model, by applying the prototype system into actual cases in hospitals.

  8. POLICE STATION LOOKING SOUTH WEST, HOSPITAL BUILDING IN BACKGROUND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    POLICE STATION LOOKING SOUTH WEST, HOSPITAL BUILDING IN BACKGROUND - New York State Soldiers & Sailors Home, Police and Voluntary Service, Department of Veterans Affairs Medical Center, 76 Veterans Avenue, Bath, Steuben County, NY

  9. 14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... assignment, for hospital emergency medical evacuation service helicopter operations unless that assignment... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Helicopter hospital emergency...

  10. 14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... assignment, for hospital emergency medical evacuation service helicopter operations unless that assignment... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Helicopter hospital emergency...

  11. 14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... assignment, for hospital emergency medical evacuation service helicopter operations unless that assignment... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Helicopter hospital emergency...

  12. 14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... assignment, for hospital emergency medical evacuation service helicopter operations unless that assignment... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Helicopter hospital emergency...

  13. 14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... assignment, for hospital emergency medical evacuation service helicopter operations unless that assignment... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Helicopter hospital emergency...

  14. 38 CFR 14.518 - Litigation involving beneficiaries in custody of Department of Veterans Affairs employees acting...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Director of a Department of Veterans Affairs hospital concerned advises that, according, to current medical... action will be taken unless so instructed by the General Counsel. (2) If the medical opinion is that... writ is so informed and will abide by the court's decision. (3) If the medical opinion is that there...

  15. 38 CFR 14.518 - Litigation involving beneficiaries in custody of Department of Veterans Affairs employees acting...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Director of a Department of Veterans Affairs hospital concerned advises that, according, to current medical... action will be taken unless so instructed by the General Counsel. (2) If the medical opinion is that... writ is so informed and will abide by the court's decision. (3) If the medical opinion is that there...

  16. 38 CFR 14.518 - Litigation involving beneficiaries in custody of Department of Veterans Affairs employees acting...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Director of a Department of Veterans Affairs hospital concerned advises that, according, to current medical... action will be taken unless so instructed by the General Counsel. (2) If the medical opinion is that... writ is so informed and will abide by the court's decision. (3) If the medical opinion is that there...

  17. Factor structure of the SOCRATES questionnaire in hospitalized medical patients

    PubMed Central

    Bertholet, Nicolas; Dukes, Kim; Horton, Nicholas J.; Palfai, Tibor P.; Pedley, Alison; Saitz, Richard

    2009-01-01

    The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), a 19-item instrument developed to assess readiness to change alcohol use among individuals presenting for specialized alcohol treatment, has been used in various populations and settings. Its factor structure and concurrent validity has been described for specialized alcohol treatment settings and primary care. The purpose of this study was to determine the factor structure and concurrent validity of the SOCRATES among medical inpatients with unhealthy alcohol use not seeking help for specialized alcohol treatment. The subjects were 337 medical inpatients with unhealthy alcohol use, identified during their hospital stay. Most of them had alcohol dependence (76%). We performed an Alpha Factor Analysis (AFA) and Principal Component Analysis (PCA) of the 19 SOCRATES items, and forced 3 factors and 2 components, in order to replicate findings from Miller & Tonigan (1996) and Maisto et al (1999). Our analysis supported the view that the 2 component solution proposed by Maisto et al (1999) is more appropriate for our data than the 3 factor solution proposed by Miller & Tonigan (1996). The first component measured Perception of Problems and was more strongly correlated with severity of alcohol related consequences, presence of alcohol dependence, and alcohol consumption levels (average number of drinks per day and total number of binge drinking days over the past 30 days)compared to the second component measuring Taking Action. Our findings support the view that the SOCRATES is comprised of two important readiness constructs in general medical patients identified by screening PMID:19395177

  18. Management evaluation about introduction of electric medical record in the national hospital organization.

    PubMed

    Nakagawa, Yoshiaki; Tomita, Naoko; Irisa, Kaoru; Yoshihara, Hiroyuki; Nakagawa, Yoshinobu

    2013-01-01

    Introduction of Electronic Medical Record (EMR) into a hospital was started from 1999 in Japan. Then, most of all EMR company said that EMR improved efficacy of the management of the hospital. National Hospital Organization (NHO) has been promoting the project and introduced EMR since 2004. NHO has 143 hospitals, 51 hospitals offer acute-phase medical care services, the other 92 hospitals offer medical services mainly for chronic patients. We conducted three kinds of investigations, questionnaire survey, checking the homepage information of the hospitals and analyzing the financial statements of each NHO hospital. In this financial analysis, we applied new indicators which have been developed based on personnel costs. In 2011, there are 44 hospitals which have introduced EMR. In our result, the hospital with EMR performed more investment of equipment/capital than personnel expenses. So, there is no advantage of EMR on the financial efficacy.

  19. The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight

    DTIC Science & Technology

    2013-09-18

    Master Sharing Agreement (MSA) and Joint Policies governing claims and reimbursement between Department of Veterans Affairs (VA) and DoD for health ...timely reimbursement for health care services provided. Specifically, the MSA and Joint Policies did not comply with DoD Regulations, deliver an...to review the reimbursement policy ; and Assistant Secretary of Defense ( Health Affairs) require the DoD/VA Program Coordination Office present the

  20. [Pharmaceuticals and Medical Devices Agency (PMDA)'s new action for Pharmaceutical Affairs Consultation on Research and Development (R&D) Strategy].

    PubMed

    Masuyama, Koichi

    2013-01-01

    Universities, research institutions, and venture capitals that possess promising "seed" research or technologies in Japan, are not always familiar with development strategies that lead to commercialization of the products in spite of their excellent science and research. In order to create innovative pharmaceuticals and medical devices originating from Japan, Pharmaceuticals and Medical Devices Agency (PMDA) launched new scientific consultation service, named 'Pharmaceutical Affairs Consultation on R&D Strategy' for universities, research institutions, and venture capitals on July 1, 2011. Through these consultations, the guidance and advice on the tests needed in the early development stage and the necessary clinical trials would be provided toward commercialization.

  1. Patient Perceptions of Provider and Hospital Factors Associated With New Medication Communication.

    PubMed

    Bartlett Ellis, Rebecca J; Bakoyannis, Giorgos; Haase, Joan E; Boyer, Kiersten; Carpenter, Janet S

    2016-09-01

    This research examined provider and hospital factors associated with patients' perceptions of how often explanations of new medications were "always" given to them, using Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. HCAHPS results were obtained for October 2012 to September 2013, from 3,420 hospitals and combined with a Magnet-designated hospital listing. Multiple regression examined correlates of new medication communication, including health care provider factors (perceptions of nurse and physician communication) and health care system factors (magnet designation, hospital ownership, hospital type, availability of emergency services, and survey numbers). Nurse and physician communication was strongly associated with new medication communication (r = .819, p < .001; r = .722, p < .001, respectively). Multivariable correlates included nurse communication (p < .001), physician communication (p < .001), hospital ownership, availability of emergency services, and survey numbers. There was a significant relationship between patients' perceptions of nurse and physician communication and the explanations they had received about their new medications during hospitalization.

  2. Linking Community Hospital Initiatives With Osteopathic Medical Students' Quality Improvement Training: A Pilot Program.

    PubMed

    Brannan, Grace D; Russ, Ronald; Winemiller, Terry R; Mast, Eric

    2016-01-01

    Quality improvement (QI) continues to be a health care challenge, and the literature indicates that osteopathic medical students need more training. To qualify for portions of managed care reimbursement, hospitals are required to meet measures intended to improve quality of care and patient satisfaction, which may be challenging for small community hospitals with limited resources. Because osteopathic medical training is grounded on community hospital experiences, an opportunity exists to align the outcomes needs of hospitals and QI training needs of students. In this pilot program, 3 sponsoring hospitals recruited and mentored 1 osteopathic medical student each through a QI project. A mentor at each hospital identified a project that was important to the hospital's patient care QI goals. This pilot program provided osteopathic medical students with hands-on QI training, created opportunities for interprofessional collaboration, and contributed to hospital initiatives to improve patient outcomes.

  3. [Historical origins between National Medical Association of China and Boji Hospital in Guangzhou].

    PubMed

    Liu, Pinming

    2015-09-01

    In 2015, National Medical Association of China, now being called the Chinese Medical Association, celebrates its centennial and Boji Hospital in Guangzhou ( also known as Canton Hospital, or the Canton Pok Tsai Hospital, and now Sun Yat-sen Memorial Hospital of Sun Yat-sen University ) marks its 180th anniversary. Three major historical events establish the role of Boji Hospital in the founding and development of the National Medical Association of China during the last 100 years, viz.: ①hosting and participating in the establishment of the Medical Missionary Association of China and its official journal: the China Medical Missionary Journal; ②holding the 11th scientific sessions of the National Medical Association of China; ③nominating Dr. Wu Lien-teh as a candidate for the Nobel Prize in Physiology or Medicine in 1935 by William Warder Cadbury, the president of Boji Hospital.

  4. A study of medication errors in a tertiary care hospital

    PubMed Central

    Patel, Nrupal; Desai, Mira; Shah, Samdih; Patel, Prakruti; Gandhi, Anuradha

    2016-01-01

    Objective: To determine the nature and types of medication errors (MEs), to evaluate occurrence of drug-drug interactions (DDIs), and assess rationality of prescription orders in a tertiary care teaching hospital. Materials and Methods: A prospective, observational study was conducted in General Medicine and Pediatric ward of Civil Hospital, Ahmedabad during October 2012 to January 2014. MEs were categorized as prescription error, dispensing error, and administration error (AE). The case records and treatment charts were reviewed. The investigator also accompanied the staff nurse during the ward rounds and interviewed patients or care taker to gather information, if necessary. DDIs were assessed by Medscape Drug Interaction Checker software (version 4.4). Rationality of prescriptions was assessed using Phadke's criteria. Results: A total of 1109 patients (511 in Medicine and 598 in Pediatric ward) were included during the study period. Total number of MEs was 403 (36%) of which, 195 (38%) were in Medicine and 208 (35%) were in Pediatric wards. The most common ME was PEs 262 (65%) followed by AEs 126 (31%). A potential significant DDIs were observed in 191 (17%) and serious DDIs in 48 (4%) prescriptions. Majority of prescriptions were semirational 555 (53%) followed by irrational 317 (30%), while 170 (17%) prescriptions were rational. Conclusion: There is a need to establish ME reporting system to reduce its incidence and improve patient care and safety. PMID:27843792

  5. Hospital financial audit of medical equipment maintenance: a case study.

    PubMed

    Baumeister, J

    1987-01-01

    Maintenance expense is becoming an area of importance in the business of health care. Methods for identification and determination of both types and amounts of expenses have also become important. This paper is a case study of one institution's total medical equipment maintenance expense, during the 1985/86 fiscal year. During this time, the total hospital medical maintenance expense was $683,614: of which $238,008 (34.8%) was salary; $85,858 (12.6%) was parts; $77,083 (11.3%) was contracts; $48,230 (7.1%) was service; $123,572 (18.1%) was X-ray tubes; $91,260 (13.3%) was maintenance insurance; $14,479 (2.1%) was for training; $1,212 (0.2%) was for operating expenses; and $3,912 (0.6%) was the 10-year amortized test-equipment expense. The maintenance-expense/acquisition-cost ratio was 4.36%. Arguments are presented on the need to obtain expense data that have some comparative value to other institutions and on developing benchmarks to be utilized in evaluating acceptable levels of expense.

  6. 76 FR 2761 - Proposed Information Collection (Department of Veterans Affairs Acquisition Regulations Clause...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-14

    ... AFFAIRS Proposed Information Collection (Department of Veterans Affairs Acquisition Regulations Clause 852.... Veterans Affairs Acquisition Regulation Clauses 852.237-7, Indemnification and Medical Liability Insurance. b. Veterans Affairs Acquisition Regulation Clauses 852.237-71, Indemnification and Insurance....

  7. Nursing, Pharmacy, and Prescriber Knowledge and Perceptions of High-Alert Medications in a Large, Academic Medical Hospital

    PubMed Central

    Engels, Melanie J.

    2015-01-01

    Background: High-alert medications pose a greater risk of causing significant harm to patients if used in error. The Joint Commission requires that hospitals define institution-specific high-alert medications and implement processes to ensure safe medication use. Method: Nursing, pharmacy, and prescribers were asked to voluntarily complete a 34-question survey to assess their knowledge, experience, and perceptions regarding high-alert medications in an academic hospital. Results: The majority of respondents identified the organization’s high-alert medications, the consequences of an error involving a high-alert medication, and the reversal agent. Most of the risk-reduction strategies within the institution were viewed as being effective by respondents. Forty-five percent of the respondents utilized a high-alert medication in the previous 24 hours. Only 14.2% had experienced an error with a high-alert medication in the previous 12 months, with 46% being near misses. The survey found the 5 rights for medication administration were not being utilized consistently. Respondents indicated that work experience or hospital orientation is the preferred learning experience for high-alert medications. Conclusions: This study assessed all disciplines involved in the medication use process. Perceptions about high-alert medications differ between disciplines. Ongoing discipline-specific education is required to ensure that individuals accept accountability in the medication use process and to close knowledge gaps on high-alert medications and risk-reduction strategies. PMID:26446747

  8. First six months of clinical usage of an ATM network link between two Veterans Affairs Medical Centers

    NASA Astrophysics Data System (ADS)

    Duerinckx, Andre J.; Gentili, Amilcare; El-Saden, Suzie; Harmon, Craig; Kenagy, John J.; Grant, Edward G.

    1998-07-01

    Purpose/Background: Asynchronous transfer mode (ATM) network technology has recently been used for high speed transmission of radiological images between hospitals and inside hospitals. However, the number of clinical sites which routinely use this technology is limited. The purpose of this study was to analyze the very early impact of an ATM link between a large tertiary referral center and small peripheral clinic on cost and clinical practice. Methodology: An ATM link using 155 bps (OC3) technology was installed between the West Los Angeles VA Medical Center and the Sepulveda VA, a large outpatient facility which provides full service radiological services. The West Los Angeles VA Medical Center is a large tertiary referral center with sub-specialist radiologist. The clinical impact of this ATM link between a large full-scale DICOM-3 compliant PACS system at the West LA VA on a smaller PACS system at the Sepulveda VA was evaluated. Results: The ability to freely exchange complicated MRI and CT studies between a tertiary referral center and a clinic could have a direct impact on patient care. Over the last six months, all and CT studies from Sepulveda VA were readily available via the ATM connection to all radiologists at the West LA VA. On average the workload at the Sepulveda VA in CT and MRI was about one tenth of the same workload at West LA VA, thus creating interesting possibilities for sharing or radiologist resources. Conclusions: Although our preliminary data and work loads have been too limited to draw any final conclusions yet, we feel that future results will show that the ability to provide immediate and fast interactive consultation between general radiologists in a large outpatient facility and sub- specialists at a tertiary referral center can have an impact upon the quality of patient care.

  9. Hazardous medical waste generation in Greece: case studies from medical facilities in Attica and from a small insular hospital.

    PubMed

    Komilis, Dimitrios; Katsafaros, Nikolaos; Vassilopoulos, Panagiotis

    2011-08-01

    The accurate calculation of the unit generation rates and composition of medical waste generated from medical facilities is necessary in order to design medical waste treatment systems. In this work, the unit medical waste generation rates of 95 public and private medical facilities in the Attica region were calculated based on daily weight records from a central medical waste incineration facility. The calculated medical waste generation rates (in kg bed(-1) day( -1)) varied widely with average values at 0.27 ± 113% and 0.24 ± 121%, for public and private medical facilities, respectively. The hazardous medical waste generation was measured, at the source, in the 40 bed hospital of the island of Ikaria for a period of 42 days during a 6 month period. The average hazardous medical waste generation rate was 1.204 kg occupied bed(-1) day(-1) or 0.33 kg (official) bed( -1) day(-1). From the above amounts, 54% resulted from the patients' room (solid and liquid wastes combined), 24% from the emergency department (solid waste), 17% from the clinical pathology lab and 6% from the X-ray lab. In average, 17% of the total hazardous medical waste was solely infectious. Conclusively, no correlation among the number of beds and the unit medical waste generation rate could be established. Each hospital should be studied separately, since medical waste generation and composition depends on the number and type of departments/laboratories at each hospital, number of external patients and number of occupied beds.

  10. Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a 12-year experience.

    PubMed

    Dunn, Bruce E; Choi, Hongyung; Recla, Daniel L; Kerr, Sarah E; Wagenman, Benjamin L

    2009-08-01

    Since mid-1996, we have operated a diagnostic robotic telepathology (TP) system at the Iron Mountain, MI, Department of Veterans Affairs Medical Center (VAMC) from the Milwaukee, WI, VAMC, located some 220 miles away. No on-site pathologist is present in Iron Mountain. Instead, an experienced, well-trained pathologist assistant, under direction of pathologists located in Milwaukee, is responsible for tissue grossing and sectioning. The pathologist assistant places slides onto the stage of the robotic microscope, which is then controlled by pathologists in Milwaukee. Each case read by TP is subsequently read by light microscopy (LM) by the same pathologist. Three distinct phases of TP have been recognized. Our experience during phase I (mid-1996 to early 1999) has been published previously. During phase II (early 1999 to mid-2004), 1 of the 2 senior telepathologists in phase I retired, and 3 junior pathologists were hired. During phase III (mid-2004 to June 2008), 2 new junior pathologists were hired, and ASAP Imaging (Apollo Telemedicine, Inc., Falls Church, VA) was implemented. The number of TP case opportunities in phases I, II, and III was 2200, 5841, and 3512, respectively, resulting in a total of 11 553. A total of 1834 cases were deferred to LM for a variety of reasons. The number of TP diagnoses rendered in phases I, II, and III was 2144, 4636, and 2939, respectively, resulting in a total of 9719. The major discordance rates in phases I, II, and III were 0.33%, 0.45%, and 0.20%, respectively, with an overall rate of 0.35%. Pathologist-specific discordance rates were not significantly different and ranged from a low of 0.12% to a high of 0.77%, whereas case deferral rates were significantly different (P < .0001) and ranged from 2.5% to 28.7%. In general, no relationship between deferral rate and discordance rate was noted. Iron Mountain clinicians have expressed great satisfaction with the services provided by their off-site pathologist colleagues.

  11. Innovative medical devices and hospital decision making: a study comparing the views of hospital pharmacists and physicians.

    PubMed

    Billaux, Mathilde; Borget, Isabelle; Prognon, Patrice; Pineau, Judith; Martelli, Nicolas

    2016-06-01

    Objectives Many university hospitals have developed local health technology assessment processes to guide informed decisions about new medical devices. However, little is known about stakeholders' perceptions and assessment of innovative devices. Herein, we investigated the perceptions regarding innovative medical devices of their chief users (physicians and surgeons), as well as those of hospital pharmacists, because they are responsible for the purchase and management of sterile medical devices. We noted the evaluation criteria used to assess and select new medical devices and suggestions for improving local health technology assessment processes indicated by the interviewees. Methods We randomly selected 18 physicians and surgeons (nine each) and 18 hospital pharmacists from 18 French university hospitals. Semistructured interviews were conducted between October 2012 and August 2013. Responses were coded separately by two researchers. Results Physicians and surgeons frequently described innovative medical devices as 'new', 'safe' and 'effective', whereas hospital pharmacists focused more on economic considerations and considered real innovative devices to be those for which no equivalent could be found on the market. No significant difference in evaluation criteria was found between these groups of professionals. Finally, hospital pharmacists considered the management of conflicts of interests in local health technology assessment processes to be an issue, whereas physicians and surgeons did not. Conclusions The present study highlights differences in perceptions related to professional affiliation. The findings suggest several ways in which current practices for local health technology assessment in French university hospitals could be improved and studied. What is known about the topic? Hospitals are faced with ever-growing demands for innovative and costly medical devices. To help hospital management deal with technology acquisition issues, hospital

  12. Potential for radioactive patient excreta in hospital trash and medical waste

    SciTech Connect

    Evdokimoff, V.; Cash, C.; Buckley, K.

    1994-02-01

    Radioactive excreta from nuclear medicine patients can enter solid waste as common trash and medical biohazardous waste. Many landfills and transfer stations now survey these waste streams with scintillation detectors which may result in rejection of a hospital`s waste. Our survey indicated that on the average either or both of Boston University Medical Center Hospital`s waste streams can contain detectable radioactive excreta on a weekly basis. To avoid potential problems, radiation detectors were installed in areas where housekeepers carting trash and medical waste must pass through to ensure no radioactivity leaves the institution. 3 refs.

  13. Impact of teaching intensity and academic status on medical resource utilization by teaching hospitals in Japan.

    PubMed

    Sato, Daisuke; Fushimi, Kiyohide

    2012-11-01

    Teaching hospitals require excess medical resources to maintain high-quality care and medical education. To evaluate the appropriateness of such surplus costs, we examined the impact of teaching intensity defined as activities for postgraduate training, and academic status as functions of medical research and undergraduate teaching on medical resource utilization. Administrative data for 47,397 discharges from 40 academic and 12 non-academic teaching hospitals in Japan were collected. Hospitals were classified into three groups according to intern/resident-to-bed (IRB) ratio. Resource utilization of medical services was estimated using fee-for-service charge schedules and normalized with case mix grouping. 15-24% more resource utilization for laboratory examinations, radiological imaging, and medications were observed in hospitals with higher IRB ratios. With multivariate adjustment for case mix and academic status, higher IRB ratios were associated with 10-15% more use of radiological imaging, injections, and medications; up to 5% shorter hospital stays; and not with total resource utilization. Conversely, academic status was associated with 21-33% more laboratory examinations, radiological imaging, and medications; 13% longer hospital stays; and 10% more total resource utilization. While differences in medical resource utilization by teaching intensity may not be associated with indirect educational costs, those by academic status may be. Therefore, academic hospitals may need efficiency improvement and financial compensation.

  14. Factor structure of the SOCRATES questionnaire in hospitalized medical patients.

    PubMed

    Bertholet, Nicolas; Dukes, Kim; Horton, Nicholas J; Palfai, Tibor P; Pedley, Alison; Saitz, Richard

    2009-01-01

    The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), a 19-item instrument developed to assess readiness to change alcohol use among individuals presenting for specialized alcohol treatment, has been used in various populations and settings. Its factor structure and concurrent validity has been described for specialized alcohol treatment settings and primary care. The purpose of this study was to determine the factor structure and concurrent validity of the SOCRATES among medical inpatients with unhealthy alcohol use not seeking help for specialized alcohol treatment. The subjects were 337 medical inpatients with unhealthy alcohol use, identified during their hospital stay. Most of them had alcohol dependence (76%). We performed an Alpha Factor Analysis (AFA) and Principal Component Analysis (PCA) of the 19 SOCRATES items, and forced 3 factors and 2 components, in order to replicate findings from Miller and Tonigan (Miller, W. R., & Tonigan, J. S., (1996). Assessing drinkers' motivations for change: The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychology of Addictive Behavior, 10, 81-89.) and Maisto et al. (Maisto, S. A., Conigliaro, J., McNeil, M., Kraemer, K., O'Connor, M., & Kelley, M. E., (1999). Factor structure of the SOCRATES in a sample of primary care patients. Addictive Behavior, 24(6), 879-892.). Our analysis supported the view that the 2 component solution proposed by Maisto et al. (Maisto, S.A., Conigliaro, J., McNeil, M., Kraemer, K., O'Connor, M., & Kelley, M.E., (1999). Factor structure of the SOCRATES in a sample of primary care patients. Addictive Behavior, 24(6), 879-892.) is more appropriate for our data than the 3 factor solution proposed by Miller and Tonigan (Miller, W. R., & Tonigan, J. S., (1996). Assessing drinkers' motivations for change: The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychology of Addictive Behavior, 10, 81-89.). The first component measured

  15. The 2012 derecho: emergency medical services and hospital response.

    PubMed

    Kearns, Randy D; Wigal, Mark S; Fernandez, Antonio; Tucker, March A; Zuidgeest, Ginger R; Mills, Michael R; Cairns, Bruce A; Cairns, Charles B

    2014-10-01

    During the early afternoon of June 29, 2012, a line of destructive thunderstorms producing straight line winds known as a derecho developed near Chicago (Illinois, USA). The storm moved southeast with wind speeds recorded from 100 to 160 kilometers per hour (kph, 60 to 100 miles per hour [mph]). The storm swept across much of West Virginia (USA) later that evening. Power outage was substantial as an estimated 1,300,000 West Virginians (more than half) were without power in the aftermath of the storm and approximately 600,000 citizens were still without power a week later. This was one of the worst storms to strike this area and occurred as residents were enduring a prolonged heat wave. The wind damage left much of the community without electricity and the crippling effect compromised or destroyed critical infrastructure including communications, air conditioning, refrigeration, and water and sewer pumps. This report describes utilization of Emergency Medical Services (EMS) and hospital resources in West Virginia in response to the storm. Also reported is a review of the weather phenomena and the findings and discussion of the disaster and implications.

  16. Medical staff contracting: legal issues in physician-hospital arrangements.

    PubMed

    Caesar, N B

    1993-01-01

    This article--the third in a series analyzing the physician-hospital contracting process from the physician's perspective--addresses the legal issues involved in physician-hospital arrangements, including those arising under federal and state illegal remuneration, antitrust, and tax laws. New applications of these issues to physician-hospital organizations and practice management/practice acquisitions by hospitals are also addressed, as well as other recent hospital efforts to maximize the benefits to be gained from the physician-hospital relationship.

  17. AVTA Federal Fleet PEV Readiness Data Logging and Characterization Study for Department of Veterans Affairs. James J. Peters VA Medical Center, Bronx, NY

    SciTech Connect

    Schey, Stephen; Francfort, Jim

    2014-10-01

    This report focuses on the Department of Veterans Affairs, James J. Peters VA Medical Center (VA - Bronx) fleet to identify daily operational characteristics of select vehicles and report findings on vehicle and mission characterizations to support the successful introduction of PEVs into the agencies’ fleets. Individual observations of these selected vehicles provide the basis for recommendations related to electric vehicle adoption and whether a battery electric vehicle or plug-in hybrid electric vehicle (collectively referred to as PEVs) can fulfill the mission requirements.

  18. Rural Hospital Ownership: Medical Service Provision, Market Mix, and Spillover Effects

    PubMed Central

    Horwitz, Jill R; Nichols, Austin

    2011-01-01

    Objective To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data Sources/Study Setting Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. Study Design We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Principal Findings Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Conclusions Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. PMID:21639860

  19. Hazards of Hospitalization: Hospitalists and Geriatricians Educating Medical Students about Delirium and Falls in Geriatric Inpatients

    ERIC Educational Resources Information Center

    Lang, Valerie J.; Clark, Nancy S.; Medina-Walpole, Annette; McCann, Robert

    2008-01-01

    Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric…

  20. [Main types of activity of specialists of medical and preventive profile in military hospitals].

    PubMed

    Akimkin, V G; Azarov, I I; Volynkov, I O; Bobylev, V A

    2015-09-01

    Infection prevention in medical organizations is an essential task to ensure quality of medical care and create a safe environment for patients and medical staff. The main task of a specialist of medical and preventive profile in the hospital is to maintain sanitary and epidemiological safety and control fulfillment of a complex of preventive measures. To achieve these goals specialists monitor epidemiological and microbiological fulfilment of the implementation and effectiveness of preventive measures, which allow to except infection entry to the hospital and possible carrying out beyond the hospital, occurrence and spread of disease. An obligatory activity of the specialist of medical and preventive profile in the hospital is a scientific and methodical work. The authors propose adoption of preventive structural subdivisions to the state largest diversified military hospitals.

  1. 38 CFR 17.45 - Hospital care for research purposes.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Hospital care for research purposes. 17.45 Section 17.45 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.45 Hospital care for research...

  2. Hospitalizations of Adults with Intellectual Disability in Academic Medical Centers

    ERIC Educational Resources Information Center

    Ailey, Sarah H.; Johnson, Tricia; Fogg, Louis; Friese, Tanya R.

    2014-01-01

    Individuals with intellectual disability (ID) represent a small but important group of hospitalized patients who often have complex health care needs. Individuals with ID experience high rates of hospitalization for ambulatory-sensitive conditions and high rates of hospitalizations in general, even when in formal community care systems; however,…

  3. Discounting medical malpractice claim reserves for self-insured hospitals.

    PubMed

    Frese, Richard; Kitchen, Patrick

    2011-01-01

    The hospital CFO often works with the hospital's actuary and external auditor to calculate the reserves recorded in financial statements. Hospital management, usually the CFO, needs to decide the discount rate that is most appropriate. A formal policy addressing the rationale for discounting and the rationale for selecting the discount rate can be helpful to the CFO, actuary, and external auditor.

  4. Implementation of a pharmacy automation system (robotics) to ensure medication safety at Norwalk hospital.

    PubMed

    Bepko, Robert J; Moore, John R; Coleman, John R

    2009-01-01

    This article reports an intervention to improve the quality and safety of hospital patient care by introducing the use of pharmacy robotics into the medication distribution process. Medication safety is vitally important. The integration of pharmacy robotics with computerized practitioner order entry and bedside medication bar coding produces a significant reduction in medication errors. The creation of a safe medication-from initial ordering to bedside administration-provides enormous benefits to patients, to health care providers, and to the organization as well.

  5. Hospital ownership and medical services: market mix, spillover effects, and nonprofit objectives.

    PubMed

    Horwitz, Jill R; Nichols, Austin

    2009-09-01

    Hospitals operate in markets with varied demographic, competitive, and ownership characteristics, yet research on ownership tends to examine hospitals in isolation. Here we examine three hospital ownership types -- nonprofit, for-profit, and government -- and their spillover effects. We estimate the effects of for-profit market share in two ways, on the provision of medical services and on operating margins at the three types of hospitals. We find that nonprofit hospitals' medical service provision systematically varies by market mix. We find no significant effect of market mix on the operating margins of nonprofit hospitals, but find that for-profit hospitals have higher margins in markets with more for-profits. These results fit best with theories in which hospitals maximize their own output.

  6. Despite regulatory changes, hospitals cautious in helping physicians purchase electronic medical records.

    PubMed

    Grossman, Joy M; Cohen, Genna

    2008-09-01

    While hospitals are evaluating strategies to help physicians purchase electronic medical records (EMRs) following recent federal regulatory changes, they are proceeding cautiously, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Hospital strategies to aid physician EMR adoption include offering direct financial subsidies, extending the hospital's ambulatory EMR vendor discounts and providing technical support. Two key factors driving hospital interest in supporting physician EMR adoption are improving the quality and efficiency of care and aligning physicians more closely with the hospital. A few hospitals have begun small-scale, phased rollouts of subsidized EMRs, but the burden of other hospital information technology projects, budget limitations and lack of physician interest are among the factors impeding hospital action. While it is too early to assess whether the regulatory changes will spur greater physician EMR adoption, the outcome will depend both on hospitals' willingness to provide support and physicians' acceptance of hospital assistance.

  7. Job stress and burnout in hospital employees: comparisons of different medical professions in a regional hospital in Taiwan

    PubMed Central

    Chou, Li-Ping; Li, Chung-Yi; Hu, Susan C

    2014-01-01

    Objectives To explore the prevalence and associated factors of burnout among five different medical professions in a regional teaching hospital. Design Cross-sectional study. Setting Hospital-based survey. Participants A total of 1329 medical professionals were recruited in a regional hospital with a response rate of 89%. These voluntary participants included 101 physicians, 68 physician assistants, 570 nurses, 216 medical technicians and 374 administrative staff. Primary and secondary outcome measures Demographic data included gender, age, level of education and marital status, and work situations, such as position, work hours and work shifts, were obtained from an electronic questionnaire. Job strain and burnout were measured by two validated questionnaires, the Chinese version of the Job Content Questionnaire and the Copenhagen Burnout Inventory. Results Among the five medical professions, the prevalence of high work-related burnout from highest to lowest was nurses (66%), physician assistants (61.8%), physicians (38.6%), administrative staff (36.1%) and medical technicians (31.9%), respectively. Hierarchical regression analysis indicated that job strain, overcommitment and low social support explained the most variance (32.6%) of burnout. Conclusions Physician assistant is an emerging high burnout group; its severity is similar to that of nurses and far more than that of physicians, administrative staff and medical technicians. These findings may contribute to the development of feasible strategies to reduce the stress which results in the burnout currently plaguing most hospitals in Taiwan. PMID:24568961

  8. The Impact of Public Hospital Closure on Medical and Residency Education: Implications and Recommendations

    PubMed Central

    Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

    2010-01-01

    Background Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. Objective To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Method Retrospective cohort study of medical students’ and residents’ and clinical placement into safety-net experiences after the closure of the primary teaching hospital. Results The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. Conclusion While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location. PMID:19110905

  9. Medical Record Clerk Training Program, Course of Study; Student Manual: For Medical Record Personnel in Small Rural Hospitals in Colorado.

    ERIC Educational Resources Information Center

    Community Health Service (DHEW/PHS), Arlington, VA. Div. of Health Resources.

    The manual provides major topics, objectives, activities and, procedures, references and materials, and assignments for the training program. The topics covered are hospital organization and community role, organization and management of a medical records department, international classification of diseases and operations, medical terminology,…

  10. [Erwin H. Ackerknecht and the Berg/Rath Affair in 1964. On the coping of German medical historians with their history].

    PubMed

    Morgeli, C; Jobmann, A

    1997-01-01

    In 1964, the Zurich medical historian Erwin H. Ackerknect announced his decision to resign from the German Society of Medical History, Natural Science and Technology (Deutsche Gesellschaft fur Geschichte der Medizin, Naturwissenschaft und Technik - DGGMNT) in a letter to 150 colleagues and prominent personalities in scientific, academic and political circles. Ackerknecht explained that he was resigning from the Society because the medical faculty of the University of Gottingen, supported by its professor of medical history, Gernot Rath - also chairman of the DGGMNT - had awarded the Venia legendi medical history chair to the x-ray specialist and medical historian Alexander Berg. Berg was ideologically compromised by his co-authorship of a book that embraced the ideals of National Socialism and in which he was mentioned as a Obersturmfuhrer of SS. Apart from describing the events surrounding Berg's promotion to the teaching position, this article presents Ackerknecht's perspective on the situation, the continuing influence of further Nazi era's leading historians of medicine the war - enabling Berg to assume his position - as well as the DGGMNT's controversial reactions to Ackerknecht's resignation and the consequences that the affair was to have for the Society.

  11. Seriously clowning: Medical clowning interaction with children undergoing invasive examinations in hospitals.

    PubMed

    Tener, Dafna; Ofir, Shoshi; Lev-Wiesel, Rachel; Franco, Nessia L; On, Avi

    2016-04-01

    This qualitative study examined the subjective experience of children undergoing an invasive examination in the hospital when accompanied by a medical clown. In-depth semi-structured interviews were conducted with nine such children and nine of their accompanying parents. The children were patients in two outpatient departments (Pediatric Gastroenterology and a Center for the Sexually Abused) in a hospital in Israel. Interviews were coded thematically using an Atlas.ti software program. Analysis of the interviews indicated that the intervention of the clown positively changed the children's perceptions of the hospital, of experiencing the examination, and of their life narrative. Medical clowns thus appear to be a central, meaningful, and therapeutic source for children undergoing invasive examinations in hospital, as well as for their parents. Therefore, it may be advisable to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include the clowns in all stages of the hospital visit.

  12. Prevalence and risk factors for medication reconciliation errors during hospital admission in elderly patients.

    PubMed

    Rodríguez Vargas, Blanca; Delgado Silveira, Eva; Iglesias Peinado, Irene; Bermejo Vicedo, Teresa

    2016-10-01

    Background Care transitions are risk points for medication discrepancies, especially in the elderly. Objective This study was undertaken to assess prevalence and describe medication reconciliation errors during admission in elderly patients and to analyze associated risk factors. We also evaluate the effect of these errors on the length of hospital stay. Setting General surgery, orthopedics, internal medicines and infectious diseases departments of a 1070-bed Spanish teaching hospital. Method This is a prospective observational study. Patients >65 years and taking ≥5 medications were randomly selected from those admitted to hospital. The pharmacist obtained the best possible medication history based on medical records, medical notes from patients' previous admissions to hospital, "brown bag" review, community care prescriptions, and comprehensive patient interviews. It was compared to current inpatient prescription to detect unintentional discrepancies (discrepancy with no apparent clinical explanation), which were reported to the physician. When the physician accepted the discrepancy by changing the medication order, it was recorded as a medication reconciliation error and classified by type of error. Several variables were analyzed as possible risk/protective factors. Main outcome measure Is prevalence of medication reconciliation errors at admission. Results Reconciliation was performed on 206 patients. Medication reconciliation errors occurred in 49.5 % (102/206) of patients. 1996 medications were recorded, and 359 had unintentional discrepancies (56.0 % (201/359) medication reconciliation errors). The most common was omission (65.1 %). Identified risk factors were as follows: physician experience, number of pre-admission prescribed medications, and previous surgeries. Computerized order entry system was a protective factor. Conclusion Medication reconciliation errors occur in almost half of the elderly patients at admission, especially omissions. Risk

  13. Clinical pharmacist-led program on medication reconciliation implementation at hospital admission: experience of a single university hospital in Croatia

    PubMed Central

    Marinović, Ivana; Marušić, Srećko; Mucalo, Iva; Mesarić, Jasna; Bačić Vrca, Vesna

    2016-01-01

    Aim To evaluate the clinical pharmacist-led medication reconciliation process in clinical practice by quantifying and analyzing unintentional medication discrepancies at hospital admission. Methods An observational prospective study was conducted at the Clinical Department of Internal Medicine, University Hospital Dubrava, during a 1-year period (October 2014 – September 2015) as a part of the implementation of Safe Clinical Practice, Medication Reconciliation of the European Network for Patient Safety and Quality of Care Joint Action (PASQ JA) project. Patients older than 18 years taking at least one regular prescription medication were eligible for inclusion. Discrepancies between pharmacists' Best Possible Medication History (BPMH) and physicians' admission orders were detected and communicated directly to the physicians to clarify whether the observed changes in therapy were intentional or unintentional. All discrepancies were discussed by an expert panel and classified according to their potential to cause harm. Results In 411 patients included in the study, 1200 medication discrepancies were identified, with 202 (16.8%) being unintentional. One or more unintentional medication discrepancy was found in 148 (35%) patients. The most frequent type of unintentional medication discrepancy was drug omission (63.9%) followed by an incorrect dose (24.2%). More than half (59.9%) of the identified unintentional medication discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration in the patient. Conclusion Around 60% of medication errors were assessed as having the potential to threaten the patient safety. Clinical pharmacist-led medication reconciliation was shown to be an important tool in detecting medication discrepancies and preventing adverse patient outcomes. This standardized medication reconciliation process may be widely applicable to other health care organizations and clinical settings. PMID:28051282

  14. Is the relationship between your hospital and your medical staff sustainable?

    PubMed

    Carlson, Greg; Greeley, Hugh

    2010-01-01

    Issues in the macro-environment are affecting the historic relationships that have existed between hospitals and their medical staffs over the last half century. Rising healthcare costs, deteriorating relationships, unexplained variations in clinical outcomes, transparency in healthcare outcomes, medical tourism, competition between hospitals and physicians, and reluctance by hospitals and physicians to change are among the issues challenging the sustainability of the current business model. This article highlights barriers to maintaining traditional relationships and concludes with strategies to preserve and strengthen relationships between physicians and hospitals.

  15. A national survey of inpatient medication systems in English NHS hospitals

    PubMed Central

    2014-01-01

    Background Systems and processes for prescribing, supplying and administering inpatient medications can have substantial impact on medication administration errors (MAEs). However, little is known about the medication systems and processes currently used within the English National Health Service (NHS). This presents a challenge for developing NHS-wide interventions to increase medication safety. We therefore conducted a cross-sectional postal census of medication systems and processes in English NHS hospitals to address this knowledge gap. Methods The chief pharmacist at each of all 165 acute NHS trusts was invited to complete a questionnaire for medical and surgical wards in their main hospital (July 2011). We report here the findings relating to medication systems and processes, based on 18 closed questions plus one open question about local medication safety initiatives. Non-respondents were posted another questionnaire (August 2011), and then emailed (October 2011). Results One hundred (61% of NHS trusts) questionnaires were returned. Most hospitals used paper-based prescribing on the majority of medical and surgical inpatient wards (87% of hospitals), patient bedside medication lockers (92%), patients’ own drugs (89%) and ‘one-stop dispensing’ medication labelled with administration instructions for use at discharge as well as during the inpatient stay (85%). Less prevalent were the use of ward pharmacy technicians (62% of hospitals) or pharmacists (58%) to order medications on the majority of wards. Only 65% of hospitals used drug trolleys; 50% used patient-specific inpatient supplies on the majority of wards. Only one hospital had a pharmacy open 24 hours, but all had access to an on-call pharmacist. None reported use of unit-dose dispensing; 7% used an electronic drug cabinet in some ward areas. Overall, 85% of hospitals had a double-checking policy for intravenous medication and 58% for other specified drugs. “Do not disturb” tabards

  16. 38 CFR 17.121 - Limitations on payment or reimbursement of the costs of emergency hospital care and medical...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... reimbursement of the costs of emergency hospital care and medical services not previously authorized. 17.121... reimbursement of the costs of emergency hospital care and medical services not previously authorized. Claims for payment or reimbursement of the costs of emergency hospital care or medical services not...

  17. 38 CFR 17.121 - Limitations on payment or reimbursement of the costs of emergency hospital care and medical...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... reimbursement of the costs of emergency hospital care and medical services not previously authorized. 17.121... reimbursement of the costs of emergency hospital care and medical services not previously authorized. Claims for payment or reimbursement of the costs of emergency hospital care or medical services not...

  18. Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti

    PubMed Central

    Holm, Michelle R.; Rudis, Maria I.; Wilson, John W.

    2015-01-01

    Background In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. Objective We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP) would optimize medication availability and decrease medication shortages. Design We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. Results The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of ‘real-time’ medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055), respectively, and the mean logins per day increased from 24.3 to 31.5, p<0.0001, respectively. The PCIP allows the hospital staff to identify and order medications with a critically low supply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization. Conclusions An efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital. PMID:25623613

  19. Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti.

    PubMed

    Holm, Michelle R; Rudis, Maria I; Wilson, John W

    2015-01-01

    Background In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. Objective We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP) would optimize medication availability and decrease medication shortages. Design We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. Results The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of 'real-time' medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055), respectively, and the mean logins per day increased from 24.3 to 31.5, p<0.0001, respectively. The PCIP allows the hospital staff to identify and order medications with a critically low supply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization. Conclusions An efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital.

  20. Labor outcome of primigravidae in Mymensingh Medical College Hospital.

    PubMed

    Latif, T; Ali, M A; Majeed, A; Nahar, K; Noor, Z

    2013-07-01

    This cross sectional study was done in the department of Obstetrics and Gynae, Mymensingh Medical College Hospital, during the period 1st January to 30th June 2000 to evaluate the labor outcome in primigrvidae women. Total 1250 cases were delivered in this period. Among all 500(40%) were primigravidae. All the primigravidae were included and labor was monitored and managed by close observation. Condition of the baby was determined by applying APGAR (Appearance, Pulse, Grimace, Activity and Respiration) score. Maximum (66.6%) of patients were belonged to 21-29 years age group. Only few 28.2% had regular antenatal check-up. Risk factors were present in 32% cases. Common risk factors were PET (Pre-eclamptic toxemia) and eclampsia. Mode of deliveries were normal vaginal delivery (NVD) in (51.6%) cases, Lower Uterine Caesarean section (LUCS) in 43.8% cases, Ventouse in 2.8% cases, Forceps in 9(1.8%) cases and craniotomy was required in 2(0.4%) cases. Complications during labor were prolonged labor, postpartum hemorrhage, obstructed labor and perineal tear. PET was common (29.62%) in age group 30-36 years and eclampsia was more common (15%) in age group 16-20 years. NVD were more (55.85%) in 21-29 years group than other age group. The duration of labor pain was short in the age group of 21-29 years and was prolonged in the age group 30-36 years. Maternal mortality was 1.6% (8) cases. Causes of death were septic shock, renal failure and Cerebrovascullar accident. Morbidities after delivery were hypertension, wound infection, puerperal psychosis, acute renal failure, vesicovaginal fistula, hypertensive retinopathy, chronic ill health and retention of urine. Among 500 cases 92.6% were live born and 7.4% were still born. Among total cases 81.6% babies were healthy, 6.8% were asphyxiated, 71.2% had normal birth weight 21.4% had low birth weight, 18% were premature and 7.4% were IUGR. This study shows the safest and easiest delivery age group of primigravidae is between 21

  1. Patient Safety Events and Harms During Medical and Surgical Hospitalizations for Persons With Serious Mental Illness

    PubMed Central

    Daumit, Gail L.; McGinty, Emma E.; Pronovost, Peter; Dixon, Lisa B.; Guallar, Eliseo; Ford, Daniel E.; Cahoon, Elizabeth K.; Boonyasai, Romsai T.; Thompson, David

    2016-01-01

    Objective This study explored the risk of patient safety events and associated nonfatal physical harms and mortality in a cohort of persons with serious mental illness. This group experiences high rates of medical comorbidity and premature mortality and may be at high risk of adverse patient safety events. Methods Medical record review was conducted for medical-surgical hospitalizations occurring during 1994–2004 in a community-based cohort of Maryland adults with serious mental illness. Individuals were eligible if they died within 30 days of a medical-surgical hospitalization and if they also had at least one prior medical-surgical hospitalization within five years of death. All admissions took place at Maryland general hospitals. A case-crossover analysis examined the relationships among patient safety events, physical harms, and elevated likelihood of death within 30 days of hospitalization. Results A total of 790 hospitalizations among 253 adults were reviewed. The mean number of patient safety events per hospitalization was 5.8, and the rate of physical harms was 142 per 100 hospitalizations. The odds of physical harm were elevated in hospitalizations in which 22 of the 34 patient safety events occurred (p<.05), including medical events (odds ratio [OR]=1.5, 95% confidence interval [CI]=1.3–1.7) and procedure-related events (OR=1.6, CI=1.2–2.0). Adjusted odds of death within 30 days of hospitalization were elevated for individuals with any patient safety event, compared with those with no event (OR=3.7, CI=1.4–10.3). Conclusions Patient safety events were positively associated with physical harm and 30-day mortality in nonpsychiatric hospitalizations for persons with serious mental illness. PMID:27181736

  2. [The management of implantable medical device and the application of the internet of things in hospitals].

    PubMed

    Zhou, Li; Xu, Liang

    2011-11-01

    Implantable medical device is a special product which belongs to medical devices. It not only possesses product characteristics in common, but also has specificity for safety and effectiveness. Implantable medical device must be managed by the relevant laws and regulations of the State Food and Drug Administration. In this paper, we have used cardiac pacemakers as an example to describe the significance of the management of implantable medical device products and the application of the internet of things in hospitals.

  3. Medication prescribing patterns among chronic kidney disease patients in a hospital in Malaysia.

    PubMed

    Al-Ramahi, Rowa

    2012-03-01

    To determine the medication prescribing patterns in hospitalized patients with chronic kidney disease (CKD) in a Malaysian hospital, we prospectively studied a cohort of 600 patients in two phases with 300 patients in each phase. The first phase was carried out from the beginning of February to the end of May 2007, and the second phase was from the beginning of March to the end of June 2008. Patients with CKD who had an estimated creatinine clearance ≤ 50 mL/min and were older than 18 years were included. A data collection form was used to collect data from the patients' medical records and chart review. All systemic medications prescribed during hospitalization were included. The patients were prescribed 5795 medications. During the first phase, the patients were prescribed 2814 medication orders of 176 different medications. The prescriptions were 2981 of 158 medications during the second phase. The mean number of medications in the first and second phases was 9.38 ± 3.63 and 9.94 ± 3.78 respectively (P-value = 0.066). The top five used medications were calcium carbonate, folic acid/vitamin B complex, metoprolol, lovastatin, and ferrous sulfate. The most commonly used medication classes were mineral supplements, vitamins, antianemic preparations, antibacterials, and beta-blocking agents. This study provides an overview of prescription practice in a cohort of hospitalized CKD patients and indicates possible areas of improvement in prescription practice.

  4. [Medical microbiology laboratories in Dutch hospitals: essential for safe patient care].

    PubMed

    Bonten, M J M

    2008-12-06

    The Netherlands Health Care Inspectorate investigated the quality of medical microbiology laboratories in Dutch hospitals. By and large the laboratories fulfilled the requirements for appropriate care, although some processes were unsatisfactory and some were insufficiently formalised. In the Netherlands, laboratories for medical microbiology are integrated within hospitals and medical microbiologists are responsible for the diagnostic processes as well as for co-treatment of patients, infection prevention and research. This integrated model contrasts to the more industrialised model in many other countries, where such laboratories are physically distinct from hospitals with a strong focus on diagnostics. The Inspectorate also concludes that the current position of medical microbiology in Dutch hospitals is necessary for patient safety and that outsourcing of these facilities is considered unacceptable.

  5. 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.

