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Sample records for city general hospital

  1. E. coli outbreak in a neonate intensive care unit in a general hospital in Mexico City.

    PubMed

    Carrillo-Casas, Erika Margarita; Suástegui-Urquijo, Zaydy; Arroyo-Escalante, Sara; Morales-Espinosa, Rosario; Moncada-Barrón, David; Hernández-Delgado, Lorena; Méndez-Sánchez, José Luis; Delgado-Sapién, Gabriela; Navarro-Ocaña, Armando; Manjarrez-Hernández, Ángel; Xicohtencatl-Cortes, Juan; Hernández-Castro, Rigoberto

    2013-05-01

    Nosocomial infections are a major cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs). The aim of this paper was to describe an outbreak of Escherichia coli among infants admitted to the NICU of the General Hospital "Dr. Manuel Gea Gonzalez" in May of 2008. The isolated E. coli strains were identified using standard biochemical methods. The susceptibilities of these strains were analysed by determining their minimal inhibitory concentrations. Following this, their molecular relationships to each other were assessed by pulsed field gel electrophoresis (PFGE) analysis and corroborated by serology. Twelve E. coli strains were isolated from blood, urine, or indwelling catheter samples from five cases of preterm infants within a 3-day period. Patients were admitted to the NICU of the general hospital and, during the outbreak, developed sepsis caused by E. coli. For four of the patients, the average age was 23 days, while one patient was a 3-month-old infant. Prior to sepsis, the infants had received assisted ventilation and hyperalimentation through a central venous catheter. Two profiles were observed by PFGE; profile A was identified as the outbreak's cause and an outcome of cross-infection, while profile B showed genetic differences but serologically it was identified as part of the same serotype. We conclude that E. coli colonised the patients through horizontal transmission. A focal source of the microorganism in this outbreak was not identified, but cross-transmission through handling was the most probable route.

  2. 26. 'CITY HOSPITAL, BLACKWELL'S ISLAND.' (Source: New York City Department ...

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

    26. 'CITY HOSPITAL, BLACKWELL'S ISLAND.' (Source: New York City Department of Public Finance, Real Estate Owned by the City of New York under Jurisdiction of the Department of Public Charities, 1909.) - Island Hospital, Roosevelt Island, New York County, NY

  3. Oxacilin-resistant Coagulase-negative staphylococci (CoNS) bacteremia in a general hospital at São Paulo city, Brasil.

    PubMed

    d'Azevedo, P A; Secchi, C; Antunes, A L S; Sales, T; Silva, F M; Tranchesi, R; Pignatari, A C C

    2008-10-01

    In the last decades, coagulase-negative staphylococci (CoNS), especially Staphylococcus epidermidis have become an important cause of bloodstream infections. In addition, rates of methicillin-resistance among CoNS have increased substantially, leading to the use of glicopeptides for therapy. The objective of this study was to evaluate eleven consecutives clinically relevant cases of oxacillin-resistant CoNS bacteremia in a general hospital localized in São Paulo city, Brazil. Five different species were identified by different phenotypic methods, including S. epidermidis (5), S. haemolyticus (3), S. hominis (1), S. warneri (1) and S. cohnii subsp urealyticus (1). A variety of Pulsed Field Gel Electrophoresis profiles was observed by macrorestriction DNA analysis in S. epidermidis isolates, but two of three S. haemolyticus isolates presented the same profile. These data indicated the heterogeneity of the CoNS isolates, suggesting that horizontal dissemination of these microorganisms in the investigated hospital was not frequent. One S. epidermidis and one S. haemolyticus isolates were resistant to teicoplanin and susceptible to vancomycin. The selective pressure due to the use of teicoplanin in this hospital is relevant.

  4. Specialty hospitals: can general hospitals compete?

    PubMed

    Dummit, Laura A

    2005-07-13

    The rapid increase in specialty cardiac, surgical, and orthopedic hospitals has captured the attention of general hospitals and policymakers. Although the number of specialty hospitals remains small in absolute terms, their entry into certain health care markets has fueled arguments about the rules of "fair" competition among health care providers. To allow the smoke to clear, Congress effectively stalled the growth in new specialty hospitals by temporarily prohibiting physicians from referring Medicare or Medicaid patients to specialty hospitals in which they had an ownership interest. During this 18-month moratorium, which expired June 8, 2005, two mandated studies of specialty hospitals provided information to help assess their potential effect on health care delivery. This issue brief discusses the research on specialty hospitals, including their payments under Medicare's hospital inpatient payment system, the quality and cost of care they deliver, their effect on general hospitals and on overall health care delivery, and the regulatory and legal environment in which they have proliferated. It concludes with open issues concerning physician self-referral and the role of general hospitals in providing a range of health care services.

  5. Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

    PubMed Central

    Gibbs, C.; Watson, R.; Singh, S.; Lip, G.

    2000-01-01

    The aim of the study was to determine the aetiology of large and symptomatic pericardial effusions and to review the management and subsequent outcome. A survey was done on a consecutive cases of patients who had undergone percutaneous pericardiocentesis over a 10 year period in a city centre general hospital serving a multiethnic catchment population. In all, 46 patients (24 male, 22 female; age range 16 to 90 years, mean 54 years) underwent a total of 51 pericardial drainage procedures (or attempted pericardiocentesis) between 1989 and 1998. Malignancy (44%), tuberculosis (26%), idiopathic (11%), and post-cardiac surgery (9%) were the most common causes of pericardial effusion. The