  6. Impact of electronic medication reconciliation at hospital admission on clinician workflow.

    PubMed

    Vawdrey, David K; Chang, Nancy; Compton, Audrey; Tiase, Vicky; Hripcsak, George

    2010-11-13

    Many hospitals have experienced challenges with accomplishing the Joint Commission's National Patient Safety Goal for medication reconciliation. Our institution implemented a fully electronic process for performing and documenting medication reconciliation at hospital admission. The process used a commercial EHR and relied on a longitudinal medication list called the "Outpatient Medication Profile" (OMP). Clinician compliance with documenting medication reconciliation was difficult to achieve, but approached 100% after a "hard-stop" reminder was implemented. We evaluated the impact of the process at a large urban academic medical center. Before the new process was adopted, the average number of medications contained in the OMP for a patient upon admission was <2. One year after adoption, the average number had increased to 4.7, and there were regular updates made to the list. Updating the OMP was predominantly done by physicians, NPs, and PAs (94%), followed by nurses (5%) and pharmacists (1%).

  7. Development of a Hospital-based Massage Therapy Course at an Academic Medical Center

    PubMed Central

    Dion, Liza J.; Cutshall, Susanne M.; Rodgers, Nancy J.; Hauschulz, Jennifer L.; Dreyer, Nikol E.; Thomley, Barbara S.; Bauer, Brent

    2015-01-01

    Background: Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. Methods: A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. Results: The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. Conclusions: The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment. PMID

  8. [Hospital-based health technology assessment in France: how to proceed to evaluate innovative medical devices?].

    PubMed

    Martelli, N; van den Brink, H; Denies, F; Dervaux, B; Germe, A F; Prognon, P; Pineau, J

    2014-01-01

    Innovative medical devices offer solutions to medical problems and greatly improve patients' outcomes. Like National Health Technology Assessment (HTA) agencies, hospitals face numerous requests for innovative and costly medical devices. To help local decision-makers, different approaches of hospital-based HTA (HB-HTA) have been adopted worldwide. The objective of the present paper is to explore HB-HTA models for adopting innovative medical devices in France and elsewhere. Four different models have been conceptualized: "ambassador" model, "mini-HTA" model, "HTA unit" model and "internal committee". Apparently, "HTA unit" and "internal committee" (or a mixture of both models) are the prevailing HB-HTA models in France. Nevertheless, some weaknesses of these models have been pointed out in previous works. Only few examples involving hospital pharmacists have been found abroad, except in France and in Italy. Finally, the harmonization of the assessment of innovative medical devices in France needs a better understanding of HB-HTA practices.

  9. Perceived Pain and Satisfaction with Medical Rehabilitation after Hospital Discharge

    PubMed Central

    Bergés, Ivonne-Marie; Ottenbacher, Kenneth J.; Smith, Pamela M.; Smith, David; Ostir, Glenn V.

    2007-01-01

    Objective To examine the association between pain and satisfaction with medical rehabilitation in patients with hip or knee replacement approximately 90 days after discharge from in-patient medical rehabilitation. Design A cross-sectional design. Participants The sample included 2,507 patients with hip or knee replacement using information from the IT HealthTrack medical outcome database. Main outcome measure Satisfaction with medical rehabilitation. Results The average age was 70.2 years, 66.5% were female, and 88.5% were non-Hispanic white. Pain scores were significantly and inversely associated with satisfaction with medical rehabilitation after adjustment for possible confounding factors. In patients with hip replacement each one-point increase in pain score was associated with a 10% decreased odds ratio of being satisfied with medical rehabilitation (OR 0.90, 95 % CI: 0.84, 0.96). In patients with knee replacement, each one-point increase in pain score was associated with a 9% decreased odds ratio (OR 0.91, 95% CI: 0.87, 0.96) of being satisfied with medical rehabilitation. Conclusion Our data indicate that postoperative pain from hip or knee replacement is associated with reduced satisfaction with medical rehabilitation. Better post-operative pain control may improve a patient’s level of satisfaction. PMID:16944829

  10. Hemophilus influenzae meningitis at the Children's Hospital Medical Center in Boston, 1958 to 1973.

    PubMed

    Peter, G; Smith, D H

    1975-04-01

    Three hundred ninety-seven children were admitted to the Children's Hospital Medical Center, Boston between 1958 and 1973 with H. influenzae meningitis. The annual rate of admission and the percent of all cases of bacterial meningitis were not changed from that of the preceding decade. The age incidence was strikingly similar to that reported from this hospital for 1920 to 1932.

  11. The liability of the hospital librarian. Why you need a professional medical librarian.

    PubMed

    Herin, N J

    1991-01-01

    Would you hire a cashier instead of a qualified accountant to manage your hospital's financial department? Certainly not--the stakes are too high. The same test holds for your hospital library: Besides running the risk of possible liability and embarrassment for your hospital, hiring an untrained person to manage your library would not serve the best interests of your medical staff and--most importantly--your patients.

  12. 78 FR 21631 - Fiscal Year 2013 Cost of Hospital and Medical Care Treatment Furnished by the Department of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-11

    ... BUDGET Fiscal Year 2013 Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Medical Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third... the cost of inpatient medical services furnished by military treatment facilities through...

  13. Evaluation of Electromagnetic Fields in a Hospital for Safe Use of Electronic Medical Equipment.

    PubMed

    Ishida, Kai; Fujioka, Tomomi; Endo, Tetsuo; Hosokawa, Ren; Fujisaki, Tetsushi; Yoshino, Ryoji; Hirose, Minoru

    2016-03-01

    Establishment of electromagnetic compatibility is important in use of electronic medical equipment in hospitals. To evaluate the electromagnetic environment, the electric field intensity induced by electromagnetic radiation in broadcasting spectra coming from outside the hospital was measured in a new hospital building before any patients visited the hospital and 6 months after the opening of the hospital. Various incoming radio waves were detected on the upper floors, with no significant difference in measured levels before and after opening of the hospital. There were no cellphone terminal signals before the hospital opened, but these signals were strongly detected at 6 months thereafter. Cellphone base stations signals were strongly detected on the upper floors, but there were no signals at most locations in the basement and in the center of the building on the lower floors. A maximum electrical intensity of 0.28 V/m from cellphone base stations (2.1 GHz) was detected at the south end of the 2nd floor before the hospital opened. This value is lower than the EMC marginal value for general electronic medical equipment specified in IEC 60601-1-2 (3 V/m). Therefore, electromagnetic interference with electronic medical equipment is unlikely in this situation. However, cellphone terminal signals were frequently detected in non-base station signal areas. This is a concern, and understanding signal strength from cellphone base stations at a hospital is important for promotion of greater safety.

  14. The European Federation of Organisations for Medical Physics Policy Statement no. 15: recommended guidelines on the role of the Medical Physicist within the hospital governance board.

    PubMed

    Christofides, Stelios; Sharp, Peter

    2015-05-01

    This EFOMP Policy Statement presents an outline on hospital governance and encourages the participation of the Medical Physicist in the hospital governance. It also emphasises how essential it is for Medical Physicists to engage in their hospital's governing board's committees for the overall good of the patient.

  15. 78 FR 16614 - Medicare Program; Medicare Hospital Insurance (Part A) and Medicare Supplementary Medical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-18

    ... Medicare Program; Medicare Hospital Insurance (Part A) and Medicare Supplementary Medical Insurance (Part B... Insurance; and Program No. 93.774, Medicare-- Supplementary Medical Insurance Program) Dated: March 13, 2013..., Utilization and Quality Control Peer Review, private health insurance, and related matters. They are...

  16. The appropriateness of referral of medically compromised dental patients to hospital.

    PubMed

    Absi, E G; Satterthwaite, J; Shepherd, J P; Thomas, D W

    1997-04-01

    Hospital departments of oral and maxillofacial surgery make a substantial contribution to both managing and treating medically-compromised dental patients. Contracting arrangements should take account of this. Demographic data suggest that the treatment of medically-compromised elderly dentate patients will become increasingly important in the General Dental Service (GDS). To determine the medical conditions and treatment requirements prompting referral of these patients to hospital, a prospective study was undertaken of 75 consecutive adults referred for hospital treatment specifically because of a medical condition which prevented delivery of routine dental care in the GDS. Patients (mean age: 56 years) were referred mainly from general medical (33%) and dental (62%) practitioners. Cardiovascular disease was the most frequently cited medical condition requiring referral (43%; n = 32 cases). Forty-eight patients (64%) were symptomatic on presentation and on average had attended on 2.3 occasions before definitive treatment was instituted. Fifty-two patients (70%) had no special treatment requirements other than those available in the GDS, 11 patients (15%) simply required antibiotic prophylaxis and 81% were treated by undergraduates or junior staff. These data suggest that many patients referred for dental hospital treatment because of underlying medical condition are not in fact medically-compromised and may be treated in the primary care setting.

  17. An effective intervention to improve the cleanliness of medical lead clothes in an orthopedic specialized hospital.

    PubMed

    Chen, Lu; Xu, YingJun; Zhang, Fengxia; Yang, Qingfeng; Yuan, Juxiang

    2016-11-01

    Dirty medical lead clothes, contaminated with blood or other infected material, may carry ongoing bioburden, which increase the risk of hospital-acquired infection. In this study, we investigated medical lead clothes contamination levels and assessed the effectiveness of the intervention that was constructed to improve the cleanliness of lead clothes.

  18. Knowledge, Attitude, and Practices regarding Whole Body Donation among Medical Professionals in a Hospital in India

    ERIC Educational Resources Information Center

    Ballala, Kirthinath; Shetty, Avinash; Malpe, Surekha Bhat

    2011-01-01

    Voluntary body donation has become an important source of cadavers for anatomical study and education. The objective of this study was to assess knowledge, attitude, and practice (KAP) regarding whole body donation among medical professionals in a medical institute in India. A cross sectional study was conducted at Kasturba Hospital, Manipal,…

  19. The microbial etiologies of diarrhea in hospitalized patients from the Puerto Rico Medical Center Hospitals.

    PubMed

    Carrer, Mildred; Vázquez, Guillermo J; Lebrón, Rafael I; Mercado, Xiomara; Martínez, Idalí; Vázquez, Carmen O; Santé, Maria; Robledo, Iraida E

    2005-03-01

    The development of diarrhea in hospitalized patients is a frequently encountered clinical problem, which may be due to infectious or non-infectious causes. The purpose of this study was to identify which common community enteric pathogens, if any, are responsible for diarrheal episodes in hospitalized patients. Stool samples from 76 consecutive, hospitalized patients were analyzed utilizing routine bacterial cultures, smears for identification of ova and parasites and Enzyme-Link Immunoadsorbent Assay (ELISA) for enteric bacteria, parasites and viruses. The results obtained demonstrated that the usual community enteric pathogens were not identified as a major cause of nosocomial diarrhea. In hospital-acquired diarrhea, Clostridium difficile toxins assay was the only clinically significant test in the evaluation of these patients. As a result of this study a guideline for the management of this condition in hospitalized patients is presented.

  20. [Continuity of medical care. Evaluation of a collaborative program between hospital and Primary Care].

    PubMed

    Fernández Moyano, A; García Garmendia, J L; Palmero Palmero, C; García Vargas-Machuca, B; Páez Pinto, J M; Alvarez Alcina, M; Aparicio Santos, R; Benticuaga Martines, M; Delgado de la Cuesta, J; de la Rosa Morales, R; Escorial Moya, C; Espinosa Calleja, R; Fernández Rivera, J; González-Becerra, C; López Herrero, E; Marín Fernández, Y; Mata Martín, A M; Ramos Guerrero, A; Romero Rivero, M J; Sánchez-Dalp, M; Vallejo Maroto, I

    2007-11-01

    The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike.

  1. An investigation Into Traditional Chinese Medicine Hospitals in China: Development Trend and Medical Service Innovation

    PubMed Central

    Wang, Liang; Suo, Sizhuo; Li, Jian; Hu, Yuanjia; Li, Peng; Wang, Yitao; Hu, Hao

    2017-01-01

    Background: This paper aims to investigate the development trend of traditional Chinese medicine (TCM) hospitals in China and explore their medical service innovations, with special reference to the changing co-existence with western medicine (WM) at TCM hospitals. Methods: Quantitative data at macro level was collected from official databases of China Health Statistical Yearbook and Extracts of Traditional Chinese Medicine Statistics. Qualitative data at micro level was gathered through interviews and second-hand material collection at two of the top-level TCM hospitals. Results: In both outpatient and inpatient sectors of TCM hospitals, drug fees accounted for the biggest part of hospital revenue. Application of WM medical exanimation increased in both outpatient and inpatient services. Even though the demand for WM drugs was much higher in inpatient care, TCM drugs was the winner in the outpatient. Also qualitative evidence showed that TCM dominated the outpatient hospital service with WM incorporated in the assisting role. However, it was in the inpatient medical care that WM prevailed over TCM which was mostly applied to the rehabilitation of patients. Conclusion: By drawing on WM while keeping it active in supporting and strengthening the TCM operation in the TCM hospital, the current system accommodates the overriding objective which is for TCM to evolve into a fully informed and more viable medical field. PMID:28005539

  2. Workload Impact of Medical Subspecialties in the Teaching Hospital

    ERIC Educational Resources Information Center

    Van Peenen, Hubert J.

    1973-01-01

    This paper documents, using a single test as a model, the significant increase in clinical laboratory workload which occurred in a university hospital when strong sections of nephrology, hematology-oncology, and immunology-rheumatology were added to the department of medicine. (Author)

  3. Evaluation of STAT medication ordering process in a community hospital

    PubMed Central

    Walsh., Kim; Schwartz., Barbara

    Background: In most health care facilities, problems related to delays in STAT medication order processing time are of common concern. Objective: The purpose of this study was to evaluate processing time for STAT orders at Kimball Medical Center. Methods: All STAT orders were reviewed to determine processing time; order processing time was also stratified by physician order entry (physician entered (PE) orders vs. non-physician entered (NPE) orders). Collected data included medication ordered, indication, time ordered, time verified by pharmacist, time sent from pharmacy, and time charted as given to the patient. Results: A total of 502 STAT orders were reviewed and 389 orders were included for analysis. Overall, median time was 29 minutes, IQR 16–63; p<0.0001.). The time needed to process NPE orders was significantly less than that needed for PE orders (median 27 vs. 34 minutes; p=0.026). In terms of NPE orders, the median total time required to process STAT orders for medications available in the Automated Dispensing Devices (ADM) was within 30 minutes, while that required to process orders for medications not available in the ADM was significantly greater than 30 minutes. For PE orders, the median total time required to process orders for medications available in the ADM (i.e., not requiring pharmacy involvement) was significantly greater than 30 minutes. [Median time = 34 minutes (p<0.001)]. Conclusion: We conclude that STAT order processing time may be improved by increasing the availability of medications in ADM, and pharmacy involvement in the verification process. PMID:27382418

  4. Performance of on-site Medical waste disinfection equipment in hospitals of Tabriz, Iran

    PubMed Central

    Taghipour, Hassan; Alizadeh, Mina; Dehghanzadeh, Reza; Farshchian, Mohammad Reza; Ganbari, Mohammad; Shakerkhatibi, Mohammad

    2016-01-01

    Background: The number of studies available on the performance of on-site medical waste treatment facilities is rare, to date. The aim of this study was to evaluate the performance of onsite medical waste treatment equipment in hospitals of Tabriz, Iran. Methods: A various range of the on-site medical waste disinfection equipment (autoclave, chemical disinfection, hydroclave, and dry thermal treatment) was considered to select 10 out of 22 hospitals in Tabriz to be included in the survey. The apparatus were monitored mechanically, chemically, and biologically for a six months period in all of the selected hospitals. Results: The results of the chemical monitoring (Bowie-Dick tests) indicated that 38.9% of the inspected autoclaves had operational problems in pre-vacuum, air leaks, inadequate steam penetration into the waste, and/or vacuum pump. The biological indicators revealed that about 55.55% of the samples were positive. The most of applied devices were not suitable for treating anatomical, pharmaceutical, cytotoxic, and chemical waste. Conclusion: Although on-site medical waste treating facilities have been installed in all the hospitals, the most of infectious-hazardous medical waste generated in the hospitals were deposited into a municipal solid waste landfill, without enough disinfection. The responsible authorities should stringently inspect and evaluate the operation of on-site medical waste treating equipment. An advanced off-site central facility with multi-treatment and disinfection equipment and enough capacity is recommended as an alternative. PMID:27766238

  5. Performance of on-site Medical waste disinfection equipment in hospitals of Tabriz, Iran.

    PubMed

    Taghipour, Hassan; Alizadeh, Mina; Dehghanzadeh, Reza; Farshchian, Mohammad Reza; Ganbari, Mohammad; Shakerkhatibi, Mohammad

    2016-01-01

    Background: The number of studies available on the performance of on-site medical waste treatment facilities is rare, to date. The aim of this study was to evaluate the performance of onsite medical waste treatment equipment in hospitals of Tabriz, Iran. Methods: A various range of the on-site medical waste disinfection equipment (autoclave, chemical disinfection, hydroclave, and dry thermal treatment) was considered to select 10 out of 22 hospitals in Tabriz to be included in the survey. The apparatus were monitored mechanically, chemically, and biologically for a six months period in all of the selected hospitals. Results: The results of the chemical monitoring (Bowie-Dick tests) indicated that 38.9% of the inspected autoclaves had operational problems in pre-vacuum, air leaks, inadequate steam penetration into the waste, and/or vacuum pump. The biological indicators revealed that about 55.55% of the samples were positive. The most of applied devices were not suitable for treating anatomical, pharmaceutical, cytotoxic, and chemical waste. Conclusion: Although on-site medical waste treating facilities have been installed in all the hospitals, the most of infectious-hazardous medical waste generated in the hospitals were deposited into a municipal solid waste landfill, without enough disinfection. The responsible authorities should stringently inspect and evaluate the operation of on-site medical waste treating equipment. An advanced off-site central facility with multi-treatment and disinfection equipment and enough capacity is recommended as an alternative.

  6. Medication problems occurring at hospital discharge among older adults with heart failure.

    PubMed

    Foust, Janice B; Naylor, Mary D; Bixby, M Brian; Ratcliffe, Sarah J

    2012-01-01

    Medication reconciliation problems are common among older adults at hospital discharge and lead to adverse events. The purpose of this study was to examine the rates and types of medication reconciliation problems among older adults hospitalized for acute episodes of heart failure who were discharged home. This secondary analysis of data generated from a transitional care intervention included 198 hospital discharge medical records, representing 162 patients. A retrospective chart review comparing medication lists between hospital discharge summaries and patient discharge instructions was completed to identify medication reconciliation problems. Most hospital discharges (71.2%) had at least one type of reconciliation problem and frequently involved a high-risk medication (76.6%). Discrepancies were the most common problem (58.9%), followed by incomplete discharge summaries (52.5%) and partial patient discharge instructions (48.9%). More attention needs to be given to the quality of discharge instructions, and the problem of vague phrases (e.g., "take as directed") can be addressed by adding it to "do not use" lists to promote safer transitions in care.

  7. Assessment of medical waste management in the main hospitals in Yemen.

    PubMed

    Al-Emad, A A

    2011-10-01

    No previous studies about the management of medical waste have been published in Yemen. This research in 5 government and 12 private hospitals in Sana'a aimed to evaluate waste-workers' and hospital administrators' knowledge and practices regarding medical waste handling. Interviews and observations showedadministrators' knowledge and practices regarding medical waste handling. Interviews and observations showed that the waste-workers were collecting medical and nonmedical wastes together manually in all hospitals without receiving adequate training and without using proper protection equipment. There was poor awareness about medical waste risks and safe handling procedures among hospital administrators, and most hospitals did not differentiate between domestic and medical waste disposal. Budgets were not allocated for waste management purposes, which led to shortages in waste handling equipment and an absence of training programmes for staff. Poor knowledge and practices and a high rate of injuries among waste-workers were noted, together with a risk of exposure of staff and visitors to hazardous waste.

  8. Opinions of Hospital Pharmacists in Canada Regarding Marijuana for Medical Purposes

    PubMed Central

    Mitchell, Fiona; Gould, Odette; LeBlanc, Michael; Manuel, Leslie

    2016-01-01

    Background: Canada’s most recent Marihuana for Medical Purposes Regulations have changed the way in which patients access marijuana. Furthermore, if authorized by the person in charge of the hospital, a pharmacist practising in a hospital may now place orders with licensed producers for dried marijuana for in-hospital use by patients. As use of this product increases, hospital pharmacists may have an increased role in the care of patients who are using marijuana for medical purposes. Objectives: The primary objective of this study was to determine the opinions of hospital pharmacists in Canada regarding marijuana for medical purposes. The secondary objective was to assess the factors influencing these opinions. Methods: An online survey was made available in early 2015 to licensed hospital pharmacists in Canada through individual provincial and territorial pharmacy regulatory bodies, pharmacist associations, hospital pharmacy directors, the Canadian Society of Hospital Pharmacists, and the Association des pharmaciens des établissements de santé du Québec. Responses were based on a 5-point Likert style scale, ranging from “completely agree” to “completely disagree”. Results: A total of 769 valid survey responses were received. Among the respondents, 44.6% (333/747) agreed that marijuana is safe, whereas 55.2% (411/745) agreed that it is effective. Only 17.2% (129/748) agreed that they were knowledgeable about marijuana for medical purposes, and about 65% of respondents reported no formal training in this area. Factors that influenced respondents’ opinions were age, education, area of clinical practice, province of work, and personal experience. Conclusion: Many Canadian hospital pharmacists agreed that marijuana for medical purposes is safe and effective, yet few considered themselves knowledgeable about this substance, with more than half reporting no formal training on the topic. PMID:27168633

  9. Hospitals and plastics. Dioxin prevention and medical waste incinerators.

    PubMed

    Thornton, J; McCally, M; Orris, P; Weinberg, J

    1996-01-01

    CHLORINATED DIOXINS and related compounds are extremely potent toxic substances, producing effects in humans and animals at extremely low doses. Because these compounds are persistent in the environment and accumulate in the food chain, they are now distributed globally, and every member of the human population is exposed to them, primarily through the food supply and mothers' milk. An emerging body of information suggests that dioxin contamination has reached a level that may pose a large-scale, long-term public health risk. Of particular concern are dioxin's effects on reproduction, development, immune system function, and carcinogenesis. Medical waste incineration is a major source of dioxins. Polyvinyl chloride (PVC) plastic, as the dominant source of organically bound chlorine in the medical waste stream, is the primary cause of "iatrogenic" dioxin produced by the incineration of medical wastes. Health professionals have a responsibility to work to reduce dioxin exposure from medical sources. Health care institutions should implement policies to reduce the use of PVC plastics, thus achieving major reductions in medically related dioxin formation.

  10. Hospitals and plastics. Dioxin prevention and medical waste incinerators.

    PubMed Central

    Thornton, J; McCally, M; Orris, P; Weinberg, J

    1996-01-01

    CHLORINATED DIOXINS and related compounds are extremely potent toxic substances, producing effects in humans and animals at extremely low doses. Because these compounds are persistent in the environment and accumulate in the food chain, they are now distributed globally, and every member of the human population is exposed to them, primarily through the food supply and mothers' milk. An emerging body of information suggests that dioxin contamination has reached a level that may pose a large-scale, long-term public health risk. Of particular concern are dioxin's effects on reproduction, development, immune system function, and carcinogenesis. Medical waste incineration is a major source of dioxins. Polyvinyl chloride (PVC) plastic, as the dominant source of organically bound chlorine in the medical waste stream, is the primary cause of "iatrogenic" dioxin produced by the incineration of medical wastes. Health professionals have a responsibility to work to reduce dioxin exposure from medical sources. Health care institutions should implement policies to reduce the use of PVC plastics, thus achieving major reductions in medically related dioxin formation. Images p298-a p299-a p300-a p301-a p305-a p307-a p310-a PMID:8711095

  11. Medical Record Clerk Training Program, Course of Study; Instructor's Guide: For Medical Record Personnel in Small Rural Hospitals in Colorado.

    ERIC Educational Resources Information Center

    Community Health Service (DHEW/PHS), Arlington, VA. Div. of Health Resources.

    A program of education including training materials is presented to improve the technical proficiency of medical record clerks in small, rural hospitals. The program is planned for fifteen days of instruction or approximately 120 hours including evaluation, orientation and discussion sessions. Students are expected to have a high school diploma…

  12. An Introduction to Emergency Medical Services (EMS). Pre-Hospital Phase. Emergency Medical Services Orientation, Lesson Plan No. 9.

    ERIC Educational Resources Information Center

    Young, Derrick P.

    Designed for use with interested students at high schools, community colleges, and four-year colleges, this lesson plan was developed to provide an introduction to the pre-hospital phase of Emergency Medical Services (EMS) and to serve as a recruitment tool for the EMS Program at Kapiolani Community College (KCC) in Hawaii. The objectives of the…

  13. Medication Adherence and the Risk of Cardiovascular Mortality and Hospitalization Among Patients With Newly Prescribed Antihypertensive Medications.

    PubMed

    Kim, Soyeun; Shin, Dong Wook; Yun, Jae Moon; Hwang, Yunji; Park, Sue K; Ko, Young-Jin; Cho, BeLong

    2016-03-01

    The importance of adherence to antihypertensive treatments for the prevention of cardiovascular disease has not been well elucidated. This study evaluated the effect of antihypertensive medication adherence on specific cardiovascular disease mortality (ischemic heart disease [IHD], cerebral hemorrhage, and cerebral infarction). Our study used data from a 3% sample cohort that was randomly extracted from enrollees of Korean National Health Insurance. Study subjects were aged ≥20 years, were diagnosed with hypertension, and started newly prescribed antihypertensive medication in 2003 to 2004. Adherence to antihypertensive medication was estimated as the cumulative medication adherence. Subjects were divided into good (cumulative medication adherence, ≥80%), intermediate (cumulative medication adherence, 50%-80%), and poor (cumulative medication adherence, <50%) adherence groups. We used time-dependent Cox proportional hazards models to evaluate the association between medication adherence and health outcomes. Among 33 728 eligible subjects, 670 (1.99%) died of coronary heart disease or stroke during follow-up. Patients with poor medication adherence had worse mortality from IHD (hazard ratio, 1.64; 95% confidence interval, 1.16-2.31; P for trend=0.005), cerebral hemorrhage (hazard ratio, 2.19; 95% confidence interval, 1.28-3.77; P for trend=0.004), and cerebral infarction (hazard ratio, 1.92; 95% confidence interval, 1.25-2.96; P for trend=0.003) than those with good adherence. The estimated hazard ratios of hospitalization for cardiovascular disease were consistent with the mortality end point. Poor medication adherence was associated with higher mortality and a greater risk of hospitalization for specific cardiovascular diseases, emphasizing the importance of a monitoring system and strategies to improve medication adherence in clinical practice.

  14. Public Affairs

    DTIC Science & Technology

    2007-11-02

    military assistance to civil authorities ( MACA ), including consequence management activities. The Armed Forces of the United States support the NSHS...mission and the close relationship between HD and homeland security, homeland defense missions may be conducted in a manner similar to MACA (i.e., with a...during a major event. 4. Public Affairs Operations Under the National Response Plan a. The NRP outlines the federal (including DOD MACA ) response to

  15. A proposed framework to improve the safety of medical devices in a Canadian hospital context

    PubMed Central

    Polisena, Julie; Jutai, Jeffrey; Chreyh, Rana

    2014-01-01

    Purpose Medical devices are used to monitor, replace, or modify anatomy or physiological processes. They are important health care innovations that enable effective treatment using less invasive techniques, and they improve health care delivery and patient outcomes. Devices can also introduce risk of harm to patients. Our objective was to propose a surveillance system framework to improve the safety associated with the use of medical devices in a hospital. Materials and methods The proposed medical device surveillance system incorporates multiple components to accurately document and assess the appropriate actions to reduce the risk of incidents, adverse events, and patient harm. The assumptions on which the framework is based are highlighted. The surveillance system was designed from the perspective of a tertiary teaching hospital that includes dedicated hospital staff whose mandate is to provide safe patient care to inpatients and outpatients and biomedical engineering services. Results The main components of the surveillance system would include an adverse medical device events database, a medical device/equipment library, education and training, and an open communication and feedback strategy. Close linkages among these components and with external medical device/equipment networks to the hospital must be established and maintained. A feedback mechanism on medical device-related incidents, as well as implementation and evaluation strategies for the surveillance system are described to ensure a seamless transition and a high satisfactory level among the hospital staff. The direct cost items of the proposed surveillance system for consideration, and its potential benefits are outlined. Conclusion The effectiveness of the proposed medical device surveillance system framework can be measured after it has been implemented in a Canadian hospital facility. PMID:24876796

  16. Military Medical Revolution: Deployed Hospital and En Route Care

    DTIC Science & Technology

    2012-01-01

    massive transfusion, the DCR protocol is initiated; thawed plasma is used as a primary resuscitation fluid in a 1:1 ratio with PRBCs. This process...3.02Y17.32). TXA is the first targeted therapy to be proven effective in hemorrhaging trauma patients, and CRASH-2 pro- vides Level I evidence to support...Deployed hospital care DCR Diagnostic evaluation for explosion injury Vascular surgery Ortho wound care Regional anesthesia and TIVA Combat burn care

  17. 42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... services; use of hospital or CAH facilities. 409.12 Section 409.12 Public Health CENTERS FOR MEDICARE... services, medical social services; use of hospital or CAH facilities. (a) Except as provided in paragraph... facilities, and medical social services as inpatient hospital or inpatient CAH services only if...

  18. Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals, 2005–2010

    PubMed Central

    Nelson, Richard E.; Grosse, Scott D.; Waitzman, Norman J.; Lin, Junji; DuVall, Scott L.; Patterson, Olga; Tsai, James; Reyes, Nimia

    2015-01-01

    Background There are limitations to using administrative data to identify postoperative venous thromboembolism (VTE). We used a novel approach to quantify postoperative VTE events among Department of Veterans Affairs (VA) surgical patients during 2005–2010. Methods We used VA administrative data to exclude patients with VTE during 12 months prior to surgery. We identified probable postoperative VTE events within 30 and 90 days post-surgery in three settings: 1) pre-discharge inpatient, using a VTE diagnosis code and a pharmacy record for anticoagulation; 2) post-discharge inpatient, using a VTE diagnosis code followed by a pharmacy record for anticoagulation within 7 days; and 3) outpatient, using a VTE diagnosis code and either anticoagulation or a therapeutic procedure code with natural language processing (NLP) to confirm acute VTE in clinical notes. Results Among 468,515 surgeries without prior VTE, probable VTEs were documented within 30 and 90 days in 3,931 (0.8%) and 5,904 (1.3%), respectively. Of probable VTEs within 30 or 90 days post-surgery, 47.8% and 62.9%, respectively, were diagnosed post-discharge. Among post-discharge VTE diagnoses, 86% resulted in a VA hospital readmission. Fewer than 25% of outpatient records with both VTE diagnoses and anticoagulation prescriptions were confirmed by NLP as acute VTE events. Conclusion More than half of postoperative VTE events were diagnosed post-discharge; analyses of surgical discharge records are inadequate to identify postoperative VTE. The NLP results demonstrate that the combination of VTE diagnoses and anticoagulation prescriptions in outpatient administrative records cannot be used to validly identify postoperative VTE events. PMID:25666908

  19. Comparison of Medical Students' Satisfaction with Family Medicine Clerkships between University Hospitals and Community Hospitals or Clinics

    PubMed Central

    2016-01-01

    Background The purpose of this study was to compare students' awareness of and satisfaction with clerkships in family medicine between a university hospital and a community hospital or clinic. Methods Thirty-eight 4th year medical students who were undergoing a clerkship in family medicine in the 1st semester of 2012 were surveyed via questionnaire. The questionnaire was administered both before and after the clerkship. Results External clerkships were completed in eight family medicine clinics and two regional hospitals. At preclerkship, participants showed strong expectation for understanding primary care and recognition of the need for community clerkship, mean scores of 4.3±0.5 and 4.1±0.7, respectively. At post-clerkship, participants showed a significant increase in recognition of the need for community clerkship (4.7±0.5, P<0.001). The pre-clerkship recognition of differences in patient characteristics between university hospitals and community hospitals or clinics was 4.1±0.7; at post-clerkship, it was 3.9±0.7. Students' confidence in their ability to see a first-visit patient and their expectation of improved interviewing skills both significantly increased at post-clerkship (P<0.01). Satisfaction with feedback from preceptors and overall satisfaction with the clerkship also significantly increased, but only for the university hospital clerkship (P<0.01). Conclusion Students' post-clerkship satisfaction was uniformly high for both clerkships. At pre-clerkship, students were aware of the differences in patient characteristics between university hospitals and community hospitals or clinics, and this awareness did not change by the end of the clerkship. PMID:27900072

  20. Hospitalization Rates and Reasons Among HIV Elite Controllers and Persons With Medically Controlled HIV Infection

    PubMed Central

    Crowell, Trevor A.; Gebo, Kelly A.; Blankson, Joel N.; Korthuis, P. Todd; Yehia, Baligh R.; Rutstein, Richard M.; Moore, Richard D.; Sharp, Victoria; Nijhawan, Ank E.; Mathews, W. Christopher; Hanau, Lawrence H.; Corales, Roberto B.; Beil, Robert; Somboonwit, Charurut; Edelstein, Howard; Allen, Sara L.; Berry, Stephen A.

    2015-01-01

    Background. Elite controllers spontaneously suppress human immunodeficiency virus (HIV) viremia but also demonstrate chronic inflammation that may increase risk of comorbid conditions. We compared hospitalization rates and causes among elite controllers to those of immunologically intact persons with medically controlled HIV. Methods. For adults in care at 11 sites from 2005 to 2011, person-years with CD4 T-cell counts ≥350 cells/mm2 were categorized as medical control, elite control, low viremia, or high viremia. All-cause and diagnostic category-specific hospitalization rates were compared between groups using negative binomial regression. Results. We identified 149 elite controllers (0.4%) among 34 354 persons in care. Unadjusted hospitalization rates among the medical control, elite control, low-viremia, and high-viremia groups were 10.5, 23.3, 12.6, and 16.9 per 100 person-years, respectively. After adjustment for demographic and clinical factors, elite control was associated with higher rates of all-cause (adjusted incidence rate ratio, 1.77 [95% confidence interval, 1.21–2.60]), cardiovascular (3.19 [1.50–6.79]) and psychiatric (3.98 [1.54–10.28]) hospitalization than was medical control. Non–AIDS-defining infections were the most common reason for admission overall (24.1% of hospitalizations) but were rare among elite controllers (2.7%), in whom cardiovascular hospitalizations were most common (31.1%). Conclusions. Elite controllers are hospitalized more frequently than persons with medically controlled HIV and cardiovascular hospitalizations are an important contributor. PMID:25512624

  1. Hospital doctors' career structure and misuse of medical womanpower.

    PubMed

    Bewley, B R; Bewley, T H

    1975-08-09

    Biological and culturel differences between men and women lead to severe discrimination against women doctors who bear the burdens of pregnancy, child-rearing, and housework. These lead, from equality within medical school and at qualification, to increasing failure to obtain posts commensurate with their innate abilities. Women doctors who temporarily and partially drop out of full-time practice have been studied frequently, but men (who are equally expensive to train) have not, despite their disappearing from National Health Service practice through emigration, death, alcoholism, suicide, or removal from the Medical Register. In a working lifetime of forty years, a woman doctor with an average family is likely to do seven-eighths of the work of a doctor who has not had to carry the primary responsibility of bearing and rearing children. Doctors with dependants are handicapped, and a separate career structure might be set up for them. Supernumerary consultant posts are proposed.

  2. How to shape positive relationships in medical practices and hospitals.

    PubMed

    Sotile, W M; Sotile, M O

    1999-01-01

    Managing workplace conflict is one of the most important, stressful, and time-consuming tasks faced by today's medical leaders. Poorly managed workplace conflict can alienate patients, demoralize staff, increase turnover, damage relationships with valued referral sources and third party carriers concerned about patient satisfaction, and lead medical practices to costly "corporate divorces." Physician executives cannot solve the problems caused by disruptive doctors simply by bolstering their own conflict management skills or by policing offenders. The larger contexts within which inappropriate workplace behavior occurs must also be assessed and addressed. The true leadership challenge is to intervene in ways that help to foster a "culture" of appropriate interpersonal dynamics throughout your organization. This requires learning to think and to intervene systematically.

  3. Confirming delivery: understanding the role of the hospitalized patient in medication administration safety.

    PubMed

    Macdonald, Marilyn T; Heilemann, MarySue V; MacKinnon, Neil J; Lang, Ariella; Gregory, David; Gurnham, Mary Ellen; Fillatre, Theresa

    2014-04-01

    The purpose of our study was to gain an understanding of current patient involvement in medication administration safety from the perspectives of both patients and nursing staff members. Administering medication is taken for granted and therefore suited to the development of theory to enhance its understanding. We conducted a constructivist, grounded theory study involving 24 patients and 26 nursing staff members and found that patients had the role of confirming delivery in the administration of medication. Confirming delivery was characterized by three interdependent subprocesses: engaging in the medication administration process, being "half out of it" (patient mental status), and perceiving time. We believe that ours is one of the first qualitative studies on the role of hospitalized patients in administering medication. Medication administration and nursing care systems, as well as patient mental status, impose limitations on patient involvement in safe medication administration.

  4. Impact of the Pacific Southwest Regional Medical Library Service on hospital library development.

    PubMed Central

    Graham, E; Van Vuren, D D; Flack, V

    1987-01-01

    A study was designed to evaluate the progress of hospital libraries within Region 7 since the Pacific Southwest Regional Medical Library Services (PSRMLS) began in 1969. Library progress was defined as an increase in extent and types of services and resources offered. The study assessed the impact of Regional Medical Library programs on hospital libraries and compared resources and services reported in 1969, 1971, and 1984. The 1984 data were also measured against a set of core library services and resources that should be provided by a full-service hospital library. In addition to assessing the quality of PSRMLS programs and their effect on Region 7 hospital libraries, the study documented extensive growth in staffing, collection size, and services. PSRMLS programs were highly rated by the respondents, who also indicated that participation in PSRMLS programs improved specific library resources and services. PMID:3676532

  5. Potentially high-risk medication categories and unplanned hospitalizations: a case–time–control study

    PubMed Central

    Lin, Chih-Wan; Wen, Yu-Wen; Chen, Liang-Kung; Hsiao, Fei-Yuan

    2017-01-01

    Empirical data of medication-related hospitalization are very limited. We aimed to investigate the associations between 12 high risk medication categories (diabetic agents, diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, antiplatelets, antihypertensives, antiarrhythmics, anticonvulsants, antipsychotics, antidepressants, benzodiazepine (BZD)/Z-hypnotics, and narcotics) and unplanned hospitalizations. A population-based case–time–control study was performed using Taiwan’s National Health Insurance Research Database. Patients who experienced an unplanned hospitalization (index visit) were identified as index subjects and matched to a randomly selected reference visit within users of a specific category of high-risk medication. An unplanned hospitalization was defined as a hospital admission immediately after an emergency department visit. Discordant exposures to the high-risk medication during the case period (1–14 days before the visit) and the control period (366–379 days before the visit) were examined in both index and reference visits. Antipsychotics was associated with the highest risk of unplanned hospitalizations (adjusted OR: 1.54, 95% CI [1.37–1.73]), followed by NSAIDs (1.50, [1.44–1.56]), anticonvulsants (1.34, [1.10–1.64]), diuretics (1.24, [1.15–1.33]), BZD/Z-hypnotics (1.23, [1.16–1.31]), antidepressants (1.17, [1.05–1.31]) and antiplatelets (1.16, [1.07–1.26]). NSAIDs and narcotics were associated with the highest risks of unplanned hospitalizations with a length of stay ≥10 days. These medication categories should be targeted for clinical and policy interventions. PMID:28112193

  6. Seizure occurrence following nonoptimal anticonvulsant medication management during the transition into the hospital.

    PubMed

    Jones, Charlotte; Kaffka, Jaimee; Missanelli, Megan; Dure, Leon; Ness, Jayne; Funkhouser, Ellen; Kilgore, Meredith; Yu, Feliciano; Safford, Monika M; Saag, Kenneth

    2013-10-01

    Previous work has shown that medication errors related to anticonvulsants are common during the transition into the hospital for pediatric patients. The purpose of this work was to evaluate whether children with epilepsy admitted for reasons other than epilepsy experience nonoptimal care in anticonvulsant medication management preceding the occurrence of seizures. Using a retrospective cohort of children with epilepsy admitted for reasons other than epilepsy, we created timelines from data in the medical record for the children who experienced seizures. These timelines included the timing and concentration of anticonvulsant administration and seizure occurrence. Three child neurologists independently identified whether nonoptimal care preceded the occurrence of seizures and potentially contributed to the occurrence of the seizure. Of 120 children, 18 experienced seizures and 12 experienced nonoptimal care in anticonvulsant management preceding seizure occurrence. Nonoptimal care that occurred during the transition into the hospital included missed doses of anticonvulsants, delays in administration during which seizures occurred, and patients inadvertently not receiving their home dosing of medication. Anticonvulsant medication errors are known to occur during the transition into the hospital. Here we present a case series of children who experienced nonoptimal care in anticonvulsant medication management who subsequently experienced seizures. Further work to identify how likely the outcome of seizures is following anticonvulsant medication errors, specifically focusing on timing as well as interventions to change the system issues that lead to these errors, is indicated.

  7. Evaluation of a hospital medical library class for NICU nurses.

    PubMed

    Mi, Misa

    2006-01-01

    A library class was designed and offered to new nurses from the Neonatal Intensive Care Unit at the Children's Hospital of Michigan between 2003 and 2005. The class was intended to increase their knowledge of quality health information resources and to assist them with their smooth transition to a new health care organization. The goal of the library training class was to develop the nurses' awareness and knowledge of the library services and online resources on the organization Intranet and to improve their skills in finding reliable information related to patient care, patient parent education, and research. An evaluation study was conducted to assess the effectiveness of the library class. Although the findings demonstrated strengths of the library class, they also revealed some areas for improvement. The data gathered resulted in a number of recommendations regarding library instruction design and evaluation.

  8. The paper crisis: from hospitals to medical practices.

    PubMed

    Park, Gregory; Neaveill, Rodney S

    2009-01-01

    Hospitals, not unlike physician practices, are faced with an increasing burden of managing piles of hard copy documents including insurance forms, requests for information, and advance directives. Healthcare organizations are moving to transform paper-based forms and documents into digitized files in order to save time and money and to have those documents available at a moment's notice. The cost of these document management/imaging systems can be easily justified with the significant savings of resources realized from the implementation of these systems. This article illustrates the enormity of the "paper problem" in healthcare and outlines just a few of the required processes that could be improved with the use of automated document management/imaging systems.

  9. [Problems in career planning for novice medical technologists in Japanese national hospitals].

    PubMed

    Ogasawara, Shu; Tsutaya, Shoji; Akimoto, Hiroyuki; Kojima, Keiya; Yabaka, Hiroyuki

    2012-12-01

    Skills and knowledge regarding many different types of test are required for medical technologists (MTs) to provide accurate information to help doctors and other medical specialists. In order to become an efficient MT, specialized training programs are required. Certification in specialized areas of clinical laboratory sciences or a doctoral degree in medical sciences may help MTs to realize career advancement, a higher earning potential, and expand the options in their career. However, most young MTs in national university hospitals are employed as part-time workers on a three-year contract, which is too short to obtain certifications or a doctoral degree. We have to leave the hospital without expanding our future. We need to take control of our own development in order to enhance our employability within the period. As teaching and training hospitals, national university hospitals in Japan are facing a difficult dilemma in nurturing MTs. I hope, as a novice medical technologist, that at least university hospitals in Japan create an appropriate workplace environment for novice MTs.

  10. SPD-based Logistics Management Model of Medical Consumables in Hospitals

    PubMed Central

    LIU, Tongzhu; SHEN, Aizong; HU, Xiaojian; TONG, Guixian; GU, Wei; YANG, Shanlin

    2016-01-01

    Background: With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. Methods: We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. Results: We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. Conclusion: The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China. PMID:27957435

  11. Evaluating hospital information systems from the point of view of the medical records section users in Medical-Educational Hospitals of Kermanshah 2014.

    PubMed

    Rostami, S; Sarmad, A; Mohammadi, M; Cheleie, M; Amiri, S; Zardoei Golanbary, S H

    2015-01-01

    Evaluating hospital information systems leads to the improvement and devotion based on the users' needs, especially the medical records section users in hospitals, which are in contact with this system from the moment the patient enters the hospital until his/ her release and after that. The present research aimed to evaluate the hospital information systems from the point of view of the medical record section employees. Materials and method: The current research was applicative-descriptive analytical and the research society included 70 users of the medical history section in the educational-medical centers of Kermanshah city. The data-gathering tool was the 10th part of 9241/ 10 Isometric standard questionnaire of evaluating hospital information systems, with 75 specific questions in 7 bases, with the five spectra Likertt scale, its conceptual admissibility being confirmed in previous researches. 22 SPSS statistical software analyzed its permanency in the present study, which was also confirmed by Cronbach's's alpha test, which equaled to 0.89, and the data. Findings: The highest level of the employees' satisfaction, based on gained scores median, was respectively the incompatibility with the users' expectations, measuring 3.55, self-description measuring 3.54 and controllability - 3.51, which in total presented the average scores of 3.39, the lowest level of satisfaction being related to useful learning , whose value was 3.19. Discussion and conclusion: Hospital information systems' users believe that it is more desirable that the existing systems are based on the measures and consider them proper for making them non-governmental and useful for undesired learning. Considering the long distance of the existing information systems with the desired performance, it is essential that "these systems pay more attention to a more complete and deeper recognition and awareness of users' opinions and requirements in their road. The movement and development is to increase

  12. Reducing serious injury from falls in two veterans' hospital medical-surgical units.

    PubMed

    Quigley, Patricia A; Hahm, Bridget; Collazo, Sonia; Gibson, Wanda; Janzen, Sandra; Powell-Cope, Gail; Rice, Fanny; Sarduy, Innette; Tyndall, Kyna; White, Susan V

    2009-01-01

    A large veteran's hospital participated in a year-long collaborative project across 9 hospitals to reduce serious injury from falls in acute care, targeting medical-surgical units. The primary objective of this project was to develop and test a set of interventions (bundles) to prevent serious physical injury (fractures and hemorrhagic bleeds) from patient falls. The interventions were implemented using tests of change on 2 medical-surgical units focused on engaging unit-based staff and combining innovations for vulnerable populations at greatest risk for injury if they fall.

  13. USSR Report, Military Affairs

    DTIC Science & Technology

    2007-11-02

    and 24 brigades were destroyed and taken prisoner. The Wehrmacht lost 1,600,000 soldiers and officers. According to German data , irreplaceable...health, taking psychological data into acount, and their physical and general-education preparation. In so doing, how sincere the youth are in...Hospital for Political Affairs Lt-Col Aleksey Tel’nov bade them farewell heartily. The soldiers answered: "Thanks for the help and the care. Thanks, dear military doctors!..." 11409 CSO: 1801/207 END 58

  14. Impact of early in-hospital medication review by clinical pharmacists on health services utilization

    PubMed Central

    Partovi, Nilu; Ghement, Isabella; Wickham, Maeve E.; McGrail, Kimberlyn; Reddekopp, Lisa N.; Sobolev, Boris

    2017-01-01

    Background Adverse drug events are a leading cause of emergency department visits and unplanned admissions, and prolong hospital stays. Medication review interventions aim to identify adverse drug events and optimize medication use. Previous evaluations of in-hospital medication reviews have focused on interventions at discharge, with an unclear effect on health outcomes. We assessed the effect of early in-hospital pharmacist-led medication review on the health outcomes of high-risk patients. Methods We used a quasi-randomized design to evaluate a quality improvement project in three hospitals in British Columbia, Canada. We incorporated a clinical decision rule into emergency department triage pathways, allowing nurses to identify patients at high-risk for adverse drug events. After randomly selecting the first eligible patient for participation, clinical pharmacists systematically allocated subsequent high-risk patients to medication review or usual care. Medication review included obtaining a best possible medication history and reviewing the patient’s medications for appropriateness and adverse drug events. The primary outcome was the number of days spent in-hospital over 30 days, and was ascertained using administrative data. We used median and inverse propensity score weighted logistic regression modeling to determine the effect of pharmacist-led medication review on downstream health services use. Results Of 10,807 high-risk patients, 6,416 received early pharmacist-led medication review and 4,391 usual care. Their baseline characteristics were balanced. The median number of hospital days was reduced by 0.48 days (95% confidence intervals [CI] = 0.00 to 0.96; p = 0.058) in the medication review group compared to usual care, representing an 8% reduction in the median length of stay. Among patients under 80 years of age, the median number of hospital days was reduced by 0.60 days (95% CI = 0.06 to 1.17; p = 0.03), representing 11% reduction in the median

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

    PubMed

    Aires, L M; Finley, J P

    2000-01-01

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

  16. Effects of Hospital Systems on Medical Home Transformation in Primary Care Residency Training Practices.

    PubMed

    Knierim, Kyle; Hall, Tristen; Fernald, Douglas; Staff, Thomas J; Buscaj, Emilie; Allen, Jessica Cornett; Onysko, Mary; Dickinson, W Perry

    2016-11-23

    Most primary care residency training practices have close financial and administrative relationships with teaching hospitals and health systems. Many residency practices have begun integrating the core principles of the patient-centered medical home (PCMH) into clinical workflows and educational experiences. Little is known about how the relationships with hospitals and health systems affect these transformation efforts. Data from the Colorado Residency PCMH Project were analyzed. Results show that teaching hospitals and health systems have significant opportunities to influence residency practices' transformation, particularly in the areas of supporting team-based care, value-based payment reforms, and health information technology.

  17. Concomitants of perceived trust in hospital and medical services following Hurricane Sandy.

    PubMed

    Ben-Ezra, Menachem; Goodwin, Robin; Palgi, Yuval; Kaniasty, Krzysztof; Crawford, Marsha Zibalese; Weinberger, Aviva; Hamama-Raz, Yaira

    2014-12-30

    The relationship between factors associated with perceived trust in hospital and medical services in the aftermath of a natural disaster is understudied. An online sample of 1000 people mainly from affected states was surveyed after Hurricane Sandy. Participants completed a survey which included disaster related questions and PTSD symptoms. Logistic regression revealed a significant association between perceived trust in hospital services to education, subjective well-being, being scared for the life of a loved one and perceived trust in emergency services. These findings may emphasis the positive association between maintaining active hospital services and mental health among the general population during crisis.

  18. Implementing hospital library automation: the GaIN project. Georgia Interactive Network for Medical Information.

    PubMed Central

    Rankin, J A; McInnis, K A; Rosner, A L

    1995-01-01

    The GaIN (Georgia Interactive Network for Medical Information) Hospital Libraries' Local Automation Project was a one-year, grant-funded initiative to implement an integrated library system in three Georgia hospitals. The purpose of the project was to install the library systems, describe the steps in hospital library automation, and identify issues and barriers related to automation in small libraries. The participating hospitals included a small, a medium, and a large institution. The steps and time required for project implementation were documented in order to develop a decision checklist. Although library automation proved a desirable approach for improving collection accessibility, simplifying daily routines, and improving the library's image in the hospital, planners must be sure to consider equipment as well as software support, staffing for the conversion, and training of the library staff and end users. PMID:7581184

  19. Eating disorder emergencies: understanding the medical complexities of the hospitalized eating disordered patient.

    PubMed

    Cartwright, Martina M

    2004-12-01

    Eating disorders are maladaptive eating behaviors that typically develop in adolescence and early adulthood. Psychiatric maladies and comorbid conditions, especially insulin-dependent diabetes mellitus, frequently co-exist with eating disorders. Serious medical complications affecting all organs and tissues can develop and result in numerous emergent hospitalizations. This article reviews the pathophysiologies of anorexia nervosa, bulimia nervosa, and orthorexia nervosa and discusses the complexities associated with the treatment of medical complications seen in these patients.

  20. Diversity, Conflict, and Recognition in Hospital Medical Practice.

    PubMed

    Fortin, Sylvie; Maynard, Serge

    2015-07-01

    The hospital is a place of encounter between health care providers, patients and family members, the healthy and the suffering, migrants and non-migrants, as well as social and cultural minorities, and majorities of various backgrounds. It is also a space where multiple conceptions of care, life, quality of life, and death are enacted, sometimes inhibiting mutual understanding between caregivers and the cared for, a scenario that in turn may provoke conflict. Through the lens of conflict, we explore in this article the theme of Otherness within the clinic, basing analysis on an ethnographic study conducted in recent years in three cosmopolitan Canadian cities. Daily practices and-on a larger scale-the social space of the clinic become material here for reflecting on recognition (and non-recognition) of the Other as actors in the clinical encounter. The examination of structural and situational conditions that contribute to the emergence of conflict offers an understanding of the diversity of values that pervade the clinic. By way of conclusion, we argue that recognition of diversity, at least on the part of practitioners, is a key condition for the emergence of a pluralist normativity in the social space of the clinic.

  1. Medical psychology services in dutch general hospitals: state of the art developments and recommendations for the future.

    PubMed

    Soons, Paul; Denollet, Johan

    2009-06-01

    In this article an overview is presented of the emergence of medical psychology in the care of somatically ill patients. The situation in the Netherlands can be considered as prototypical. For 60 years, clinical psychologists have been working in general, teaching and academic hospitals. Nowadays, they are an integrated non-medical specialism working in the medical setting of hospitals in the Netherlands, and are a full-member of the medical board. This paper discusses several topics: the position of the general hospital in the health care system in the Netherlands, the emergence of medical psychology in Dutch hospitals, the role of the professional association of medical psychologists, and the characteristics of patients seen by clinical psychologists. Following the discussion about the situation of medical psychology in other countries, recommendations are formulated for the further development of medical psychology in the Netherlands as well as in other countries.

  2. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.50 Use of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to...

  3. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.50 Use of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to...

  4. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.50 Use of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to...

  5. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.50 Use of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to...

  6. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.50 Use of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to...

  7. A bill to redesignate the Department of Veterans Affairs Healthcare System located at 10000 Bay Pines Boulevard in Bay Pines, Florida, as the "C.W. Bill Young Department of Veterans Affairs Medical Center".

    THOMAS, 113th Congress

    Sen. Nelson, Bill [D-FL

    2013-10-28

    10/30/2013 Committee on Veterans' Affairs. Hearings held. Hearings printed: S.Hrg. 113-280. (All Actions) Notes: For further action, see H.R.3302, which became Public Law 113-49 on 11/13/2013. Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  8. Partnerships between Medical Centres and General Hospitals Providing Normal Care Standards in Gynaecology and Obstetrics in Germany

    PubMed Central

    Schütz, F.; Maleika, A.; Poeschl, J.; Domschke, C.; Seitz, H.; Beuter-Winkler, P.; Sohn, C.

    2012-01-01

    Hospital managers and the heads of medical departments are nowadays being faced with ever increasing demands. It is becoming difficult for some small hospitals to find highly experienced or even experienced medical staff, to provide specific health-care services at break-even prices and to maintain their position in competition with other hospitals. On the other hand, large hospitals are facing enormous pressure in the investment and costs fields. Cooperation could provide a solution for these problems. For an optimal strategic exploitation of the hospitals, their direction could be placed in the hands of a joint medical director. However, the directorship of two hospitals is associated both with opportunities and with risks. The present article illustrates the widely differing aspects of the cooperation between a medical centre and a general hospital providing standard care from both a theoretical point of view and on the basis of practical experience with an actual cooperation of this type in Heidelberg. PMID:25308978

  9. Does a global budget superimposed on fee-for-service payments mitigate hospitals' medical claims in Taiwan?

    PubMed

    Hsu, Pi-Fem

    2014-12-01

    Taiwan's global budgeting for hospital health care, in comparison to other countries, assigns a regional budget cap for hospitals' medical benefits claimed on the basis of fee-for-service (FFS) payments. This study uses a stays-hospitals-years database comprising acute myocardial infarction inpatients to examine whether the reimbursement policy mitigates the medical benefits claimed to a third-payer party during 2000-2008. The estimated results of a nested random-effects model showed that hospitals attempted to increase their medical benefit claims under the influence of initial implementation of global budgeting. The magnitudes of hospitals' responses to global budgeting were significantly attributed to hospital ownership, accreditation status, and market competitiveness of a region. The results imply that the regional budget cap superimposed on FFS payments provides only blunt incentive to the hospitals to cooperate to contain medical resource utilization, unless a monitoring mechanism attached with the payment system.

  10. Medication knowledge of patients hospitalized for heart failure at admission and after discharge

    PubMed Central

    Custodis, Florian; Rohlehr, Franziska; Wachter, Angelika; Böhm, Michael; Schulz, Martin; Laufs, Ulrich

    2016-01-01

    Background A substantial aspect of health literacy is the knowledge of prescribed medication. In chronic heart failure, incomplete intake of prescribed drugs (medication non-adherence) is inversely associated with clinical prognosis. Therefore, we assessed medication knowledge in a cohort of patients with decompensated heart failure at hospital admission and after discharge in a prospective, cross-sectional study. Methods One hundred and eleven patients presenting at the emergency department with acute decompensated heart failure were included (mean age 78.4±9.2, 59% men) in the study. Patients’ medication knowledge was assessed during individual interviews at baseline, course of hospitalization, and 3 months after discharge. Individual responses were compared with the medical records of the referring general practitioner. Results Median N-terminal prohormone of brain natriuretic peptide plasma concentration in the overall population at baseline was 4,208 pg/mL (2,023–7,101 pg/mL [interquartile range]), 20 patients died between the second and third interview. The number of prescribed drugs increased from 8±3 at baseline to 9±3 after 3 months. The majority of patients did not know the correct number of their drugs. Medication knowledge decreased continuously from baseline to the third interview. At baseline, 37% (n=41) of patients stated the correct number of drugs to be taken, whereas only 18% (n=16) knew the correct number 3 months after discharge (P=0.008). Knowledge was inversely related to N-terminal prohormone of brain natriuretic peptide levels. Conclusion Medication knowledge of patients with acute decompensated heart failure is poor. Despite care in a university hospital, patients’ individual medication knowledge decreased after discharge. The study reveals an urgent need for better strategies to improve and promote the knowledge of prescribed medication in these very high-risk patients. PMID:27877025

  11. Feasibility of ensuring confidentiality and security of computer-based patient records. Council on Scientific Affairs, American Medical Association.

    PubMed

    1993-05-01

    Legal and ethical precepts that apply to paper-based medical records, including requirements that patient records be kept confidential, accurate and legible, secure, and free from unauthorized access, should also apply to computer-based patient records. Sources of these precepts include federal regulations, state medical practice acts, licensing statutes and the regulations that implement them, accreditation standards, and professional codes of ethics. While the legal and ethical principles may not change, the risks to confidentiality and security of patient records appear to differ between paper- and computer-based records. Breaches of system security, the potential for faulty performance that may result in inaccessibility or loss of records, the increased technical ability to collect, store, and retrieve large quantities of data, and the ability to access records from multiple and (sometimes) remote locations are among the risk factors unique to computer-based record systems. Managing these risks will require a combination of reliable technological measures, appropriate institutional policies and governmental regulations, and adequate penalties to serve as a dependable deterrent against the infringement of these precepts.

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

    PubMed

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

    2015-09-01

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

  13. Hospital medication errors in a pharmacovigilance system in Colombia.

    PubMed

    Machado Alba, Jorge Enrique; Moreno Gutiérrez, Paula Andrea; Moncada Escobar, Juan Carlos

    2015-11-01

    Objetivos: analizar los errores de medicacion reportados en un sistema de farmacovigilancia en 26 hospitales para pacientes del sistema de salud de Colombia. Métodos: estudio retrospectivo que evaluo las bases de datos sistematizadas de reportes de errores de medicacion entre el 1 de enero de 2008 y el 12 de septiembre de 2013 de los medicamentos dispensados por la empresa Audifarma S.A a hospitales de Colombia. Se utilizo la clasificacion taxonomica del National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). El analisis de los datos se realizo mediante SPSS 22.0 para Windows Se determino como nivel de significacion estadistica una p < 0,05. Resultados: se reportaron 9.062 EM en 45 servicios farmaceuticos hospitalarios. El 51,9% (n = 4.707) de los errores realmente se produjeron, de los cuales el 12,0% (n = 567) afectaron al paciente (categorias C a I) y causaron dano (categorias E a I) a 17 (0,36%). El proceso implicado en los EM ocurridos (categorias B a I) con mayor frecuencia fue la prescripcion (n = 1.758, 37,3%), seguido por la dispensacion (n = 1.737, 36,9%), la transcripcion (n = 970, 20,6%) y, por ultimo, la administracion (n = 242, 5,1%). Los errores relacionados con los procesos de administracion aumentaban 45,2 veces el riesgo de que el medicamento erroneo afectara al paciente (IC 95% 20,2-100,9). Conclusiones: es necesario aumentar la cobertura de los sistemas de reporte de errores de medicacion, y crear estrategias para su prevencion, especialmente en la etapa de administracion del medicamento.

  14. Antimicrobial Susceptibility Pattern of Methicillin-Resistance Staphylococcus aureus from Different Tertiary Care Hospitals Including Mymensingh Medical College Hospital.

    PubMed

    Roy, S; Hossain, M A; Paul, S K; Haque, N; Barman, T K; Ahmed, S; Nasreen, S A; Hossain, M S; Ahmed, F; Biswas, P; Nahar, F; Begum, H; Islam, M S

    2016-07-01

    The aim of this study was to detect antimicrobial susceptibilities and the presence of drug resistance genes of MRSA from tertiary care hospitals. This study was carried out in the Department of Microbiology, Mymensingh Medical College during the period from Jan, 2015 to Dec, 2015. Clinical samples, including wound swab, pus, exudates from diabetic ulcer and burn ulcer, aural swab, blood and urine were collected. Standard microbiological procedure & biochemical tests were carried out to detect S. aureus. Oxacillin disk diffusion test was done by Kirby-Bauer disk diffusion method. Total 69 isolates of S. aureus were selected for the study. The isolates were collected from three different tertiary care hospitals, of which 33, 27 and 9 were from Mymensingh Medical College Hospital (MMCH), BIRDEM hospital and Sir Salimullah Medical College Hospital (SSMCH) respectively. Among the 69 isolates, 17(24.6%) and 52(75.3%) were distinguished as MRSA and MSSA respectively by ODDM (Oxacillin disk diffusion method). In contrast, detection of presence and absence of mecA gene by PCR identified 20 (28.9%) and 49 (71.01%) isolates as MRSA and MSSA respectively. All of the S. aureus (MRSA and MSSA) isolates were sensitive to vancomycin and gentamicin. All MRSA isolates (100%) showed resistance to Penicillin and Oxacillin. Among the MRSA isolates about 88.2% were resistance to Ceftazidime, 64.7% were resistance to Erythromycin and Ciprofloxacin, 11.7% were resistance to Tetracycline. Among the MSSA isolates about 94.2% were resistance to Penicillin and 9.6% resistance to Ciprofloxacin. The MSSA were less resistance for non-beta lactam drugs than MRSA. Regarding drug resistance genes, the blaZ genes were present in 47 out of 49(95.8%) MSSA and in 18 out of 18 (100%) MRSA. The erythromycin resistance gene ermB was found in 8.69% isolates, of which highest 20% in MRSA and 4.08% in MSSA. The ermA was not found in any isolates. Among tetracycline resistance genes, tetK were detected in 10

  15. Care provider perspectives on medical travel: A three-country study of destination hospitals.

    PubMed

    Garman, Andrew N; Johnson, Tricia J; Lynch, Elizabeth B; Satjapot, Siriporn

    2016-01-01

    Despite growing interest in the current and potential role of medical travel in U.S. patient care, very little research has been conducted on clinician and other provider organizations' perspectives on providing international patient care. The present study sought to gain formative insights about medical travel from the providers' perspectives, by conducting structured interviews and focus groups in six hospitals from three countries catering to patients traveling from the United States. Findings highlighted the surprising role of international events and policies in the evolution of medical travel, as well as both the desire and need for more transparent quality standards.

  16. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Special medical record requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS...

  17. A management plan for hospitals and medical centers facing radiation incidents

    PubMed Central

    Davari, Fereshteh; Zahed, Arash

    2015-01-01

    Background: Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. Materials and Methods: In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. Results: We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. Conclusion: With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary. PMID:26759575

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

    PubMed

    Deorukhkar, Sachin C; Saini, Santosh

    2016-01-01

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

  19. Adopting new medical technologies in Russian hospitals: what causes inefficiency? (qualitative study).

    PubMed

    Shishkin, Sergey; Zasimova, Liudmila

    2017-03-02

    The adoption of new medical technologies often generates losses in efficiency associated with the excess or insufficient acquisition of new equipment, an inappropriate choice (in terms of economic and clinical parameters) of medical equipment, and its poor use. Russia is a good example for exploring the problem of the ineffective adoption of new medical technologies due to the massive public investment in new equipment for medical institutions in 2006-2013. This study examines the procurement of new technologies in Russian hospitals to find the main causes of inefficiency. The research strategy was based on in-depth semistructured interviews with representatives of prominent actors (regional health care authorities, hospital executives, senior physicians). The main result is that inefficiencies arise from the contradiction between hospitals' and authorities' motivation for acquiring new technologies: hospitals tend to adopt technologies which bring benefits to their department heads and physicians and minimize maintenance and servicing costs, while the authorities' main concern is the initial cost of the technology.

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

    PubMed Central

    Deorukhkar, Sachin C.; Saini, Santosh

    2016-01-01

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

  1. The Role of International Medical Graduates in America?s Small Rural Critical Access Hospitals

    ERIC Educational Resources Information Center

    Hagopian, Amy; Thompson, Matthew J.; Kaltenbach, Emily; Hart, L. Gary

    2004-01-01

    Critical access hospitals (CAHs) are a federal Medicare category for isolated rural facilities with 15 or fewer acute care beds that receive cost-based reimbursement from Medicare. Purpose: This study examines the role of foreign-born international medical graduates (IMGs) in the staffing of CAHs. Methods: Chief executive officers (CEOs) of CAH…

  2. Analysis of the medication reconciliation process conducted at hospital admission.

    PubMed

    Contreras Rey, María Beatriz; Arco Prados, Yolanda; Sánchez Gómez, Ernesto

    2016-06-01

    fueron y en 93 (29,8%) la aceptación no procedía por un cambio en la situación del paciente. Las mayores oportunidades de mejora se identificaron en los servicios de Digestivo, Medicina Interna y Cirugía General y en los grupos terapéuticos: sangre y órganos hematopoyéticos, sistema cardiovascular y sistema nervioso. Conclusiones: En nuestro hospital solo una tercera parte de las intervenciones fueron aceptadas y reconocidas como errores de conciliación. No obstante, la conciliación de la medicación al ingreso realizada por un farmacéutico mostró ser útil en la identificación y prevención de errores de medicación. Un mejor entendimiento de los casos en los que las intervenciones no fueron aceptadas podría mejorar el resultado en el futuro.

  3. The Direct Cost of Parkinson Disease at Juntendo Medical University Hospital, Japan.

    PubMed

    Yoritaka, Asako; Fukae, Jiro; Hatano, Taku; Oda, Eisei; Hattori, Nobutaka

    2016-01-01

    Objective Many studies on the cost of Parkinson disease (PD) have been published; however, there are limited studies pertaining to this issue in Asia. This study looks to assess the direct medical costs of patients with PD at a university hospital in Japan by calculating the average monthly direct medical costs of PD patients from July to December 2008. Methods We enrolled 724 consecutive patients (411 women and 313 men) with PD who were registered in Japan's "Specified Disease Treatment Research Program" and obtained data on the total direct medical costs of all patients. Results Values are reported as the mean (standard deviation). The major finding of the direct medical cost analysis was that the outpatient clinic cost per subject (n=715) was USD 485.74 (376.31) per month. A multivariate analysis revealed that a younger age, the presence of wearing-off, hallucination, and longer disease duration increased the direct medical cost significantly. Disease severity had no influence on the direct medical costs. A longer disease duration was significantly correlated with higher hospitalization costs. Conclusion The direct medical cost of PD in Japan was found to be similar to that in Western countries. Costs due to productivity loss exceeded the direct costs, and they may be reduced through the better integration of PD patients in the work environment.

  4. Applying Toyota production system techniques for medication delivery: improving hospital safety and efficiency.

    PubMed

    Newell, Terry L; Steinmetz-Malato, Laura L; Van Dyke, Deborah L

    2011-01-01

    The inpatient medication delivery system used at a large regional acute care hospital in the Midwest had become antiquated and inefficient. The existing 24-hr medication cart-fill exchange process with delivery to the patients' bedside did not always provide ordered medications to the nursing units when they were needed. In 2007 the principles of the Toyota Production System (TPS) were applied to the system. Project objectives were to improve medication safety and reduce the time needed for nurses to retrieve patient medications. A multidisciplinary team was formed that included representatives from nursing, pharmacy, informatics, quality, and various operational support departments. Team members were educated and trained in the tools and techniques of TPS, and then designed and implemented a new pull system benchmarking the TPS Ideal State model. The newly installed process, providing just-in-time medication availability, has measurably improved delivery processes as well as patient safety and satisfaction. Other positive outcomes have included improved nursing satisfaction, reduced nursing wait time for delivered medications, and improved efficiency in the pharmacy. After a successful pilot on two nursing units, the system is being extended to the rest of the hospital.

  5. Direct medical costs of hospitalizations for cardiovascular diseases in Shanghai, China: trends and projections.

    PubMed

    Wang, Shengnan; Petzold, Max; Cao, Junshan; Zhang, Yue; Wang, Weibing

    2015-05-01

    Few studies in China have focused on direct expenditures for cardiovascular diseases (CVDs), making cost trends for CVDs uncertain. Epidemic modeling and forecasting may be essential for health workers and policy makers to reduce the cost burden of CVDs.To develop a time series model using Box-Jenkins methodology for a 15-year forecasting of CVD hospitalization costs in Shanghai.Daily visits and medical expenditures for CVD hospitalizations between January 1, 2008 and December 31, 2012 were analyzed. Data from 2012 were used for further analyses, including yearly total health expenditures and expenditures per visit for each disease, as well as per-visit-per-year medical costs of each service for CVD hospitalizations. Time series analyses were performed to determine the long-time trend of total direct medical expenditures for CVDs and specific expenditures for each disease, which were used to forecast expenditures until December 31, 2030.From 2008 to 2012, there were increased yearly trends for both hospitalizations (from 250,354 to 322,676) and total costs (from US $ 388.52 to 721.58 million per year in 2014 currency) in Shanghai. Cost per CVD hospitalization in 2012 averaged US $ 2236.29, with the highest being for chronic rheumatic heart diseases (US $ 4710.78). Most direct medical costs were spent on medication. By the end of 2030, the average cost per visit per month for all CVDs was estimated to be US $ 4042.68 (95% CI: US $ 3795.04-4290.31) for all CVDs, and the total health expenditure for CVDs would reach over US $1.12 billion (95% CI: US $ 1.05-1.19 billion) without additional government interventions.Total health expenditures for CVDs in Shanghai are estimated to be higher in the future. These results should be a valuable future resource for both researchers on the economic effects of CVDs and for policy makers.

  6. The effect of early in-hospital medication review on health outcomes: a systematic review

    PubMed Central

    Hohl, Corinne M; Wickham, Maeve E; Sobolev, Boris; Perry, Jeff J; Sivilotti, Marco L A; Garrison, Scott; Lang, Eddy; Brasher, Penny; Doyle-Waters, Mary M; Brar, Baljeet; Rowe, Brian H; Lexchin, Joel; Holland, Richard

    2015-01-01

    Aims Adverse drug events are an important cause of emergency department visits, unplanned admissions and prolonged hospital stays. Our objective was to synthesize the evidence on the effect of early in-hospital pharmacist-led medication review on patient-oriented outcomes based on observed data. Methods We systematically searched eight bibliographic reference databases, electronic grey literature, medical journals, conference proceedings, trial registries and bibliographies of relevant papers. We included studies that employed random or quasi-random methods to allocate subjects to pharmacist-led medication review or control. Medication review had to include, at a minimum, obtaining a best possible medication history and reviewing medications for appropriateness and adverse drug events. The intervention had to be initiated within 24 h of emergency department presentation or 72 h of admission. We extracted data in duplicate and pooled outcomes from clinically homogeneous studies of the same design using random effects meta-analysis. Results We retrieved 4549 titles of which seven were included, reporting the outcomes of 3292 patients. We pooled data from studies of the same design, and found no significant differences in length of hospital admission (weighted mean difference [WMD] –0.04 days, 95% confidence interval [CI] –1.63, 1.55), mortality (odds ratio [OR] 1.09, 95% CI 0.69, 1.72), readmissions (OR 1.15, 95% CI 0.81, 1.63) or emergency department revisits at 3 months (OR 0.60, 95% CI 0.27, 1.32). Two large studies reporting reductions in readmissions could not be included in our pooled estimates due to differences in study design. Conclusions Wide confidence intervals suggest that additional research is likely to influence the effect size estimates and clarify the effect of medication review on patient-oriented outcomes. This systematic review failed to identify an effect of pharmacist-led medication review on health outcomes. PMID:25581134

  7. Hospitals as a `risk environment: An ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs

    PubMed Central

    McNeil, Ryan; Small, Will; Wood, Evan; Kerr, Thomas

    2014-01-01

    People who inject drugs (PWID) experience high levels of HIV/AIDS and hepatitis C (HCV) infection that, together with injection-related complications such as non-fatal overdose and injection-related infections, lead to frequent hospitalizations. However, injection drug-using populations are among those most likely to be discharged from hospital against medical advice, which significantly increases their likelihood of hospital readmission, longer overall hospital stays, and death. In spite of this, little research has been undertaken examining how social-structural forces operating within hospital settings shape the experiences of PWID in receiving care in hospitals and contribute to discharges against medical advice. This ethno-epidemiological study was undertaken in Vancouver, Canada to explore how the social-structural dynamics within hospitals function to produce discharges against medical advice among PWID. In-depth interviews were conducted with thirty PWID recruited from among participants in ongoing observational cohort studies of people who inject drugs who reported that they had been discharged from hospital against medical advice within the previous two years. Data were analyzed thematically, and by drawing on the `Risk Environment' framework and concepts of social violence. Our findings illustrate how intersecting social and structural factors led to inadequate pain and withdrawal management, which led to continued drug use in hospital settings. In turn, diverse forms of social control operating to regulate and prevent drug use in hospital settings amplified drug-related risks and increased the likelihood of discharge against medical advice. Given the significant morbidity and health care costs associated with discharge against medical advice among drug-using populations, there is an urgent need to reshape the social-structural contexts of hospital care for PWID by shifting emphasis toward evidence-based pain and drug treatment augmented by harm

  8. Developing a programme for medication reconciliation at the time of admission into hospital.

    PubMed

    Giménez Manzorro, Álvaro; Zoni, Ana Clara; Rodríguez Rieiro, Cristina; Durán-García, Esther; Trovato López, Alejandro Nicolás; Pérez Sanz, Cristina; Bodas Gutiérrez, Patricia; Jiménez Muñoz, Ana Belén

    2011-08-01

    The aim of this article is to describe the methods used to develop the medication reconciliation programme implemented in a tertiary care hospital, and to discuss the main problems encountered and lessons learned during the process. A quasi-experimental study was carried out, analysing discrepancies between routine medication and drugs prescribed in the hospital, before and after an electronic reconciliation tool was introduced at admission. This tool was integrated into the computerized provider order entry system. The implementation of the electronic reconciliation tool has shown a reduction of the rate of discrepancies, decreasing from 7.24% (CI 95% 6.0-8.5) before the intervention to 4.18% (CI 95% 3.2-5.1) afterwards. Projects like this are costly, but this study has made it possible to detect numerous areas where interventions could be useful and proved the importance of a medication reconciliation programme.

  9. Investment subsidies and the adoption of electronic medical records in hospitals.

    PubMed

    Dranove, David; Garthwaite, Craig; Li, Bingyang; Ody, Christopher

    2015-12-01

    In February 2009 the U.S. Congress unexpectedly passed the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH provides up to $27 billion to promote adoption and appropriate use of Electronic Medical Records (EMR) by hospitals. We measure the extent to which HITECH incentive payments spurred EMR adoption by independent hospitals. Adoption rates for all independent hospitals grew from 48 percent in 2008 to 77 percent by 2011. Absent HITECH incentives, we estimate that the adoption rate would have instead been 67 percent in 2011. When we consider that HITECH funds were available for all hospitals and not just marginal adopters, we estimate that the cost of generating an additional adoption was $48 million. We also estimate that in the absence of HITECH incentives, the 77 percent adoption rate would have been realized by 2013, just 2 years after the date achieved due to HITECH.

  10. Effect of preceding medications on resuscitation outcome of out-of-hospital cardiac arrest

    PubMed Central

    Hung, Shih-Wen; Chu, Chien-Ming; Su, Chih-Feng; Tseng, Li-Ming; Wang, Tzong-Luen

    2017-01-01

    As evidence regarding the impact of preceding medications on resuscitation outcomes has been inconsistent, this study aimed to analyze the association between preceding medications and resuscitation outcomes in patients experiencing out-of-hospital cardiac arrest (OHCA). This retrospective study included patients with OHCA presenting to a tertiary care hospital by emergency medical service (EMS) between January 2006 and June 2011. Using the Utstein template, data were collected from EMS and hospital medical records for prehospital care, in-hospital care, and medications which were taken continuously for at least 2 weeks preceding OHCA. Primary outcome was the proportion of patients with a survived event. Multivariable logistic regression analyses were performed to evaluate the predictors of survived events. Among the 1381 included patients with OHCA, 552 (40.0%) patients achieved sustained return of spontaneous circulation and 463 (33.5%) patients survived after resuscitation, 96 (7.0%) patients survived until discharge, and 20 (1.4%) patients had a favorable neurological outcome at discharge. The multivariable analyses revealed that use of statins preceding OHCA was independently associated with a greater probability of a survived events (OR=2.09, 95% CI 1.08 to 4.03, p=0.028).Use of digoxin was adversely associated with survived events (OR=0.39, 95% CI 0.16 to 0.90, p=0.028) in patients with OHCA. The continuous use of statins preceding OHCA was positively associated with survived events, while use of digoxin was adversely related. It deserves more attention on medications preceding OHCA because of their potential effect on resuscitation outcomes. PMID:27965361

  11. Assessment of informatization for the dispensing of medications at a university hospital

    PubMed Central

    Serafim, Sônia Aparecida Dias; Forster, Aldaisa Cassanho; Simões, Maria Jacira Silva; Penaforte, Thais Rodrigues

    2010-01-01

    INTRODUCTION Informatics and automation are important tools for the reduction of work, errors and costs in a hospital pharmacy. OBJECTIVES To describe the structuring and function of an informatized system for the dispensing of medications and to assess its effect on nursing and pharmacy services during the period from 1997 to 2003. MATERIALS AND METHODS In this descriptive and retrospective study, we performed an analysis of documents addressing the structuring and implementation of the informatized medication dispensing system. In addition, we analyzed the perceptions of nurses, pharmacists and pharmacy assistants who participated in the structuring phase of the system when interviewed about the effect of informatization on administrative aspects (e.g., requisition of medications, presentation of the dispensed medication and system operationalization). RESULTS The major advantages provided by the new system were 1) the elimination of manual transcripts for prescribed medications, 2) increased speed, 3) better identification of the doses prescribed by physicians, 4) medication labels containing all necessary identification and 5) practicality and safety of optical bar code-based verification of the requested and dispensed medications. CONCLUSIONS The great majority of the interviewees considered the informatized medication supply system to be of good quality. Analysis of the data provided information that could contribute to the expansion and refinement of the system, provide support for studies regarding the utilization of medications and offer new perspectives for work and productivity. PMID:20454500

  12. Hospital-based health technology assessment in France: A focus on medical devices.

    PubMed

    Martelli, Nicolas; Puc, Cyril; Szwarcensztein, Karine; Beuscart, Régis; Coulonjou, Hélène; Degrassat-Théas, Albane; Dutot, Camille; Epis de Fleurian, Anne-Aurélie; Favrel-Feuillade, Florence; Hounliasso, Iliona; Lechat, Philippe; Luigi, Emmanuel; Mairot, Laurent; Nguyen, Thao; Piazza, Laurent; Roussel, Christophe; Vienney, Cécile

    2017-02-01

    Hospital-based health technology assessment (HTA) guides decisions as to whether new healthcare products should be made available within hospital structures. Its extension to medical devices (MDs) makes it possible to analyse several relevant aspects of these healthcare products in addition to their clinical value, and such evaluations are of interest to national health authorities, other healthcare establishments and industry. The aim of this work was to formulate several recommendations for a blueprint for hospital-based HTA for MDs in France. Five themes based on the work of the European Adopting hospital-based HTA in the EU (AdHopHTA) project were defined. Each member of the roundtable was then allocated a documentation task based on their experience of the theme concerned, and a literature review was carried out. An inventory of hospital-based HTA was performed and six recommendations aiming to strengthen and improve this approach were put forward: (1) encouragement of the spread of the hospital-based HTA culture and participation in communications and the promotion of this approach to hospital decision-makers; (2) adaptation of hospital-based HTA to the needs of decision-makers, taking into account the financial timetable and strategic objectives of the healthcare establishment; (3) harmonisation of the dossiers requested from industry between healthcare establishments, based on a common core; (4) promotion of the sharing of hospital-based HTA data under certain conditions, with data dissociable from the HTA report and the use of a validated methodology for the literature review; (5) creation of a composite indicator reflecting data production effort and the sharing of HTA activities, to be taken into account in the distribution of funds allocated for teaching, research and innovation missions considered of general interest; (6) the transmission of information directly from local to national level by pioneering centres. This work highlights the major issues

  13. 42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or...

  14. 42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or...

  15. 42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or...

  16. 42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or...

  17. The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study

    PubMed Central

    Garfield, Sara; Jheeta, Seetal; Husson, Fran; Lloyd, Jill; Taylor, Alex; Boucher, Charles; Jacklin, Ann; Bischler, Anna; Norton, Christine; Hayles, Rob; Dean Franklin, Bryony

    2016-01-01

    Background Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting. In this study we aimed to explore hospital inpatients’ involvement with medication safety-related behaviours, facilitators and barriers to this involvement, and the impact of electronic prescribing. Methods We conducted ethnographic observations and interviews in two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during our study. Researchers and lay volunteers observed nurses’ medication administration rounds, pharmacists’ ward rounds, doctor-led ward rounds and drug history taking. We also conducted interviews with healthcare professionals, patients and carers. Interviews were audio-recorded and transcribed. Observation notes and transcripts were coded thematically. Results Paper or electronic medication records were shown to patients in only 4 (2%) of 247 cases. However, where they were available during patient-healthcare professional interactions, healthcare professionals often viewed them in order to inform patients about their medicines and answer any questions. Interprofessional discussions about medicines seemed more likely to happen in front of the patient where paper or electronic drug charts were available near the bedside. Patients and carers had more access to paper-based drug charts than electronic equivalents. However, interviews and observations suggest there are potentially more significant factors that affect patient involvement with their inpatient medication. These include patient and healthcare professional beliefs concerning patient involvement, the way in which healthcare professionals operate as a team, and the underlying culture. Conclusion Patients appear to have more access to

  18. Hospital adoption of medical technology: an empirical test of alternative models.

    PubMed Central

    Teplensky, J. D.; Pauly, M. V.; Kimberly, J. R.; Hillman, A. L.; Schwartz, J. S.

    1995-01-01

    OBJECTIVE. This study examines hospital motivations to acquire new medical technology, an issue of considerable policy relevance: in this case, whether, when, and why hospitals acquire a new capital-intensive medical technology, magnetic resonance imaging equipment (MRI). STUDY DESIGN. We review three common explanations for medical technology adoption: profit maximization, technological preeminence, and clinical excellence, and incorporate them into a composite model, controlling for regulatory differences, market structures, and organizational characteristics. All four models are then tested using Cox regressions. DATA SOURCES. The study is based on an initial sample of 637 hospitals in the continental United States that owned or leased an MRI unit as of 31 December 1988, plus nonadopters. Due to missing data the final sample consisted of 507 hospitals. The data, drawn from two telephone surveys, are supplemented by the AHA Survey, census data, and industry and academic sources. PRINCIPAL FINDING. Statistically, the three individual models account for roughly comparable amounts of variance in past adoption behavior. On the basis of explanatory power and parsimony, however, the technology model is "best." Although the composite model is statistically better than any of the individual models, it does not add much more explanatory power adjusting for the number of variables added. CONCLUSIONS. The composite model identified the importance a hospital attached to being a technological leader, its clinical requirements, and the change in revenues it associated with the adoption of MRI as the major determinants of adoption behavior. We conclude that a hospital's adoption behavior is strongly linked to its strategic orientation. PMID:7649751

  19. Possible electromagnetic interference with electronic medical equipment by radio waves coming from outside the hospital.

    PubMed

    Hanada, E; Kodama, K; Takano, K; Watanabe, Y; Nose, Y

    2001-08-01

    Electromagnetic interference (EMI) with electronic medical equipment by radio waves from mobile telephone handsets has been reported and is currently receiving wide attention. The possibility of EMI with electronic medical equipment by radio waves coming into the hospital has also been pointed out. But so far, there are no reports measuring the frequency distribution of electric field intensity induced by incoming radio waves. Therefore, we measured electric field intensity induced by radio waves coming into our 11-floor hospital, which was under construction. The maximum intensity observed was about 200 V/m at 2.79 GHz, from airport surveillance radar waves. The maximum intensity induced by radio waves from cellular phone base stations was 1.78 V/m. These data show that various frequencies of radio waves are common in this urban area, and that they induce strong electricfield intensity. This strong electric field intensity might cause EMI with electronic medical equipment. Measurement of the electromagnetic environment should be done by each hospital in urban areas to prevent EMI with electronic medical equipment.

  20. Assessing the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients

    PubMed Central

    Chopra, Vineet; Bernstein, Steven J.; Hofer, Timothy P.; Flanders, Scott A.

    2017-01-01

    Background The optimal approach to assess risk of venous thromboembolism (VTE) in hospitalized medical patients is unknown. We examined how well the Caprini risk assessment model (RAM) predicts VTE in hospitalized medical patients. Methods Between January 2011 and March 2014, VTE events and risk factors were collected from non-intensive care unit (ICU) medical patients hospitalized in facilities across Michigan. Following calculation of the Caprini score for each patient, mixed logistic spline regression was used to determine the predicted probabilities of 90-day VTE by receipt of pharmacologic prophylaxis across the Caprini risk continuum. Results A total of 670 (1.05%) of 63,548 eligible patients experienced a VTE event within 90 days of hospital admission. The mean Caprini risk score was 4.94 (range 0 - 28). Predictive modeling revealed a consistent linear increase in VTE for Caprini scores between 1-10; estimates beyond a score of 10 were unstable. Receipt of pharmacologic prophylaxis resulted in a modest decrease in VTE risk (odds ratio=0.85; 95% confidence interval 0.72 - 0.99, p = 0.04). However, the low overall incidence of VTE led to large estimates of numbers needed to treat in order to prevent a single VTE event. A Caprini cut-point demonstrating clear benefit of prophylaxis was not detected. Conclusions Although a linear association between the Caprini RAM and risk of VTE was noted, an extremely low incidence of VTE events in non-ICU medical patients was observed. The Caprini RAM was unable to identify a subset of medical patients who benefit from pharmacologic prophylaxis. PMID:26551977

  1. Elihu Yale and the medicine he promoted: the government general hospital and Madras Medical College, India.

    PubMed Central

    Mariappan, M. Rajan; Narayan, Deepak; Fadare, Oluwole; Sankarand, J. R.

    2004-01-01

    Much has been written about the philanthropist Elihu Yale and his life in the Americas and England, where he spent his beginnings and end. Less publicized is his life in India, where he spent the majority of his adult life and where he raised his family. A major contribution of Elihu Yale to medicine in India was his promotion of a local hospital in the major Indian trading port city of Madras. This essay briefly describes the history of that hospital and the medical college that grew out of it. PMID:15829148

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

    PubMed Central

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

    2016-01-01

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

  3. A simulated hospital pharmacy module using an electronic medical record in a pharmaceutical care skills laboratory course.

    PubMed

    Kirwin, Jennifer L; DiVall, Margarita V; Guerra, Christina; Brown, Todd

    2013-04-12

    OBJECTIVES. To implement and evaluate the effects of a simulated hospital pharmacy module using an electronic medical record on student confidence and abilities to perform hospital pharmacist duties. DESIGN. A module was developed that simulated typical hospital pharmacist tasks. Learning activities were modified based upon student feedback and instructor assessment. ASSESSMENTS. Ninety-seven percent of respondents reported full-time hospital internship experience and 72% had electronic medical record experience prior to completing the module. Mean scores on confidence with performing typical hospital pharmacist tasks significantly increased from the pre-module survey to the post-module survey from 1.5-2.9 (low comfort/confidence) to 2.0-3.4 (moderate comfort/confidence). Course assessments confirmed student achievement of covered competencies. CONCLUSIONS. A simulated hospital pharmacy module improved pharmacy students' hospital practice skills and their perceived comfort and confidence in completing the typical duties of a hospital pharmacist.

  4. [The university hospital palliative care team's approach to the transfer of end-stage cancer patients from hospital care to home medical care].

    PubMed

    Yoshino, Kazuho; Nishiumi, Noboru; Kushino, Nobuhisa; Tsukada, Michiko; Douzono, Sachiko; Saito, Yuki; Yagame, Mitsunori; Tokuda, Yutaka

    2009-12-01

    The palliative care team's roles are to provide a symptom relief to cancer patients, help them accept their medical conditions, and offer advice regarding the selection of appropriate medical treatments to suit their needs. Seeking the comfort of their homes, patients prefer a home care of superior medical care provided at hospitals. In 2008, 25 of the end-stage cancer patients at hospitals were expressed their desires to have a home medical care, and 10 of them were allowed to do so. We considered the following contributing factors that a patient should have for a smooth transition from hospital care to home medical care: (1) life expectancy of more than 2 months, (2) no progressive breathing difficulties experienced daily, (3) good awareness of medical condition among patients and families, (4) living with someone who has a good understanding of the condition, (5) availability of an appropriate hospital in case of a sudden change in medical requirements, and (6) good collaboration between emergency care hospitals, home physicians, and visiting nurses. To treat the end-stage cancer patients at home, there is a need for information sharing and a joint training of physicians specialized in cancer therapy, palliative care teams, home physicians, and visiting nurses. This would ensure a sustainable "face-to-face collaboration" in community health care.

  5. Evaluation of Unpreparedness When Issuing Copies of Medical Records in Tertiary Referral Hospitals

    PubMed Central

    Moon, Myong-Mo; Seo, Sun-Won; Park, Woo-Sung; Kim, Yoon; Kim, Sung-Soo; Choi, Eun-Mi; Park, Jong; Park, Il-Soon

    2010-01-01

    Objectives As a baseline study to aid in the development of proper policy, we investigated the current condition of unpreparedness of documents required when issuing copies of medical records and related factors. Methods The study was comprised of 7,203 cases in which copies of medical records were issued from July 1st, 2007 through June 30th, 2008 to 5 tertiary referral hospitals. Data from these hospitals was collected using their established electronic databases and included study variables such as unpreparedness of the required documents as a dependent variable and putative covariates. Results The rate of unpreparedness of required documents was 14.9%. Multiple logistic regression analysis revealed the following factors as being related to the high rate of unpreparedness: patient age (older patients had a higher rate), issuance channels (on admission > via out-patient clinic), type of applicant (others such as family members > for oneself > insurers), type of original medical record (utilization records on admission > other records), issuance purpose (for providing insurer > medical use), residential area of applicant (Seoul > Honam province and Jeju), and number of copied documents (more documents gave a lower rate). The rate of unpreparedness differed significantly among the hospitals; suggesting that they may have followed their own conventional protocols rather than legal procedures in some cases. Conclusions The study results showed that the level of compliance to the required legal procedure was high, but that problems occurred in assuring the safety of the medical information. A proper legislative approach is therefore required to balance the security of and access to medical information. PMID:21818431

  6. Performance improvement indicators of the Medical Records Department and Information Technology (IT) in hospitals

    PubMed Central

    Ajami, Sima; Ketabi, Saedeh; Torabiyan, Fatemeh

    2015-01-01

    Medical Record Department (MRD) has a vital role in making short and long term plans to improve health system services. The aim of this study was to describe performance improvement indicators of hospital MRD and information technology (IT). Collection of Data: A search was conducted in various databases, through related keywords in articles, books, and abstracts of conferences from 2001 to 2009. About 58 articles and books were available which were evaluated and finally 15 of them were selected based on their relevance to the study. MRD must be capable of supporting tasks such as patient care and continuity, institute management processes, medical education programs, medical research, communication between different wards of a hospital and administrative and medical staff. The use of IT in MRD can facilitate access to department, expedite communication within and outside department, reduce space with electronic medical records, reduce costs, accelerate activities such as coding by use of coding guide software and facilitate retrieval of records that will ultimately improve the performance of MRD. PMID:26150874

  7. [Role and future aspects of hospital clinical laboratories in medical team approaches].

    PubMed

    Suwabe, Akira

    2011-09-01

    The recent progress in medicine increases the routine works of the physicians or nurses and decreases the chances to obtain the new information on the laboratory medicine. Although the patients desire to know their test results in detail, it is likely to be difficult to obtain them from the physician in charge. Thereby, the quality of the medical services may be deteriorated. In these situations, needs of the medical team approaches in which the medical technologists (MTs) in the hospital laboratories participate are increasing. In Japan, there are a variety of medical team approaches in which MTs are involved. In our university hospital, MTs play important roles in the infection control team (ICT), in the nutrition support team (NST), in the educational class for the patients with diabetes mellitus, in the clinical research center, in the order-made medicine realizing project, in the infertility center and in the laboratory information room. In April 2010, the new payment system for the team approaches such as ICT or NST was established. In the future, the team approaches other than ICT or NST could be chosen for the subjects for the payment if they are recognized as important. The goal of the team approaches is to realize a patient-oriented medicine. MTs can reconfirm that they are working as one of the medical staffs through these team approaches. It is important to always find out a possibility of new team approaches.

  8. Children's oral health in the medical curriculum: a collaborative intervention at a university-affiliated hospital.

    PubMed

    Graham, Elinor; Negron, Reinaldo; Domoto, Peter; Milgrom, Peter

    2003-03-01

    The purpose of this study was to 1) describe the structure of the oral health program in a university-affiliated hospital; 2) evaluate staff's knowledge and attitudes toward oral health; and 3) propose ways to strengthen the incorporation of oral health prevention for children into clinical medical education. Qualitative methods were used to evaluate the program. Structured interviews with seventeen medical center personnel were conducted, and clinic utilization reports provided ICD-9 diagnostic frequency and visits. Clinic staff, pediatric residents, dental and pediatric faculty, hospital administrators, and clinic directors were interviewed. The themes identified during these interviews were motivation, roles, operational and organizational issues, and integration into the larger medical care system. Integration of an early childhood caries prevention program into the clinical medical education curriculum can be accomplished. After implementation of the oral health program described in this paper, dental caries became the eleventh most common diagnosis seen in the clinic when previously it did not appear in the top forty. However, institutional and organizational barriers are significant. Barriers identified were 1) lack of clarity in defining leadership and roles regarding oral health, 2) time and work overload in a busy pediatric clinic, 3) a tracking system was not available to quickly determine which children needed caries prevention procedures and education, and 4) billing and medical record form changes could not be fully established prior to starting the program.

  9. Cockroaches (Blattella germanica) as carriers of microorganisms of medical importance in hospitals.

    PubMed Central

    Fotedar, R.; Shriniwas, U. B.; Verma, A.

    1991-01-01

    A study was conducted to isolate and identify microorganisms of medical importance from cockroaches (Blattella germanica) and to ascertain their vector potential in the epidemiology of nosocomial infections. Bacteria, fungi and parasites of medical importance were isolated and identified. Important bacterial pathogens responsible for wound infections, were further studies by antibiograms. One hundred and fifty-eight out of 159 (99.4%) cockroaches collected from hospital (test) and 113 out of 120 (94.2%) cockroaches collected from residential areas (control) were carrying medically important microorganisms (P less than 0.05). significantly higher (P less than 0.001) number of test cockroaches were carrying a higher bacterial load (1 x 10(4) and 1 x 10(5] as compared to control cockroaches. Multiple drug-resistant bacterial were isolated from test cockroaches. The diversity of drug-resistant bacterial species isolated from test cockroaches suggests their involvement in the transmission of drug-resistant bacteria. Various fungi and parasitic cysts of medical importance were also isolated from the test and control cockroaches, but the carriage rates were low. The findings suggest that cockroaches, in hospitals, can act as potential vectors of medically important bacteria/parasites/fungi. PMID:1879483

  10. Herbal use amongst multiethnic medical patients in Penang Hospital: pattern and perceptions.

    PubMed

    Saw, J T; Bahari, M B; Ang, H H; Lim, Y H

    2006-10-01

    A cross sectional survey on pattern and perception of herbal use among medical patients in Penang Hospital was conducted. Among 250 patients surveyed, 67.9% were using herbal medicine and conventional medicine concomitantly. A majority of the patients used herbs for health maintenance (51.3%) purpose. More than 90% of herbal users did not disclose herbal use to their physician and "Doctor never asked" was the major reason given (54.2%). The Chinese reported the highest rate of herbal use but was least likely to disclose. These findings are important for health professionals to ensure medication safety and recognise potential drug herb interaction.

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

    PubMed

    Hellerstein, David J

    2015-12-01

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

  12. Medical social work practice in child protection in China: A multiple case study in Shanghai hospitals.

    PubMed

    Zhao, Fang; Hämäläinen, Juha; Chen, Yu-Ting

    2017-01-24

    With the rapid development of the child welfare system in China over recent years, medical social work has been increasingly involved in providing child protection services in several hospitals in Shanghai. Focusing on five cases in this paper, the exploratory study aims to present a critical overview of current practices and effects of medical social work for child protection, based on a critical analysis of the multidimensional role of social work practitioners engaged in the provision of child protection services as well as potential challenges. Implications and suggestions for future improvements of China's child protection system are also discussed.

  13. 38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Persons entitled to hospital or domiciliary care. 17.43 Section 17.43 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to...

  14. 38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Persons entitled to hospital or domiciliary care. 17.43 Section 17.43 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to...

  15. 38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Persons entitled to hospital or domiciliary care. 17.43 Section 17.43 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to...

  16. 38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Persons entitled to hospital or domiciliary care. 17.43 Section 17.43 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to...

  17. 38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Persons entitled to hospital or domiciliary care. 17.43 Section 17.43 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to...

  18. Reorganizing departments of psychiatry, hospitals, and medical centers for the 21st century.

    PubMed

    Schreter, R K

    1998-11-01

    Market forces are reshaping health care, transforming it from a public service into a product that is sold in a highly competitive marketplace. This transformation has been particularly disruptive for hospital departments of psychiatry and medical centers that were the early targets for managed care efforts at cost containment. To survive, health care institutions have embarked on a clinical and administrative re-engineering process. The author describes a series of steps for reconfiguring departments, hospitals, and medical centers as they enter the 21st century. The steps include identifying the leadership team, formulating a mission statement and strategic plan, creating a legal entity capable of achieving the organization's goals, drawing up an organizational chart, and developing the provider network. Other steps in the process include enhancing the continuum of services offered, developing administrative capability, dealing with managed care, paying attention to fundamental business practices, integrating psychiatric services into the health care system, and marketing psychiatric services.

  19. 75 FR 9102 - Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United States...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-01

    ..., or dental care. This change responds to the increase in medical costs since 1992, when the current... Part 43 Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United States... intervening period, the cost of medical care and treatment has increased substantially. That increase...

  20. 42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... costs for graduate medical education programs. 412.105 Section 412.105 Public Health CENTERS FOR... costs for graduate medical education programs. CMS makes an additional payment to hospitals for indirect medical education costs using the following procedures: (a) Basic data. CMS determines the following...

  1. Lean Six Sigma in health care and the challenge of implementation of Six Sigma methodologies at a Veterans Affairs Medical Center.

    PubMed

    Pocha, Christine

    2010-01-01

    Six Sigma and Lean Thinking are quality initiatives initially deployed in industry to improve operational efficiency leading to better quality and subsequent cost savings. The financial rationale for embarking on this quality journey is clear; applying it to today's health care remains challenging. The cost of medical care is increasing at an alarming rate; most of these cost increases are attributed to an aging population and technological advances; therefore, largely beyond control. Furthermore, health care cost increases are caused by unnecessary operational inefficiency associated with the direct medical service delivery process. This article describes the challenging journey of implementing Six Sigma methodology at a tertiary care medical center. Many lessons were learned; however, of utmost importance were team approach, "buy in" of the stakeholders, and the willingness of team members to change daily practice and to adapt new and innovative ways how health care can be delivered. Six Sigma incorporated as part of the "company's or hospital's culture" would be most desirable but the learning curve will be steep.

  2. Improving Medication Administration Safety in a Community Hospital Setting Using Lean Methodology.

    PubMed

    Critchley, Sandy

    2015-01-01

    Virtually all health care organizations have goals of improving patient safety, but despite clear goals and considerable investments, gains have been limited. This article explores a community hospital's resounding success using Lean methodology to improve medication administration safety with process changes designed by engaged employees and leaders with the knowledge and skill to effect improvements. This article inspires an interdisciplinary approach to quality improvement using reproducible strategies.

  3. [Outcomes of Infection Control Team Inspections at the Dental Hospital, Tokyo Medical and Dental University].

    PubMed

    Sunakawa, Mitsuhiro; Matsumoto, Hiroyuki; Okihata, Rie; Tsuruoka, Hiromi; Yamada, Yuichi; Adachi, Toshiko; Izumi, Yuichi

    2015-07-01

    In the Dental Hospital, Tokyo Medical and Dental University, an infection control team (ICT) has been formed to inspect each diagnosis department of clinics and wards in order to identify problems regarding nosocomial infection control. In this study, we analyzed the inspection reports and highlighted the following serious problems: 1) inadequate hygienic hand-washing for out- and in-patient treatment, 2) incomplete wearing of personal protective equipment (PPE) by dental health care workers, 3) necessity of environmental improvement in the clinics, and 4) cross-infection risk induced by. the continuous use of treatment devices without appropriate disinfection. The ICT provided feedback to the inspected departments, suggesting solutions to problems regarding nosocomial infection control. In order to enhance infection control in our hospital, dental healthcare practitioners must make further efforts on nosocomial infection control and prevention, and act according to their position by continuously educating students and enlightening hospital staff about the importance of infection control.

  4. Obligation towards medical errors disclosure at a tertiary care hospital in Dubai, UAE

    PubMed Central

    Zaghloul, Ashraf Ahmad; Rahman, Syed Azizur; Abou El-Enein, Nagwa Younes

    2016-01-01

    OBJECTIVE: The study aimed to identify healthcare providers’ obligation towards medical errors disclosure as well as to study the association between the severity of the medical error and the intention to disclose the error to the patients and their families. DESIGN: A cross-sectional study design was followed to identify the magnitude of disclosure among healthcare providers in different departments at a randomly selected tertiary care hospital in Dubai. SETTING AND PARTICIPANTS: The total sample size accounted for 106 respondents. Data were collected using a questionnaire composed of two sections namely; demographic variables of the respondents and a section which included variables relevant to medical error disclosure. RESULTS: Statistical analysis yielded significant association between the obligation to disclose medical errors with male healthcare providers (X2 = 5.1), and being a physician (X2 = 19.3). Obligation towards medical errors disclosure was significantly associated with those healthcare providers who had not committed any medical errors during the past year (X2 = 9.8), and any type of medical error regardless the cause, extent of harm (X2 = 8.7). Variables included in the binary logistic regression model were; status (Exp β (Physician) = 0.39, 95% CI 0.16–0.97), gender (Exp β (Male) = 4.81, 95% CI 1.84–12.54), and medical errors during the last year (Exp β (None) = 2.11, 95% CI 0.6–2.3). CONCLUSION: Education and training of physicians about disclosure conversations needs to start as early as medical school. Like the training in other competencies required of physicians, education in communicating about medical errors could help reduce physicians’ apprehension and make them more comfortable with disclosure conversations. PMID:27567766

  5. Functional status of bio-medical engg. departments in tertiary care hospitals--a comparative study.

    PubMed

    Kumar, G V; Satyanarayana, P

    1993-01-01

    The Bio-medical Engineering departments of two major hospitals having high-tech equipment needed for routine day to day patient care were compared with respect to their staffing pattern, proficiency, frequency of failure of major and minor equipment and predictable/non-predictable 'Down time' of the selected equipment using non-parametric statistical test. The study shows that Bio-medical Engineering Department (BME) of our Institute though not full fledged as compared to Hospital 'B' however showed better results in bringing down the down time both in major, minor equipment. The major cause of failure of equipment in both the hospitals was found to be rough handling, the need for imparting training to physicians, nurses, paramedical personnel dealing with bio-medical equipment and its role in preventive maintenance is discussed. Based on the study recommendations were made for preventive maintenance, purchase policy and linked to the policy of administration. Recommendations were made to bring down the Down time to acceptable limit though not for complete elimination.

  6. Influenza Vaccination Coverage Rate for Medical Staff: Influence of Hospital-Based Vaccination Campaign.

    PubMed

    Zielonka, T M; Szymańczak, M; Jakubiak, J; Nitsch-Osuch, A; Życińska, K

    2016-01-01

    Despite intensive recommendations, influenza vaccination rate in medical staff in Poland ranges from about 20 % in physicians to 10 % in nurses. The objective of this work was to assess the influence of hospital influenza vaccination campaign directed toward health care workers, combined with dispensing free of charge vaccine, on vaccination rate. The campaign was conducted by the Hospital Infection Control Team of the Czerniakowski Hospital in Warsaw, Poland, separately for physicians, nurses, and physiotherapists. Overall, 37 % of medical staff were vaccinated, including 55 % of physicians and 21 % of nurses. Concerning physicians, the greatest vaccination rate was in the orthopedic (80 %) and ophthalmology units (73 %), whereas the lowest rate was in the intensive care (22 %) and neurology units (20 %). Concerning nurses, the greatest vaccination rate was in those working in the outpatient (40 %) and emergency units (29 %), whereas the lowest rate was in the ophthalmology (6 %) and surgery units (11 %). We conclude that the professional knowledge campaign combined with the incentive of free of charge vaccine substantially raises the vaccination rate among medical staff.

  7. Preparing an Academic Medical Center to Manage Patients Infected With Ebola: Experiences of a University Hospital.

    PubMed

    Schultz, Carl H; Koenig, Kristi L; Alassaf, Wajdan

    2015-10-01

    As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population's health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented.

  8. Detection of medication-related problems in hospital practice: a review

    PubMed Central

    Manias, Elizabeth

    2013-01-01

    This review examines the effectiveness of detection methods in terms of their ability to identify and accurately determine medication-related problems in hospitals. A search was conducted of databases from inception to June 2012. The following keywords were used in combination: medication error or adverse drug event or adverse drug reaction, comparison, detection, hospital and method. Seven detection methods were considered: chart review, claims data review, computer monitoring, direct care observation, interviews, prospective data collection and incident reporting. Forty relevant studies were located. Detection methods that were better able to identify medication-related problems compared with other methods tested in the same study included chart review, computer monitoring, direct care observation and prospective data collection. However, only small numbers of studies were involved in comparisons with direct care observation (n = 5) and prospective data collection (n = 6). There was little focus on detecting medication-related problems during various stages of the medication process, and comparisons associated with the seriousness of medication-related problems were examined in 19 studies. Only 17 studies involved appropriate comparisons with a gold standard, which provided details about sensitivities and specificities. In view of the relatively low identification of medication-related problems with incident reporting, use of this method in tracking trends over time should be met with some scepticism. Greater attention should be placed on combining methods, such as chart review and computer monitoring in examining trends. More research is needed on the use of claims data, direct care observation, interviews and prospective data collection as detection methods. PMID:23194349

  9. Medication errors in a paediatric teaching hospital in the UK: five years operational experience

    PubMed Central

    Ross, L; Wallace, J; Paton, J; STEPHENSON, T.

    2000-01-01

    BACKGROUND—In the past 10 years, medication errors have come to be recognised as an important cause of iatrogenic disease in hospital patients.
AIMS—To determine the incidence and type of medication errors in a large UK paediatric hospital over a five year period, and to ascertain whether any error prevention programmes had influenced error occurrence.
METHODS—Retrospective review of medication errors documented in standard reporting forms completed prospectively from April 1994 to August 1999. Main outcome measure was incidence of error reporting, including pre- and post-interventions.
RESULTS—Medication errors occurred in 0.15% of admissions (195 errors; one per 662 admissions). While the highest rate occurred in neonatal intensive care (0.98%), most errors occurred in medical wards. Nurses were responsible for most reported errors (59%). Errors involving the intravenous route were commonest (56%), with antibiotics being the most frequent drug involved (44%). Fifteen (8%) involved a tenfold medication error. Although 18 (9.2%) required active patient intervention, 96% of errors were classified as minor at the time of reporting. Forty eight per cent of parents were not told an error had occurred. The introduction of a policy of double checking all drugs dispensed by pharmacy staff led to a reduction in errors from 9.8 to 6 per year. Changing the error reporting form to make it less punitive increased the error reporting rate from 32.7 to 38 per year.
CONCLUSION—The overall medication error rate was low. Despite this there are clear opportunities to make system changes to reduce error rates further.
 PMID:11087283

  10. Knowledge of medical professionalism in medical students and physicians at Shahid Beheshti University of Medical Sciences and affiliated hospitals-Iran.

    PubMed

    Seif-Farshad, Mehran; Bazmi, Shabnam; Amiri, Farzad; Fattahi, Faeze; Kiani, Mehrzad

    2016-11-01

    Although medical professionalism is a fundamental aspect of competence in medicine and a distinct facet of physicians' competence, evidence suggests that the subject of professionalism is not taught or assessed as part of medical students' curricula in Iran and many other countries. Assessing the knowledge of medical students and physicians about medical professionalism seems to be helpful in identifying the weaknesses of training in the field of professionalism and devise plans for future training on the subject.The present cross-sectional, quantitative, observational, and prevalence study recruited 149 medical interns, clinical residents, physicians, and professors working in hospitals selected through stratified random sampling using a questionnaire designed by the researchers and confirmed for its validity and reliability. The results were analyzed by Stata at a significance level of 0.05.Out of 149 cases, 61.64% were male with the mean age of 30.81 years. A total of 66 participants (44.29%) (95% confidence interval [CI]: 36.44%-52.44%) had heard and 83 (55.70%) (95% CI: 47.55%-63.55%) had not heard the term "medical professionalism" before the study. After adjusting for potential confounders, age and degree did not have statistically significant difference in assessed knowledge of medical professionalism, but sex had (mean difference: 5.88, P = 0.045), and the mean of the female was significantly higher than that of the male participants. The mean percentage of correct answers was 47.67.The present study demonstrated that the medical professionals working in the national healthcare system have an unfavorable theoretical knowledge about medical professionalism in Iran; although this does not indicate that their practices are unethical, it should be noted that one of the prerequisites of possessing a high level of medical professionalism and for establishing a proper relationship between the medical community and the patients is to have a proper knowledge of

  11. The role of the VA in academic radiology: a report of the ACR's Committee on Governmental and Regulatory Affairs in Academic Radiology.

    PubMed

    Sherrier, Robert H; Chang, Barbara K; Rawson, James V; Romanelli, Gloria

    2012-08-01

    Academic radiology departments have benefited from their relationships with US Department of Veterans Affairs hospitals. Review of the history of the care of veterans shows a unique relationship with academic medical centers. Opportunities for future collaborations include clinical care, teaching, and research.

  12. [HIV antibody detection results in patients seeking medical care in Peking Union Medical College Hospital, 2003-2014].

    PubMed

    Song, X J; Qiu, Z F; Cao, W; Xie, J; Zhang, Z J; Xu, S X; Li, T S

    2017-01-10

    Objective: To better understand the infection status of HIV in the patients seeking medical care in Peking Union Medical College Hospital. Methods: The HIV detection data of the patients in the hospital from 2003-2014 were collected for a statistical analysis with software SPSS 19.0. Results: A total of 715 421 patients were screened, and 1 012 (0.14%) patients were HIV positive, and HIV infection were confirmed in 776 (0.11%) patients by Western Blot testing. The detection rate of HIV infection increased from 0.05% in 2003 to 0.17% in 2014 (trend χ(2)=66.83 , P=0.000), and the increase during 2012-2014 was obvious. Of the 776 newly diagnosed HIV-infected individuals, 631 (81.31%) were men and 145 (18.69%) were women. The percentage of the males infected with HIV increased from 50.00% to 90.26% (trend χ(2)=58.41, P=0.000). The median age was 36 years (interquartile range: 27-43), and the age group 18-50 years were mostly affected. In the 776 patients infected with HIV, 634 (81.70% ) were infected through sexual contacts, and the proportion of sexual transmissions increased with year (trend χ(2)=126.38, P=0.000). The proportion of infected men who have sex with men (MSM) increased from 0% in 2003 to 53.90% in 2014 (trend χ(2)=11.96, P=0.001), similar to the trend in western countries. The proportion of infected patients who were not married increased from 18.75% to 42.21% (trend χ(2)=43.74, P=0.000). The top three source departments of HIV/AIDS cases were internal medicine (51.03%), emergency room (18.30%) and dermatology (13.53%). The proportion of the HIV/AIDS patients from department of gynecology and obstetrics declined from 18.75% in 2003 to 2.60% in 2014. No HIV/AIDS patients were detected in department of surgery, department of otorhinolaryngology, department of ophthalmology, department of stomatology and health examination center in 2003, but 14 cases (9.10%), 11 cases (7.14%) and 4 cases (2.60%) were detected in these departments respectively in 2014

  13. Initiation of a medical toxicology consult service at a tertiary care children’s hospital

    PubMed Central

    WANG, GEORGE SAM; MONTE, ANDREW; HATTEN, BENJAMIN; BRENT, JEFFREY; BUCHANAN, JENNIE; HEARD, KENNON J.

    2015-01-01

    Currently, only 10% of board-certified medical toxicologists are pediatricians. Yet over half of poison center calls involve children < 6 years, poisoning continues to be a common pediatric diagnosis and bedside toxicology consultation is not common at children’s hospitals. In collaboration with executive staff from Department of Pediatrics and Emergency Medicine, regional poison center, and our toxicology fellowship, we established a toxicology consulting service at our tertiary-care children’s hospital. There were 139 consultations, and the service generated 13 consultations in the first month; median of 11 consultations per month thereafter (range 8–16). The service increased pediatric cases seen by the fellowship program from 30 to 94. The transition to a consult service required a culture change. Historically, call center advice was the mainstay of consulting practice and the medical staff was not accustomed to the availability of bedside medical toxicology consultations. However, after promotion of the service and full attending and fellowship coverage, consultations increased. In collaboration with toxicologists from different departments, a consultation service can be rapidly established. The service filled a clinical need that was disproportionately utilized for high acuity patients, immediately utilized by the medical staff and provided a robust pediatric population for the toxicology fellowship. PMID:25686099

  14. Knowledge, attitude, and practices regarding whole body donation among medical professionals in a hospital in India.

    PubMed

    Ballala, Kirthinath; Shetty, Avinash; Malpe, Surekha Bhat

    2011-01-01

    Voluntary body donation has become an important source of cadavers for anatomical study and education. The objective of this study was to assess knowledge, attitude, and practice (KAP) regarding whole body donation among medical professionals in a medical institute in India. A cross sectional study was conducted at Kasturba Hospital, Manipal, India, among medical doctors. Data was collected from consenting individuals in the age group of 25-65 years by convenience sampling method. A semi-structured, pretested, questionnaire designed to assess KAP regarding whole body donation was provided to the study population (n = 106); 97 individuals returned the completed questionnaire. Results showed that 8% of the medical professionals were unaware of the term body donation and 85% believed that donated bodies were misused. A large proportion of the respondents did not know about the authority that oversaw body donation, or its criteria for accepting donated bodies and diseases for which bodies were screened before acceptance. Only 22% of polled physicians were willing to donate their bodies for medical education, but 68% expected the public to do the same. While only 7% had already registered their own names for body donation, 64% were not aware of any known person having registered and 72% indicated that their decision would not be influenced even if they knew of friends who had registered. These results suggest that educating medical students and professionals regarding the altruistic act of body donation is as important as educating the general public.

  15. [Study of morbidity in patients hospitalized at the Clinic Hospital at the Medical School of the USP-1989].

    PubMed

    Lebrão, M L; Litvoc, J; Figueiredo, G M; Leite, R M

    1993-01-01

    The diagnostic categories of the patients discharged from the "Hospital das Clínicas" of the University of São Paulo in 1989 were arranged according the International Classification of Diseases (I.C.D.) and analysed. In each Group sex, age and the reason of discharge or death was indicated. The data concerning 39,601 cases were provided by the Medical Data Service of the "Instituto Central" of the "Hospital das Clínicas". Only the principal diagnosis was taken into account. In the "Instituto de Psiquiatria" most the patients (55.4%) were males between 20 and 49 years of age. The main diagnostic categories were affective psychoses (20.3%), schizophrenic disorders (15%), and disorders related to alcoholism (9.5%). The mortality rate was 0.27%. In the "Instituto da Criança" 56% of the patients that left the hospital were male children and 45.8% of them were less than one year old. Regarding to the diagnostic categories the most important one was that of the diseases of the respiratory system with 27.1% of cases, followed by that of infectious and parasitic diseases with 16.0% of cases. Within the respiratory diseases the most important were the pneumonias caused by not specified microorganisms, and within the infectious diseases the most important was the diarrhea of presumably infectious origin. The mortality rate in this Institute was 9.4%. The "Instituto de Ortopedia e Traumatologia" left 3,825 patients 61.7% males, and 46.9% of them were aged between 20 and 49 years. The greatest number of cases (57.1%) belonged to the Chapter "Injury and Poisoning" followed by that of "Diseases of the Muscoleskeletal System" and Connective Tissue Diseases (23.5%). In this Institute the mortality rate was 1.2%. From the "Instituto do Coração" 7,194 patients were discharged; 65% of them were males, varying their age between 50 and 69 years. The diseases of the circulatory system were mostly ischemic heart disease, miocardiopathies and rheumatic heart diseases. Mortality rate

  16. Health care professionals’ pain narratives in hospitalized children’s medical records. Part 1: Pain descriptors

    PubMed Central

    Rashotte, Judy; Coburn, Geraldine; Harrison, Denise; Stevens, Bonnie J; Yamada, Janet; Abbott, Laura K

    2013-01-01

    BACKGROUND: Although documentation of children’s pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children. OBJECTIVES: To describe health care professionals’ use of written language related to the quality and quantity of pain experienced by hospitalized children. METHODS: Free-text pain narratives documented during a 24 h period were collected from the medical records of 3822 children (0 to 18 years of age) hospitalized on 32 inpatient units in eight Canadian pediatric hospitals. A qualitative descriptive exploration using a content analysis approach was used. RESULTS: Pain narratives were documented a total of 5390 times in 1518 of the 3822 children’s medical records (40%). Overall, word choices represented objective and subjective descriptors. Two major categories were identified, with their respective subcategories of word indicators and associated cues: indicators of pain, including behavioural (eg, vocal, motor, facial and activities cues), affective and physiological cues, and children’s descriptors; and word qualifiers, including intensity, comparator and temporal qualifiers. CONCLUSIONS: The richness and complexity of vocabulary used by clinicians to document children’s pain lend support to the concept that the word ‘pain’ is a label that represents a myriad of different experiences. There is potential to refine pediatric pain assessment measures to be inclusive of other cues used to identify children’s pain. The results enhance the discussion concerning the development of standardized nomenclature. Further research is warranted to determine whether there is congruence in interpretation across time, place and individuals. PMID:24093122

  17. Medication Errors in Vietnamese Hospitals: Prevalence, Potential Outcome and Associated Factors

    PubMed Central

    Nguyen, Huong-Thao; Nguyen, Tuan-Dung; van den Heuvel, Edwin R.; Haaijer-Ruskamp, Flora M.; Taxis, Katja

    2015-01-01

    Background Evidence from developed countries showed that medication errors are common and harmful. Little is known about medication errors in resource-restricted settings, including Vietnam. Objectives To determine the prevalence and potential clinical outcome of medication preparation and administration errors, and to identify factors associated with errors. Methods This was a prospective study conducted on six wards in two urban public hospitals in Vietnam. Data of preparation and administration errors of oral and intravenous medications was collected by direct observation, 12 hours per day on 7 consecutive days, on each ward. Multivariable logistic regression was applied to identify factors contributing to errors. Results In total, 2060 out of 5271 doses had at least one error. The error rate was 39.1% (95% confidence interval 37.8%- 40.4%). Experts judged potential clinical outcomes as minor, moderate, and severe in 72 (1.4%), 1806 (34.2%) and 182 (3.5%) doses. Factors associated with errors were drug characteristics (administration route, complexity of preparation, drug class; all p values < 0.001), and administration time (drug round, p = 0.023; day of the week, p = 0.024). Several interactions between these factors were also significant. Nurse experience was not significant. Higher error rates were observed for intravenous medications involving complex preparation procedures and for anti-infective drugs. Slightly lower medication error rates were observed during afternoon rounds compared to other rounds. Conclusions Potentially clinically relevant errors occurred in more than a third of all medications in this large study conducted in a resource-restricted setting. Educational interventions, focusing on intravenous medications with complex preparation procedure, particularly antibiotics, are likely to improve patient safety. PMID:26383873

  18. How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians.

    PubMed

    Warner, Alex; Walters, Kate; Lamahewa, Kethakie; Buszewicz, Marta

    2017-02-01

    Objective Medically unexplained symptoms are a common presentation in medical practice and are associated with significant morbidity and high levels of service use. Most research exploring the attitudes and training of doctors in treating patients with unexplained symptoms has been conducted in primary care. This study aims to explore the ways in which doctors working in secondary care approach and manage patients with medically unexplained symptoms. Design A qualitative study using in-depth interviews and thematic analysis. Setting Three hospitals in the North Thames area. Participants Twenty consultant and training-grade physicians working in cardiology, gastroenterology, rheumatology and neurology. Main outcome measure Physicians' approach to patients with medically unexplained symptoms and their views on managing these patients. Results There was considerable variation in how the physicians approached patients who presented with medically unexplained symptoms. Investigations were often ordered without a clear rationale and the explanations given to patients when results of investigations were normal were highly variable, both within and across specialties. The doctor's level of experience appeared to be a more important factor in their investigation and management strategies than their medical specialty. Physicians reported little or no formal training in how to manage such presentations, with no apparent consistency in how they had developed their approach. Doctors described learning from their own experience and from senior role models. Organisational barriers were identified to the effective management of these patients, particularly in terms of continuity of care. Conclusions Given the importance of this topic, there is a need for serious consideration as to how the management of patients with medically unexplained symptoms is included in medical training and in the planning and delivery of services.

  19. How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians

    PubMed Central

    Walters, Kate; Lamahewa, Kethakie; Buszewicz, Marta

    2017-01-01

    Objective Medically unexplained symptoms are a common presentation in medical practice and are associated with significant morbidity and high levels of service use. Most research exploring the attitudes and training of doctors in treating patients with unexplained symptoms has been conducted in primary care. This study aims to explore the ways in which doctors working in secondary care approach and manage patients with medically unexplained symptoms. Design A qualitative study using in-depth interviews and thematic analysis. Setting Three hospitals in the North Thames area. Participants Twenty consultant and training-grade physicians working in cardiology, gastroenterology, rheumatology and neurology. Main outcome measure Physicians' approach to patients with medically unexplained symptoms and their views on managing these patients. Results There was considerable variation in how the physicians approached patients who presented with medically unexplained symptoms. Investigations were often ordered without a clear rationale and the explanations given to patients when results of investigations were normal were highly variable, both within and across specialties. The doctor’s level of experience appeared to be a more important factor in their investigation and management strategies than their medical specialty. Physicians reported little or no formal training in how to manage such presentations, with no apparent consistency in how they had developed their approach. Doctors described learning from their own experience and from senior role models. Organisational barriers were identified to the effective management of these patients, particularly in terms of continuity of care. Conclusions Given the importance of this topic, there is a need for serious consideration as to how the management of patients with medically unexplained symptoms is included in medical training and in the planning and delivery of services. PMID:28169588

  20. China Report, Economic Affairs.

    DTIC Science & Technology

    2007-11-02

    This is China Report include Economic Affairs. It contains the issues with different topics on People’s Republic of China: Provincial Affairs, Economic Planning, Economic Management, Finance and Banking, Mineral Resources , Industry, Transportation.

  1. Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care

    PubMed Central

    Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao

    2016-01-01

    Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736–1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215–0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust—the most significant predictor of patient satisfaction—is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction

  2. Nurses' attitudes to a medical emergency team service in a teaching hospital

    PubMed Central

    Jones, D; Baldwin, I; McIntyre, T; Story, D; Mercer, I; Miglic, A; Goldsmith, D; Bellomo, R

    2006-01-01

    Background Cultural barriers including allegiance to traditional models of ward care and fear of criticism may restrict use of a medical emergency team (MET) service, particularly by nursing staff. A 1‐year preparation and education programme was undertaken before implementing the MET at the Austin Hospital, Melbourne, Australia. During the 4 years after introduction of the MET, the programme has continued to inform staff of the benefits of the MET and to overcome barriers restricting its use. Objective To assess whether nurses value the MET service and to determine whether barriers to calling the MET exist in a 400‐bed teaching hospital. Methods Immediately before hand‐over of ward nursing, we conducted a modified personal interview, using a 17‐item Likert agreement scale questionnaire. Results We created a sample of 351 ward nurses and obtained a 100% response rate. This represents 50.9% of the 689 ward nurses employed at the hospital. Most nurses felt that the MET prevented cardiac arrests (91%) and helped manage unwell patients (97%). Few nurses suggested that they restricted MET calls because they feared criticism of their patient care (2%) or criticism that the patient was not sufficiently unwell to need a MET call (10%). 19% of the respondents indicated that MET calls are required because medical management by the doctors has been inadequate; many ascribed this to junior doctors and a lack of knowledge and experience. Despite hospital MET protocol, 72% of nurses suggested that they would call the covering doctor before the MET for a sick ward patient. However, 81% indicated that they would activate the MET if they were unable to contact the covering doctor. In line with hospital MET protocol, 56% suggested that they would make a MET call for a patient they were worried about even if the patient's vital signs were normal. Further, 62% indicated that they would call the MET for a patient who fulfilled MET physiological criteria but did not look

  3. [A guide to successful public relations for hospitals and emergency medical services].

    PubMed

    Ausserer, J; Schwamberger, J; Preloznik, R; Klimek, M; Paal, P; Wenzel, V

    2014-04-01

    Tragic accidents, e.g. involving celebrity patients or severe incidents in hospital occur suddenly without any advance warning, often produce substantial interest by the media and quickly overburden management personnel involved in both hospitals and emergency medical services. While doctors, hospitals and emergency medical services desire objective media reports, the media promote emotionalized and dramatized reports to ensure maximum attention and circulation. When briefing the media, the scales may quickly tilt from professional, well-deliberated information to unfortunate, often unintended disinformation. Such phenomena may result in continuing exaggerated reports in the tabloid press, which in the presence of aggressive lawyers and a competitive hospital environment can turn into image and legal problems. In this article, several aspects are discussed in order to achieve successful public relations.Interviews should be given only after consultation with the responsible press officer and the director of the respective department or hospital director. Requests for information by the media should always be answered as otherwise one-sided, unintentional publications can result that are extremely difficult to correct later. One should be available to be contacted easily by journalists, regular press conferences should be held and critics should be taken seriously and not be brushed off. Questions by journalists should be answered in a timely manner as journalists are continuously under time pressure and do not understand unnecessary delays. Information for the media should always be provided at the same time, no publication should be given preference and an absolutely current list of E-mail contacts is required. When facing big events a press conference is preferred as many questions can be answered at once. Always be well prepared for an interview or even for just a statement. Each interview should be regarded as an opportunity to put a story forward which you

  4. Prevalence of hospital-acquired infections in the university medical center of Rabat, Morocco

    PubMed Central

    2012-01-01

    Background The aims of this study were to determine the hospital-acquired infections (HAI) prevalence in all institutions of Rabat University Medical Center, to ascertain risk factors, to describe the pathogens associated with HAI and their susceptibility profile to antibiotics. Materials and methods Point-prevalence survey in January 2010 concerning all patients who had been in the hospital for at least 48 hours. At bedside, 27 investigators filled a standardized questionnaire from medical records, temperature charts, radiographs, laboratory reports and by consultation with the ward’s collaborating health professionals. Risk factors were determined using logistic regression. Results 1195 patients involved, occupancy rate was 51%. The prevalence of HAI was 10.3%. Intensive care units were the most affected wards (34.5%). Urinary tract infection was the most common infected site (35%). Microbiological documentation was available in 61% of HAI. Staphylococcus was the organism most commonly isolated (18.7%) and was methicillin-resistant in 50% of cases. In multivariate analysis, risk factors associated with HAI were advanced age, longer length of hospital stay, presence of comorbidity, invasive devices and use of antibiotic use. Conclusion HAI prevalence was high in this study. Future prevention program should focus on patients with longer length of stay, invasive devices, and overprescribing antibiotics. PMID:23031793

  5. The prevalence of maternal medical conditions during pregnancy and a validation of their reporting in hospital discharge data.

    PubMed

    Hadfield, Ruth M; Lain, Samantha J; Cameron, Carolyn A; Bell, Jane C; Morris, Jonathan M; Roberts, Christine L

    2008-02-01

    Population health datasets are a valuable resource for studying maternal and obstetric health outcomes. However, their validity has not been thoroughly examined. We compared medical records from a random selection of New South Wales (NSW) women who gave birth in a NSW hospital in 2002 with coded hospital discharge records. We estimated the population prevalence of maternal medical conditions during pregnancy and found a tendency towards underreporting although specificities were high, indicating that false positives were uncommon.

  6. Drug-related problems in medical wards of Tikur Anbessa specialized hospital, Ethiopia

    PubMed Central

    Ayalew, Mohammed Biset; Megersa, Teshome Nedi; Mengistu, Yewondwossen Taddese

    2015-01-01

    Objective: This study was aimed to determine the prevalence of drug-related problems (DRPs), identify the most common drugs, and drug classes involved in DRPs as well as associated factors with the occurrence of DRPs. Methods: A prospective cross-sectional study was conducted on 225 patients admitted to medical wards of Tikur Anbessa Specialized Hospital, Addis Ababa from March to June 2014. Data regarding patient characteristics, medications, diagnosis, length of hospitalization, investigation, and laboratory results were collected using data abstraction forms through review of patients’ medical card and medication charts. Identified DRPs were recorded and classified using DRP registration forms. The possible intervention measures for the identified DRPs were proposed and communicated to either the physician or the patient. Data were entered into Epi Info 7 and analyzed using SPSS version 21 (IBM Corp. Released 2012, Armonk, NY: IBM Corp). Findings: DRPs were found in 52% of study subjects. A drug-drug interaction (48% of all DRPs) was the most common DRP followed by adverse drug reaction (23%). Anti-infectives and gastrointestinal medicines were commonly involved in DRPs. Drugs with the highest drug risk ratio were gentamycin, warfarin, nifedipine, and cimetidine. The number of drugs taken by the patient per day is an important risk factor for DRPs. Conclusion: DRPs are common among medical ward patients. Polypharmacy has a significant association with the occurrence of DRP. Drugs such as gentamycin, warfarin, nifedipine, and cimetidine have the highest probability of causing DRP. So, patients who are taking either of these drugs or polypharmacy should be closely assessed for identification and timely correction of DRPs. PMID:26645029

  7. Experiences of parenting a child with medical complexity in need of acute hospital care.

    PubMed

    Hagvall, Monica; Ehnfors, Margareta; Anderzén-Carlsson, Agneta

    2016-03-01

    Parents of children with medical complexity have described being responsible for providing advanced care for the child. When the child is acutely ill, they must rely on the health-care services during short or long periods of hospitalization. The purpose of this study was to describe parental experiences of caring for their child with medical complexity during hospitalization for acute deterioration, specifically focussing on parental needs and their experiences of the attitudes of staff. Data were gathered through individual interviews and analyzed using qualitative content analysis. The care period can be interpreted as a balancing act between acting as a caregiver and being in need of care. The parents needed skilled staff who could relieve them of medical responsibility, but they wanted to be involved in the care and in the decisions taken. They needed support, including relief, in order to meet their own needs and to be able to take care of their children. It was important that the child was treated with respect in order for the parent to trust the staff. An approach where staff view parents and children as a single unit, as recipients of care, would probably make the situation easier for these parents and children.

  8. A first evaluation of a pedagogical network for medical students at the University Hospital of Rennes.

    PubMed

    Fresnel, A; Jarno, P; Burgun, A; Delamarre, D; Denier, P; Cleret, M; Courtin, C; Seka, L P; Pouliquen, B; Cléran, L; Riou, C; Leduff, F; Lesaux, H; Duvauferrier, R; Le Beux, P

    1998-01-01

    A pedagogical network has been developed at University Hospital of Rennes from 1996. The challenge is to give medical information and informatics tools to all medical students in the clinical wards of the University Hospital. At first, nine wards were connected to the medical school server which is linked to the Internet. Client software electronic mail and WWW Netscape on Macintosh computers. Sever software is set up on Unix SUN providing a local homepage with selected pedagogical resources. These documents are stored in a DBMS database ORACLE and queries can be provided by specialty, authors or disease. The students can access a set of interactive teaching programs or electronic textbooks and can explore the Internet through the library information system and search engines. The teachers can send URL and indexation of pedagogical documents and can produce clinical cases: the database updating will be done by the users. This experience of using Web tools generated enthusiasm when we first introduced it to students. The evaluation shows that if the students can use this training early on, they will adapt the resources of the Internet to their own needs.

  9. Moral dilemmas faced by hospitals in time of war: the Rambam Medical Center during the second Lebanon war.

    PubMed

    Bar-El, Yaron; Reisner, Shimon; Beyar, Rafael

    2014-02-01

    Rambam Medical Center, the only tertiary care center and largest hospital in northern Israel, was subjected to continuous rocket attacks in 2006. This extreme situation posed serious and unprecedented ethical dilemmas to the hospital management. An ambiguous situation arose that required routine patient care in a tertiary modern hospital together with implementation of emergency measures while under direct fire. The physicians responsible for hospital management at that time share some of the moral dilemmas faced, the policy they chose to follow, and offer a retrospective critical reflection in this paper. The hospital's first priority was defined as delivery of emergency surgical and medical services to the wounded from the battlefields and home front, while concomitantly providing the civilian population with all elective medical and surgical services. The need for acute medical service was even more apparent as the situation of conflict led to closure of many ambulatory clinics, while urgent or planned medical care such as open heart surgery and chemotherapy continued. The hospital management took actions to minimize risks to patients, staff, and visitors during the ongoing attacks. Wards were relocated to unused underground spaces and corridors. However due to the shortage of shielded spaces, not all wards and patients could be relocated to safer areas. Modern warfare will most likely continue to involve civilian populations and institutes, blurring the division between peaceful high-tech medicine and the rough battlefront. Hospitals in high war-risk areas must be prepared to function and deliver treatment while under fire or facing similar threats.

  10. A bill to authorize major medical facility projects for the Department of Veterans Affairs for fiscal year 2010, and for other purposes.

    THOMAS, 111th Congress

    Sen. Akaka, Daniel K. [D-HI

    2009-06-19

    06/19/2009 Read twice and referred to the Committee on Veterans' Affairs. (text of measure as introduced: CR S6847-6848) (All Actions) Notes: For further action, see S.1717, which became Public Law 111-82 on 10/26/2009. Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  11. The Difference in the Online Medical Information Searching Behaviors of Hospital Patients and Their Relatives versus the General Public

    ERIC Educational Resources Information Center

    Wang, Hung-Yuan; Liang, Jyh-Chong; Tsai, Chin-Chung

    2014-01-01

    The purpose of this study is two-fold: to explore the differences in online medical information searching behaviors, including evaluative standards and search strategies, of the general public (general group) and those of hospital patients and their relatives (hospital group); and to compare the predictive relationship between the evaluative…

  12. 42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Payment System for Inpatient Operating Costs § 412.105 Special treatment: Hospitals that incur indirect... 42 Public Health 2 2012-10-01 2012-10-01 false Special treatment: Hospitals that incur indirect costs for graduate medical education programs. 412.105 Section 412.105 Public Health CENTERS...

  13. 42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Payment System for Inpatient Operating Costs § 412.105 Special treatment: Hospitals that incur indirect... 42 Public Health 2 2013-10-01 2013-10-01 false Special treatment: Hospitals that incur indirect costs for graduate medical education programs. 412.105 Section 412.105 Public Health CENTERS...

  14. Medical Aid, Repression, and International Relations: The East German Hospital at Metema.

    PubMed

    Borowy, Iris

    2016-01-01

    Between 1984 and 1988, the German Democratic Republic (GDR) built a hospital in a remote part of Ethiopia, close to the Sudanese border. The project evolved in a complex combination of contexts, including the general foreign policy goals of the GDR, its specific alliance with Ethiopia, the famine of 1984-85, civil war in Ethiopia, and a controversial resettlement program by the government of Mengistu Haile Mariam. Though almost unknown today, it was a high-profile project at the time, which received the personal support both by Erich Honecker in the GDR and Mengistu Haile Mariam in Ethiopia. However, their interest was directed more at the political goals the project was expected to serve than at the hospital itself. Both the preparation and the implementation of the project were extremely difficult and almost failed due to problems of transportation, of red tape, and of security. The operation of the hospital was also not ideal, involving frustrated personnel and less than complete acceptance by the local population. Ironically, for all its practical difficulties, the hospital has outlived both governments and their political goals, surviving as a medical institution.

  15. Prevalence and nature of adverse medical device events in hospitalized children.

    PubMed

    Brady, Patrick W; Varadarajan, Kartik; Peterson, Laura E; Lannon, Carole; Gross, Thomas

    2013-07-01

    Our objective was to describe the prevalence and nature of adverse medical device events (AMDEs) in tertiary care children's hospitals. In our retrospective cohort study of patients at 44 children's hospitals in the Pediatric Health Information System (PHIS), we included all inpatient stays with an AMDE-related diagnosis from January 1, 2004 to December 31, 2011. We identified AMDEs by diagnoses that specified a device in their definition. We included events present on admission as well as those complicating hospital stays. We described the characteristics of these admissions and patients, and stratified analysis by device category and presence of a complex chronic condition. Of 4,115,755 admissions in the PHIS database during the study period, 136,465 (3.3%) had at least 1 AMDE. Vascular access and nervous system devices together represented 44.4% of pediatric AMDE admissions. The majority (75.5%) of AMDE admissions were of children with complex chronic conditions. The most common age group was patients aged 2 years or less at the time of their first AMDE-related admission. AMDEs occur commonly in a population cared for in tertiary children's hospitals. Research to more specifically delineate AMDEs and their predictors are next steps to understand and improve device safety in children.

  16. The effect of pharmaceutical innovation on longevity, hospitalization and medical expenditure in Turkey, 1999-2010.

    PubMed

    Lichtenberg, Frank R; Tatar, Mehtap; Çalışkan, Zafer

    2014-09-01

    We investigate the impact of pharmaceutical innovation on longevity, hospitalization and medical expenditure in Turkey during the period 1999-2010 using longitudinal, disease-level data. From 1999 to 2008, mean age at death increased by 3.6 years, from 63.0 to 66.6 years. We estimate that in the absence of any pharmaceutical innovation, mean age at death would have increased by only 0.6 years. Hence, pharmaceutical innovation is estimated to have increased mean age at death in Turkey by 3.0 years during the period 1999-2008. We also examine the effect of pharmaceutical innovation on hospital utilization. We estimate that pharmaceutical innovation has reduced the number of hospital days by approximately 1% per year. We use our estimates of the effect of pharmaceutical innovation on age at death, hospital utilization and pharmaceutical expenditure to assess the incremental cost-effectiveness of pharmaceutical innovation, i.e., the cost per life-year gained from the introduction of new drugs. The baseline estimate of the cost per life-year gained from pharmaceutical innovation is $2776. Even the latter figure is a very small fraction of leading economists' estimates of the value of (or consumers' willingness to pay for) a one-year increase in life expectancy.

  17. Defense Health Care. Reimbursement of Hospitals Not Meeting CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) Copayment Requirements.

    DTIC Science & Technology

    1988-06-01

    treatment for one type of hospital (and possibly only one hospital). Such special treat- ment raises a concern that other specialty hospitals would seek...similar treatment . CHAmPUS officials were concerned that it would erode cHAJIUs’s copayment requirements in a piecemeal fashion. (See p. 27.) 4...other uniformed services treatment facili- ties. Under cwAwmus, beneficiaries must share in the cost of their medical care by paying deductibles and

  18. A Study on Strategic Planning and Procurement of Medicals in Uganda's Regional Referral Hospitals.

    PubMed

    Masembe, Ishak Kamaradi

    2016-12-31

    This study was an analysis of the effect of strategic planning on procurement of medicals in Uganda's regional referral hospitals (RRH's). Medicals were defined as essential medicines, medical devices and medical equipment. The Ministry of Health (MOH) has been carrying out strategic planning for the last 15 years via the Health Sector Strategic Plans. Their assumption was that strategic planning would translate to strategic procurement and consequently, availability of medicals in the RRH's. However, despite the existence of these plans, there have been many complaints about expired drugs and shortages in RRH's. For this purpose, a third variable was important because it served the role of mediation. A questionnaire was used to obtain information on perceptions of 206 respondents who were selected using simple random sampling. 8 key informant interviews were held, 2 in each RRH. 4 Focus Group Discussions were held, 1 for each RRH, and between 5 and 8 staff took part as discussants for approximately three hours. The findings suggested that strategic planning was affected by funding to approximately 34% while the relationship between funding and procurement was 35%. The direct relationship between strategic planning and procurement was 18%. However when the total causal effect was computed it turned out that strategic planning and the related variable of funding contributed 77% to procurement of medicals under the current hierarchical model where MOH is charged with development of strategic plans for the entire health sector. Since even with this contribution there were complaints, the study proposed a new model called CALF which according to a simulation, if adopted by MOH, strategic planning would contribute 87% to effectiveness in procurement of medicals.

  19. A Study on Strategic Planning and Procurement of Medicals in Uganda’s Regional Referral Hospitals

    PubMed Central

    2016-01-01

    This study was an analysis of the effect of strategic planning on procurement of medicals in Uganda’s regional referral hospitals (RRH’s). Medicals were defined as essential medicines, medical devices and medical equipment. The Ministry of Health (MOH) has been carrying out strategic planning for the last 15 years via the Health Sector Strategic Plans. Their assumption was that strategic planning would translate to strategic procurement and consequently, availability of medicals in the RRH’s. However, despite the existence of these plans, there have been many complaints about expired drugs and shortages in RRH’s. For this purpose, a third variable was important because it served the role of mediation. A questionnaire was used to obtain information on perceptions of 206 respondents who were selected using simple random sampling. 8 key informant interviews were held, 2 in each RRH. 4 Focus Group Discussions were held, 1 for each RRH, and between 5 and 8 staff took part as discussants for approximately three hours. The findings suggested that strategic planning was affected by funding to approximately 34% while the relationship between funding and procurement was 35%. The direct relationship between strategic planning and procurement was 18%. However when the total causal effect was computed it turned out that strategic planning and the related variable of funding contributed 77% to procurement of medicals under the current hierarchical model where MOH is charged with development of strategic plans for the entire health sector. Since even with this contribution there were complaints, the study proposed a new model called CALF which according to a simulation, if adopted by MOH, strategic planning would contribute 87% to effectiveness in procurement of medicals. PMID:28299158

  20. Frequency of medication errors in an emergency department of a large teaching hospital in southern Iran

    PubMed Central

    Vazin, Afsaneh; Zamani, Zahra; Hatam, Nahid

    2014-01-01

    This study was conducted with the purpose of determining the frequency of medication errors (MEs) occurring in tertiary care emergency department (ED) of a large academic hospital in Iran. The incidence of MEs was determined through the disguised direct observation method conducted by a trained observer. A total of 1,031 medication doses administered to 202 patients admitted to the tertiary care ED were observed over a course of 54 6-hour shifts. Following collection of the data and analysis of the errors with the assistance of a clinical pharmacist, frequency of errors in the different stages was reported and analyzed in SPSS-21 software. For the 202 patients and the 1,031 medication doses evaluated in the present study, 707 (68.5%) MEs were recorded in total. In other words, 3.5 errors per patient and almost 0.69 errors per medication are reported to have occurred, with the highest frequency of errors pertaining to cardiovascular (27.2%) and antimicrobial (23.6%) medications. The highest rate of errors occurred during the administration phase of the medication use process with a share of 37.6%, followed by errors of prescription and transcription with a share of 21.1% and 10% of errors, respectively. Omission (7.6%) and wrong time error (4.4%) were the most frequent administration errors. The less-experienced nurses (P=0.04), higher patient-to-nurse ratio (P=0.017), and the morning shifts (P=0.035) were positively related to administration errors. Administration errors marked the highest share of MEs occurring in the different medication use processes. Increasing the number of nurses and employing the more experienced of them in EDs can help reduce nursing errors. Addressing the shortcomings with further research should result in reduction of MEs in EDs. PMID:25525391

  1. Deploying information technology and continuous control monitoring systems in hospitals to prevent medication errors.

    PubMed

    Escobar-Rodríguez, Tomás; Monge-Lozano, Pedro; Romero-Alonso, Ma Mercedes; Bolívar-Raya, Ma Antonia

    2012-01-01

    The serious repercussions of healthcare errors on patient safety have led hospitals to deploy information technology and continuous control monitoring systems to prevent them. Hospitals are moving away from traditional paper-based systems and focusing on designing new systems that prevent errors, using information technologies to catalyse the process re-engineering. This paper presents a case study that analyses the effect of computerised physician order entry and automated unit-based medication storage and distribution systems on the drug ordering and delivery process. It is concluded that information technology and continuous control monitoring systems have led to significant process re-engineering in the sequential stages of the drug ordering and delivery system. The new systems have also provided the opportunity to improve information available. This is an exploratory case study and the conclusions drawn from it offer possible routes for future research in this field.

  2. 38 CFR 17.44 - Hospital care for certain retirees with chronic disability (Executive Orders 10122, 10400 and...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Hospital care for certain retirees with chronic disability (Executive Orders 10122, 10400 and 11733). 17.44 Section 17.44 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and...

  3. Medical tourism in india: perceptions of physicians in tertiary care hospitals

    PubMed Central

    2013-01-01

    Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical

  4. Medical tourism in India: perceptions of physicians in tertiary care hospitals.

    PubMed

    Qadeer, Imrana; Reddy, Sunita

    2013-12-17

    Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians' however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical

  5. Managerial procedures and hospital practices: a case study of the development of a new medical discipline.

    PubMed

    Cabridain, M O

    1985-01-01

    In anesthésie-réanimation, a discipline that brings together anaesthesiology and emergency as well as intensive care, the managerial methods of evaluation and control of needs in personnel, were not adequate for describing medical practices. Around four managerial standards that were used by the Paris public hospital administration, new situations have crystalized. The historical analysis of how these standards have been put into use, used and put in question throws light upon the way organizations function. The present day situation in this speciality seems to be mainly determined by the strategies of specialists for obtaining professional recognition of their discipline and for advancing their careers.

  6. [Clinical features in fatal Spanish influenza: Japanese Army Hospital medical records investigation].

    PubMed

    Fujikura, Yuji; Kawana, Akihiko; Kato, Yasuyuki; Mizuno, Yasutaka; Kudo, Koichiro

    2010-03-01

    Pandemic influenza preparedness requires a thorough knowledge of past pandemics. Tokyo First Army Hospital medical records from January 1918 to December 1920 found recently included 132 consecutive records of those diagnosed with influenza. We report on the clinical features in 8 fatal cases. Inpatient mortality was found to be 6.1% (8/132). Cough was noted in 6 (75%) and thoracic rales in 8 (100%) on admission, mimicking pneumonia. Bloody sputum was noted in 5 (62.5%) and diarrhea in 4 (50%), with marked hemorrhagic and digestive symptoms, resembling highly pathogenic avian influenza. Clinical features may differ from seasonal influenza, making early detection and treatment essential especially in severe cases.

  7. Integrated Medical Information Services: A Resource Management View of Automated Hospital Information Systems

    PubMed Central

    Melrose, J. Peter; Ericson, R. Peter

    1981-01-01

    Rapid changes in information processing technology have made the problems of administrative and technical planning and integration difficult. Vendor-inspired terms such as “office of the future” have created confusion rather than clarification. However, the term “information resource management” (IRM) that has evolved in the private sector has potential merit. From the idea of IRM, the authors have developed the planning concept of Integrated Medical Information Services (IMIS) as a common administrative-technical basis for planning and implementing new information technology in the hospital environment.

  8. Beliefs and attitudes of interns at Ibadan General Hospitals concerning ten medical specialties.

    PubMed

    Ohaeri, J U; Akinyinka, O O; Asuzu, M C

    1994-12-01

    Fifty-two interns at Ibadan general hospitals (89% response rate), participated in a study of their attitudes towards ten medical specialties. This involved completing a 40-item questionnaire. The highly preferred specialties (surgery, paediatrics, obstetrics and gynaecology, internal medicine) were those in which there was expectation of material rewards, societal appreciation, quick response of patients to treatment, and inspiration by teachers. The less preferred specialties were viewed negatively in these regards. The findings support the suggestion that, in order to give medical graduates a greater chance to see that the less preferred specialties can provide career fulfillment, interns should be allowed to spend part of their one year clinical rotation in radiology, pathology, psychiatry, anaesthesia and community medicine.

  9. Accessing to electronic medical history using a mobility intra hospital system.

    PubMed

    Guillén, Sergio; Traver, Vicente; Monton, Eduardo; Castellano, Elena; Valdivieso, Bernardo; Valero, Manuel Regaña

    2011-01-01

    The aim of this paper is to describe the solution that has been developed in Valencia Region (Spain) to provide health professionals (physicians and nurses) access to all the functionalities of a Hospital Information System (HIS) already available at fixed clients workstations. These functionalities are adapted to the care process carried out at patient bedside. In this way, professionals will have access to treatment and administration, recording of vital signs, nursing assessment, scales, care plan, extractions, medical records, progress notes so that they have all necessary information at the bedside, and record swiftly changes that occur in-situ. In addition, clinical safety is reinforced, including RFID patient identification mechanisms and barcode readers for blood samples or unidosis medication.

  10. Guidelines for zoo and aquarium veterinary medical programs and veterinary hospitals.

    PubMed

    Backues, Kay; Clyde, Vickie; Denver, Mary; Fiorello, Christine; Hilsenroth, Rob; Lamberski, Nadine; Larson, Scott; Meehan, Tom; Murray, Mike; Ramer, Jan; Ramsay, Ed; Suedmeyer, Kirk; Whiteside, Doug

    2011-03-01

    These guidelines for veterinary medical care and veterinary hospitals are written to conform with the requirements of the Animal Welfare Act, which states that programs of disease prevention and parasite control, euthanasia, and adequate veterinary care shall be established and maintained under the supervision of a veterinarian. Ideally the zoo and aquarium should be providing the best possible veterinary medical care for the animals in their collections. Many of these animals are rare and endangered and the institutions should endeavor both to provide for the long term health and well being of these animals and to advance the field of non-domestic animal medicine. It is hoped that this publication will aid in this process.

  11. The ethics of policy writing: how should hospitals deal with moral disagreement about controversial medical practices?

    PubMed Central

    Winkler, E

    2005-01-01

    Every healthcare organisation (HCO) enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it. Using, as an example, the controversy about patient's refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency. Policy writing for morally controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO's obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy. PMID:16199594

  12. Problems and perceived needs for medical ethics education of resident physicians in Alexandria teaching hospitals, Egypt.

    PubMed

    Mohamed, A M; Ghanem, M A; Kassem, A

    2012-08-01

    There is a call for greater preparation for the ethical challenges encountered by physicians in their future professional duties. This study in Egypt aimed to reveal problems and perceived needs for medical ethics education of resident physicians working at University of Alexandria hospitals. In a descriptive, cross-sectional survey, 128 residents answered a self-administered questionnaire. More than half were of the opinion that their medical ethics course was ineffective; 56.3% mentioned poor curricular planning. The majority complained that the subject was not tailored to specialties, the course was too short, there was a shortage of resources to facilitate the educational process and that assessment was done for knowledge but not for skills. Problems related to staffing were low staff:student ratios and staff lack of experience. Trainees, regardless of clinical discipline, felt that there was a great need for improvement to their medicalethics education.

  13. 75 FR 24754 - Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Military...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-05

    ... BUDGET Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Military Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third Persons AGENCY: Office... inpatient medical services furnished by military treatment facilities through the Department of Defense...

  14. 76 FR 15349 - Fiscal Year 2011 Cost of Hospital and Medical Care Treatment Furnished by the Department of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-21

    ... BUDGET Fiscal Year 2011 Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Medical Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third... furnished by military treatment facilities through the Department of Defense (DoD). The rates have...

  15. Analysis of the technology acceptance model in examining hospital nurses' behavioral intentions toward the use of bar code medication administration.

    PubMed

    Song, Lunar; Park, Byeonghwa; Oh, Kyeung Mi

    2015-04-01

    Serious medication errors continue to exist in hospitals, even though there is technology that could potentially eliminate them such as bar code medication administration. Little is known about the degree to which the culture of patient safety is associated with behavioral intention to use bar code medication administration. Based on the Technology Acceptance Model, this study evaluated the relationships among patient safety culture and perceived usefulness and perceived ease of use, and behavioral intention to use bar code medication administration technology among nurses in hospitals. Cross-sectional surveys with a convenience sample of 163 nurses using bar code medication administration were conducted. Feedback and communication about errors had a positive impact in predicting perceived usefulness (β=.26, P<.01) and perceived ease of use (β=.22, P<.05). In a multiple regression model predicting for behavioral intention, age had a negative impact (β=-.17, P<.05); however, teamwork within hospital units (β=.20, P<.05) and perceived usefulness (β=.35, P<.01) both had a positive impact on behavioral intention. The overall bar code medication administration behavioral intention model explained 24% (P<.001) of the variance. Identified factors influencing bar code medication administration behavioral intention can help inform hospitals to develop tailored interventions for RNs to reduce medication administration errors and increase patient safety by using this technology.

  16. The Perceptions of the Preparedness of Medical Graduates to Take on Internship Responsibilities in Low Resource Hospitals in Kenya

    ERIC Educational Resources Information Center

    Muthaura, Patricia N.; Khamis, Tashmin K.

    2013-01-01

    The Aga Khan University is developing an Undergraduate Medical Education (UGME) curriculum for implementation in East Africa in 2016, which aims to serve the health needs of the populations there. Pilot focus group discussions of recent interns were conducted at the Aga Khan University Hospital, Nairobi to find out: (1) If Kenyan medical students…

  17. 77 FR 24451 - Direct Final Approval of Hospital/Medical/Infectious Waste Incinerators State Plan for Designated...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-24

    ... From the Federal Register Online via the Government Publishing Office ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 62 Direct Final Approval of Hospital/Medical/Infectious Waste Incinerators State Plan...' revised State Plan to control air pollutants from Hazardous/ Medical/Infectious Waste Incinerators...

  18. 77 FR 24451 - Direct Final Approval of Hospital/Medical/Infectious Waste Incinerators State Plan for Designated...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-24

    ... From the Federal Register Online via the Government Publishing Office ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 62 Direct Final Approval of Hospital/Medical/Infectious Waste Incinerators State Plan... revised State Plan to control air pollutants from Hazardous/ Medical/Infectious Waste Incinerators...

  19. Occurrence of Medication Errors and Comparison of Manual and Computerized Prescription Systems in Public Sector Hospitals in Lahore, Pakistan

    PubMed Central

    Riaz, Muhammad Kashif; Hashmi, Furqan Khurshid; Bukhari, Nadeem Irfan; Riaz, Mohammad; Hussain, Khalid

    2014-01-01

    The knowledge of medication errors is an essential prerequisite for better healthcare delivery. The present study investigated prescribing errors in prescriptions from outpatient departments (OPDs) and emergency wards of two public sector hospitals in Lahore, Pakistan. A manual prescription system was followed in Hospital A. Hospital B was running a semi-computerised prescription system in the OPD and a fully computerised prescription system in the emergency ward. A total of 510 prescriptions from both departments of these two hospitals were evaluated for patient characteristics, demographics and medication errors. The data was analysed using a chi square test for comparison of errors between both the hospitals. The medical departments in OPDs of both hospitals were the highest prescribers at 45%–60%. The age group receiving the most treatment in emergency wards of both the hospitals was 21–30 years (21%–24%). A trend of omitting patient addresses and diagnoses was observed in almost all prescriptions from both of the hospitals. Nevertheless, patient information such as name, age, gender and legibility of the prescriber’s signature were found in almost 100% of the electronic-prescriptions. In addition, no prescribing error was found pertaining to drug concentrations, quantity and rate of administration in e-prescriptions. The total prescribing errors in the OPD and emergency ward of Hospital A were found to be 44% and 60%, respectively. In hospital B, the OPD had 39% medication errors and the emergency department had 73.5% errors; this unexpected difference between the emergency ward and OPD of hospital B was mainly due to the inclusion of 69.4% omissions of route of administration in the prescriptions. The incidence of prescription overdose was approximately 7%–19% in the manual system and approximately 8% in semi and fully electronic system. The omission of information and incomplete information are contributors of prescribing errors in both manual and

  20. Occurrence of medication errors and comparison of manual and computerized prescription systems in public sector hospitals in Lahore, Pakistan.

    PubMed

    Riaz, Muhammad Kashif; Hashmi, Furqan Khurshid; Bukhari, Nadeem Irfan; Riaz, Mohammad; Hussain, Khalid

    2014-01-01

    The knowledge of medication errors is an essential prerequisite for better healthcare delivery. The present study investigated prescribing errors in prescriptions from outpatient departments (OPDs) and emergency wards of two public sector hospitals in Lahore, Pakistan. A manual prescription system was followed in Hospital A. Hospital B was running a semi-computerised prescription system in the OPD and a fully computerised prescription system in the emergency ward. A total of 510 prescriptions from both departments of these two hospitals were evaluated for patient characteristics, demographics and medication errors. The data was analysed using a chi square test for comparison of errors between both the hospitals. The medical departments in OPDs of both hospitals were the highest prescribers at 45%-60%. The age group receiving the most treatment in emergency wards of both the hospitals was 21-30 years (21%-24%). A trend of omitting patient addresses and diagnoses was observed in almost all prescriptions from both of the hospitals. Nevertheless, patient information such as name, age, gender and legibility of the prescriber's signature were found in almost 100% of the electronic-prescriptions. In addition, no prescribing error was found pertaining to drug concentrations, quantity and rate of administration in e-prescriptions. The total prescribing errors in the OPD and emergency ward of Hospital A were found to be 44% and 60%, respectively. In hospital B, the OPD had 39% medication errors and the emergency department had 73.5% errors; this unexpected difference between the emergency ward and OPD of hospital B was mainly due to the inclusion of 69.4% omissions of route of administration in the prescriptions. The incidence of prescription overdose was approximately 7%-19% in the manual system and approximately 8% in semi and fully electronic system. The omission of information and incomplete information are contributors of prescribing errors in both manual and electronic

  1. [Promotion plan for the promotion of cancer: coping measures at Matsuyama Red Cross Hospital in Ehime prefecture - the current state of affairs at the hospital's cancer treatment promotion office].

    PubMed

    Fujii, Motohiro

    2013-05-01

    Recent cancer control strategies in Japan have been aimed at lowering morbidity and mortality rates, based on the Thirdterm Comprehensive 10-year Strategy for Cancer Control initiated by the Japanese government. In April 2007, the Cancer Control Basic Law was promulgated to necessitate promotion of cancer control by national and local authorities. In June 2007, the Japanese Health Ministry released a plan for the promotion of measures to cope with cancer. The cancer control measures adopted by the Matsuyama Red Cross Hospital(MRCH)in Ehime Prefecture were as follows: ·Progress in the promotion of measures to cope with cancer in Ehime, including a review of 2012, problems with new treatment methods for childhood cancer, employment of cancer patients, and promotion of home care. ·Cancer treatment measures adopted by MRCH as a hub medical institution for the past 5 years. ·The distinctive efforts of the intensive professionals team at the Cancer Treatment Promotion Office for cancer treatment at MRCH, and its work on cancer care from the 4 perspectives of the balanced scorecard in accordance with the basic policy of MRCH.

  2. Modeling the acceptance of clinical information systems among hospital medical staff: an extended TAM model.

    PubMed

    Melas, Christos D; Zampetakis, Leonidas A; Dimopoulou, Anastasia; Moustakis, Vassilis

    2011-08-01

    Recent empirical research has utilized the Technology Acceptance Model (TAM) to advance the understanding of doctors' and nurses' technology acceptance in the workplace. However, the majority of the reported studies are either qualitative in nature or use small convenience samples of medical staff. Additionally, in very few studies moderators are either used or assessed despite their importance in TAM based research. The present study focuses on the application of TAM in order to explain the intention to use clinical information systems, in a random sample of 604 medical staff (534 physicians) working in 14 hospitals in Greece. We introduce physicians' specialty as a moderator in TAM and test medical staff's information and communication technology (ICT) knowledge and ICT feature demands, as external variables. The results show that TAM predicts a substantial proportion of the intention to use clinical information systems. Findings make a contribution to the literature by replicating, explaining and advancing the TAM, whereas theory is benefited by the addition of external variables and medical specialty as a moderator. Recommendations for further research are discussed.

  3. Knowledge, perceptions and practices towards medical ethics among physician residents of University of Alexandria Hospitals, Egypt.

    PubMed

    Mohamed, A M; Ghanem, M A; Kassem, A

    2012-09-01

    This cross-sectional study was conducted to assess the knowledge, perceptions and practices towards medical ethics of physician residents at university hospitals in Alexandria, Egypt. A self-administered structured questionnaire was used for knowledge and perceptions and a checklist for observations of doctor-patient interactions in the outpatient setting. Only 18.0% ofthe 128 participating residents had obtained their knowledge from their medical education and 29.9% were dissatisfied with the roles played by the ethics committee. Most of the residents had satisfactory knowledge and 60.2% had satisfactory perceptions regarding ethical issues. The lowest perception score was in the domain of disclosing medical errors. Only 48.0% of the residents were compliant with the principles of medical ethics in practice and 52.0% of patients were dissatisfied with their treating physicians. The study identified areas of unsatisfactory knowledge and practices towards ethical issues so as to devise means to sensitize residents to these issues and train them appropriately.

  4. The tele-interpreter service at the Bangkok Hospital Medical Center, Thailand.

    PubMed

    Jaroensawat, Boonthida; Wankijcharoen, Somsak

    2013-01-01

    Thailand has become one of the most famous medical hub countries, which is reflected in the increasing number of international patients visiting the Bangkok Hospital Medical Center (BMC). In response, the Interpreter Department at BMC has been established to provide translation for non-English speaking patients. Overtime the Interpreter Department frequently reaches maximum capacity when providing prompt services on demand, resulting in long waiting times and delayed medical treatment. BMC has foreseen the necessity to implement a tele-interpreter system via videoconferencing technology to provide effective translations in the medical environment where delay is usually not tolerated. Tele-interpretation allows doctors to simply select a language icon on their Wi-Fi IP telephone to instantly connect to an interpreter. After implementation in 2oo9, the overall customer satisfaction index for the Interpreter Department increased from 64.5% in Quarter 1 to 85.5% in Quarter 3 of 2011. The tele-interpretation system is currently the closest approximation to the face-to-face interpretation method.

  5. Supporting management of medical equipment for inpatient service in public hospitals: a case study.

    PubMed

    Figueroa, Rosa L; Vallejos, Guido E

    2013-01-01

    This work presents a study of medical equipment availability in the short and long term. The work is divided in two parts. The first part is an analysis of the medical equipment inventory for the institution of study. We consider the replacement, maintenance, and reinforcement of the available medical equipment by considering local guidelines and surveying clinical personnel appreciation. The resulting recommendation is to upgrade the current equipment inventory if necessary. The second part considered a demand analysis in the short and medium term. We predicted the future demand with a 5-year horizon using Holt-Winters models. Inventory analysis showed that 27% of the medical equipment in stock was not functional. Due to this poor performance result we suggested that the hospital gradually addresses this situation by replacing 29 non-functional equipment items, reinforcing stock with 40 new items, and adding 11 items not available in the inventory but suggested by the national guidelines. The results suggest that general medicine inpatient demand has a tendency to increase within the time e.g. for general medicine inpatient service the highest increment is obtained by respiratory (12%, RMSE=8%) and genitourinary diseases (20%, RMSE=9%). This increment did not involve any further upgrading of the proposed inventory.

  6. Venous thromboembolism prophylaxis for hospitalized medical patients, current status and strategies to improve

    PubMed Central

    Abdel-Razeq, Hikmat

    2010-01-01

    Venous thromboembolism (VTE), comprising life-threatening pulmonary embolism (PE) and its precursor deep-vein thrombosis (DVT), is commonly encountered problem. Although most patients survive DVT, they often develop serious and costly long-term complications. Both unfractionated heparin and low molecular weight heparins significantly reduce the incidence of VTE and its associated complications. Despite the evidence demonstrating significant benefit of VTE prophylaxis in acutely ill medical patients, several registries have shown significant underutilization. This underutilization indicates the need for educational and audit programs in order to increase the number of medical patients receiving appropriate prophylaxis. Many health advocacy groups and policy makers are paying more attention to VTE prophylaxis; the National Quality Forum and the Joint Commission recently endorsed strict VTE risk assessment evaluation for each patient upon admission and regularly thereafter. In the article, all major studies addressing this issue in medical patients have been reviewed from the PubMed. The current status of VTE prophylaxis in hospitalized medical patients is addressed and some improvement strategies are discussed. PMID:20981179

  7. Patterns of paging medical interns during night calls at two teaching hospitals.

    PubMed Central

    Harvey, R; Jarrett, P G; Peltekian, K M

    1994-01-01

    OBJECTIVE: To assess the patterns of paging medical interns during night calls. DESIGN: Descriptive study; diaries were used to log calls between 7 pm and 7 am for 1 week in February 1991. SETTING: Two teaching hospitals in Halifax. PARTICIPANTS: All 10 interns assigned to the 15 medical units and nurses from 3 representative medical units. MAIN OUTCOME MEASURES: Number and nature of calls. RESULTS: The overall response rate was 90%. A total of 309 calls were logged by the interns and 107 by the nurses. Each intern had 17 calls on average (range 6 to 33) per 12-hour period. Of the calls 27% occurred after midnight, 25% disrupted sleeping, and 19% interrupted direct patient contact. Overall, the most common reasons for paging interns were related to prescribing of medications (42% of the calls), direct patient assessment (25%) and reporting of laboratory results (18%). According to the nurses, there were no delays in the interns' responding to the pages, and 61% of the calls led to a new physician order. CONCLUSIONS: Paging frequently interrupts interns during work and rest on night calls. Assessment of paging patterns may be useful in identifying specific interventions to reduce the number of calls so that interns will have fewer interruptions during patient encounters and more rest. The collection of data from nurses in a routine nursing audit may be useful for evaluating the communication between interns and nurses and, indirectly, for assessing interns' workload. PMID:8039084

  8. Use of osteoporosis medications after hospitalization for hip fracture: a cross-national study

    PubMed Central

    Kim, Seoyoung C.; Kim, Mi-Sook; Sanfélix-Gimeno, Gabriel; Song, Hong Ji; Liu, Jun; Hurtado, Isabel; Peiró, Salvador; Lee, Joongyub; Choi, Nam-Kyong; Park, Byung-Joo; Avorn, Jerry

    2015-01-01

    Purpose While current osteoporosis management guidelines recommend use of pharmacologic treatment following hip fracture, the care of such patients has been suboptimal. The objective of this cross-national study is to quantify the use of and adherence to osteoporosis medication following hip fracture in three countries with different health care systems- the United States, Korea and Spain. Methods In three cohorts of patients aged ≥65 years hospitalized for hip fracture, we calculated the proportion receiving ≥1 osteoporosis drug after discharge. Adherence to osteoporosis treatment was measured as the proportion of days covered (PDC) during the first year following the hip fracture. Results We identified 86,202 patients with a hip fracture - 4,704 (U.S. Medicare), 6,700 (U.S. commercial), 57,631(Korea), and 17,167 (Spain). The mean age was 77–83 years and 74–78% were women. In the year prior to the index hip fracture, 16–18% were taking an osteoporosis medication. Within 3 months following the index hip fracture, 11% (U.S. Medicare), 13% (U.S. commercial), 39% (Korea), and 25% (Spain) of patients filled ≥1 prescription for osteoporosis medication. For those who filled one or more prescriptions for an osteoporosis medication, the mean PDC in the year following the fracture was 0.70 (U.S. Medicare), 0.67 (U.S. commercial), 0.43 (Korea) and 0.66 (Spain). Conclusions Regardless of differences in health care delivery systems and medication reimbursement plans, the use of osteoporosis medications for the secondary prevention of osteoporotic fracture was low. Adherence to osteoporosis treatment was also suboptimal with the PDC<0.70 in all three countries. PMID:25660252

  9. The quality of medical record documentation and External cause of fall injury coding in a tertiary teaching hospital.

    PubMed

    Cunningham, Janet; Williamson, Dianne; Robinson, Kerin M; Carroll, Rhonda; Buchanan, Ross; Paul, Lindsay

    2014-01-01

    This paper reviews the documentation and coding of External causes of admitted fall cases in a major hospital. Intensive analysis of a random selection of 100 medical records included blind re-coding in the International Statistical Classification of Diseases and Related Health Problems, Tenth revision, Australian Modification (ICD-10-AM), Fifth Edition for External causes to ascertain whether: (i) the medical records contained sufficient information for assignment of specific External cause codes; and (ii) the most appropriate External cause codes were assigned per available documentation. Comparison of the hospital data with the state-wide Victorian Admitted Episodes Database (VAED) data on frequency of use of External cause codes revealed that the index hospital, a major trauma centre, treated comparatively more falls involving steps, stairs and ladders. The hospital sample reflected lower usage, than state-wide, of unspecified External cause codes and Other specified activity codes; otherwise, there was similarity in External cause coding. A comparison of researcher and hospital codes for the falls study sample revealed differences. The ambulance report was identified as the best source of External cause information; only 50% of hospital medical records contained sufficient information for specific code assignation for all three External cause codes, mechanism of injury, place of occurrence and activity at time of injury. Whilst all medical records contained mechanism of falls injury information, 16% contained insufficient details, indicating a deficiency in medical record documentation to underpin external cause coding. This was compounded by flaws in the ICD-10-AM classification.

  10. Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events?

    PubMed Central

    Charles, Krista; Cannon, Margaret; Hall, Robert; Coustasse, Alberto

    2014-01-01

    Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to be capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision support systems designed to alert physicians and other healthcare providers of pending lab or medical errors. However, CPOE systems face major barriers associated with adoption in a hospital system, mainly high implementation costs and physicians’ resistance to change. PMID:25593568

  11. The Medical Duty Officer: An Attempt to Mitigate the Ambulance At-Hospital Interval

    PubMed Central

    Halliday, Megan H.; Bouland, Andrew J.; Lawner, Benjamin J.; Comer, Angela C.; Ramos, Daniel C.; Fletcher, Mark

    2016-01-01

    Introduction A lack of coordination between emergency medical services (EMS), emergency departments (ED) and systemwide management has contributed to extended ambulance at-hospital times at local EDs. In an effort to improve communication within the local EMS system, the Baltimore City Fire Department (BCFD) placed a medical duty officer (MDO) in the fire communications bureau. It was hypothesized that any real-time intervention suggested by the MDO would be manifested in a decrease in the EMS at-hospital time. Methods The MDO was implemented on November 11, 2013. A senior EMS paramedic was assigned to the position and was placed in the fire communication bureau from 9 a.m. to 9 p.m., seven days a week. We defined the pre-intervention period as August 2013 – October 2013 and the post-intervention period as December 2013 – February 2014. We also compared the post-intervention period to the “seasonal match control” one year earlier to adjust for seasonal variation in EMS volume. The MDO was tasked with the prospective management of city EMS resources through intensive monitoring of unit availability and hospital ED traffic. The MDO could suggest alternative transport destinations in the event of ED crowding. We collected and analyzed data from BCFD computer-aided dispatch (CAD) system for the following: ambulance response times, ambulance at-hospital interval, hospital diversion and alert status, and “suppression wait time” (defined as the total time suppression units remained on scene until ambulance arrival). The data analysis used a pre/post intervention design to examine the MDO impact on the BCFD EMS system. Results There were a total of 15,567 EMS calls during the pre-intervention period, 13,921 in the post-intervention period and 14,699 in the seasonal match control period one year earlier. The average at-hospital time decreased by 1.35 minutes from pre- to post-intervention periods and 4.53 minutes from the pre- to seasonal match control

  12. Pre-Stage Acute Kidney Injury Can Predict Mortality and Medical Costs in Hospitalized Patients

    PubMed Central

    Ahn, Shin Young; Chin, Ho Jun; Na, Ki Young; Chae, Dong-Wan; Kim, Sejoong

    2016-01-01

    The significance of minimal increases in serum creatinine below the levels indicative of the acute kidney injury (AKI) stage is not well established. We aimed to investigate the influence of pre-stage AKI (pre-AKI) on clinical outcomes. We enrolled a total of 21,261 patients who were admitted to the Seoul National University Bundang Hospital from January 1, 2013 to December 31, 2013. Pre-AKI was defined as a 25–50% increase in peak serum creatinine levels from baseline levels during the hospital stay. In total, 5.4% of the patients had pre-AKI during admission. The patients with pre-AKI were predominantly female (55.0%) and had a lower body weight and lower baseline levels of serum creatinine (0.63 ± 0.18 mg/dl) than the patients with AKI and the patients without AKI (P < 0.001). The patients with pre-AKI had a higher prevalence of diabetes mellitus (25.1%) and malignancy (32.6%). The adjusted hazard ratio of in-hospital mortality for pre-AKI was 2.112 [95% confidence interval (CI), 1.143 to 3.903]. In addition, patients with pre-AKI had an increased length of stay (7.7 ± 9.7 days in patients without AKI, 11.4 ± 11.4 days in patients with pre-AKI, P < 0.001) and increased medical costs (4,061 ± 4,318 USD in patients without AKI, 4,966 ± 5,099 USD in patients with pre-AKI, P < 0.001) during admission. The adjusted hazard ratio of all-cause mortality for pre-AKI during the follow-up period of 2.0 ± 0.6 years was 1.473 (95% CI, 1.228 to 1.684). Although the adjusted hazard ratio of pre-AKI for overall mortality was not significant among the patients admitted to the surgery department or who underwent surgery, pre-AKI was significantly associated with mortality among the non-surgical patients (adjusted HR 1.542 [95% CI, 1.330 to 1.787]) and the patients admitted to the medical department (adjusted HR 1.384 [95% CI, 1.153 to 1.662]). Pre-AKI is associated with increased mortality, longer hospital stay, and increased medical costs during admission. More attention

  13. 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

  14. [Intraosseous access for in-hospital emergencies. Intensive medical care case study].

    PubMed

    Werner, M; Daniel, H-P; Hoitz, J

    2010-07-01

    Since the release of the 2005 resuscitation guidelines intraosseous infusion has been recognized as the favorite alternative vascular access in emergency patients. It is no longer restricted to paediatric emergencies but is also considered the vascular access of choice for adult patients with difficult venous access. Intraosseous access has been used in an increasing proportion of patients especially in an out-of-hospital emergency care setting while only limited experience exists for in-hospital usage of this technique. This article reports on a case of intraosseous access performed in a critically ill patient directly after admission to the intensive care unit (ICU) due to difficult peripheral venous access. Despite the extensive medical resources available in the ICU (i.e. central venous catheterization) less invasive means were used to render appropriate care. Based on this case different strategies of critical care and possible improvements will be discussed. Intraosseous infusion should be regarded as an infrequently needed but potentially life-saving procedure that is still too often considered as an option at later stages during in-hospital emergency care.

  15. [Geriatric emergencies versus adult emergencies: retrospective analysis of medical emergencies at a general hospital].

    PubMed

    Rodríguez Artalejo, F; González Montalvo, J I; Sanz Segovia, F; Jaramillo Gómez, E; Banegas Banegas, J R; Rodríguez Mañas, L; Carbonell Collar, A

    1989-10-14

    The aim of the study was to evaluate the process of the attention to emergencies in patients older than 65 years and to compare it with the same process in adult patients. To this end, 965 clinical records of medical emergencies from the Hospital Central de la Cruz Roja in Madrid were retrospectively evaluated, and data were obtained regarding age, the cause for consultation, the investigations performed and their yield, the administration of drug therapy, the major diagnosis at the time of discharge from the service and the clinical course. It was found that all evaluated diagnostic investigations were carried out with equal or higher frequency in patients older than 65 years and that their mean clinical effectiveness was also higher. In addition, it was found that the patients older than 65 years were more commonly admitted to the hospital through the emergency service than the rest of the population. It was concluded, therefore, that the process of attention to emergencies has differential characteristics in the elderly population, and that if the number and proportion of old people increase as it will presumably happen during the two next decades, the cost of attention to emergencies and the number of emergency hospital admissions will also increase.

  16. Medication-related emergency department visits and hospitalizations among older adults

    PubMed Central

    Bayoumi, Imaan; Dolovich, Lisa; Hutchison, Brian; Holbrook, Anne

    2014-01-01

    Abstract Objective To identify medications that have a high risk of adverse drug effects (ADEs) among seniors, using data from publicly available administrative databases. Design Cross-sectional study using the Discharge Abstracts Database (DAD) (which contains data on acute care institutions in all provinces and territories except Quebec), the National Ambulatory Care Reporting System (NACRS) (which contains data on emergency department [ED] visits in Ontario), and the IMS Brogan database Canadian CompuScript. Setting Canada. Participants Adults 65 years of age and older with diagnostic codes for drugs, medicaments, and biologic substances causing adverse effects in therapeutic use. Main outcome measures Adverse drug events from 2006 to 2008 associated with hospitalizations and ED visits among adults 65 years of age and older were identified by the DAD and the NACRS. The medications most frequently prescribed by primary care providers in 2008 were identified using data from Canadian CompuScript. Results From 2006 to 2008, the DAD identified 92 141 ADEs among older adults, and the NACRS identified 23 845 ADEs among older adults in Ontario EDs, which represented 2.9% of inpatients and 0.8% of ED patients (21.5% of whom were admitted to hospital). Drugs implicated in the DAD ADEs included anticoagulants (15.4%), antineoplastic agents (10.6%), opioids (9.2%), and nonsteroidal anti-inflammatory drugs (6.5%); drugs included in the ADEs of ED visits were anti-infective agents (15.9%), anticoagulants (14.2%), antineoplastic agents (9.6%), and opioids (7.3%). Conclusion Among older adults, the drug classes most often associated with causing harm in the hospital setting and occurring out of proportion to the frequency prescribed were anticoagulants, opioids, antibiotics, and cardiovascular drugs. Thus, these drug classes should be the focus of quality improvement efforts in primary care. PMID:24733341

  17. Descriptions of Acute Transfusion Reactions in the Teaching Hospitals of Kermanshah University of Medical Sciences, Iran

    PubMed Central

    Payandeh, Mehrdad; Zare, Mohammad Erfan; Kansestani, Atefeh Nasir; Pakdel, Shirin Falah; Jahanpour, Firuzeh; Yousefi, Hoshang; Soleimanian, Farzaneh

    2013-01-01

    Background Transfusion services rely on transfusion reaction reporting to provide patient care and protect the blood supply. Unnecessary discontinuation of blood is a major wastage of scarce blood, as well as man, hours and funds. The aim of the present study was to describe the main characteristics of acute transfusion reactions reported in the 4 hospital of Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran. Material and Methods The study was carried out at 4 teaching hospital of Kermanshah University of Medical Sciences, Kermanshah, Iran, over18 months from April 2010. All adult patients on admission in the hospitals who required blood transfusion and had establish diagnosis and consented were included in the study. Results In the year 2010 until 2012, a total of 6238 units of blood components were transfused. A total of 59 (0.94%) cases of transfusion reaction were reported within this 3 years period. The commonest were allergic reactions which presented with various skin manifestations such as urticarial, rashes and pruritus (49.2%), followed by increase in body temperature of > 1°C from baseline which was reported as febrile non-hemolytic transfusion reaction (37.2%). pain at the transfusion site (6.8%) and hypotension (6.8%). Conclusion It is important that each transfusion of blood components to be monitor carefully. Many transfusion reactions are not recognized, because signs and symptoms mimic other clinical conditions. Any unexpected symptoms in a transfusion recipient should at least be considered as a possible transfusion reaction and be evaluated. Prompt recognition and treatment of acute transfusion reaction are crucial and would help in decreasing transfusion related morbidity and mortality, but prevention is preferable. PMID:24505522

  18. [THE MOTIVATION OF MEDICAL PERSONNEL OF MULTIFIELD HOSPITAL TO WORKING OVER STANDARDS OF SINGLE JOB POSITION].

    PubMed

    Khazov, M V; Romanov, S V; Abaeva, O P; Murigina, M M

    2015-01-01

    The article considers results of study concerning prevalence of physicians working over standards of single job position in multifield hospital, including factors motivating to extra job. The research purpose was to analyze impact of gender age structure of medical personnel of multfield public medical organization on motivation of physicians to work over standards of single job position. The objectives consisted of analyzing prevalence of over standard work of medical personnel of multifield public medical organization with consideration of social structure and studying factors motivating physicians to work over standards of single job position. The study was carried out on the basis of questionnaire survey of physicians. The results of study testify higher degree of prevalence of working over standards of single job position in modern health care. So, 64.8 ± 3.6% of respondents work subject to conditions of internal and/or external moonlighting. Moreover; one third of physicians enlisted to extra job. Among physicians males more often than females work subject to conditions of moonlighting, perform extra job, enlist to working during days off. The specialists of age group from 35 to 54 years work subject to conditions of external and internal moonlighting more often than younger physicians. Among physicians, the most significant cause of working subject to conditions of moonlighting is additional earnings. At that, every fifth physician works over standards of job position with purpose to increase one's professional competence. The study results permit concluding that aspects of social structure of modern medical staff significantly impact motivation and hence possibility of enlisting workers to work over standards of single job position.

  19. Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital

    PubMed Central

    2010-01-01

    Background The objective of this study was to investigate how medical and nursing staff of the Nicosia General Hospital is affected by specific motivation factors, and the association between job satisfaction and motivation. Furthermore, to determine the motivational drive of socio-demographic and job related factors in terms of improving work performance. Methods A previously developed and validated instrument addressing four work-related motivators (job attributes, remuneration, co-workers and achievements) was used. Two categories of health care professionals, medical doctors and dentists (N = 67) and nurses (N = 219) participated and motivation and job satisfaction was compared across socio-demographic and occupational variables. Results The survey revealed that achievements was ranked first among the four main motivators, followed by remuneration, co-workers and job attributes. The factor remuneration revealed statistically significant differences according to gender, and hospital sector, with female doctors and nurses and accident and emergency (A+E) outpatient doctors reporting greater mean scores (p < 0.005). The medical staff showed statistically significantly lower job satisfaction compared to the nursing staff. Surgical sector nurses and those >55 years of age reported higher job satisfaction when compared to the other groups. Conclusions The results are in agreement with the literature which focuses attention to management approaches employing both monetary and non-monetary incentives to motivate health care professionals. Health care professionals tend to be motivated more by intrinsic factors, implying that this should be a target for effective employee motivation. Strategies based on the survey's results to enhance employee motivation are suggested. PMID:21080954

  20. Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement

    PubMed Central

    Holbrook, Anne; Bowen, James M; Patel, Harsit; O'Brien, Chris; You, John J; Tahavori, Roshan; Doleweerd, Jeff; Berezny, Tim; Perri, Dan; Nieuwstraten, Carmine; Troyan, Sue; Patel, Ameen

    2016-01-01

    Background Medication reconciliation (MedRec) has been a mandated or recommended activity in Canada, the USA and the UK for nearly 10 years. Accreditation bodies in North America will soon require MedRec for every admission, transfer and discharge of every patient. Studies of MedRec have revealed unintentional discrepancies in prescriptions but no clear evidence that clinically important outcomes are improved, leading to widely variable practices. Our objective was to apply process mapping methodology to MedRec to clarify current processes and resource usage, identify potential efficiencies and gaps in care, and make recommendations for improvement in the light of current literature evidence of effectiveness. Methods Process engineers observed and recorded all MedRec activities at 3 academic teaching hospitals, from initial emergency department triage to patient discharge, for general internal medicine patients. Process maps were validated with frontline staff, then with the study team, managers and patient safety leads to summarise current problems and discuss solutions. Results Across all of the 3 hospitals, 5 general problem themes were identified: lack of use of all available medication sources, duplication of effort creating inefficiency, lack of timeliness of completion of the Best Possible Medication History, lack of standardisation of the MedRec process, and suboptimal communication of MedRec issues between physicians, pharmacists and nurses. Discussion MedRec as practised in this environment requires improvements in quality, timeliness, consistency and dissemination. Further research exploring efficient use of resources, in terms of personnel and costs, is required. PMID:28039294

  1. [Designing and Operating a Comprehensive Mental Health Management System to Support Faculty at a University That Contains a Medical School and University Hospital].

    PubMed

    Kawanishi, Chiaki

    2016-01-01

    In Japan, healthcare professionals and healthcare workers typically practice a culture of self-assessment when it comes to managing their own health. Even where this background leads to instances of mental health disorders or other serious problems within a given organization, such cases are customarily addressed by the psychiatrists or psychiatric departments of the facilities affected. Organized occupational mental health initiatives for professionals and workers within the healthcare system are extremely rare across Japan, and there is little recognition of the need for such initiatives even among those most directly affected. The author has some experience designing and operating a comprehensive health management system to support students and faculty at a university in the Tokyo Metropolitan Area that contains a medical school and university hospital. At this university, various mental health-related problems were routinely being allowed to develop into serious cases, while the fundamental reforms required by the health management center and the mental health management scheme organized through the center had come to represent a challenge for the entire university. From this initial situation, we undertook several successive initiatives, including raising the number of staff in the health management center and its affiliated organizations, revising and drafting new health management rules and regulations, launching an employment support and management system, implementing screenings to identify people with mental ill-health, revamping and expanding a counselling response system, instituting regular collaboration meetings with academic affairs staff, and launching educational and awareness-raising activities. This resulted in the possibility of intervention in all cases of mental health crisis, such as suicidal ideation. We counted more than 2,400 consultations (cumulative total number; more than half of consultations was from the medical school, postgraduate

  2. Medical errors in neonatal intensive care unit at Benha University Hospital, Egypt.

    PubMed

    El-Shazly, Ahmed N; Al-Azzouny, Mahmoud A; Soliman, Doaa R; Abed, Neveen T; Attia, Sameh S

    2017-02-21

    This study was conducted in the neonatal intensive care unit of Benha University Hospital, Egypt from 1 August 2012 to the 31 January 2013 to identify medical errors and to determine the risk factors and consequences of these errors. Errors were detected by follow-up of neonates and review of reports including nursing followup sheets, resident progression notes and investigation reports. We detected 3819 errors that affected 97% of neonates. Types of errors included 403 medication errors (10.55% of total errors), 652 errors in daily routine procedures (17.07%), 1042 errors in invasive procedures (27.28%), 68 errors in nutrition (1.78%), 63 equipment errors (1.64%), 260 administration errors (6.8%), 656 staffing errors (17.18%), 107 environmental errors (2.8%), 448 infection control errors (11.73%) and 120 nosocomial infection errors (3.14%). Medical errors were high in low birth weight, low gestational age neonates and increased with duration of admission.

  3. [Learning styles in medical residents and their professors of a pediatric hospital.

    PubMed

    Juárez-Muñoz, Irina Elizabeth; Gómez-Negrete, Alonso; Varela-Ruiz, Margarita; Mejía-Aranguré, Juan Manuel; Mercado-Arellano, José Agustín; Sciandra-Rico, Martha Minerva; Matute-González, Mario Manuel

    2013-01-01

    Background: the learning styles are cognitive, emotional, and psychological characteristics, which function as relatively stable indicators of how teachers and students perceive, interact, and respond to their learning environments. Knowing students' styles allows teachers to have tools to improve medical education. Our objective was to identify learning styles in pediatric residents and professors from a pediatric hospital. Methods: a learning styles questionnaire was applied to residents and theirs professors; data was analyzed in SPSS 12 software. Results: the dominant learning style in pediatric residents was reflexive and for professors was theoretical. There wasn't any difference between sexes or between medical or surgical specialities. There was more correlation between professors and residents when there was an increase in training time. Conclusions: the learning styles between professors and residents are different, especially at the beginning of the medical specialty courses; that's why it is necessary to realize a confrontation between the students' learning styles and teaching methods used by professors to improve significant learning. To know learning styles gives residents an important alternative to find a better study strategy.

  4. Accreditation status of hospital pharmacies and their challenges of medication management: A case of south Iranian largest university.

    PubMed

    Barati, Omid; Dorosti, Hesam; Talebzadeh, Alireza; Bastani, Peivand

    2016-01-01

    Considering the importance of accreditation for hospital pharmacies, this study was to determine the challenges of medication management in hospital pharmacies affiliated with Shiraz University of Medical Sciences, Iran. The study was a mix-method research conducted in two qualitative and quantitative phases during the years 2014-2015 in Shiraz, Iran. National Accreditation Standard checklist for hospitals was used for data collection in the first phase, and Delphi method was applied in three rounds to achieve the most challenges of medication management and the related solutions. Results indicated a medium status of accreditation for all three dimensions in the above hospital pharmacies (3.53, 42.15 and 7, respectively). Lack of clinical pharmacists, nonparticipation of the pharmacy director in annual budgeting, lack of access to patient information, discontinuity of pharmaceutical care for patients discharged, defects in pharmacy staff training, lack of legislation in support of pharmacists and lack of adequate access to physicians' prescriptions, shortages in reporting medication errors, and lack of evidence related to microbial contamination are the most challenges extracted from the second phase. It seems that the studied hospital pharmacies encounter numerous problems regarding accreditation, pharmaceutical care as well as appropriate medication management and supply chain. Attempts to solve these problems can play an important role in improving the efficiency and effectiveness of pharmacies in Iran.

  5. Whose responsibility is medication reconciliation: Physicians, pharmacists or nurses? A survey in an academic tertiary care hospital.

    PubMed

    Al-Hashar, Amna; Al-Zakwani, Ibrahim; Eriksson, Tommy; Al Za'abi, Mohammed

    2017-01-01

    Background: Medication errors occur frequently at transitions in care and can result in morbidity and mortality. Medication reconciliation is a recognized hospital accreditation requirement and designed to limit errors in transitions in care. Objectives: To identify beliefs, perceived roles and responsibilities of physicians, pharmacists and nurses prior to the implementation of a standardized medication reconciliation process. Methods: A survey was distributed to the three professions: pharmacists in the pharmacy and physicians and nurses in hospital in-patient units. It contained questions about the current level of medication reconciliation practices, as well as perceived roles and responsibilities of each profession when a standardized process is implemented. Value, barriers to implementing medication reconciliation and the role of information technology were also assessed. Analyses were performed using univariate statistics. Results: There was a lack of clarity of current medication reconciliation practices as well as lack of agreement between the three professions. Physicians and pharmacists considered their professions as the main providers while nurses considered physicians followed by themselves as the main providers with limited roles for pharmacists. The three professions recognize the values and benefits of medication reconciliation yet pharmacists, more than others, stated limited time to implement reconciliation is a major barrier. Obstacles such as unreliable sources of medication history, patient knowledge and lack of coordination and communication between the three professions were expressed. Conclusions: The three health care professions recognize the value of medication reconciliation and want to see it implemented in the hospital, yet there is a lack of agreement with regard to roles and responsibilities of each profession within the process. This needs to be addressed by the hospital administration to design clear procedures and defined roles

  6. Benchmarking in Student Affairs.

    ERIC Educational Resources Information Center

    Mosier, Robert E.; Schwarzmueller, Gary J.

    2002-01-01

    Discusses the use of benchmarking in student affairs, focusing on issues related to student housing. Provides examples of how benchmarking has influenced administrative practice at many institutions. (EV)

  7. [Local communalization of clinical records between the municipal community hospital and local medical institutes by using information technology].

    PubMed

    Iijima, Shohei; Shinoki, Keiji; Ibata, Takeshi; Nakashita, Chisako; Doi, Seiko; Hidaka, Kumi; Hata, Akiko; Matsuoka, Mio; Waguchi, Hideko; Mito, Saori; Komuro, Ryutaro

    2012-12-01

    We introduced the electronic health record system in 2002. We produced a community medical network system to consolidate all medical treatment information from the local institute in 2010. Here, we report on the present status of this system that has been in use for the previous 2 years. We obtained a private server, set up a virtual private network(VPN)in our hospital, and installed dedicated terminals to issue an electronic certificate in 50 local institutions. The local institute applies for patient agreement in the community hospital(hospital designation style). They are then entitled to access the information of the designated patient via this local network server for one year. They can access each original medical record, sorted on the basis of the medical attendant and the chief physician; a summary of hospital stay; records of medication prescription; and the results of clinical examinations. Currently, there are approximately 80 new registrations and accesses per month. Information is provided in real time allowing up to date information, helping prescribe the medical treatment at the local institute. However, this information sharing system is read-only, and there is no cooperative clinical pass system. Therefore, this system has a limit to meet the demand for cooperation with the local clinics.

  8. THE DETERMINANTS OF NURSING, ALLIED HEALTH AND NON MEDICAL STAFFS’ HEALTH LITERACY IN HOSPITALS OF A DEVELOPING COUNTRY

    PubMed Central

    Kahouei, Mehdi; Roghani, Panoe Seyed; Zadeh, Jamileh Mahdi; Firouzeh, Mehri

    2015-01-01

    Introduction: Given the role of personnel working in hospitals in promoting health, there is a clear need for a study to clarify the level of health literacy and affecting factors on it among the non medical and medical staffs working in hospitals. Methods: A cross-sectional survey was performed on 389 employees who were working in hospitals affiliated to Semnan University of Medical Sciences of Iran in 2013. Results: There were significant relationships among the use of TV (P=0.044, CI=95%, Odd’s Ratio= 1.825), the use of books and journals (P<0.0001, CI=95%, Odd’s Ratio= 5.551), the use of internet (P<0.039, CI=95%, Odd’s Ratio= 0.641), the use of physicians (P<0.0001, CI=95%, Odd’s Ratio=0.070) and the nonmedical and medical staffs’ health literacy level. Conclusions: The findings indicate media and print information resources more than physicians and electronic information sources affect on the increase of nonmedical and medical staffs’ health literacy of hospitals of Iran. It also is better to train Iranian physicians more about the skills required for transferring health concepts. Given the important role of medical staffs in the increase of health literacy level in other members of the community, it is better to use other suitable information sources to transfer health information to all individuals in the community. PMID:26889103

  9. Association between Internet addiction and depression in Thai medical students at Faculty of Medicine, Ramathibodi Hospital

    PubMed Central

    Boonvisudhi, Thummaporn

    2017-01-01

    Objective To study the extent of Internet addiction (IA) and its association with depression in Thai medical students. Methods A cross-sectional study was conducted at Faculty of Medicine, Ramathibodi Hospital. Participants were first- to fifth-year medical students who agreed to participate in this study. Demographic characteristics and stress-related factors were derived from self-rated questionnaires. Depression was assessed using the Thai version of Patient Health Questionnaire (PHQ-9). A total score of five or greater derived from the Thai version of Young Diagnostic Questionnaire for Internet Addiction was classified as “possible IA”. Then chi-square test and logistic regression were used to evaluate the associations between possible IA, depression and associated factors. Results From 705 participants, 24.4% had possible IA and 28.8% had depression. There was statistically significant association between possible IA and depression (odds ratio (OR) 1.92, 95% confidence interval (CI): 1.34–2.77, P-value <0.001). Logistic regression analysis illustrated that the odds of depression in possible IA group was 1.58 times of the group of normal Internet use (95% CI: 1.04–2.38, P-value = 0.031). Academic problems were found to be a significant predictor of both possible IA and depression. Conclusion IA was likely to be a common psychiatric problem among Thai medical students. The research has also shown that possible IA was associated with depression and academic problems. We suggest that surveillance of IA should be considered in medical schools. PMID:28319167

  10. Western University (No. 10 Canadian Stationary Hospital and No. 14 Canadian General Hospital): a study of medical volunteerism in the First World War

    PubMed Central

    Istl, Alexandra C.; McAlister, Vivian C.

    2016-01-01

    Summary The Canadian government depended on chaotic civilian volunteerism to staff a huge medical commitment during the First World War. Offers from Canadian universities to raise, staff and equip hospitals for deployment, initially rejected, were incrementally accepted as casualties mounted. When its offer was accepted in 1916, Western University Hospital quickly adopted military decorum and equipped itself using Canadian Red Cross Commission guidelines. Staff of the No. 10 Canadian Stationary Hospital and the No. 14 Canadian General Hospital retained excellent morale throughout the war despite heavy medical demand, poor conditions, aerial bombardment and external medical politics. The overwhelming majority of volunteers were Canadian-born and educated. The story of the hospital’s commanding officer, Edwin Seaborn, is examined to understand the background upon which the urge to volunteer in the First World War was based. Although many Western volunteers came from British stock, they promoted Canadian independence. A classical education and a broad range of interests outside of medicine, including biology, history and native Canadian culture, were features that Seaborn shared with other leaders in Canadian medicine, such as William Osler, who also volunteered quickly in the First World War. PMID:27827791

  11. Photocopy of post card from Fitzsimons Army Medical Center Public ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of post card from Fitzsimons Army Medical Center Public Affairs Office, building 120. Photograph by Rocky Mountain photo. CO was no copyrighted and is , therefore, in the public domain. - Fitzsimons General Hospital, Memorial Tablet, West McAfee, South of Building No. 524, Aurora, Adams County, CO

  12. Risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in MRSA-colonized patients discharged from a Veterans Affairs hospital.

    PubMed

    Cadena, J; Richardson, A M; Frei, C R

    2016-02-01

    Currently, limited studies have quantified the risk of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) for MRSA-colonized patients on discharge from hospital. Our retrospective, case-control study identified independent risk factors for the development of MRSA SSTIs among such patients detected by active MRSA nasal screening in an acute care hospital by PCR on admission, and bacteriological cultures on discharge. Cases were MRSA-colonized patients aged ⩾18 years who developed a MRSA SSTI post-discharge and controls were those who did not develop a MRSA SSTI post-discharge. Controls were matched to cases by length of follow-up (±10 days) for up to 18 months. Potential demographic and clinical risk factors for MRSA infection were identified using electronic queries and manual chart abstraction; data were compared by standard statistical tests and variables with P values ⩽0·05 in bivariable analysis were entered into a logistic regression model. Multivariable analysis demonstrated prior hospital admission within 12 months (P = 0·02), prior MRSA infection (P = 0·05), and previous myocardial infarction (P = 0·01) were independently predictive of a MRSA SSTI post-discharge. Identification of MRSA colonization upon admission and recognition of risk factors could help identify a high-risk population that could benefit from MRSA SSTI prevention strategies.

  13. Associated Roles of Perioperative Medical Directors and Anesthesia: Hospital Agreements for Operating Room Management.

    PubMed

    Dexter, Franklin; Epstein, Richard H

    2015-12-01

    As reviewed previously, decision making can be made systematically shortly before the day of surgery based on reducing the hours of overutilized operating room (OR) time and tardiness of case starts (i.e., patient waiting). We subsequently considered in 2008 that such decision making depends on rational anesthesia-hospital agreements specifying anesthesia staffing. Since that prior study, there has been a substantial increase in understanding of the timing of decision making to reduce overutilized OR time. Most decisions substantively influencing overutilized OR time are those made within 1 workday before the day of surgery and on the day of surgery, because only then are ORs sufficiently full that case scheduling and staff assignment decisions affect overutilized OR time. Consequently, anesthesiologists can easily be engaged in such decisions, because generally they must be involved to ensure that the corresponding anesthesia staff assignments are appropriate. Despite this, at hospitals with >8 hours of OR time used daily in each OR, computerized recommendations are superior to intuition because of cognitive biases. Decisions need to be made by a Perioperative Medical Director who has knowledge of the principles of perioperative managerial decision making published in the scientific literature rather than by a committee lacking this competency. Education in the scientific literature, and when different analytical methods should be used, is important. The addition that we make in this article is to show that an agreement between an anesthesia group and a hospital can both reduce overutilized OR time and patient waiting: The anesthesia group and hospital will ensure, hourly, that, when there are case(s) waiting to start, the number of ORs in use for each service will be at least the number that maximizes the efficiency of use of OR time. Neither the anesthesia group nor the hospital will be expected to run more than that number of ORs without mutual agreement

  14. Study on elder abuse and neglect among patients in a medical college hospital, Bangalore, India.

    PubMed

    Nisha, Catherin; Manjaly, Steve; Kiran, Pretesh; Mathew, Betsy; Kasturi, Arvind

    2016-01-01

    Elder abuse and neglect is a problem that occurs across all settings and all populations. Elder abuse has many forms, such as abandonment, emotional or psychological abuse, financial or material exploitation, neglect, physical abuse, and sexual abuse. We conducted this research to determine the prevalence of various types of abuse and neglect and their associated factors among elderly patients attending the urban and rural geriatric clinics at a medical college hospital in Bangalore, India. A total of 200 elderly patients participated in the study. The overall prevalence of elder abuse or neglect was 32 (16%), comprised of: verbal abuse in 25 (12.5%); neglect in 22 (11%); financial abuse in 17 (8.5%); and physical abuse in 3 (1.5%). Hence, many elderly patients had experienced multiple forms of abuse. There was statistically significant association between elder abuse and total financial dependence, lack of social support, and depression among the elderly patients.

  15. The Sociology of the Deceased Harvard Medical Unit at Boston City Hospital.

    PubMed

    Tishler, Peter V

    2015-12-01

    Many graduates of the Harvard Medical Unit (HMU) at Boston City Hospital, in either the clinical training/residency program or the research program at the Thorndike Memorial Laboratory, contributed in major ways to the HMU and constantly relived their HMU experiences. The HMU staff physicians, descending from founder and mentor physicians Francis W. Peabody, Soma Weiss, and George R. Minot, were dedicated to the teaching, development, and leadership of its clinical and research trainees, whose confidence and dedication to patient care as a result of their mentorship led many to lifelong achievements as clinicians, teachers, and mentors. Their experience also led to a lifelong love of the HMU (despite its loss), camaraderie, happiness, and intense friendships with their associates.

  16. The Sociology of the Deceased Harvard Medical Unit at Boston City Hospital

    PubMed Central

    Tishler, Peter V.

    2015-01-01

    Many graduates of the Harvard Medical Unit (HMU) at Boston City Hospital, in either the clinical training/residency program or the research program at the Thorndike Memorial Laboratory, contributed in major ways to the HMU and constantly relived their HMU experiences. The HMU staff physicians, descending from founder and mentor physicians Francis W. Peabody, Soma Weiss, and George R. Minot, were dedicated to the teaching, development, and leadership of its clinical and research trainees, whose confidence and dedication to patient care as a result of their mentorship led many to lifelong achievements as clinicians, teachers, and mentors. Their experience also led to a lifelong love of the HMU (despite its loss), camaraderie, happiness, and intense friendships with their associates. PMID:26604868

  17. 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.

  18. Transforming the Primary Care Training Clinic: New York State’s Hospital Medical Home Demonstration Pilot

    PubMed Central

    Angelotti, Marietta; Bliss, Kathryn; Schiffman, Dana; Weaver, Erin; Graham, Laura; Lemme, Thomas; Pryor, Veronica; Gesten, Foster C.

    2015-01-01

    Background Training in patient-centered medical home (PCMH) settings may prepare new physicians to measure quality of care, manage the health of populations, work in teams, and include cost information in decision making. Transforming resident clinics to PCMHs requires funding for additional staff, electronic health records, training, and other resources not typically available to residency programs. Objective Describe how a 1115 Medicaid waiver was used to transform the majority of primary care training sites in New York State to the PCMH model and improve the quality of care provided. Methods The 2013–2014 Hospital Medical Home Program provided awards to 60 hospitals and 118 affiliated residency programs (training more than 5000 residents) to transform outpatient sites into PCMHs and provide high-quality, coordinated care. Site visits, coaching calls, resident surveys, data reporting, and feedback were used to promote and monitor change in resident continuity and quality of care. Descriptive analyses measured improvements in these areas. Results A total of 156 participating outpatient sites (100%) received PCMH recognition. All sites enhanced resident education using PCMH principles through patient empanelment, development of quality dashboards, and transforming resident scheduling and training. Clinical quality outcomes showed improvement across the demonstration, including better performance on colorectal and breast cancer screening rates (rate increases of 13%, P ≤ .001, and 11%, P = .011, respectively). Conclusions A 1115 Medicaid waiver is a viable mechanism for states to transform residency clinics to reflect new primary care models. The PCMH transformation of 156 sites led to improvements in resident continuity and clinical outcomes. PMID:26221444

  19. Educational outreach visits to improve nurses' use of mechanical venous thromboembolism prevention in hospitalized medical patients.

    PubMed

    Duff, Jed; Walker, Kim; Omari, Abdullah; Middleton, Sandy; McInnes, Elizabeth

    2013-12-01

    Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in hospitalized medical patients. Evidence-based guidelines exist for preventing VTE; unfortunately, these guidelines are not always adhered to by clinicians. The aim of this study was to evaluate the acceptability, utility and clinical impact of an educational outreach visit (EOV) on nurses' provision of mechanical prophylaxis to hospitalized medical patients using a prospective, uncontrolled, before-and-after design. Nurses received a 1-to-1 educational session on mechanical VTE prevention by a trained nurse facilitator. The EOV intervention was designed by a multidisciplinary group of healthcare professionals using social marketing theory. Eighty-five of the 120 eligible nurses (71%) attended the EOV. The median length of each visit was 11.5 minutes (interquartile range [IQR], 10-15) and the median time spent arranging and conducting each visit was 63 minutes (IQR, 49-85). Eighty-four (99%) of the 85 participants gave a verbal commitment to trial the new evidence-based mechanical VTE prevention practices. However, there were no measurable improvements in the proportion of patients risk assessed (-1.7% improvement; 95% confidence interval [CI], -7.0 to 10.3; P = .68) or provided appropriate mechanical prophylaxis (-0.3% improvement; 95% CI, -13.4 to 14; P = .96). Researchers conclude that EOV should not be used to improve nurses' use of mechanical VTE prevention because it has no measurable impact on clinical practice and is resource intensive, requiring 4.5 minutes of preparation for every minute spent face to face with participants. Further research into the specific mechanism of action is required to explain the variability in clinical effect seen with this intervention.

  20. The Tablet Device in Hospital Neurology and in Neurology Graduate Medical Education

    PubMed Central

    Newey, Christopher R.; Bhimraj, Adarsh

    2015-01-01

    Background and Purpose: There is limited literature on tablet devices for neurohospitalists and in neurological graduate medical education. This study evaluated utilization, benefits, and limitations of customized tablets on inpatient neurology practice and resident education. The hypothesis was the perception of the tablet would be positive, given their portability, convenience to accessing point-of-care reference, and accessibility to the electronic medical record. Methods: Second-generation iPads with neurology-specific applications and literature were provided to our in-hospital general, stroke, and consult neurology teams. After 1 year, residents on these teams were surveyed on demographic data, familiarity, and utilization of the iPad and their perceptions of the device. Results: All 27 residents responded to the survey. Most participants (23 of 27) used a tablet while on inpatient service. Twelve regularly utilized the neurology-specific apps and/or accessed scientific articles. Technologically savvy residents felt significantly more comfortable using tablets and were more quickly acquainted with the features. Thirteen respondents wanted a formal orientation on the advanced features of the tablet independent of their familiarity with the device or level of technological comfort. Conclusion: Overall, the perception was that the tablet was beneficial for inpatient clinical care and as an educational reference. Participants became easily familiarized with the device features quickly, regardless of whether they owned one previously or not. Most physicians indicated interest in advanced features of tablets; however, a formal orientation may be beneficial for optimal utilization. A reliable network connection is essential to in-hospital use of tablet devices. Additional research pertaining to patient outcomes, objective educational benefit, and cost-effectiveness is necessary. PMID:25553224

  1. Weighing the views of a university hospital and medical school regarding an HMO.

    PubMed

    Herrmann, T J; Matthews, C W; Segadelli, L J

    1983-09-01

    After 14 years of study, the University of Michigan decided to terminate development of a health maintenance organization (HMO). The process was long and difficult because of the university's need to consider the HMO from the university's perspective of both an employer and a provider. As an employer, the university's early view was favorable and then declined when employee interest was found to be weak and the HMO's impact on the rapidly rising cost of the university's health insurance benefit was determined to be modest. As a provider, the university's view was mixed. In regard to its hospitals, the university's judgment was positive largely because it hoped that HMO incentives might help the hospitals remain viable in the health care delivery environment that was becoming increasingly competitive. From the Medical School's point of view, an HMO was felt not to be desirable because it could put in jeopardy the professional fee revenue used by the school to help underwrite its academic programs, which are the primary source of faculty pride and recognition.

  2. Prescribing Pattern of Antifungal Medications at a Tertiary Care Hospital in Oman

    PubMed Central

    Alzaabi, Mohammed A.; Alghafri, Fatma

    2016-01-01

    Introduction Inappropriate use of antifungal agents is implicated in the global burden of antifungal resistance, adverse outcomes like persistent infections, unnecessary exposure and increased cost. Data collection from time to time is to be done in order to have a check on the resistance/sensitivity pattern of the commonly prescribed antifungal drugs. Aim To describe the pattern of antifungal drug prescription and administration to patients attending a university hospital in Oman. Materials and Methods This was a descriptive, retrospective cross-sectional study conducted at Sultan Qaboos University Hospital (SQUH), a university hospital in Oman that covered the electronic patient’s data for a period of one year (January 2013 to December 2013). The study included inpatients and outpatients of all ages and both genders attending SQUH and receiving antifungal medications at the study period. Frequencies and percentages were reported for categorical variables, while the mean and standard deviation were used to summarize the data for continuous variables. Results A total of 1353 antifungal drug prescriptions were prescribed for 244 patients. More than half of all antifungal drug prescriptions were prescribed by haematology, infectious disease and family medicine departments. The majority of patients to whom these drugs were prescribed were diagnosed to have infectious diseases followed by prophylactic use in leukaemias and immunocompromised conditions. Fluconazole was the most commonly prescribed antifungal drug (n=715, 52.8%) followed by nystatin and voriconazole (n=233; 17.2% and n=152; 11.2%, respectively). Conclusion This study will help in understanding antifungal prescription practices and help in directing future studies and also in developing local policies for appropriate use of antifungal drugs. PMID:28208876

  3. Understanding the causes of intravenous medication administration errors in hospitals: a qualitative critical incident study

    PubMed Central

    Keers, Richard N; Williams, Steven D; Cooke, Jonathan; Ashcroft, Darren M

    2015-01-01

    Objectives To investigate the underlying causes of intravenous medication administration errors (MAEs) in National Health Service (NHS) hospitals. Setting Two NHS teaching hospitals in the North West of England. Participants Twenty nurses working in a range of inpatient clinical environments were identified and recruited using purposive sampling at each study site. Primary outcome measures Semistructured interviews were conducted with nurse participants using the critical incident technique, where they were asked to discuss perceived causes of intravenous MAEs that they had been directly involved with. Transcribed interviews were analysed using the Framework approach and emerging themes were categorised according to Reason's model of accident causation. Results In total, 21 intravenous MAEs were discussed containing 23 individual active failures which included slips and lapses (n=11), mistakes (n=8) and deliberate violations of policy (n=4). Each active failure was associated with a range of error and violation provoking conditions. The working environment was implicated when nurses lacked healthcare team support and/or were exposed to a perceived increased workload during ward rounds, shift changes or emergencies. Nurses frequently reported that the quality of intravenous dose-checking activities was compromised due to high perceived workload and working relationships. Nurses described using approaches such as subconscious functioning and prioritising to manage their duties, which at times contributed to errors. Conclusions Complex interactions between active and latent failures can lead to intravenous MAEs in hospitals. Future interventions may need to be multimodal in design in order to mitigate these risks and reduce the burden of intravenous MAEs. PMID:25770226

  4. Insects associated with hospital environment in Egypt with special reference to the medically important species.

    PubMed

    Kenawy, Mohamed A; Amer, Hanan S; Lotfy, Nadia M; Khamis, Nagwa; Abdel-Hamid, Yousrya M

    2014-12-01

    A study was planned to examine the insect fauna associated with two hospitals: urban (A) in Cairo and rural (B) in Banha, Egypt with varying hygienic levels and their adjacent residential areas (AC) and (BC), respectively and to investigate the effect of hygienic level on species composition and relative abundance. A total of 22 species belonging to 7 orders and 15 families were reported in the four study areas of which, Dipterous flies were the most common (8/22, 36.36% species). A total of 5257 adults were collected of which Dipterous flies were the abundant (3800, 72.28% insect) and Musca domestica was the most abundant species (3535, 67.24% insect) which was present in all areas where it was more common / predominant species (21.94%-90.91% insect). Moreover, higher densities of M domestica were in (B) and BC than in (A) or (AC). The heavily infested area was AC (54.55% species) followed by (A), (BC) and (B) however, the total number of the collected insects was higher in (BC) and (B) than in (AC) and (A). This was confirmed by finding maximum diversity indices in (AC) and minimum ones in B. In all areas, means of M domestica was more common during summer/autumn and spring than in the winter. Periplaneta americana collected oily during autumn in AC and was more common in autumn in (BC) while Blatella germanica collected only during summer in (AC) and was more common in autumn in (B). The prevalence and higher abundance of the medically important species mainly M domestica, P. americana and B. germanica in rural hospital than in urban one attribute mainly to the lower hygienic level of rural hospital This require a control program based mainly on sanitation supplemented by other measures to overcome the risk of disease transmission by such insects

  5. Antimicrobial Stewardship in a Long-Term Acute Care Hospital Using Offsite Electronic Medical Record Audit.

    PubMed

    Beaulac, Kirthana; Corcione, Silvia; Epstein, Lauren; Davidson, Lisa E; Doron, Shira

    2016-04-01

    OBJECTIVE To offer antimicrobial stewardship to a long-term acute care hospital using telemedicine. METHODS We conducted an uninterrupted time-series analysis to measure the impact of antimicrobial stewardship on hospital-acquired Clostridium difficile infection (CDI) rates and antimicrobial use. Simple linear regression was used to analyze changes in antimicrobial use; Poisson regression was used to estimate the incidence rate ratio in CDI rates. The preimplementation period was April 1, 2010-March 31, 2011; the postimplementation period was April 1, 2011-March 31, 2014. RESULTS During the preimplementation period, total antimicrobial usage was 266 defined daily doses (DDD)/1,000 patient-days (PD); it rose 4.54 (95% CI, -0.19 to 9.28) per month then significantly decreased from preimplementation to postimplementation (-6.58 DDD/1,000 PD [95% CI, -11.48 to -1.67]; P=.01). The same trend was observed for antibiotics against methicillin-resistant Staphylococcus aureus (-2.97 DDD/1,000 PD per month [95% CI, -5.65 to -0.30]; P=.03). There was a decrease in usage of anti-CDI antibiotics by 50.4 DDD/1,000 PD per month (95% CI, -71.4 to -29.2; P<.001) at program implementation that was maintained afterwards. Anti-Pseudomonas antibiotics increased after implementation (30.6 DDD/1,000 PD per month [95% CI, 4.9-56.3]; P=.02) but with ongoing education this trend reversed. Intervention was associated with a decrease in hospital-acquired CDI (incidence rate ratio, 0.57 [95% CI, 0.35-0.92]; P=.02). CONCLUSION Antimicrobial stewardship using an electronic medical record via remote access led to a significant decrease in antibacterial usage and a decrease in CDI rates.

  6. Prevalence of Smoking and Associated Risk Factors Among Medical Professionals in Hospitals of Karachi, Pakistan

    PubMed Central

    Zafar, Mubashir

    2014-01-01

    Background: Cigarette smoking is the largest preventable risk factor for morbidity and mortality in developed countries where at least one in four adults smoke cigarettes. Healthcare providers who smoke are less likely to advise patients to quit smoking. The aim of this study is to find out the frequency of tobacco smoking among medical professionals in tertiary care hospitals of Karachi, and to identify the common factors responsible for the continuation of smoking among healthcare providers. Methods: This descriptive cross-sectional study was carried out at public and private tertiary Care Hospitals/Institutes at Karachi. A self-administered questionnaire was used to collect data from 180 subjects. An informed consent was obtained from all the subjects. The data were analyzed using SPSS version 16.0. Results: Prevalence of smoking was 29%. High prevalence of smoking was among male doctors as compared to female doctors. Sixty-eight per cent of smokers started smoking between 20 to 30 years of age. Age less than 35 years, male and public sectors hospitals were more likely OR 1.23, CI (0.98-2.41), 6.40 CI (4.48-10.52) and 2.61 CI (2.20-3.78) respectively. Conclusions: The Result of the study suggests that while healthcare smoking habits appear to be high, they are not uniformly low when compared from an international perspective. Health promotion programs focused on self-efficacy may be an effective tool for reducing the initiation, frequency, and amount of cigarette smoking among healthcare providers. PMID:24829733

  7. Security mechanism based on Hospital Authentication Server for secure application of implantable medical devices.

    PubMed

    Park, Chang-Seop

    2014-01-01

    After two recent security attacks against implantable medical devices (IMDs) have been reported, the privacy and security risks of IMDs have been widely recognized in the medical device market and research community, since the malfunctioning of IMDs might endanger the patient's life. During the last few years, a lot of researches have been carried out to address the security-related issues of IMDs, including privacy, safety, and accessibility issues. A physician accesses IMD through an external device called a programmer, for diagnosis and treatment. Hence, cryptographic key management between IMD and programmer is important to enforce a strict access control. In this paper, a new security architecture for the security of IMDs is proposed, based on a 3-Tier security model, where the programmer interacts with a Hospital Authentication Server, to get permissions to access IMDs. The proposed security architecture greatly simplifies the key management between IMDs and programmers. Also proposed is a security mechanism to guarantee the authenticity of the patient data collected from IMD and the nonrepudiation of the physician's treatment based on it. The proposed architecture and mechanism are analyzed and compared with several previous works, in terms of security and performance.

  8. Sexual Dysfunction among Females Receiving Psychotropic Medication: A Hospital-based Cross-sectional Study

    PubMed Central

    Shetageri, Veda N.; Bhogale, Govind S.; Patil, N. M.; Nayak, R. B.; Chate, S. S.

    2016-01-01

    Background: Sexual dysfunction (SD) is a known adverse effect of psychotropic medications. Even though sexual difficulties are common among women; very few studies have been carried out in India. Objective: To study the prevalence and nature of SD among females receiving psychotropic medications and to compare the SD among female patients receiving antipsychotics and antidepressants. Materials and Methods: Female investigator conducted a hospital-based cross-sectional study on female patients visiting the psychiatry outpatient department. Patients meeting inclusion criteria were assessed for SD disorder as per Diagnostic and Statistical Manual of Mental Disorders 4th Edition Text Revision. SD severity was measured using Female Sexual Function Index (FSFI) scale. Results: The prevalence of SD in this study was 68.32%. There was more than one SD in 48 (47.52%). FSFI score was significantly low in patients with SD as compared to patients not having SD (P = 0.001). SD was more common in patients who were on combination of antidepressants and benzodiazepines than antidepressant alone or antipsychotic alone. Conclusion: SD was prevalent in more than 50% of female patients on psychotropic drugs. Number of patients on individual psychotropic drugs was so small that a definite conclusion could not be drawn. Study emphasizes the need to carry out similar study on larger number of patients to get better insight into this problem. PMID:27833229

  9. Security Mechanism Based on Hospital Authentication Server for Secure Application of Implantable Medical Devices

    PubMed Central

    2014-01-01

    After two recent security attacks against implantable medical devices (IMDs) have been reported, the privacy and security risks of IMDs have been widely recognized in the medical device market and research community, since the malfunctioning of IMDs might endanger the patient's life. During the last few years, a lot of researches have been carried out to address the security-related issues of IMDs, including privacy, safety, and accessibility issues. A physician accesses IMD through an external device called a programmer, for diagnosis and treatment. Hence, cryptographic key management between IMD and programmer is important to enforce a strict access control. In this paper, a new security architecture for the security of IMDs is proposed, based on a 3-Tier security model, where the programmer interacts with a Hospital Authentication Server, to get permissions to access IMDs. The proposed security architecture greatly simplifies the key management between IMDs and programmers. Also proposed is a security mechanism to guarantee the authenticity of the patient data collected from IMD and the nonrepudiation of the physician's treatment based on it. The proposed architecture and mechanism are analyzed and compared with several previous works, in terms of security and performance. PMID:25276797

  10. Perceptions of an 'international hospital' in Thailand by medical travel patients: cross-cultural tensions in a transnational space.

    PubMed

    Whittaker, Andrea; Chee, Heng Leng

    2015-01-01

    The growing trade in patients seeking health care in other countries, or medical travel, is changing the forms and experiences of health care seeking and producing changes to hospitals in terms of their design, organization and spaces. What is termed in marketing parlance in Thailand as an 'international hospital' oriented to attracting foreign patients, is a hotel-hospital hybrid that is locally produced through the inflexion of local practices to make a therapeutic space for international patients. The paper reports on work undertaken within a Thai hospital in 2012 which included observations and interviews with thirty foreign in-patients and nine informal interviews with hospital staff. Although theorized as a culturally neutral transnational 'space of connectivity', we show how cross-cultural tensions affect the experience of the hospital with implications for the organization of the hospital and notions of 'cultural competence' in care. There is no single universal experience of this space, instead, there are multiple experiences of the 'international hospital', depending on who patients are, where they are from, their expectations and relationships. Such hospitals straddle the expectations of both local patients and international clientele and present highly complex cross-cultural interactions between staff and patients but also between patients and other patients. Spatial organisation within such settings may either highlight cultural difference or help create culturally safe spaces.

  11. California's county hospitals and the University of California graduate medical education system. Current issues and future directions.

    PubMed Central

    Jameson, W J; Pierce, K; Martin, D K

    1998-01-01

    California's county hospitals train 45% of the state's graduate medical residents, including 33% of residents in the University of California system. This paper describes the interrelationships of California's county hospitals and the University of California (UC) graduate medical education (GME) programs, highlighting key challenges facing both systems. The mission of California's county health care systems is to serve all who need health care services regardless of ability to pay. Locating UC GME programs in county hospitals helps serve the public missions of both institutions. Such partnerships enhance the GME experience of UC residents, provide key primary care training opportunities, and ensure continued health care access for indigent and uninsured populations. Only through affiliation with university training programs have county hospitals been able to run the cost-effective, quality programs that constitute an acceptable safety net for the poor. Financial stress, however, has led county hospitals and UC's GME programs to advocate for reform in both GME financing and indigent care funding. County hospitals must participate in constructing strategies for GME reform to assure that GME funding mechanisms provide for equitable compensation of county hospitals' essential role. Joint advocacy will also be essential in achieving significant indigent care policy reform. PMID:9614786

  12. Adherence to medication: A nation-wide study from the Children’s Cancer Hospital, Egypt

    PubMed Central

    El Malla, Hanan; Ylitalo Helm, Nathalie; Wilderäng, Ulrica; El Sayed Elborai, Yasser; Steineck, Gunnar; Kreicbergs, Ulrika

    2013-01-01

    AIM: To investigate adherence to medical regimen and predictors for non-adherence among children with cancer in Egypt. METHODS: We administered two study specific questionnaires to 304 parents of children diagnosed with cancer at the Children’s Cancer Hospital in Cairo, Egypt, one before the first chemotherapy treatment and the other before the third. The questionnaires were translated to colloquial Egyptian Arabic, and due, to the high illiteracy level in Egypt an interviewer read the questions in Arabic to each parent and registered the answers. Both questionnaires consisted of almost 90 questions each. In addition, a Case Report Form was filled in from the child’s medical journal. The study period consisted of 7 mo (February until September 2008) and we had a participation rate of 97%. Descriptive statistics are presented and Fisher’s exact test was used to check for possible differences between the adherent and non-adherent groups. A P-value below 0.05 was considered significant. Software used was SAS version 9.3 for Windows (SAS Institute Inc., Cary, NC, United States). RESULTS: Two hundred and eighty-one (90%) parents answered the second questionnaire, regarding their child’s adherence behaviour. Approximately two thirds of the children admitted to their third chemotherapy treatment had received medical recommendations upon discharge from the first or second chemotherapy treatment (181/281, 64%). Sixty-eight percent (123/181) of the parents who were given medical recommendations reported that their child did not follow the recommendations. Two main predictors were found for non-adherence: child resistance (111/123, 90%) and inadequate information (100/123, 81%). In the adherent group, 20% of the parents (n = 12/58) reported trust in their child’s doctor while 14 percent 8/58 reported trust in the other health-care professionals. Corresponding numbers for the non-adherent group are 8/123 (7%) for both their child’s doctor and other health

  13. Standardizing Management of Adults with Delirium Hospitalized on Medical-Surgical Units

    PubMed Central

    Angel, Clay; Brooks, Kristen; Fourie, Julie

    2016-01-01

    Context Delirium is common among inpatients aged 65 years and older and is associated with multiple adverse consequences, including increased length of stay (LOS). However, delirium is frequently unrecognized and poorly understood. At one hospital, baseline management of delirium on medical-surgical units varied greatly, and psychiatric consultations focused exclusively on crisis management. Objective To implement a multidisciplinary program for rapid identification and proactive management of patients with delirium on medical-surgical units. Design A pilot from September 2010 to July 2012 included 920 unique patients, of whom 470 were seen by the delirium management team. A delirium management team included a redesigned role for consulting psychiatrists and a new clinical nurse specialist role; the team provided assistance with diagnosis and recommendations for nonpharmacologic and pharmacologic management of delirium. Multidisciplinary education focused on delirium identification and management and nurses’ use of appropriate assessment tools. Electronic health record functions supported accurate problem list coding, referrals to the team, and standardized documentation. Main Outcome Measure Length of stay. Results During the study period, average LOS in the target population decreased from 8.5 days to 6.5 days (p = 0.001); average LOS for the Medical Center remained stable. Compared with patients whose delirium was diagnosed during the baseline period, patients who received a delirium diagnosis during the pilot period had a higher illness burden and were likelier to have a history of delirium and diagnosed dementia. Conclusion Program implementation was associated with reduced LOS among older inpatients with delirium. The delirium team is an effective model that can be quickly implemented with few additional resources. PMID:27644045

  14. Bio-Medical Waste Managment in a Tertiary Care Hospital: An Overview

    PubMed Central

    Ahuja, Sanjiv; Madan, Molly; Asthana, Ajay Kumar

    2016-01-01

    Introduction Bio-Medical Waste (BMW) management is of utmost importance as its improper management poses serious threat to health care workers, waste handlers, patients, care givers, community and finally the environment. Simultaneously, the health care providers should know the quantity of waste generated in their facility and try to reduce the waste generation in day-to-day work because lesser amount of BMW means a lesser burden on waste disposal work and cost saving. Aim To have an overview of management of BMW in a tertiary care teaching hospital so that effective interventions and implementations can be carried out for better outcome. Materials and Methods The observational study was carried out over a period of five months from January 2016 to May 2016 in Chhatrapati Shivaji Subharti Hospital, Meerut by the Infection Control Team (ICT). Assessment of knowledge was carried out by asking set of questions individually and practice regarding awareness of BMW Management among the Health Care Personnel (HCP) was carried out by direct observation in the workplace. Further, the total BMW generated from the present setup in kilogram per bed per day was calculated by dividing the mean waste generated per day by the number of occupied beds. Results Segregation of BMW was being done at the site of generation in almost all the areas of the hospital in color coded polythene bags as per the hospital protocol. The different types of waste being collected were infectious solid waste in red bag, soiled infectious waste in yellow bag and sharp waste in puncture proof container and blue bag. Though awareness (knowledge) about segregation of BMW was seen in 90% of the HCP, 30%-35% did not practice. Out of the total waste generated (57912 kg.), 8686.8 kg. (15%) was infectious waste. Average infectious waste generated was 0.341 Kg per bed per day. The transport, treatment and disposal of each collected waste were outsourced and carried out by ‘Synergy’ waste management Pvt. Ltd

  15. Management of Adult Growth Hormone Deficiency at Peking Union Medical College Hospital: A Survey among Physicians(△).

    PubMed

    Yang, Hong-Bo; Zhang, Meng-Qi; Pan, Hui; Zhu, Hui-Juan

    2016-09-20

    Objective To evaluate physicians' attitude and knowledge about the management of adult growth hormone deficiency (AGHD) at Peking Union Medical College Hospital and impact factors associated with better decision-making.Methods A 21-question anonymous survey was distributed and collected at Peking Union Medical College Hospital, a major teaching hospital in Chinese Academy of Medical Sciences. Data of physicians' educational background, clinical training, patient workload per year and continuing medical education in AGHD were collected. Factors associated with appropriate answers were further analyzed by multivariate regression models.Results One hundred and eighteen internal medicine residents, endocrine fellows, attending physicians and visiting physicians responded to the survey. Among them, 44.9% thought that AGHD patients should accept recombinant human growth hormone replacement therapy. Moreover, 56.8% selected insulin tolerance test and growth hormone-releasing hormone-arginine test for the diagnosis of AGHD. Logistic regression analysis of physician demographic data, educational background, and work experience found no consistent independent factors associated with better decision-making, other than continued medical education, that were associated with treatment choice.Conclusions The physicians' reported management of AGHD in this major academic healthcare center in Beijing was inconsistent with current evidence. High quality continued medical education is required to improve Chinese physician management of AGHD.

  16. Patients' satisfaction with inpatient services provided in hospitals affiliated to Tehran University of Medical Sciences, Iran, during 2011-2013

    PubMed Central

    Makarem, Jalil; Larijani, Bagher; Joodaki, Kobra; Ghaderi, Sahar; Nayeri, Fatemeh; Mohammadpoor, Masoud

    2016-01-01

    Implementation of patient feedback is considered as a critical part of effective and efficient management in developed countries. The main objectives of this study were to assess patient satisfaction with the services provided in hospitals affiliated to Tehran University of Medical Sciences, Iran, identify areas of patient dissatisfaction, and find ways to improve patient satisfaction with hospital services. This cross-sectional study was conducted in 3 phases. After 2 initial preparation phases, the valid instrument was applied through telephone interviews with 21476 participants from 26 hospitals during August, 2011 to February, 2013.Using the Satisfaction Survey tool, information of patient's demographic characteristics were collected and patient satisfaction with 15 areas of hospital services and the intent to return the same hospitals were assessed. The mean score of overall satisfaction with hospital services was 16.86 ± 2.72 out of 20. It was found that 58% of participants were highly satisfied with the services provided. Comparison of mean scores showed physician and medical services (17.75 ± 4.02), laboratory and radiology services (17.67 ± 3.66), and privacy and religious issues (17.55 ± 4.32) had the highest satisfaction. The patients were the most dissatisfied with the food services (15.50 ± 5.54). It was also found that 83.7% of the participants intended to return to the same hospital in case of need, which supported the measured satisfaction level. Patient satisfaction in hospitals affiliated to Tehran University of Medical Sciences was high. It seems that the present study, with its large sample size, has sufficient reliability to express the patient satisfaction status. Moreover, appropriate measures should be taken in some areas (food, cost, and etc.) to increase patient satisfaction. PMID:27471589

  17. A Study of the Readiness of Hospitals for Implementation of High Reliability Organizations Model in Tehran University of Medical Sciences.

    PubMed

    Mousavi, Seyed Mohammad Hadi; Dargahi, Hossein; Mohammadi, Sara

    2016-10-01

    Creating a safe of health care system requires the establishment of High Reliability Organizations (HROs), which reduces errors, and increases the level of safety in hospitals. This model focuses on improving reliability through higher process design, building a culture of accreditation, and leveraging human factors. The present study intends to determine the readiness of hospitals for the establishment of HROs model in Tehran University of Medical Sciences from the viewpoint of managers of these hospitals. This is a descriptive-analytical study carried out in 2013-2014. The research population consists of 105 senior and middle managers of 15 hospitals of Tehran University of Medical Sciences. The data collection tool was a 55-question researcher-made questionnaire, included six elements of HROs to assess the level of readiness for establishing HROS model from managers' point of view. The validity of the questionnaire was calculated through the content validity method using 10 experts in the area of hospitals' accreditation, and its reliability was calculated through test-retest method with a correlation coefficient of 0.90. The response rate was 90 percent. The Likert scale was used for the questions, and data analysis was conducted through SPSS version 21 Descriptive statistics was presented via tables and normal distributions of data and means. Analytical methods, including t-test, Mann-Whitney, Spearman, and Kruskal-Wallis, were used for presenting inferential statistics. The study showed that from the viewpoint of senior and middle managers of the hospitals considered in this study, these hospitals are indeed ready for acceptance and establishment of HROs model. A significant relationship was showed between HROs model and its elements with demographic details of managers like their age, work experience, management experience, and level of management. Although the studied hospitals, as viewed by their managers, are capable of attaining the goals of HROs, it

  18. Study of the cost-benefit analysis of electronic medical record systems in general hospital in China.

    PubMed

    Li, Kai; Naganawa, Shinji; Wang, Kai; Li, Ping; Kato, Ken; Li, Xiu; Zhang, Jie; Yamauchi, Kazunobu

    2012-10-01

    Electronic medical record (EMR) systems have been proposed as technology to improve the quality of patient care, decrease medical errors, control and reduce medical expenditure, however the financial effects have not yet been as well documented in China. We presented a net financial cost-benefit analysis of implementing electronic medical record systems in general hospital in China. The data, which were obtained from studies of the general hospital and the published literature, collected from 15 consecutive fiscal months from May 1, 2009 to August 30, 2010. We performed a perspective cost-benefit study to analyze the financial effects of EMR system implementing. The reference strategy for comparisons was the traditional paper-based medical record. The net financial benefits or costs for a 6-year period were calculated. All data were adjusted for inflation. The totally assessed net benefit from implementing an EMR system for a 6-year period was $559,025 in the general hospital. Benefits accrue primarily from savings in new medical record creation, decreased full-time-equivalent (FTE) employees, saving of adverse drug events (ADEs) and dose errors, improved charge capture and decreased billing errors. In this model, the time of return on investment is 3.00 years. In one-way sensitivity analysis, the model was most sensitive in new medical record creation; the net benefit varied from $398,057 to $719,992. The five-way sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from a $76,970 net cost to a $1,062,122 net benefit; the pessimistic time of return on investment is 5.38 years. An EMR system cost-benefit analysis can rapidly demonstrate a positive return on investment when implemented in hospitals. The magnitude of the return is sensitive to several key factors.

  19. 20 CFR 404.462 - Nonpayment of hospital and medical insurance benefits of alien outside United States for more...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Nonpayment of hospital and medical insurance benefits of alien outside United States for more than 6 months. 404.462 Section 404.462 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Deductions; Reductions; and Nonpayments...

  20. 20 CFR 404.462 - Nonpayment of hospital and medical insurance benefits of alien outside United States for more...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Nonpayment of hospital and medical insurance benefits of alien outside United States for more than 6 months. 404.462 Section 404.462 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Deductions; Reductions; and Nonpayments...

  1. 20 CFR 404.462 - Nonpayment of hospital and medical insurance benefits of alien outside United States for more...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Nonpayment of hospital and medical insurance benefits of alien outside United States for more than 6 months. 404.462 Section 404.462 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Deductions; Reductions; and Nonpayments...

  2. Explaining medical disputes in Chinese public hospitals: the doctor-patient relationship and its implications for health policy reforms.

    PubMed

    He, Alex Jingwei; Qian, Jiwei

    2016-10-01

    In recent years China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. This is the result of a confluence of inappropriate incentives in the health system, the consequent distorted behaviors of physicians, mounting social distrust of the medical profession, and institutional failures of the legal framework. The detrimental effects of the damaged doctor-patient relationship have begun to emerge, calling for rigorous study and serious policy intervention. Using a sequential exploratory design, this article seeks to explain medical disputes in Chinese public hospitals with primary data collected from Shenzhen City. The analysis finds that medical disputes of various forms are disturbingly widespread and reveals that inappropriate internal incentives in hospitals and the heavy workload of physicians undermine the quality of clinical encounters, which easily triggers disputes. Empirically, a heavy workload is associated with a larger number of disputes. A greater number of disputes are associated with higher-level hospitals, which can afford larger financial settlements. The resolution of disputes via the legal channel appears to be unpopular. This article argues that restoring a healthy doctor-patient relationship is no less important than other institutional aspects of health care reform.

  3. How to market an affiliation. St. Elizabeth Hospital and Mercy Medical Center affiliate to create Affinity Health System.

    PubMed

    1996-01-01

    When Wisconsin's St. Elizabeth Hospital and Mercy Medical Center affiliated to create Affinity Health System, Inc., strategic planning and a solid marketing plan carefully executed were instrumental in its success. A corporate identity campaign and product line identification were follow-up phases to the merger approval.

  4. 75 FR 1396 - The General Hospital and Personal Use Devices Panel of the Medical Devices Advisory Committee...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-11

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration The General Hospital and Personal Use Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a...

  5. Retrospective Analysis of the Blood Component Utilization in a University Hospital of Maximum Medical Care

    PubMed Central

    Geißler, R. Georg; Franz, Dominik; Buddendick, Hubert; Krakowitzky, Petra; Bunzemeier, Holger; Roeder, Norbert; Van Aken, Hugo; Kessler, Torsten; Berdel, Wolfgang; Sibrowski, Walter; Schlenke, Peter

    2012-01-01

    Background Demographic data illustrate clearly that people in highly developed countries get older, and the elderly need more blood transfusions than younger patients. Additionally, special extensive therapies result in an increased consumption of blood components. Beyond that the aging of the population reduces the total number of preferably young and healthy blood donors. Therefore, Patient Blood Management will become more and more important in order to secure an increasing blood supply under fair-minded conditions. Methods At the University Hospital of Münster (UKM) a comprehensive retrospective analysis of the utilization of all conventional blood components was performed including all medical and surgical disciplines. In parallel, a new medical reporting system was installed to provide a monthly analysis of the transfusional treatments in the whole infirmary, in every department, and in special blood-consuming cases of interest, as well. Results The study refers to all UKM in-patient cases from 2009 to 2011. It clearly demonstrates that older patients (>60 years, 35.2–35.7% of all cases, but 49.4–52.6% of all cases with red blood cell (RBC) transfusions, 36.4–41. 6% of all cases with platelet (PTL, apheresis only) transfusions, 45.2–48.0% of all cases with fresh frozen plasma (FFP) transfusions) need more blood products than younger patients. Male patients (54.4–63.9% of all cases with transfusions) are more susceptible to blood transfusions than female patients (36.1–45.6% of all cases with transfusions). Most blood components are used in cardiac, visceral, and orthopedic surgery (49.3–55.9% of all RBC units, 45.8–61.0% of all FFP units). When regarding medical disciplines, most transfusions are administered to hematologic and oncologic patients (12.9–17.7% of all RBC units, 9.2–12.0% of all FFP units). The consumption of PTL in this special patient cohort (40.6–50.9% of all PTL units) is more pronounced than in all other surgical or

  6. Financial Pressures Prompt Teaching Hospitals to Cut Costs, Raising Fears about Medical Education and Patient Care.

    ERIC Educational Resources Information Center

    Grassmuck, Karen

    1991-01-01

    Financial pressures are forcing the closure of some teaching hospitals and retrenchment using such strategies as development of ambulatory care and satellite facilities, merging with or acquiring other hospitals, and shortening patient hospital stays. A table lists revenues and profit margins for the 20 largest university-owned teaching hospitals.…

  7. [Outsourcing: theory and practice at a clinical hospital in Szczecin exemplified by medical waste transport and treatment service].

    PubMed

    Kotlega, Dariusz; Nowacki, Przemysław; Lewiński, Dariusz; Chmurowicz, Ryszard; Ciećwiez, Sylwester

    2011-01-01

    Outsourcing proves to be a useful tool in the difficult process of improving the financial result of hospitals. Outsourcing means separation of some functions and services in one entity and their transfer to another. The aim of this study was to analyze the use of outsourcing at the Second Independent Public University Hospital of the Pomeranian Medical University (SPSK 2 PUM) in Szczecin. We studied the transport and treatment of medical waste. Outsourcing of waste treatment services led to financial savings. The cost of treatment of one kilogram of waste by an external company was PLN 2.53. The same service provided by the hospital would cost approximately PLN 7 per kilogram. Appropriate attention should be paid to the quality of services. It seems useful to have appropriate tools for quality control and monitoring. SPSK 2 PUM can serve as a good example of effective use of outsourcing.

  8. Electronic medical record in the simulation hospital: does it improve accuracy in charting vital signs, intake, and output?

    PubMed

    Mountain, Carel; Redd, Roxanne; O'Leary-Kelly, Colleen; Giles, Kim

    2015-04-01

    Nursing care delivery has shifted in response to the introduction of electronic health records. Adequate education using computerized documentation heavily influences a nurse's ability to navigate and utilize electronic medical records. The risk for treatment error increases when a bedside nurse lacks the correct knowledge and skills regarding electronic medical record documentation. Prelicensure nursing education should introduce electronic medical record documentation and provide a method for feedback from instructors to ensure proper understanding and use of this technology. RN preceptors evaluated two groups of associate degree nursing students to determine if introduction of electronic medical record in the simulation hospital increased accuracy in documenting vital signs, intake, and output in the actual clinical setting. During simulation, the first group of students documented using traditional paper and pen; the second group used an academic electronic medical record. Preceptors evaluated each group during their clinical rotations at two local inpatient facilities. RN preceptors provided information by responding to a 10-question Likert scale survey regarding the use of student electronic medical record documentation during the 120-hour inpatient preceptor rotation. The implementation of the electronic medical record into the simulation hospital, although a complex undertaking, provided students a safe and supportive environment in which to practice using technology and receive feedback from faculty regarding accurate documentation.

  9. Prevention of venous thromboembolism in hospitalized acutely ill medical patients: focus on the clinical utility of (low-dose) fondaparinux.

    PubMed

    Di Nisio, Marcello; Porreca, Ettore

    2013-01-01

    Venous thromboembolism (VTE) is a frequent complication among acutely ill medical patients hospitalized for congestive heart failure, acute respiratory insufficiency, rheumatologic disorders, and acute infectious and/or inflammatory diseases. Based on robust data from randomized controlled studies and meta-analyses showing a reduced incidence of VTE by 40% to about 60% with pharmacologic thromboprophylaxis, prevention of VTE with low molecular weight heparin (LMWH), unfractionated heparin (UFH), or fondaparinux is currently recommended in all at-risk hospitalized acutely ill medical patients. In patients who are bleeding or are at high risk for major bleeding, mechanical prophylaxis with graduated compression stockings or intermittent pneumatic compression may be suggested. Thromboprophylaxis is generally continued for 6 to 14 days or for the duration of hospitalization. Selected cases could benefit from extended thromboprophylaxis beyond this period, although the risk of major bleeding remains a concern, and additional studies are needed to identify patients who may benefit from prolonged prophylaxis. For hospitalized acutely ill medical patients with renal insufficiency, a low dose (1.5 mg once daily) of fondaparinux or prophylactic LMWH subcutaneously appears to have a safe profile, although proper evaluation in randomized studies is lacking. The evidence on the use of prophylaxis for VTE in this latter group of patients, as well as in those at higher risk of bleeding complications, such as patients with thrombocytopenia, remains scarce. For critically ill patients hospitalized in intensive care units with no contraindications, LMWH or UFH are recommended, with frequent and careful assessment of the risk of bleeding. In this review, we discuss the evidence for use of thromboprophylaxis for VTE in acutely ill hospitalized medical patients, with a focus on (low-dose) fondaparinux.

  10. The Effect of Motivational Interviewing on Medication Adherence and Hospitalization Rates in Nonadherent Patients with Multi-Episode Schizophrenia

    PubMed Central

    Barkhof, Emile

    2013-01-01

    Background: Medication nonadherence in patients with schizophrenia presents a serious clinical problem. Research on interventions incorporating motivational interviewing (MI) to improve adherence have shown mixed results. Aims: Primary aim is to determine the effectiveness of a MI intervention on adherence and hospitalization rates in patients, with multi-episode schizophrenia or schizoaffective disorder, who have experienced a psychotic relapse following medication nonadherence. Secondary aim is to evaluate whether MI is more effective in specific subgroups. Methods: We performed a randomized controlled study including 114 patients who experienced a psychotic relapse due to medication nonadherence in the past year. Participants received an adapted form of MI or an active control intervention, health education (HE). Both interventions consisted of 5–8 sessions, which patients received in adjunction to the care as usual. Patients were assessed at baseline and at 6 and 12 months follow-up. Results: Our results show that MI did not improve medication adherence in previously nonadherent patients who experienced a psychotic relapse. Neither were there significant differences in hospitalization rates at follow-up between MI and HE (27% vs 40%, P = .187). However, MI resulted in reduced hospitalization rates for female patients (9% vs 63%, P = .041), non-cannabis users (20% vs 53%, P = .041), younger patients (14% vs 50%, P = .012), and patients with shorter illness duration (14% vs 42%, P = .040). Conclusions: Targeted use of MI may be of benefit for improving medication adherence in certain groups of patients, although this needs further examination. PMID:24072808

  11. Effectiveness of an improvement programme to prevent interruptions during medication administration in a paediatric hospital: a preintervention–postintervention study

    PubMed Central

    Dall'Oglio, Immacolata; Fiori, Martina; Di Ciommo, Vincenzo; Tiozzo, Emanuela; Mascolo, Rachele; Bianchi, Natalia; Ciofi Degli Atti, Marta Luisa; Ferracci, Antonella; Gawronski, Orsola; Pomponi, Manuel; Raponi, Massimiliano

    2017-01-01

    Objective To assess the effectiveness of an improvement programme to reduce the number of interruptions during the medication administration process in a paediatric hospital. Design and methods A prestudy–post study design was used to monitor nursing interruptions during medication cycles in a paediatric hospital. Interruptions were reported on an observation sheet (MADOS-P) adapted to the paediatric context. Setting A 600-bed tertiary paediatric research hospital in Italy. Intervention The interventions included a yellow sash worn by nurses during medication cycles, a yellow-taped floor area indicating the ‘No interruption area’, visual notices in the medication areas, education sessions for healthcare providers and families, patient and parent information material. Results 225 medication cycles were observed before the intervention (T0) and 261 after the intervention (T1). The median of interruptions occurring in each cycle decreased significantly from baseline to postintervention (8.0 vs 2.0, p=0.002), as the rate ratios (interruptions/patient post–pre ratio: 0.34; interruptions/medication post–pre ratio: 0.37; interruptions/hour of medication cycle post–pre ratio: 0.53, p<0.001). During preintervention, the main causes of interruptions were ‘other patients’ (19.9%), ‘other nurses’ (17.2%) and ‘conversation’ (15.7%); during postintervention, they were ‘other nurses’ (26.1%), ‘conversation’ (18.2%) and ‘other patients’ (17.4%). Conclusions This bundle of interventions proved to be an effective improvement programme to prevent interruptions during medication administration in a paediatric context. PMID:28062470

  12. Antihypertensive medications and risk of death and hospitalizations in US hemodialysis patients

    PubMed Central

    Shafi, Tariq; Sozio, Stephen M.; Luly, Jason; Bandeen-Roche, Karen J.; St. Peter, Wendy L.; Ephraim, Patti L.; McDermott, Aidan; Herzog, Charles A.; Crews, Deidra C.; Scialla, Julia J.; Tangri, Navdeep; Miskulin, Dana C.; Michels, Wieneke M.; Jaar, Bernard G.; Zager, Philip G.; Meyer, Klemens B.; Wu, Albert W.; Boulware, L. Ebony

    2017-01-01

    Abstract Antihypertensive medications are commonly prescribed to hemodialysis patients but the optimal regimens to prevent morbidity and mortality are unknown. The goal of our study was to compare the association of routinely prescribed antihypertensive regimens with outcomes in US hemodialysis patients. We used 2 datasets for our analysis. Our primary cohort (US Renal Data System [USRDS]) included adult patients initiating in-center hemodialysis from July 1, 2006 to June 30, 2008 (n = 33,005) with follow-up through December 31, 2009. Our secondary cohort included adult patients from Dialysis Clinic, Inc. (DCI), a national not-for-profit dialysis provider, initiating in-center hemodialysis from January 1, 2003 to June 30, 2008 (n = 11,291) with follow-up through December 31, 2008. We linked the USRDS cohort with Medicare part D prescriptions-fill data and the DCI cohort with USRDS data. Unique aspect of USRDS cohort was pharmacy prescription-fill data and for DCI cohort was detailed clinical data, including blood pressure, weight, and ultrafiltration. We classified prescribed antihypertensives into the following mutually exclusive regimens: β-blockers, renin–angiotensin system blocking drugs-containing regimens without a β-blocker (RAS), β-blocker + RAS, and others. We used marginal structural models accounting for time-updated comorbidities to quantify each regimen's association with mortality (both cohorts) and cardiovascular hospitalization (DCI-Medicare Subcohort). In the USRDS and DCI cohorts there were 9655 (29%) and 3200 (28%) deaths, respectively. In both cohorts, RAS compared to β-blockers regimens were associated with lower risk of death; (hazard ratio [HR]) (95% confidence interval [CI]) for all-cause mortality, (0.90 [0.82–0.97] in USRDS and 0.87 [0.76–0.98] in DCI) and cardiovascular mortality (0.84 [0.75–0.95] in USRDS and 0.88 [0.71–1.07] in DCI). There was no association between antihypertensive regimens and the risk of

  13. 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.

  14. Investigations of the quality of hospital electric power supply and the tolerance of medical electric devices to voltage dips.

    PubMed

    Hanada, Eisuke; Itoga, Shuuya; Takano, Kyoko; Kudou, Takato

    2007-06-01

    Medical devices driven by electric power have come to be commonly used in hospitals, and rapid changes of voltage or current can easily cause them to fail. A stable and high quality power supply is indispensable in order to maintain safety in the modern clinical setting. Therefore, we investigated the quality of the power supply in a hospital and determined the tolerance of 13 pieces of medical equipment to voltage dips. The results showed little distortion of the voltage wave. However, we found an approximately 7% momentary voltage dip caused by lightening and other problems, such as 2 to 5% periodic drops in voltage and voltage wave distortions caused by incorrect grounding. In a tolerance test, the settings of some medical devices were changed at the time of automatic reboot after a disturbance. For another device, trend information was initialized.

  15. Moral Distress in Physicians Practicing in Hospitals Affiliated to Medical Sciences Universities

    PubMed Central

    Abbasi, Mahmoud; Nejadsarvari, Nasrin; Kiani, Mehrzad; Borhani, Fariba; Bazmi, Shabnam; Nazari Tavaokkoli, Saeid; Rasouli, Hamidreza

    2014-01-01

    Background: Researchers have regarded moral distress as a major concern in the health care system. Symptoms associated with moral distress may manifest as frustration, dissatisfaction, and anxiety and may lead to burnout, job leaving, and finally, failure to provide safe and competent care to patients. Proper management of this phenomenon can be fulfilled through study of its causes at different levels of health services and taking necessary measures to solve them. Objectives: This study aimed to determine the status of moral distress in physicians practicing in hospitals affiliated to Medical Sciences Universities in Tehran. Materials and Methods: This cross-sectional study was carried out using the Standard Hamric Scale to collect data after modification and evaluation of its reliability and validity. A total of 399 physicians responded to the scale. Data analysis was performed using descriptive and correlation statistics with respect to the variables. Results: Results showed that the frequency of moral distress of physicians was 1.24 ± 0.63 and the intensity of moral distress and composite score of moral distress were 2.14 ± 0.80 and 2.94 ± 2.38, respectively. A significant negative correlation existed between age and frequency and composite score (r = -0.15, P < 0.01 and r = -0.16, P < 0.01, respectively) as well as years of experience and composite score (r = -0.11, P = 0.04). Moral distress composite score in adults specialists was higher than pediatricians (P = 0.002), but lower in physicians participated in medical ethics training courses compared to those not participated. Conclusions: Physicians may encounter moral distress during their practice; therefore, the common causes of distress should be identified in order to prevent its occurrence. PMID:25558387

  16. Antibiogram of Medical Intensive Care Unit at Tertiary Care Hospital Setting of Pakistan

    PubMed Central

    Qadeer, Aayesha; Akhtar, Aftab; Ain, Qurat Ul; Saadat, Shoab; Mansoor, Salman; Ishtiaq, Wasib; Ilyas, Abid; Khan, Ali Y; Ajam, Yousaf

    2016-01-01

    Objective: To determine the frequency of micro-organisms causing sepsis as well as to determine the antibiotic susceptibility and resistance of microorganisms isolated in a medical intensive care unit. Materials and methods: This is a cross-sectional analysis of 802 patients from a medical intensive care unit (ICU) of Shifa International Hospital, Islamabad, Pakistan over a one-year period from August 2015 to August 2016. Specimens collected were from blood, urine, endotracheal secretions, catheter tips, tissue, pus swabs, cerebrospinal fluid, ascites, bronchoalveolar lavage (BAL), and pleural fluid. All bacteria were identified by standard microbiological methods, and antibiotic sensitivity/resistance was performed using the disk diffusion technique, according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data was collected using a critical care unit electronic database and data analysis was done by using  the Statistical Package for Social Sciences (SPSS), version 20 (IBM SPSS Statistics, Armonk, NY). Results: Gram-negative bacteria were more frequent as compared to gram-positive bacteria. Most common bacterial isolates were Acinetobacter (15.3%), Escherichia coli (15.3%), Pseudomonas aeruginosa (13%), and Klebsiella pneumoniae (10.2%), whereas Enterococcus (7%) and methicillin-resistant staphylococcus aureus (MRSA) (6.2%) were the two most common gram-positive bacteria. For Acinetobacter, colistin was the most effective antibiotic (3% resistance). For E.coli, colistin (0%), tigecycline (0%), amikacin (7%), and carbapenems (10%) showed low resistance. Pseudomonas aeruginosa showed low resistance to colistin (7%). For Klebsiella pneumoniae, low resistance was seen for tigecycline (0%) and minocycline (16%). Overall, ICU mortality was 31.3%, including miscellaneous cases. Conclusion: Gram-negative infections, especially by multidrug-resistant organisms, are on the rise in ICUs. Empirical antibiotics should be used according to the local

  17. Analysis of psoriatic patients registered in Asahikawa Medical College Hospital from 1983 to 2007.

    PubMed

    Takahashi, Hidetoshi; Takahashi, Ichiro; Tsuji, Hitomi; Ibe, Masaki; Kinouchi, Motoshi; Hashimoto, Yoshio; Ishida-Yamamoto, Akemi; Matsuo, Shinobu; Ohkuma, Noritaka; Ohkawara, Akira; Iizuka, Hajime

    2009-12-01

    Psoriasis is a chronic inflammatory skin disease, which has been increasing during the last 50 years in Japan. The aim of the present study is to analyze psoriatic patients registered from 1983-2007 in Asahikawa Medical College Hospital, which is located in the northern part of Japan. A total of 607 cases were registered at the first inspection in the Department of Dermatology, Asahikawa Medical College. Men (403 cases, 66.4%) were predominant over women (204 cases, 33.6%). The clinical types of psoriasis were psoriasis vulgaris (91.5%), guttate psoriasis (4.2%), psoriasis arthropathica (2.8%), psoriatic erythroderma (0.6%), generalized pustular psoriasis (0.6%), localized pustular psoriasis (0.15%) and infantile psoriasis (0.15%). Topical corticosteroids (78.1%) and vitamin D3 (18.1%) products were the main previous topical agents. Previous systemic treatments included etretinate (7.7%), cyclosporine (1.5%) and methotrexate (0.3%). Use of topical vitamin D3 and cyclosporine therapies have been gradually increasing during the past 25 years. Regarding the previous phototherapy, topical psoralen and ultraviolet A therapy (PUVA) (4.9%) was predominant over ultraviolet B (0.9%), and systemic PUVA (0.7%). Use of ultraviolet B phototherapy has been increasing during the past 5 years. The results are essentially similar to those of a survey of psoriasis in Japan from 1982-2001. Although the incidence of psoriasis might be higher in Hokkaido Prefecture, there is essentially no variation in the disease profile of psoriatic patients.

  18. Orthopedic board certification and physician performance: an analysis of medical malpractice, hospital disciplinary action, and state medical board disciplinary action rates.

    PubMed

    Kocher, Mininder S; Dichtel, Laura; Kasser, James R; Gebhardt, Mark C; Katz, Jeffery N

    2008-02-01

    Specialty board certification status has become the de facto standard of competency by which the profession and the public recognize physician specialists. However, the relationship between orthopedic board certification and physician performance has not been established. Rates of medical malpractice claims, hospital disciplinary actions, and state medical board disciplinary actions were compared between 1309 board-certified (BC) and 154 non-board-certified (NBC) orthopedic surgeons in 3 states. There was no significant difference between BC and NBC surgeons in medical malpractice claim proportions (BC, 19.1% NBC, 16.9% P = .586) or in hospital disciplinary action proportions (BC, 0.9% NBC, 0.8% P = 1.000). There was a significantly higher proportion of state medical board disciplinary action for NBC surgeons (BC, 7.6% NBC, 13.0% P = .028). An association between board certification status and physician performance is necessary to validate its status as the de facto standard of competency. In this study, BC surgeons had lower rates of state medical board disciplinary action.

  19. 26 CFR 31.3121(a)(2)-1 - Payments on account of sickness or accident disability, medical or hospitalization expenses, or...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... disability, medical or hospitalization expenses, or death. 31.3121(a)(2)-1 Section 31.3121(a)(2)-1 Internal... Contributions Act (Chapter 21, Internal Revenue Code of 1954) General Provisions § 31.3121(a)(2)-1 Payments on account of sickness or accident disability, medical or hospitalization expenses, or death. (a) The...

  20. 26 CFR 31.3306(b)(4)-1 - Payments on account of sickness or accident disability, or medical or hospitalization expenses.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... disability, or medical or hospitalization expenses. 31.3306(b)(4)-1 Section 31.3306(b)(4)-1 Internal Revenue... (Chapter 23, Internal Revenue Code of 1954) § 31.3306(b)(4)-1 Payments on account of sickness or accident disability, or medical or hospitalization expenses. The term “wages” does not include any payment made by...

  1. 26 CFR 31.3121(a)(4)-1 - Payments on account of sickness or accident disability, or medical or hospitalization expenses.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... disability, or medical or hospitalization expenses. 31.3121(a)(4)-1 Section 31.3121(a)(4)-1 Internal Revenue... Act (Chapter 21, Internal Revenue Code of 1954) General Provisions § 31.3121(a)(4)-1 Payments on account of sickness or accident disability, or medical or hospitalization expenses. The term “wages”...

  2. 26 CFR 31.3306(b)(4)-1 - Payments on account of sickness or accident disability, or medical or hospitalization expenses.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... disability, or medical or hospitalization expenses. 31.3306(b)(4)-1 Section 31.3306(b)(4)-1 Internal Revenue... (Chapter 23, Internal Revenue Code of 1954) § 31.3306(b)(4)-1 Payments on account of sickness or accident disability, or medical or hospitalization expenses. The term “wages” does not include any payment made by...

  3. 26 CFR 31.3306(b)(4)-1 - Payments on account of sickness or accident disability, or medical or hospitalization expenses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... disability, or medical or hospitalization expenses. 31.3306(b)(4)-1 Section 31.3306(b)(4)-1 Internal Revenue... (Chapter 23, Internal Revenue Code of 1954) § 31.3306(b)(4)-1 Payments on account of sickness or accident disability, or medical or hospitalization expenses. The term “wages” does not include any payment made by...

  4. 26 CFR 31.3121(a)(4)-1 - Payments on account of sickness or accident disability, or medical or hospitalization expenses.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... disability, or medical or hospitalization expenses. 31.3121(a)(4)-1 Section 31.3121(a)(4)-1 Internal Revenue... Act (Chapter 21, Internal Revenue Code of 1954) General Provisions § 31.3121(a)(4)-1 Payments on account of sickness or accident disability, or medical or hospitalization expenses. The term “wages”...

  5. 26 CFR 31.3121(a)(4)-1 - Payments on account of sickness or accident disability, or medical or hospitalization expenses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... disability, or medical or hospitalization expenses. 31.3121(a)(4)-1 Section 31.3121(a)(4)-1 Internal Revenue... Act (Chapter 21, Internal Revenue Code of 1954) General Provisions § 31.3121(a)(4)-1 Payments on account of sickness or accident disability, or medical or hospitalization expenses. The term “wages”...

  6. USSR Report, Economic Affairs.

    DTIC Science & Technology

    2007-11-02

    This report from the USSR contains articles on Economic Affairs. The main topics are Economic Policy, Organization and Management; Resource Utilization and Supply; Regional Development ; and Introduction of New Technology;

  7. USSR Report, Economic Affairs.

    DTIC Science & Technology

    1985-05-22

    This report from the USSR contains articles on Economic Affairs. The main topics are Economic Policy, Organization and Management; Planning and Plan Implementation; Investment, Prices, Budget and Finance; Resource Utilization and Supply; and Regional Development .

  8. USSR Report, Economic Affairs.

    DTIC Science & Technology

    1984-11-16

    This report from the USSR contains articles on Economic Affairs. The main topics are Economic Policy, Organization and Management; Investment, Prices, Budget and Finance; Resource Utilization and Supply and Regional Development .

  9. China Report, Economic Affairs.

    DTIC Science & Technology

    2007-11-02

    This is China Report include Economic Affairs. It contains the issues with different topics on People’s Republic of China: National Policy and Issues, Finance and Banking, Mineral Resources , Domestic Trade, Foreign Trade.

  10. 76 FR 16043 - Agency Information Collection (Department of Veterans Affairs Acquisition Regulations Clause 852...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-22

    ... AFFAIRS Agency Information Collection (Department of Veterans Affairs Acquisition Regulations Clause 852... Regulation Clause 852.237-7, Indemnification and Medical Liability Insurance. b. Veterans Affairs Acquisition Regulation Clause 852.228-71 (formerly 852.237.71), Indemnification and Insurance. c. Veterans...

  11. [Audit as a tool to assess and promote the quality of medical records and hospital appropriateness: metodology and preliminary results].

    PubMed

    Poscia, Andrea; Cambieri, Andrea; Tucceri, Chiara; Ricciardi, Walter; Volpe, Massimo

    2015-01-01

    In the actual economic context, with increasing health needs, efficiency and efficacy represents fundamental keyword to ensure a successful use of the resources and the best health outcomes. Together, the medical record, completely and correctly compiled, is an essential tool in the patient diagnostic and therapeutic path, but it's becoming more and more essential for the administrative reporting and legal claims. Nevertheless, even if the improvement of medical records quality and of hospital stay appropriateness represent priorities for every health organization, they could be difficult to realize. This study aims to present the methodology and the preliminary results of a training and improvement process: it was carried out from the Hospital Management of a third level Italian teaching hospital through audit cycles to actively involve their health professionals. A self assessment process of medical records quality and hospital stay appropriateness (inpatients admission and Day Hospital) was conducted through a retrospective evaluation of medical records. It started in 2012 and a random sample of 2295 medical records was examined: the quality assessment was performed using a 48-item evaluation grid modified from the Lombardy Region manual of the medical record, while the appropriateness of each days was assessed using the Italian version of Appropriateness Evaluation Protocol (AEP) - 2002ed. The overall assessment was presented through departmental audit: the audit were designed according to the indication given by the Italian and English Ministry of Health to share the methodology and the results with all the involved professionals (doctors and nurses) and to implement improvement strategies that are synthesized in this paper. Results from quality and appropriateness assessment show several deficiencies, due to 40% of minimum level of acceptability not completely satisfied and to 30% of inappropriateness between days of hospitalization. Furthermore, there are

  12. Evaluation of performance of the Medical Research Department in ‘Research naive’ non-academic hospital: An audit

    PubMed Central

    Kuyare, Mukta Sunil; Sarve, Parag Vijayrao; Dalal, Komal S.; Tripathi, Raakhi K.

    2016-01-01

    Introduction: Conducting medical research is not limited to academia and pharmaceutical industry but even multispeciality hospitals need to venture in this area along with patient care. To develop research culture among well-established non-acedemic hospital is always difficult and challenging task. This article attempts to evaluate the performance of the department in ‘Research naïve’ hospital in the last two years and review the strengths and challenges it faced at each step. Methods: This was a retrospective document analysis study evaluating the steps towards setting and sustaining of Medical Research Department of Bhaktivedanta Hospital during the period of January 2013 to June 2015 (30 Months). The authors developed a checklist (along with performance indicators) to assess the Preparatory phase and Activity phase of the research department which were evaluated by Institute Quality Management Team. Each step of both phases was also reviewed in terms of strengths and challenges as perceived by the authors. Results: During 2 year journey of research naïve Hospital, Institute had witnessed Hospital initiated (n=24, 59%) and sponsored projects (n=17, 41%) in all specialties. HRC reviewed (n=2.13) projects per meeting for administrative consideration while IEC reviewed (n=2.15) projects for scientific and ethical review. Challenges during preparatory phases were circumvent by immense cooperation of hospital management for initial investment, sensitization through research workshops for consultants, established procedures and trained support manpower and constant encouragement by research coordinator. Conclusion: Considering evaluation of 41 studies in very first 2 years in ‘Research naive non academic institute demonstrated successful implementation of trio model of Hospital Research Committee for administrative review, IEC for scientific-ethical review, centralized MRD for coordinating all research projects under one roof which may act as role model for

  13. USSR Report, International Affairs

    DTIC Science & Technology

    2007-11-02

    Imperialist Expansion (KNIZHNOYE OBOZRENIYE, No 37, 12 Sep 86) 2 SOCIALIST COMMUNITY AND CEMA AFFAIRS Responses to PRAVDA Query on Direct Economic...Ties’ (Ya. Macheyevich, Yu. Shiryayev; PRAVDA, 13 Oct 86) 4 CEMA Economic Integration Defended Against Bourgeois Attacks (A. Nikolskiy...countries; they also reap a profit of 5 billion dollars. 13080/12859 CSO: 1807/039 SOCIALIST COMMUNITY AND CEMA AFFAIRS RESPONSES TO PRAVDA QUERY ON

  14. USSR Report, International Affairs

    DTIC Science & Technology

    2007-11-02

    AFFAIRS CONTENTS SOCIALIST COMMUNITY AND CEMA AFFAIRS International Scientific Coordinating Conference in USSR (ZARYA VOSTOKA, 30 Oct 86) • ■ • • 1 ...Czechoslovak Meeting on S&T Cooperation With CEMA (EKONOMICHESKAYA GAZETA, No 1 , Jan 87) 2 Non-Use of CEMA Economic Experience Queried (V. G...U.S. Export Control Laws Revised (Moscow in English to North America, 1 Mar 87) 64 Reagan’s 1984 Directive on Concentration Camps Noted (Vadim

  15. High Hospitalization Rates in Survivors of Childhood Cancer: A Longitudinal Follow-Up Study Using Medical Record Linkage

    PubMed Central

    Sieswerda, Elske; Font-Gonzalez, Anna; Reitsma, Johannes B.; Dijkgraaf, Marcel G. W.; Heinen, Richard C.; Jaspers, Monique W.; van der Pal, Helena J.; van Leeuwen, Flora E.; Caron, Huib N.

    2016-01-01

    Hospitalization rates over time of childhood cancer survivors (CCS) provide insight into the burden of unfavorable health conditions on CCS and health care resources. The objective of our study was to examine trends in hospitalizations of CCS and risk factors in comparison with the general population. We performed a medical record linkage study of a cohort of 1564 ≥five-year CCS with national registers. We obtained a random sample of the general population matched on year of birth, gender and calendar year per CCS retrieved. We quantified and compared hospitalization rates of CCS and reference persons from 1995 until 2005, and we analyzed risk factors for hospitalization within the CCS cohort with multivariable Poisson models. We retrieved hospitalization information from 1382 CCS and 25583 reference persons. The overall relative hospitalization rate (RHR) was 2.2 (95%CI:1.9–2.5) for CCS compared to reference persons. CCS with central nervous system and solid tumors had highest RHRs. Hospitalization rates in CCS were increased compared to reference persons up to at least 30 years after primary diagnosis, with highest rates 5–10 and 20–30 years after primary cancer. RHRs were highest for hospitalizations due to neoplasms (10.7; 95%CI:7.1–16.3) and endocrine/nutritional/metabolic disorders (7.3; 95%CI:4.6–11.7). Female gender (P<0.001), radiotherapy to head and/or neck (P<0.001) or thorax and/or abdomen (P = 0.03) and surgery (P = 0.01) were associated with higher hospitalization rates in CCS. In conclusion, CCS have increased hospitalization rates compared to the general population, up to at least 30 years after primary cancer treatment. These findings imply a high and long-term burden of unfavorable health conditions after childhood cancer on survivors and health care resources. PMID:27433937

  16. Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies

    PubMed Central

    Sanghavi, Prachi; Jena, Anupam B.; Newhouse, Joseph P.; Zaslavsky, Alan M.

    2016-01-01

    Background Most Medicare patients seeking emergency medical transport are treated by ambulance providers trained in advanced life support (ALS). Evidence supporting the superiority of ALS over basic life support (BLS) is limited, but some studies suggest ALS may harm patients. Objective To compare outcomes after ALS and BLS in out-of-hospital medical emergencies. Design Observational study with adjustment for propensity score weights and instrumental variable analyses based on county-level variations in ALS use. Setting Traditional Medicare. Patients 20% random sample of Medicare beneficiaries from nonrural counties between 2006 and 2011 with major trauma, stroke, acute myocardial infarction (AMI), or respiratory failure. Measurements Neurologic functioning and survival to 30 days, 90 days, 1 year, and 2 years. Results Except in cases of AMI, patients showed superior unadjusted outcomes with BLS despite being older and having more comorbidities. In propensity score analyses, survival to 90 days among patients with trauma, stroke, and respiratory failure was higher with BLS than ALS (6.1 percentage points [95% CI, 5.4 to 6.8 percentage points] for trauma; 7.0 percentage points [CI, 6.2 to 7.7 percentage points] for stroke; and 3.7 percentage points [CI, 2.5 to 4.8 percentage points] for respiratory failure). Patients with AMI did not exhibit differences in survival at 30 days but had better survival at 90 days with ALS (1.0 percentage point [CI, 0.1 to 1.9 percentage points]). Neurologic functioning favored BLS for all diagnoses. Results from instrumental variable analyses were broadly consistent with propensity score analyses for trauma and stroke, showed no survival differences between BLS and ALS for respiratory failure, and showed better survival at all time points with BLS than ALS for patients with AMI. Limitation Only Medicare beneficiaries from nonrural counties were studied. Conclusion Advanced life support is associated with substantially higher mortality

  17. Organizational Justice and the Shortage of Nurses in Medical & Educational Hospitals, in Urmia-2014

    PubMed Central

    Fathabad, Heidar Sharifi; Yazdanpanah, Abbas; Hessam, Somayeh; Chimeh, Elham Ehsani; Aghlmand, Siamak

    2016-01-01

    Objective: One of the most important reasons of turnover is perceptions of organizational justice. The purpose of this study was to investigate the effect of perceived organizational justice and its components on turnover intentions of nurses in hospitals of Urmia University of Medical Sciences. Methods: This cross-sectional study was among nurses. 310 samples were estimated according to Morgan Table. Two valid and reliable questionnaires of turnover and organizational justice were used. Data analysis was performed using the software SPSS20. Using the Kolmogorov-Smirnov test, the normality and relationship between variables with Pearson and Spearman correlation test were analyzed. Results: Most people were married and aged between 26 and 35 years, BA and were hired with contraction. The mean score of organizational justice variable was 2.59. The highest average was the interactional justice variable (2.81) and then Procedural fairness variable (2.75) and distributive justices (2.03) were, respectively. The mean range of turnover variable was 3.10. The results showed weak and negative relationship between various dimensions of organizational justice and turnover in nurses. Conclusion: Organizational justice and turnover had inverse relationship with each other. Therefore how much organizational justice in the organization is more; employees tend to stay more. Finally, suggestions for improvement of justice proposed. PMID:26383199

  18. Intestinal parasitic infections among patients attending Nepal Medical College Teaching Hospital, Kathmandu, Nepal.

    PubMed

    Agrawal, P K; Rai, S K; Khanal, L K; Ghimire, G; Banjara, M R; Singh, A

    2012-06-01

    This study was conducted to find out the prevalence of intestinal parasitic infection among patients attending Nepal Medical College Teaching Hospital, Kathmandu from July 2011 to February 2012. A total of 312 stool samples collected in a clean, dry screw capped plastic container were examined using the formal-ether concentration and sucrose-flotation techniques. Overall parasite positivity rate was 30.1% with significant difference between males (34.2%) and Female (26.3%) (p < 0.05). Out of total positive, 90.4% had single parasitism whereas 9.6% had multiple parasitism. Children aged < or = 5 years were found to be highly infected (35.8%), followed by 6-15 years (32.1%) and > 15 years old (26.9%). Rate of infection was significantly higher among patients from inside Kathmandu Valley (31.1%) than outside valley (17.4%) (p < 0.05). E. histolytica (38.5%) and Hookworm (10.6%) were the commonest protozoa and helminthes respectively. Other parasites detected were G. lamblia (26.0%), E. coli (1.0%), T. trichiura (7.7%), A. lumbricoides (6.7%), H. nana (5.8%) and Taenia species (3.8%). Out of total parasites detected, 65.4% were protozoa and 34.6% were helminthes. Positive rate was higher in Dalit (37.5%) and Aadibasi-Janjati (34.3%) than Brahman-Chhetri (22.6%) (p < 0.05).

  19. The transition to electronic documentation on a teaching hospital medical service.

    PubMed

    Payne, Thomas H; Perkins, Monica; Kalus, Robert; Reilly, Dom

    2006-01-01

    The transition to electronic medical records (EMRs) often includes the transition from paper to electronic documentation, a topic less well described in the literature than other aspects of EMR adoption. As part of a broader EMR project, we have participated in the transition to electronic notes on the Medicine service of a teaching hospital affiliated with the University of Washington. During a one year period beginning in February 2005 we adopted the use of semi-structured documentation templates permitting both encoded and narrative text components for admission, progress, and procedure notes, and for some discharge summaries. Currently over 1400 notes are entered each week. Fifty eight percent are entered by residents, 20% by attending physicians, and the remainder by other trainees and staff. The period of greatest change from paper to electronic notes occurred (by design) during the late spring and summer. Leadership, application functionality, speed, note writing time requirements, data availability, training needs, and other factors influenced adoption of this important part of our EMR.

  20. Charging for hospital pharmaceutical services: flat free based on the medication record.

    PubMed

    Wyatt, B K

    1979-03-01

    A 200-bed hospital's change in pricing drug products from a cost-plus-fee system to a flat fee per dose based on the medication administration record (MAR) is described. With the flat-fee system, drug charges are not recorded when the drug is dispensed by the pharmacy; data for charging doses are obtained directly from the MAR forms generated by the nursing staff. Charges are 55 cents per oral or suppository dose and $3.00 per injection dose. Drugs administered intravenously, topical drugs, injections costing more than $10.00 per dose, and miscellaneous nondrug items are still charged on a cost-plus-fee basis. Man-hours are saved in the pharmacy department because of the elimination of the pricing function and maintenance of price lists. The need for nursing staff to charge for any doses administered from emergency or Schedule II floor-stock supplies is eliminated. The workload for business office personnel is reduced because the number of individual charges is less than with the cost-plus charging system. The system is accepted by patients and third-party payers and has made a complete unit dose drug distribution system possible at lower cost.

  1. Medical student-led patient education prior to hospital discharge improves 1-month adherence rates.

    PubMed

    Leung, Chun H S; Chong, Carol; Lim, Wen K

    2017-03-01

    Approximately 40% of patients are non-adherent to their medications. A prospective study of 80 patients evaluated the effectiveness of medical student-led pre-discharge medication education sessions. A significantly greater proportion of patients in the intervention group were adherent to their regular medications at 1 month compared with the control group (76.3% compared to 60.3%, P = 0.037). Medical student-led patient education significantly improved medication adherence rates.

  2. Facilitators and Barriers to Safe Medication Administration to Hospital Inpatients: A Mixed Methods Study of Nurses’ Medication Administration Processes and Systems (the MAPS Study)

    PubMed Central

    McLeod, Monsey; Barber, Nicholas; Franklin, Bryony Dean

    2015-01-01

    double-checker’. Conclusions We have identified practical examples of system effects on work optimisation and nurse behaviours that potentially increase medication safety, and conceptualized ways in which patient involvement can increase medication safety in hospitals. PMID:26098106

  3. Mobile emergency (surgical) hospital: Development and application in medical relief of "4.20" Lushan earthquake in Sichuan Province, China.

    PubMed

    Cheng, Bin; Shi, Ruo-Fei; Du, Ding-Yuan; Hu, Ping; Feng, Jun; Huang, Guang-Bin; Cai, An-Ning; Yin, Wei; Yang, Rong-Gang

    2015-01-01

    In the 21st century, natural disasters and emergencies occur frequently worldwide, which leads to the loss of hundreds of thousands of lives as well as the direct and indirect economic losses. China has a vast territory frequently struck by natural disasters. However, the reality is not optimistic. Poor organization and management during the rescue actions, the lack of large-scale, systematic medical rescue equipment were all great barriers to the outcomes. Mobile hospitals are expected to provide better health care. We were inspired by the concept of mobile hospital. Chongqing Emergency Medical Center, has set up trauma care system since 1988, in which prehospital care, intensive care, and in-hospital treatment is fully integrated. As a major advantage, such a system provided assurance of "golden hour" rescue treatment. Providing mobile intensive care and prehospital surgical service for severe trauma patients could reduce mortality significantly. Based on the civilian experiences in Chongqing Emergency Medical Center, the mobile emergency (surgical) hospital was developed.

  4. Medical school hotline: A History of the University of Hawai'i Postgraduate Medical Education Program at Okinawa Chubu Hospital, 1966-2012.

    PubMed

    Maeshiro, Masao; Izutsu, Satoru; Connolly, Kathleen Kihmm

    2014-06-01

    The University of Hawai'i (UH) has been collaborating with Okinawa Prefectural Chubu Hospital for over 46 years. This collaboration started as a post-World War II effort to increase the physician workforce. At the initiation of the US Army and State Department, the University of Hawai'i was recruited, in cooperation with the government of the Ryukyus and USCAR, to initiate a US style postgraduate clinical training program. The Postgraduate Medical Training Program of University of Hawai'i at Okinawa Chubu Hospital introduced a style of training similar to that in the US by offering a rotating internship. The initial contract had UH establish and run the Postgraduate Medical Training Program of University of Hawaii at Okinawa Central Hospital. After Okinawa's reversion to Japan, under a new contract, UH physicians participated as consultants by providing lectures at "grand rounds" and guidance to faculty, staff, and students. To date, 895 physicians have completed the University of Hawai'i Postgraduate Medical Training Program with 74 currently training. Approximately 662 (74%) of the trainees have remained in Okinawa Prefecture to practice medicine. As a result, the program has enhanced the physician workforce for the islands of Okinawa and neighbor archipelagos of Miyako and Yaeyama Islands.

  5. Evaluation of Patients’ Rights Observance According to Patients’ Rights Charter in Educational Hospitals Affiliated to Mashhad University of Medical Sciences: Medical Staffs’ Views

    PubMed Central

    Sabzevari, Alireza; Kiani, Mohammad Ali; Saeidi, Masumeh; Jafari, Seyed Ali; Kianifar, Hamidreza; Ahanchian, Hamid; Jarahi, Lida; Zakerian, Mohsen

    2016-01-01

    Introduction To supply quality services and healthcare, it is evident that medical ethics and patients’ rights, while providing medical and healthcare services need to be observed. This study was conducted to evaluate observance of the Patients’ Rights Charter among medical staff of educational hospitals affiliated to Mashhad University of Medical Sciences. Methods This cross-sectional study was conducted in four educational hospitals in Mashhad on eighty physicians, nurses, nurse aids and medical students. Data were collected using a two-part inventory of patients’ rights, including demographic data and inventory of patients’ rights observance. Data analysis was conducted using SPSS-16 as well as descriptive statistics, independent t-test, chi-square, Spearman correlation coefficient and Pearson correlation. Results Mean age of subjects was 36.3±8.3. Observance of human rights was perfect by 84.4 percent of subjects. The highest amount of observance of patients’ rights was related to the area of respecting patients’ privacy and observing the principle of confidentiality, which was evaluated to be perfect by all subjects (100%). The lowest value of patients’ rights observance was related to presenting appropriate and adequate information for patients, which was perfect among 48.1% of subjects. There was no significant relation between personal details (age, gender, education and career) and observance of patients’ rights (p>0.05). Conclusion Although in this study, the observance of patients’ rights by medical staff is optimal in most areas, the area of providing appropriate and adequate information needs to be promoted. Therefore, it is suggested that more stringent regulatory policies be compiled and implemented to the items of Patients’ Rights Charter along with training courses, to strengthen medical staff’s awareness in this regard. PMID:27957310

  6. Evaluating the Efficacy of a Short Aging Simulation Workshop for an Interdisciplinary Group of Health-Care Employees at a Veterans Affairs Medical Center

    ERIC Educational Resources Information Center

    Halpin, Sean N.

    2015-01-01

    Several interventions aimed at increasing positive attitudes towards older adults among health-care professionals have been introduced. These interventions tend to focus on a small subset of clinical employees, ignoring other clinical and nonclinical hospital staff. The objective of this study was to evaluate the efficacy of a short aging…

  7. A rural cancer outreach program lowers patient care costs and benefits both the rural hospitals and sponsoring academic medical center.

    PubMed

    Desch, C E; Grasso, M A; McCue, M J; Buonaiuto, D; Grasso, K; Johantgen, M K; Shaw, J E; Smith, T J

    1999-01-01

    The Rural Cancer Outreach Program (RCOP) between two rural hospitals and the Medical College of Virginia's Massey Cancer Center (MCC) was developed to bring state-of-the-art cancer care to medically underserved rural patients. The financial impact of the RCOP on both the rural hospitals and the MCC was analyzed. Pre- and post-RCOP financial data were collected on 1,745 cancer patients treated at the participating centers, two rural community hospitals and the MCC. The main outcome measures were costs (estimated reimbursement from all sources), revenues, contribution margins and profit (or loss) of the program. The RCOP may have enhanced access to cancer care for rural patients at less cost to society. The net annual cost per patient fell from $10,233 to $3,862 associated with more use of outpatient services, more efficient use of resources, and the shift to a less expensive locus of care. The cost for each rural patient admitted to the Medical College of Virginia fell by more than 40 percent compared with only an 8 percent decrease for all other cancer patients. The rural hospitals experienced rapid growth of their programs to more than 200 new patients yearly, and the RCOP generated significant profits for them. MCC benefited from increased referrals from RCOP service areas by 330 percent for cancer patients and by 9 percent for non-cancer patients during the same time period. While it did not generate a major profit for the MCC, the RCOP generated enough revenue to cover costs of the program. The RCOP had a positive financial impact on the rural and academic medical center hospitals, provided state-of-the-art care near home for rural patients and was associated with lower overall cancer treatment costs.

  8. Health care professionals’ pain narratives in hospitalized children’s medical records. Part 2: Structure and content

    PubMed Central

    Rashotte, Judy; Harrison, Denise; Coburn, Geraldine; Yamada, Janet; Stevens, Bonnie J

    2013-01-01

    BACKGROUND: Although clinical narratives – described as free-text notations – have been noted to be a source of patient information, no studies have examined the composition of pain narratives in hospitalized children’s medical records. OBJECTIVES: To describe the structure and content of health care professionals’ narratives related to hospitalized children’s acute pain. METHODS: All pain narratives documented during a 24 h period were collected from the medical records of 3822 children (0 to 18 years of age) hospitalized in 32 inpatient units in eight Canadian pediatric hospitals. A qualitative descriptive exploration using a content analysis approach was performed. RESULTS: Three major structural elements with their respective categories and subcategories were identified: information sources, including clinician, patient, parent, dual and unknown; compositional archetypes, including baseline pain status, intermittent pain updates, single events, pain summation and pain management plan; and content, including pain declaration, pain assessment, pain intervention and multidimensional elements of care. CONCLUSIONS: The present qualitative analysis revealed the multidimensionality of structure and content that was used to document hospitalized children’s acute pain. The findings have the potential to inform debate on whether the multidimensionality of pain narratives’ composition is a desirable feature of documentation and how narratives can be refined and improved. There is potential for further investigation into how health care professionals’ pain narratives could have a role in generating guidelines for best pain documentation practice beyond numerical representations of pain intensity. PMID:24093123

  9. Evaluation of organizational maturity based on people capacity maturity model in medical record wards of Iranian hospitals

    PubMed Central

    Yarmohammadian, Mohammad H.; Tavakoli, Nahid; Shams, Assadollah; Hatampour, Farzaneh

    2014-01-01

    Context: People capacity maturity model (PCMM) is one of the models which focus on improving organizational human capabilities. Aims: The aim of this model's application is to increase people ability to attract, develop, motivate, organize and retain the talents needed to organizational continuous improvement. Settings and Design: In this study, we used the PCMM for investigation of organizational maturity level in medical record departments of governmental hospitals and determination strengths and weaknesses of their staff capabilities. Materials and Methods: This is an applied research and cross sectional study in which data were collected by questionnaires to investigation of PCMM model needs in medical record staff of governmental hospitals at Isfahan, Iran. We used the questionnaire which has been extracted from PCMM model and approved its reliability with Cronbach's Alpha 0.96. Statistical Analysis Used: Data collected by the questionnaire was analyzed based on the research objectives using SPSS software and in accordance with research questions descriptive statistics were used. Results: Our findings showed that the mean score of medical record practitioners, skill and capability in governmental hospitals was 35 (62.5%) from maximum 56 (100%). There is no significant relevance between organizational maturity and medical record practitioners, attributes. Conclusions: Applying PCMM model is caused increasing staff and manager attention in identifying the weaknesses in the current activities and practices, so it will result in improvement and developing processes. PMID:25077147

  10. Abusive Head Trauma in Young Children: Characteristics and Medical Charges in a Hospitalized Population

    ERIC Educational Resources Information Center

    Ettaro, L.; Berger, R. P.; Songer, T.

    2004-01-01

    Objective: To describe the presenting characteristics, hospital course, and hospital charges associated with hospital admissions for head trauma in young children at a regional pediatric trauma center, and to examine whether these factors differ among abused and non-abused subjects. Method: Comparative case series study involving a retrospective…

  11. Reduced rates of hospital-acquired UTI in medical patients. Prevalence surveys indicate effect of active infection control programmes.

    PubMed

    Christensen, M; Jepsen, O B

    2001-01-01

    Prevalence surveys have been part of the Danish infection control programme since 1974. Nationwide surveys were carried out in 1978, 1979, 1980, 1991 and 1999. The results indicate a net reduction of approximately 25%, mainly due to a reduction of urinary tract infections (UTIs) in medical patients. Results from the nationwide surveys are validated by results of occasional independent surveys performed in regions or single hospitals. The reduction coincides with preventive programmes focused on catheter policy and UTI. We conclude that the prevalence survey is an important part of our strategic programme for infection control in hospitals.

  12. The Deaf Strong Hospital Program: A Model of Diversity and Inclusion Training for First-Year Medical Students

    PubMed Central

    Thew, Denise; Smith, Scott R.; Chang, Christopher; Starr, Matt

    2013-01-01

    Recent research indicates that the cultural competence training students receive during medical school might not adequately address the issues that arise when caring for patients of different cultures. Because of their unique communication, linguistic, and cultural issues, incorporating deaf people who use sign language into cultural competence education at medical schools might help to bridge this gap in cross-cultural education. The Deaf Strong Hospital (DSH) program at the University of Rochester School of Medicine and Dentistry, started in 1998, exposes first-year medical students to the issues that are relevant to providing effective patient care and to establishing multicultural sensitivity early in their medical education. Because medical students better acquire cross-cultural competence through hands on experience rather than through lectures, the DSH program, which includes a role-reversal exercise in which medical students play the role of the patients, provides such a model for other medical schools and health care training centers to use in teaching future health care providers how to address the relevant cultural, linguistic, and communication needs of both their deaf patients and their non-English-speaking patients. This article describes the DSH program curriculum, shares findings from both medical students’ short-term and long-term post-program evaluations, and provides a framework for the implementation of a broader cultural and linguistic sensitivity training program specific to working with and improving the quality of health care among deaf people. PMID:23018327

  13. Offshore Medical Schools Are Buying Clinical Clerkships in U.S. Hospitals: The Problem and Potential Solutions.

    PubMed

    Halperin, Edward C; Goldberg, Robert B

    2016-05-01

    U.S. medical education faces a threat from for-profit Caribbean medical schools which purchase clinical rotation slots for their students at U.S. hospitals. These offshore schools are monetizing a system that was previously characterized as a duty-the duty of the current generation of physicians to educate their successors. Offshore schools purchase clinical rotation slots using funds largely derived from federally subsidized student loans. This leads to pressure on U.S. schools to pay for clinical clerkships and is forcing some of them to find new clinical training sites.For-profit Caribbean schools largely escape the type of scrutiny that U.S. schools face from U.S. national accreditation organizations. They also enroll large classes of students with lower undergraduate GPAs and Medical College Admission Test scores than those of students at U.S. medical schools; their students take and pass Step 1 of the United States Medical Licensing Examination at a substantially lower rate than that of U.S. medical students; and their students match for residencies at a fraction of the rate of U.S. medical school graduates.Among the potential solutions proposed by the authors are passing laws to hold for-profit Caribbean schools to standards for board passage rates, placing restrictions on federal student loans, monitoring attrition rates, and denying offshore schools access to U.S. clinical training sites unless they meet accreditation standards equivalent to those of U.S. medical schools.

  14. Pseudo-outbreak of Mycobacterium gordonae Following the Opening of a newly constructed hospital at a Chicago Medical Center.

    PubMed

    Prabaker, Kavitha; Muthiah, Chethra; Hayden, Mary K; Weinstein, Robert A; Cheerala, Jyothirmai; Scorza, Mary L; Segreti, John; Lavin, Mary A; Schmitt, Barbara A; Welbel, Sharon F; Beavis, Kathleen G; Trenholme, Gordon M

    2015-02-01

    OBJECTIVE To identify the source of a pseudo-outbreak of Mycobacterium gordonae DESIGN Outbreak investigation. SETTING University Hospital in Chicago, Ilinois. PATIENTS Hospital patients with M. gordonae-positive clinical cultures. METHODS An increase in isolation of M. gordonae from clinical cultures was noted immediately following the opening of a newly constructed hospital in January 2012. We reviewed medical records of patients with M. gordonae-positive cultures collected between January and December 2012 and cultured potable water specimens in new and old hospitals quantitatively for mycobacteria. RESULTS Of 30 patients with M. gordonae-positive clinical cultures, 25 (83.3%) were housed in the new hospital; of 35 positive specimens (sputum, bronchoalveolar lavage, gastric aspirate), 32 (91.4%) had potential for water contamination. M. gordonae was more common in water collected from the new vs. the old hospital [147 of 157 (93.6%) vs. 91 of 113 (80.5%), P=.001]. Median concentration of M. gordonae was higher in the samples from the new vs. the old hospital (208 vs. 48 colony-forming units (CFU)/mL; P<.001). Prevalence and concentration of M. gordonae were lower in water samples from ice and water dispensers [13 of 28 (46.4%) and 0 CFU/mL] compared with water samples from patient rooms and common areas [225 of 242 (93%) and 146 CFU/mL, P<.001]. CONCLUSIONS M. gordonae was common in potable water. The pseudo-outbreak of M. gordonae was likely due to increased concentrations of M. gordonae in the potable water supply of the new hospital. A silver ion-impregnated 0.5-μm filter may have been responsible for lower concentrations of M. gordonae identified in ice/water dispenser samples. Hospitals should anticipate that construction activities may amplify the presence of waterborne nontuberculous mycobacterial contaminants.

  15. 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

  16. Discrepancies between dental and medical records of cardiac patients in AlHada Armed Forces Hospital, Taif, Saudi Arabia

    PubMed Central

    Al Hibshi, Sana M.; Al-Raddadi, Rajaa M.; Assery, Mansour K.

    2016-01-01

    Aims and Objectives: This study aims to estimate the prevalence of medical information discrepancies between dental and medical records of cardiac patients at AlHada Armed Forces Hospital in Taif and to identify the factors contributing to these information discrepancies. Materials and Methods: The study applied a descriptive retrospective medical and dental records review of a stratified proportional sample of 289 cardiac patients, which was extracted from 1154 cardiac patients who visited both the cardiology and dental clinics at the AlHada Armed Forces Hospital between 2007 and June 2012. Data were analyzed using the Statistical Package for the Social Sciences version 19. Results: The main results of this study are the following: The mean and standard deviation of patient's age was 56 ± 16.9, female patients represented 47.8% of the study population. A total of 78.5% of dental records were documented by dental residents whereas 48.4% of the dentists had more than 6 years of experience. Two hundred and seventy-nine (96.5%) of the 289 dental records had medical information discrepancies compared to the corresponding medical records. One hundred percent of systemic lupus erythematosus and rheumatic fever cases were not documented in the dental records followed by 93% of medications, 92% of stroke, and 88.5% of hyperlipidemia, whereas the least prevalent were cardiac disease (26%) and diabetes mellitus (22.2%). Conclusion: Approximately 75% of the patients who directly or indirectly accessed the dental services showed discrepancies. The researcher concludes that critical information gaps exist between dental and medical records that mostly attributed to system level problems. A well-established model for efficient communication among medical and dental care providers caring for cardiac patients does not appear to exist. The absence of such a model can threaten the overall health of patients. PMID:28032050

  17. Impact of an Antibiotic Restriction Program on Antibiotic Utilization in the Treatment of Community Acquired Pneumonia in a Veterans Affairs Medical Center

    PubMed Central

    Mansouri, Mohammad D.; Cadle, Richard M.; Agbahiwe, Sylvester O.; Musher, Daniel M.

    2011-01-01

    Purpose The impact of an Antibiotic Restriction Program (ARP) on the patterns of antibiotic use in the treatment of community-acquired pneumonia (CAP) was examined. We also evaluated the association between the ARP and the length of hospital stay in regard to CAP treatment and cost savings associated with the implementation of the ARP. Methods A retrospective cohort study of patients admitted with CAP was conducted at two six-month periods, one prior to the ARP and one after the ARP. The health system’s Computerized Patient Record System (CPRS) was used to obtain demographics, length of hospital stays, readmission rates, blood culture results, co–morbidities, antibiotic use, and durations of therapy. A total of 130 patients met the inclusion criteria for the final analyses. Average drug costs, employee salaries, and the cost of laboratory procedures were used to assess cost savings associated with the ARP. Results From a total of 132 antibiotics that were ordered to treat CAP in the pre-ARP period, 28 were restricted (21.2%). However, the number of restricted antibiotics ordered was significantly reduced to 12 out of 114 (10.2%) antibiotics ordered in the post-ARP period (P = 0.024). In post-ARP implementation, mean length of hospital stay was also significantly reduced from 7.6 to 5.8 days (P = 0.017), and although not statistically significant, 30-day readmission rates declined from 16.9% to 6.2% (P = 0.097). The ARP was also associated with $943 savings per patient treated for CAP. Conclusions In addition to a decrease in the antibiotic utilization and the mean length of hospital stay, the ARP may have yielded cost savings and reduced the readmission rates for those patients admitted and treated for CAP. PMID:21318422

  18. Planning and Implementing a Disaster Recovery Capability for a Mainframe-Based Hospital Information System: Duke University Medical Center's Experience

    PubMed Central

    Kirby, J. David; Walker, L. Phillip; Aaron, Walter H.; Whitesell, Judy J.; Stead, William W.

    1988-01-01

    Since October 1986, the Medical Center Information Systems Department at Duke University Medical Center (DUMC) has been developing and implementing a plan to provide for the continuation of the functions performed by Duke Hospital's central computing system in the event of a disaster that would disable the central hardware configuration for an extended amount of time. The key characteristic of the plan is that it provides for the full function and performance of the system to be returned to the end users within twenty four hours of the primary system's failure.

  19. An Evaluation of Current CCTV Usage To Support Patient Health Education Activities at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Brecksville Division.

    ERIC Educational Resources Information Center

    Kromke, Diane

    Closed-circuit television (CCTV) is a promising technology used by many medical centers to support health education activities for patients and their families. It may provide one method of reaching multiple patients at various times and locations, providing consistent, easily repeated information in a low stress manner, but it is unclear how much…

  20. Vitamin D Deficiency among Female Nurses of Children's Medical Center Hospital and Its Related Factors.

    PubMed

    Rajebi, Hamid; Khodadad, Ahmad; Fahimi, Golshan; Abolhassani, Hassan

    2016-02-01

    Vitamin D deficiency is one of the most preventable challenges worldwide. The aim of this study was to determine the prevalence of vitamin D deficiency among female nurses working at Children's Medical Center Hospital in Tehran, Iran, due to the risk factor of being a notably long period indoors and the fact that their health status may have consequences on the process of patients' treatment. A total of 114 female nurses who were at least 20 years old entered the study voluntarily, and a questionnaire was applied to collect information on lifestyle and other factors associated with vitamin D deficiency. A sample of blood was taken to measure 25-hydroxyvitamin D (25-OHD) and cut off value to indicate deficiency was considered below 10 ng/ml, and the amounts of 10-29 ng/ml were declared insufficient. The mean of 25-OHD was 11.7±9.3 ng/ml. A total of 79 subjects (69.3%) had a deficient level of vitamin D, 28 subjects (24.6%) had an insufficient level and only 7 subjects (6.1%) had sufficient level of vitamin D. The deficiency was more noticeable in the age group of 26-35 years old. Prevalence of vitamin D deficiency had a significant correlation with younger subjects (P<0.001). There was no significant association among other factors such as body mass index (BMI), health status complications, regular exercise, and duration of sun exposure. High prevalence of vitamin D deficiency in the study population leads to emphasise the need to screen health care workers for vitamin D levels.

  1. Modeling nurses' acceptance of bar coded medication administration technology at a pediatric hospital

    PubMed Central

    Brown, Roger L; Scanlon, Matthew C; Karsh, Ben-Tzion

    2012-01-01

    Objective To identify predictors of nurses' acceptance of bar coded medication administration (BCMA). Design Cross-sectional survey of registered nurses (N=83) at an academic pediatric hospital that recently implemented BCMA. Methods Surveys assessed seven BCMA-related perceptions: ease of use; usefulness for the job; social influence from non-specific others to use BCMA; training; technical support; usefulness for patient care; and social influence from patients/families. An all possible subset regression procedure with five goodness-of-fit indicators was used to identify which set of perceptions best predicted BCMA acceptance (intention to use, satisfaction). Results Nurses reported a moderate perceived ease of use and low perceived usefulness of BCMA. Nurses perceived moderate-or-higher social influence to use BCMA and had moderately positive perceptions of BCMA-related training and technical support. Behavioral intention to use BCMA was high, but satisfaction was low. Behavioral intention to use was best predicted by perceived ease of use, perceived social influence from non-specific others, and perceived usefulness for patient care (56% of variance explained). Satisfaction was best predicted by perceived ease of use, perceived usefulness for patient care, and perceived social influence from patients/families (76% of variance explained). Discussion Variation in and low scores on ease of use and usefulness are concerning, especially as these variables often correlate with acceptance, as found in this study. Predicting acceptance benefited from using a broad set of perceptions and adapting variables to the healthcare context. Conclusion Success with BCMA and other technologies can benefit from assessing end-user acceptance and elucidating the factors promoting acceptance and use. PMID:22661559

  2. Public affairs plan

    SciTech Connect

    Not Available

    1994-09-01

    The purpose of the Uranium Mill Tailings Remedial Action (UMTRA) Project Public Affairs Plan is to establish goals for the Fiscal Year 1995 UMTRA public affairs program and identify specific activities to be conducted during the year. It also describes the roles of various agencies involved in the conduct of the public affairs program and defines the functions of the Technical Assistance Contractor (TAC) Public Affairs Department. It integrates and replaces the Public Participation Plan (DOE/AL/62350-47D) and Public Information Plan (DOE/AL/623590-71). The plan describes the US Department of Energy`s (DOE) plans to keep stakeholders and other members of the public informed about project policies, plans, and activities, and provide opportunities for stakeholders and interested segments of the public to participate in project decision-making processes. The plan applies to the UMTRA Project Office; the DOE Albuquerque Operations Office, Office of Intergovernmental and External Affairs (OIEA); the UMTRA TAC; the UMTRA Remedial Action Contractor (RAC); and other cooperating agencies.

  3. Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update.

    PubMed

    Zafren, Ken; Giesbrecht, Gordon G; Danzl, Daniel F; Brugger, Hermann; Sagalyn, Emily B; Walpoth, Beat; Weiss, Eric A; Auerbach, Paul S; McIntosh, Scott E; Némethy, Mária; McDevitt, Marion; Dow, Jennifer; Schoene, Robert B; Rodway, George W; Hackett, Peter H; Bennett, Brad L; Grissom, Colin K

    2014-12-01

    To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia published in Wilderness & Environmental Medicine 2014;25(4):425-445.

  4. Characterization of Staphylococcus aureus Isolates That Colonize Medical Students in a Hospital of the City of Cali, Colombia

    PubMed Central

    Collazos Marín, Luis Fernando; Estupiñan Arciniegas, Gina; Chavez Vivas, Monica

    2015-01-01

    Introduction. Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) represents a risk for the spread of bacteria. This study characterized the S. aureus isolated from medical students, who were in their clinical rotation at a hospital in the city of Cali. Materials and Methods. 216 students participated in the study and 63 isolates of S. aureus were evaluated for susceptibility and PCR amplification of agr and mecA genes. The origin of MRSA isolates was established by analyzing agr polymorphisms. Results. A total of 29.2% of students were colonized by S. aureus and nasal carriage rate was 23.6% and 14.3% MRSA. Three agr groups (agr II, and agr III) were identified; the agr I group was the most common, with a 35% prevalence; this group is from community origin. Conclusion. The present study demonstrates that medical students carry S. aureus strains, with the threat of spreading them both to community and hospital environments. PMID:26495001

  5. Pulmonary rehabilitation coupled with negative pressure ventilation decreases decline in lung function, hospitalizations, and medical cost in COPD

    PubMed Central

    Huang, Hung-Yu; Chou, Pai-Chien; Joa, Wen-Ching; Chen, Li-Fei; Sheng, Te-Fang; Lin, Horng-Chyuan; Yang, Lan-Yan; Pan, Yu-Bin; Chung, Fu-Tsai; Wang, Chun-Hua; Kuo, Han-Pin

    2016-01-01

    Abstract Pulmonary rehabilitation (PR) brings benefits to patients with chronic obstructive pulmonary disease (COPD). Negative pressure ventilation (NPV) increases ventilation and decreases hyperinflation as well as breathing work in COPD. We evaluated the long-term effects of a hospital-based PR program coupled with NPV support in patients with COPD on clinical outcomes. One hundred twenty-nine patients with COPD were followed up for more than 5 years, with the NPV group (n = 63) receiving the support of NPV (20–30 cm H2O delivery pressure for 60 min) and unsupervised home exercise program of 20 to 30 min daily walk, while the control group (n = 6) only received unsupervised home exercise program. Pulmonary function tests and 6 min walk tests (6MWT) were performed every 3 to 6 months. Emergency room (ER) visits and hospitalization with medical costs were recorded. A significant time-by-group interaction in the yearly decline of forced expiratory volume in 1 s in the control group analyzed by mixed-model repeated-measure analysis was found (P = 0.048). The 6MWT distance of the NPV group was significantly increased during the first 4 years, with the interaction of time and group (P = 0.003), the time alone (P = 0.014), and the quadratic time (P < 0.001) being significant between the 2 groups. ER exacerbations and hospitalizations decreased by 66% (P < 0.0001) and 54% (P < 0.0001) in the NPV group, respectively. Patients on PR program coupled with NPV had a significant reduction of annual medical costs (P = 0.022). Our hospital-based multidisciplinary PR coupled with NPV reduced yearly decline of lung function, exacerbations, and hospitalization rates, and improved walking distance and medical costs in patients with COPD during a 5-year observation PMID:27741132

  6. An Implementation Plan for a Hospital-Wide Recycling Program at William Beaumont Army Medical Center, El Paso, Texas

    DTIC Science & Technology

    1993-08-01

    enrgy costs. Establishing a hospital recycling program involves three steps: (1) forming a team that assists with the plans, iu.eenation, and on-going...was finding a market for materials and corivining recyclers that clean medical trash was safe if separated and handled correctly. Another challenge was...collection of mi par because In- .a’ate mterials and trash wmrs being placed in the containers. Wiite cUmP*ter paper turned cut to be the easiest and

  7. Development of an Integrated Medical Record System at a Large Hospital Using COSTAR as a Designing Tool

    PubMed Central

    Schteingart, R.; Wachenchauzer, R.; Jamschon, R.; Uman, G.; Visciglio, H.; Donovan, K.; D'Adamo, G.; Panuncio, C.

    1982-01-01

    It is usually very complex to design an Integrated Information System in a hospital that includes both in-patient and out-patient medical care data. The difficulty appears because each department within the organization tends to create its own information system, according to its requirements and interests, and absolutely unaware of the requirements of the other departments. In this article, we will describe the design, programming and implementation of an integrated information system in a hospital. It has a unique data base to store all the in-patient and out-patient information. COSTAR experience was used to design this system. Advantages and disadvantages of using COSTAR in a hospital with 850 beds and 2.500 daily out-patient visits are pointed out, and the new system designed on the basis of COSTAR functionality is described.

  8. Special funding schemes for innovative medical devices in French hospitals: the pros and cons of two different approaches.

    PubMed

    Martelli, Nicolas; van den Brink, Hélène

    2014-07-01

    Financing innovative medical devices is an important challenge for national health policy makers, and a crucial issue for hospitals. However, when innovative medical devices are launched on the European market there is generally little clinical evidence regarding both efficacy and safety, both because of the flaws in the European system for regulating such devices, and because they are at an early stage of development. To manage the uncertainty surrounding the reimbursement of innovation, several European countries have set up temporary funding schemes to generate evidence about the effectiveness of devices. This article explores two different French approaches to funding innovative in-hospital devices and collecting supplementary data: the coverage with evidence development (CED) scheme introduced under Article L. 165-1-1 of the French Social Security Code; and national programs for hospital-based research. We discuss pros and cons of both approaches in the light of CED policies in Germany and the UK. The CED policies for devices share common limitations. Thus, transparency of CED processes should be enhanced and decisions need to be made in a timely way. Finally, we think that closer collaboration between manufacturers, health authorities and hospitals is essential to make CED policies more operational.

  9. Medical work Assessment in German hospitals: a Real-time Observation study (MAGRO) – the study protocol

    PubMed Central

    Mache, Stefanie; Groneberg, David A

    2009-01-01

    Background The increasing economic pressure characterizes the current situation in health care and the need to justify medical decisions and organizational processes due to limited financial resources is omnipresent. Physicians tend to interpret this development as a decimation of their own medical influence. This becomes even more obvious after a change in hospital ownership i.e. from a public to a private profit oriented organization. In this case each work procedure is revised. To date, most research studies have focused mainly on differences between hospitals of different ownership regarding financial outcomes and quality of care, leaving important organizational issues unexplored. Little attention has been devoted to the effects of hospital ownership on physicians' working routines. The aim of this observational real time study is to deliver exact data about physicians' work at hospitals of different ownership. Methods The consequences of different management types on the organizational structures of the physicians' work situation and on job satisfaction in the ward situation are monitored by objective real time studies and multi-level psycho diagnostic measurements. Discussion This study is unique in its focus. To date no results have been found for computer-based real time studies on work activity in the clinical field in order to objectively evaluate a physician's work-related stress. After a complete documentation of the physicians' work processes the daily work flow can be estimated and systematically optimized. This can stimulate an overall improvement of health care services in Germany. PMID:19505318

  10. The founding of Walter Reed General Hospital and the beginning of modern institutional army medical care in the United States.

    PubMed

    Adler, Jessica L

    2014-10-01

    When Walter Reed United States Army General Hospital opened its doors in 1909, the Spanish-American War had been over for a decade, World War I was in the unforeseeable future, and army hospital admission rates were steadily decreasing. The story of the founding of Walter Reed, which remained one of the flagship military health institutions in the United States until its 2011 closure, is a story about the complexities of the turn of the twentieth century. Broad historical factors-heightened imperial ambitions, a drive to modernize the army and its medical services, and a growing acceptance of hospitals as ideal places for treatment-explain why the institution was so urgently fought for and ultimately won funding at the particular moment it did. The justifications put forth for the establishment of Walter Reed indicate that the provision of publicly funded medical care for soldiers has been predicated not only on a sense of humanitarian commitment to those who serve, but on principles of military efficiency, thrift, pragmatism, and international competition. On a more general level, the story of Walter Reed's founding demonstrates a Progressive Era shift in health services for U.S. soldiers-from temporary, makeshift hospitals to permanent institutions with expansive goals.

  11. A 1911 postcard of the National Hospital for the Paralysed and Epileptic highlighting European medical specialty training

    PubMed Central

    Zubair, Adeel

    2017-01-01

    The purpose of this study was to describe the historical importance of a 1911 European hospital postcard sent from one American physician to another. In the late 19th and early 20th centuries, very few formal residency programs existed in America for training physicians. Most authors rightfully emphasize Johns Hopkins Hospital, founded in 1889, as the site of origin of the American medical residency, but these positions were for a chosen few. Many young physicians would go abroad to study medicine after completing medical school, a decision with many benefits and few drawbacks. At least 15,000 Americans took some kind of medical training in Austria-Hungary, Germany, and Switzerland between 1870 and 1914. Dr. Frank F. Hutchins took such a trip to Europe. On March 12, 1911, Dr. Hutchins wrote a postcard from Queen Square, London, to Dr. Allison Maxwell admiring the positive attributes of The National Hospital for the Paralysed and Epileptic. This trip would serve to shape Dr. Hutchins' subsequent career and would influence the future of the Indiana University School of Medicine, neuropsychiatry in the US military, and the care of veterans. PMID:28127153

  12. Interventional Pain Management in Rheumatological Diseases - A Three Years Physiatric Experience in a Tertiary Medical College Hospital in Bangladesh

    PubMed Central

    Hasan, Suzon Al; Das, Gautam; Khan, Amin Uddin A

    2011-01-01

    Background Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues. Methods A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital. Results The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis. Conclusions All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties. PMID:22220242

  13. The Role of the Medical Physicist in Radiation Protection in Hospitals.

    ERIC Educational Resources Information Center

    Harrison, R. M.

    1989-01-01

    Described is the role of the medical physicist in five areas of medical application, including radiotherapy, nuclear medicine, diagnostic radiology, environmental radioactivity, and dosimetry and personal monitoring. The management contribution of the medical physicist is discussed. Provided are two examples of new techniques influencing radiation…

  14. Safe medication management and use of narcotics in a Joint Commission International-accredited academic medical center hospital in the People's Republic of China.

    PubMed

    Fang, Xu; Zhu, Ling-Ling; Pan, Sheng-Dong; Xia, Ping; Chen, Meng; Zhou, Quan

    2016-01-01

    Safe medication management and use of high-alert narcotics should arouse concern. Risk management experiences in this respect in a large-scale Joint Commission International (JCI)-accredited academic medical center hospital in the People's Republic of China during 2011-2015, focusing on organizational, educational, motivational, and information technological measures in storage, prescribing, preparing, dispensing, administration, and monitoring of medication are summarized. The intensity of use of meperidine in hospitalized patients in 2015 was one-fourth that in 2011. A 100% implementation rate of standard storage of narcotics has been achieved in the hospital since December 2012. A "Plan, Do, Check, Act" cycle was efficient because the ratio of number of inappropriate narcotics prescriptions to total number of narcotics prescriptions for inpatients decreased from August 2014 to December 2014 (28.22% versus 2.96%, P=0.0000), and it was controlled below 6% from then on. During the journey to good pain management ward accreditation by the Ministry of Health, People's Republic of China, (April 2012-October 2012), the medical oncology ward successfully demonstrated an increase in the pain screening rate at admission from 43.5% to 100%, cancer pain control rate from 85% to 96%, and degree of satisfaction toward pain nursing from 95.4% to 100% (all P-values <0.05). Oral morphine equivalent dosage in the good pain management ward increased from 2.3 mg/patient before June 2012 to 54.74 mg/patient in 2014. From 2011 to 2015, the oral morphine equivalent dose per discharged patient increased from 8.52 mg/person to 20.36 mg/person. A 100% implementation rate of independent double-check prior to narcotics dosing has been achieved since January 2013. From 2014 to 2015, the ratio of number of narcotics-related medication errors to number of discharged patients significantly decreased (6.95% versus 0.99%, P=0.0000). Taken together, continuous quality improvements have been

  15. Safe medication management and use of narcotics in a Joint Commission International-accredited academic medical center hospital in the People’s Republic of China

    PubMed Central

    Fang, Xu; Zhu, Ling-ling; Pan, Sheng-dong; Xia, Ping; Chen, Meng; Zhou, Quan

    2016-01-01

    Safe medication management and use of high-alert narcotics should arouse concern. Risk management experiences in this respect in a large-scale Joint Commission International (JCI)-accredited academic medical center hospital in the People’s Republic of China during 2011–2015, focusing on organizational, educational, motivational, and information technological measures in storage, prescribing, preparing, dispensing, administration, and monitoring of medication are summarized. The intensity of use of meperidine in hospitalized patients in 2015 was one-fourth that in 2011. A 100% implementation rate of standard storage of narcotics has been achieved in the hospital since December 2012. A “Plan, Do, Check, Act” cycle was efficient because the ratio of number of inappropriate narcotics prescriptions to total number of narcotics prescriptions for inpatients decreased from August 2014 to December 2014 (28.22% versus 2.96%, P=0.0000), and it was controlled below 6% from then on. During the journey to good pain management ward accreditation by the Ministry of Health, People’s Republic of China, (April 2012–October 2012), the medical oncology ward successfully demonstrated an increase in the pain screening rate at admission from 43.5% to 100%, cancer pain control rate from 85% to 96%, and degree of satisfaction toward pain nursing from 95.4% to 100% (all P-values <0.05). Oral morphine equivalent dosage in the good pain management ward increased from 2.3 mg/patient before June 2012 to 54.74 mg/patient in 2014. From 2011 to 2015, the oral morphine equivalent dose per discharged patient increased from 8.52 mg/person to 20.36 mg/person. A 100% implementation rate of independent double-check prior to narcotics dosing has been achieved since January 2013. From 2014 to 2015, the ratio of number of narcotics-related medication errors to number of discharged patients significantly decreased (6.95% versus 0.99%, P=0.0000). Taken together, continuous quality improvements

  16. Real-time seismic monitoring of instrumented hospital buildings

    USGS Publications Warehouse

    Kalkan, Erol; Fletcher, Jon Peter B.; Leith, William S.; McCarthy, William S.; Banga, Krishna

    2012-01-01

    In collaboration with the Department of Veterans Affairs (VA), the U.S. Geological Survey's National Strong Motion Project has recently installed sophisticated seismic monitoring systems to monitor the structural health of two hospital buildings at the Memphis VA Medical Center in Tennessee. The monitoring systems in the Bed Tower and Spinal Cord Injury buildings combine sensing technologies with an on-site computer to capture and analyze seismic performance of buildings in near-real time.

  17. Use of mobile phones by medical staff at Queen Elizabeth Hospital, Barbados: evidence for both benefit and harm.

    PubMed

    Ramesh, J; Carter, A O; Campbell, M H; Gibbons, N; Powlett, C; Moseley, H; Lewis, D; Carter, T

    2008-10-01

    All members of medical staff, including students, were asked to participate in a self-administered questionnaire concerning patterns of mobile phone use and care. Participants' phones were cultured for micro-organisms. Healthcare professionals working in close proximity to sensitive equipment were surveyed concerning adverse events associated with mobile phones. Telephone operators were asked to monitor time elapsed as they attempted to contact medical staff by various methods. Of 266 medical staff and students at the time of the study, 116 completed questionnaires (response rate=44%). Almost all (98%) used mobile phones: 67% used their mobile phones for hospital-related matters; 47% reported using their phone while attending patients. Only 3% reported washing their hands after use and 53% reported never cleaning their phone. In total, 101 mobile phones were cultured for micro-organisms; 45% were culture-positive and 15% grew Gram-negative pathogens. The survey of staff working in close proximity to sensitive equipment revealed only one report of minor interference with life-saving equipment. Telephone operators were able to contact medical staff within 2 min most easily by mobile phone. Mobile phones were used widely by staff and were considered by most participants as a more efficient means of communication. However, microbial contamination is a risk associated with the infrequent cleaning of phones. Hospitals should develop policies to address the hygiene of mobile phones.

  18. Dental Hygiene, Dental, and Medical Students' OMFS/Hospital Dentistry-Related Knowledge/Skills, Attitudes, and Behavior: An Exploration.

    PubMed

    Munz, Stephanie M; Kim, Roderick Y; Holley, Tyler J; Donkersloot, John N; Inglehart, Marita R

    2017-02-01

    Engaging other health care providers in oral health-related activities and interprofessional care (IPC) could increase access to oral health care for underserved populations in the U.S. The aims of this study were to assess dental hygiene, dental, and medical students' intra- and interprofessional and oral and maxillofacial surgery (OMFS)/hospital dentistry-related knowledge/skills, attitudes, and behavior; determine whether first and second year vs. third and fourth year cohorts' responses differed; and explore how intra- and interprofessional knowledge was related to interprofessional education (IPE) and interprofessional attitudes and behavior. Data were collected between April 2014 and May 2015 from 69 dental hygiene, 316 dental, and 187 medical students. Response rates across classes for the dental hygiene students ranged from 85% to 100%; 24% to 100% for the dental students; and 13% to 35% for the medical students. The results showed that the medical students had lower oral health-related and interprofessional knowledge and less positive attitudes about oral health-related behavior, IPE, and interprofessional teamwork than the dental hygiene and dental students. While third- and fourth-year medical students' interprofessional knowledge/skills and behavior were higher than those of first- and second-year students, the two groups' IPE-related and interprofessional attitudes did not differ. The students' knowledge correlated with their IPE and interprofessional communication-related skills and behavior, but not with their interprofessional attitudes. These dental hygiene, dental, and medical students' OMFS/hospital dentistry-related knowledge/skills and behavior increased over the course of their academic programs, while their IPE-related and intra- and interprofessional attitudes, especially for medical students, did not improve over time. OMFS and hospital dentistry units in medical centers offer distinctive opportunities for IPE and IPC. Utilizing these units

  19. Discharge Against Medical Advice in the Pediatric Wards in Boo-ali Sina Hospital, Sari, Iran 2010

    PubMed Central

    Mohseni Saravi, Benyamin; Reza Zadeh, Esmaeil; Siamian, Hasan; Yahghoobian, Mahboobeh

    2013-01-01

    Introduction: Since children neither comprehended nor contribute to the decision, discharge against medical advice is a challenge of health care systems in the world. Therefore, the current study was designed to determine the rate and causes of discharge against medical advice. Methods: This descriptive cross-sectional study was done by reviewing the medical records by census method. Data was analyzed using SPSS software and x2 statistics was used to determine the relationship between variables. The value of P<0.05 was considered significant. Results: Rate of discharged against medical advice was 108 (2.2%). Mean of age and length of stay were 2.8±4 (SD).3 years old and 3.7±5.4 (SD) days, respectively. Totally, 95 patients (88.7%) had health insurance and 65 (60.2%) patients lived in urban areas. History of psychiatric disease and addiction in 22 (20.6%) of the parents were negative. In addition, 100 (92.3%) patients admitted for medical treatment and the others for surgery. The relationship of the signatory with patients (72.3%) was father. Of 108 patients discharged against medical advice, 20 (12%) were readmitted. The relationship between the day of discharge and discharge against medical advice was significant (ρ =0/03). Conclusion: Rate of discharge against medical advice in Boo-ali hospital is the same as the other studies in the same range. The form which is used for this purpose did not have suitable data elements about description of consequence of such discharge, and it has not shown the real causes of discharge against medical advice. PMID:24554800

  20. Evaluation of self-reported medication adherence and its associated factors among epilepsy patients in Hospital Kuala Lumpur

    PubMed Central

    Molugulu, Nagashekhara; Gubbiyappa, Kumar Shiva; Vasudeva Murthy, C. R.; Lumae, Lim; Mruthyunjaya, Anil Tumkur

    2016-01-01

    Introduction: Reports on medication adherence and its associated factors in patients with epilepsy in South East Asian countries are lacking. The primary purpose of this study was to assess the degree of medication adherence and its relationship with patient's satisfaction, psychosocial factors, quality of life and mental health in a sample of Malaysian epilepsy patients. Methodology: It is a cross-sectional study and was carried out in the outpatient Neurology Department of Hospital Kuala Lumpur, Malaysia (n=272). Data was collected by administering the structured questionnaire. Results and Discussion: Results showed that 49.3% of the epilepsy patients were non-adherent to their prescribed regimen. Univariate analysis showed significant associations between medication adherence and the following factors: race, seizure frequency, overall patient satisfaction, medication taste and smell, medication cost and physical appearance, medication effectiveness, complexity of medication regimen, patient barrier, patient understanding, patient role functioning, patient positivity, vitality and general interest. Multiple regression analysis indicated that factors that are influencing medication adherence are seizure frequency (P = 0.048), overall patient satisfaction (P = 0.043) and patient understanding about their illness (P = 0.001). The model chosen for testing the relationship between medication adherence and its associated factors give an R2 value of 25.2% with an adjusted R2 of 21.4%. The F value was also significant (P = 0.000). Based on the research findings, the researchers recommends that clinicians need to play a vital role in educating the patients on their disease conditions. By educating the patients on nature of epilepsy, different modalities of treatment and benefits of adherence to treatment will help in the better adherence and management. PMID:27999469

  1. Changing Environment and the Academic Medical Center: The Johns Hopkins Hospital.

    ERIC Educational Resources Information Center

    Heyssel, Robert M.

    1989-01-01

    Johns Hopkins Hospital expanded its health care delivery capabilities and strengthened its position in the marketplace by acquisitions of and mergers with other hospitals and a health maintenance organization. The resulting conglomerate has achieved its goals of expanding patient care, broadening the patient base, and enlarging the asset base and…

  2. Children and Young People in Hospitals: Doing Youth Work in Medical Settings

    ERIC Educational Resources Information Center

    Yates, Scott; Payne, Malcolm; Dyson, Simon

    2009-01-01

    Young people in hospitals face a range of challenging issues. Many have chronic conditions and experience stigmatisation, anxiety and family conflict. They may also experience social isolation in hospitals, separation from local peer groups and sources of support, and separation from trusted carers during transition to adult care. These issues can…

  3. Saint Anthony Hospital: Infusing Developmental and Family Support Services in Community-Based Medical Practice

    ERIC Educational Resources Information Center

    Casas, Paula; Isarowong, Nucha

    2015-01-01

    Physicians affiliated with small community hospitals face numerous barriers to using developmentally oriented best practices in primary care with young children. Saint Anthony Hospital's Developmental Support Project model promotes improved developmental outcomes for children through two complementary strands of services: (a) training and…

  4. Using scientific evidence to improve hospital library services: Southern Chapter/Medical Library Association journal usage study.

    PubMed Central

    Dee, C R; Rankin, J A; Burns, C A

    1998-01-01

    BACKGROUND: Journal usage studies, which are useful for budget management and for evaluating collection performance relative to library use, have generally described a single library or subject discipline. The Southern Chapter/Medical Library Association (SC/MLA) study has examined journal usage at the aggregate data level with the long-term goal of developing hospital library benchmarks for journal use. METHODS: Thirty-six SC/MLA hospital libraries, categorized for the study by size as small, medium, or large, reported current journal title use centrally for a one-year period following standardized data collection procedures. Institutional and aggregate data were analyzed for the average annual frequency of use, average costs per use and non-use, and average percent of non-used titles. Permutation F-type tests were used to measure difference among the three hospital groups. RESULTS: Averages were reported for each data set analysis. Statistical tests indicated no significant differences between the hospital groups, suggesting that benchmarks can be derived applying to all types of hospital libraries. The unanticipated lack of commonality among heavily used titles pointed to a need for uniquely tailored collections. CONCLUSION: Although the small sample size precluded definitive results, the study's findings constituted a baseline of data that can be compared against future studies. PMID:9681164

  5. Dispensing medications at the hospital upon discharge from an emergency department.

    PubMed

    Yamamoto, Loren G; Manzi, Shannon; Shaw, Kathy N; Ackerman, Alice D; Chun, Thomas H; Conners, Gregory P; Dudley, Nanette C; Fein, Joel A; Fuchs, Susan M; Moore, Brian R; Selbst, Steven M; Wright, Joseph L

    2012-02-01

    Although most health care services can and should be provided by their medical home, children will be referred or require visits to the emergency department (ED) for emergent clinical conditions or injuries. Continuation of medical care after discharge from an ED is dependent on parents or caregivers' understanding of and compliance with follow-up instructions and on adherence to medication recommendations. ED visits often occur at times when the majority of pharmacies are not open and caregivers are concerned with getting their ill or injured child directly home. Approximately one-third of patients fail to obtain priority medications from a pharmacy after discharge from an ED. The option of judiciously dispensing ED discharge medications from the ED's outpatient pharmacy within the facility is a major convenience that overcomes this obstacle, improving the likelihood of medication adherence. Emergency care encounters should be routinely followed up with primary care provider medical homes to ensure complete and comprehensive care.

  6. Multifaceted Intervention to Prevent Venous Thromboembolism in Patients Hospitalized for Acute Medical Illness: A Multicenter Cluster-Randomized Trial

    PubMed Central

    Roy, Pierre-Marie; Rachas, Antoine; Meyer, Guy; Le Gal, Grégoire; Durieux, Pierre; El Kouri, Dominique; Honnart, Didier; Schmidt, Jeannot; Legall, Catherine; Hausfater, Pierre; Chrétien, Jean-Marie; Mottier, Dominique

    2016-01-01

    Background Misuse of thromboprophylaxis may increase preventable complications for hospitalized medical patients. Objectives To assess the net clinical benefit of a multifaceted intervention in emergency wards (educational lectures, posters, pocket cards, computerized clinical decision support systems and, where feasible, electronic reminders) for the prevention of venous thromboembolism. Patients/Methods Prospective cluster-randomized trial in 27 hospitals. After a pre-intervention period, centers were randomized as either intervention (n = 13) or control (n = 14). All patients over 40 years old, admitted to the emergency room, and hospitalized in a medical ward were included, totaling 1,402 (712 intervention and 690 control) and 15,351 (8,359 intervention and 6,992 control) in the pre-intervention and intervention periods, respectively. Results Symptomatic venous thromboembolism or major bleeding (primary outcome) occurred at 3 months in 3.1% and 3.2% of patients in the intervention and control groups, respectively (adjusted odds ratio: 1.02 [95% confidence interval: 0.78–1.34]). The rates of thromboembolism (1.9% vs. 1.9%), major bleedings (1.2% vs. 1.3%), and mortality (11.3% vs. 11.1%) did not differ between the groups. Between the pre-intervention and intervention periods, the proportion of patients who received prophylactic anticoagulant treatment more steeply increased in the intervention group (from 35.0% to 48.2%: +13.2%) than the control (40.7% to 44.1%: +3.4%), while the rate of adequate thromboprophylaxis remained stable in both groups (52.4% to 50.9%: -1.5%; 49.1% to 48.8%: -0.3%). Conclusions Our intervention neither improved adequate prophylaxis nor reduced the rates of clinical events. New strategies are required to improve thromboembolism prevention for hospitalized medical patients. Trial Registration ClinicalTrials.gov NCT01212393 PMID:27227406

  7. Managing Legal Affairs.

    ERIC Educational Resources Information Center

    Weeks, Richard H.

    2001-01-01

    Discusses school administrators' legal-affairs management responsibilities regarding legal advice, law versus ethics, and sources of law. Suggests strategies for retaining and managing legal counsel and avoiding situations involving litigation, torts, and conflict resolution. Explains general counsel services; outlines education,…

  8. Soviet Union, Military Affairs

    DTIC Science & Technology

    2007-11-02

    agency of the Soviet Union. Permission for further reproduction must be obtained from copyright owner. SOVIET UNION MILITARY AFFAIRS CONTENTS...internationalists, it has always embodied the inviolable friendship of the peoples of the USSR. But are some of us not hypnotized by this principle

  9. Student Affairs Researcher: Information Broker.

    ERIC Educational Resources Information Center

    Hadley, Thomas D.

    1999-01-01

    Examines the skills and research tools necessary for the student affairs researcher to become an agent for organizational learning within the student affairs division and the institution. Draws upon Peter Senge's theory of "The Learning Organization" and discusses the resulting implications for student affairs researchers. (GCP)

  10. Misoprostol use in medical evacuation of spontaneous miscarriage: Pilot drug use evaluation study at the Women's Hospital in Qatar

    PubMed Central

    ElSalem, Samah A.; AlSaad, Doua T.; Abdulrouf, Palli V.; Ahmed, Afif A.; AlHail, Moza S.

    2016-01-01

    Background: Misoprostol is a synthetic prostaglandin E1 that induces cervical effacement and uterine contractions at all gestational ages, thus facilitating uterine evacuation and pregnancy termination. Successful medical evacuation of spontaneous miscarriage with minimal adverse effects can be performed using misoprostol-only regimen if given as indicated and if the administered dose, frequency of the dosage, and number of total doses are appropriate. Aim: To conduct a drug use evaluation by investigating indications, appropriateness of dosing, and clinical outcome of misoprostol-only regimen when used for medical evacuation of spontaneous miscarriage at the Women's Hospital in Doha, Qatar. Materials and methods: A retrospective descriptive drug use evaluation was conducted on women with spontaneous miscarriage who received misoprostol for medical evacuation during August 2013. The current practice at the Women's Hospital was compared with the recommendation from the World Health Organization (WHO). Patients were stratified into three groups based on weeks of amenorrhea. Results: A total of 107 patients received misoprostol during August 2013, of which 33 (31%) were included in the study. In these patients, the main indication for misoprostol use was missed miscarriage (54.5%). In the group of patients at ≤ 9 weeks of gestation, 80% received an initial dose of 800 μg, 80% received frequency within the WHO recommendation, and the majority had surgical evacuation (80%). In the group of patients at 10–12 weeks of gestation, more than 80% received an initial dose of 800 μg, 6% received frequency within the WHO recommendation, and more than 75% had successful medical evacuation. In the group of patients at 13–22 weeks of gestation, more than 80% received an initial dose of 400 μg, more than 80% received frequency within the WHO recommendation, and 54% had successful medical evacuation. Overall, more than 70% of the patients received ≤ 3 total doses of

  11. Inappropriateness of medication prescriptions about chronic kidney disease patients without dialysis therapy in a Chinese tertiary teaching hospital

    PubMed Central

    Yang, Ping; Chen, Na; Wang, Rong-Rong; Li, Lu; Jiang, Sai-Ping

    2016-01-01

    Background With the increasing incidence rate of chronic kidney disease (CKD), inappropriate use of medicine in CKD patients is an important issue, as it may cause adverse effects in patients and progression to chronic renal failure. Objective The aim of this study is to assess the frequency of inappropriate medicine use among CKD patients. Methods A cross-sectional study was conducted from November 1 to December 1, 2014 in a Chinese teaching tertiary hospital. All medication prescriptions for CKD patients with serum creatinine level above normal value were enrolled. The prescriptions, including unreasonable dosage, contraindicated, and cautiously used medicines in CKD patients, were evaluated and the related medications were also analyzed and classified. Results Two hundred and two patients were included, and a total of 1,733 lines of medication prescriptions were evaluated. The prevalence of inappropriate medication prescriptions in CKD patients was 15.18%, of which, unreasonable dosage (n=56), contraindicated (n=46), and cautiously used medicines (n=161) accounted for 3.23%, 2.65%, and 9.29%, respectively. Spearman’s rank correlation coefficient implied that there was a significant correlation between the severity of renal insufficiency and frequency of inappropriate medication prescriptions (P=0.02, r=0.056). Among the inappropriate medication prescriptions, nutraceutical and electrolytes (n=65, 24.71%), cardiovascular drugs (n=61, 23.19%), and antimicrobial drugs (n=55, 20.91%) represented the top three medicine categories in CKD patients. Conclusion The study confirmed that inappropriate medication prescriptions were prevalent in CKD patients. Improving the quality of medication prescriptions in CKD patients is necessary. PMID:27785039

  12. The effect of pre-existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (VA) medical center.

    PubMed

    Wadia, Roxanne J; Yao, Xiaopan; Deng, Yanhong; Li, Jia; Maron, Steven; Connery, Donna; Gunduz-Bruce, Handan; Rose, Michal G

    2015-09-01

    There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15-20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care.

  13. Questions and Answers Regarding the 2009 New Source Performance Standards (NSPS) Emissions Guidelines, and State Plan Process for Hospital, Medical, and Infectious Waste Incinerators (HMIWI)

    EPA Pesticide Factsheets

    This July 2011 document contains questions and answers on the Hospital/Medical/Infectious Waste Incinerators (HMIWI) regulations. The questions cover topics such as state plan requirements, compliance, applicability, operator training, and more.

  14. [Development of a microbiology data warehouse (Akita-ReNICS) for networking hospitals in a medical region].

    PubMed

    Ueki, Shigeharu; Kayaba, Hiroyuki; Tomita, Noriko; Kobayashi, Noriko; Takahashi, Tomoe; Obara, Toshikage; Takeda, Masahide; Moritoki, Yuki; Itoga, Masamichi; Ito, Wataru; Ohsaga, Atsushi; Kondoh, Katsuyuki; Chihara, Junichi

    2011-04-01

    The active involvement of hospital laboratory in surveillance is crucial to the success of nosocomial infection control. The recent dramatic increase of antimicrobial-resistant organisms and their spread into the community suggest that the infection control strategy of independent medical institutions is insufficient. To share the clinical data and surveillance in our local medical region, we developed a microbiology data warehouse for networking hospital laboratories in Akita prefecture. This system, named Akita-ReNICS, is an easy-to-use information management system designed to compare, track, and report the occurrence of antimicrobial-resistant organisms. Participating laboratories routinely transfer their coded and formatted microbiology data to ReNICS server located at Akita University Hospital from their health care system's clinical computer applications over the internet. We established the system to automate the statistical processes, so that the participants can access the server to monitor graphical data in the manner they prefer, using their own computer's browser. Furthermore, our system also provides the documents server, microbiology and antimicrobiotic database, and space for long-term storage of microbiological samples. Akita-ReNICS could be a next generation network for quality improvement of infection control.

  15. Knowledge and practices of obtaining informed consent for medical procedures among specialist physicians: questionnaire study in 6 Croatian hospitals.

    PubMed

    Jukic, Marko; Kvolik, Slavica; Kardum, Goran; Kozina, Slavica; Tomic Juraga, Ana

    2009-12-01

    AIM. To assess physicians' knowledge and practices for obtaining patients' informed consent to medical procedures. METHODS. An anonymous and voluntary survey of knowledge and practices for obtaining informed consent was conducted among 470 physicians (63% response rate) working in 6 hospitals: 93 specialists in anesthesiology, 166 in internal medicine, and 211 in surgery. RESULTS. Only 54% physicians were acquainted with the fact that the procedure for obtaining consent was regulated by the law. Internists and surgeons were better informed than anesthesiologists (P=0.024). More than a half of respondents (66%) were familiar with the fact that a law on patient rights was passed in Croatia; there were no differences among different specialties (P=0.638). Only 38% of the physicians were fully informed about the procedure of obtaining consent. Internists and surgeons provided detailed information to the patient in 33% of the cases and anesthesiologists in 16% of the cases (P<0.050). Internists reported spending more time on informing the patient than anesthesiologists and surgeons (P<0.001). There were no differences in knowledge and practices for obtaining informed consent between physicians working in university and those working in community hospitals (P> or =0.05 for all questions). CONCLUSION. Physicians in Croatia have no formal education on informed consent and implement the informed consent process in a rather formal manner, regardless of the type of hospital or medical specialty. Systemic approach at education and training at the national level is needed to improve the informed consent process.

  16. The role of patient-provider interactions: Using an accounts framework to explain hospital discharges against medical advice.

    PubMed

    Lekas, Helen-Maria; Alfandre, David; Gordon, Peter; Harwood, Katherine; Yin, Michael T

    2016-05-01

    The phenomenon of leaving the hospital against medical advice (AMA) despite being quite common and associated with significant deleterious health outcomes remains inadequately understood and addressed. Researchers have identified certain patient characteristics as predictors of AMA discharges, but the patients' reasons for these events have not been comprehensively explored. Moreover, because the medical authority model dominates this research area, providers' experiences of AMA discharges remain unstudied. We examined the AMA discharge from a patient-centered perspective by analyzing the content of notes providers generate to record such events. We analyzed providers' notes for all inpatients with a primary HIV diagnosis (N = 33) that, in 2012, left an urban hospital AMA. Applying the Scott and Lyman accounts framework, we identified that the notes constituted records of providers' and patients' excuses and justifications for failing to meet the expectations of a provider offering patient-centered care and a compliant patient receiving care. Alongside the patients' reasons for leaving AMA, the notes also revealed the providers' reasons for honoring or discrediting the patients' accounts. The style of the accounts and the professional status of the notes' authors enabled us to contextualize the production and sharing of AMA notes in the hospital hierarchy. Conceptualizing AMA notes as dyadic accounts elicited specific factors that challenge the patient-provider relationship, and generated insights on how to strengthen it, and thus decrease the rates of AMA discharges and their associated health effects.

  17. A Qualitative Analysis of Resource Sharing Agreements Between Naval Hospital Great Lakes and North Chicago Veterans Affairs Medical Center: The Iron Triangle Theory of Healthcare Integration

    DTIC Science & Technology

    2005-05-19

    62 Financial Accountability. ...................................................................................... 62 Culture and...analysis of the internal and external environment provides an awareness of organizational expectations and cultural norms integral to consider when planning...they can involve a single product line or envelope the joining of governance boards, organizational structures, and cultures Qualitative Analysis of

  18. 38 CFR 17.52 - Hospital care and medical services in non-VA facilities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... World War I or who is in receipt of increased pension or additional compensation based on the need for... life or health of a veteran which developed during authorized travel to the hospital, or...

  19. Effectiveness of off-the-shelf footwear in reducing foot pain in Australian Department of Veterans’ Affairs recipients not eligible for medical grade footwear: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Foot pain is highly prevalent in older people, and in many cases is associated with wearing inadequate footwear. In Australia, the Department of Veterans’ Affairs (DVA) covers the costs of medical grade footwear for veterans who have severe foot deformity. However, there is a high demand for footwear by veterans with foot pain who do not meet this eligibility criterion. Therefore, this article describes the design of a randomized controlled trial to evaluate the effectiveness of low cost, off-the-shelf footwear in reducing foot pain in DVA recipients who are currently not eligible for medical grade footwear. Methods One hundred and twenty DVA clients with disabling foot pain residing in Melbourne, Australia, who are not eligible for medical grade footwear will be recruited from the DVA database, and will be randomly allocated to an intervention group or a ‘usual care’ control group. The intervention group will continue to receive their usual DVA-subsidized podiatry care in addition to being provided with low-cost, supportive footwear (Dr Comfort®, Vasyli Medical, Labrador, Queensland, Australia). The control group will also continue to receive DVA-subsidized podiatry care, but will not be provided with the footwear until the completion of the study. The primary outcome measure will be pain subscale on the Foot Health Status Questionnaire (FHSQ), measured at baseline and 4, 8, 12 and 16 weeks. Secondary outcome measures measured at baseline and 16 weeks will include the function subscale of the FHSQ, the Manchester Foot Pain and Disability Index, the number of DVA podiatry treatments required during the study period, general health-related quality of life (using the Short Form 12® Version 2.0), the number of falls experienced during the follow-up period, the Timed Up and Go test, the presence of hyperkeratotic lesions (corns and calluses), the number of participants using co-interventions to relieve foot pain, and participants’ perception of

  20. Antidepressant adherence after psychiatric hospitalization

    PubMed Central

    Zivin, Kara; Ganoczy, Dara; Pfeiffer, Paul N.; Miller, Erin M.; Valenstein, Marcia

    2010-01-01

    Objective Depressed patients discharged from psychiatric hospitalizations face increased risks for adverse outcomes including suicide, yet antidepressant adherence rates during this high-risk period are unknown. Using Veterans Affairs (VA) data, we assessed antidepressant adherence and predictors of poor adherence among depressed veterans following psychiatric hospitalization. Method We identified VA patients nationwide with depressive disorders who had a psychiatric hospitalization between April 1, 1999 and September 30, 2003, received antidepressant medication, and had an outpatient appointment following discharge. We calculated medication possession ratios (MPRs), a measure of medication adherence, within three and six months following discharge. We assessed patient factors associated with having lower levels of adherence (MPRs <0.8) after discharge. Results 20,931 and 23,182 patients met criteria for three and six month MPRs. The mean three month MPR was 0.79 (s.d.=0.37). The mean six month MPR was 0.66 (s.d.=0.40). Patients with poorer adherence were male, younger, non-white, and had a substance abuse disorder, but were less likely to have PTSD or other anxiety disorders. Conclusion Poor antidepressant adherence is common among depressed patients after psychiatric hospitalization. Efforts to improve adherence at this time may be critical in improving the outcomes of these high-risk patients. PMID:19609666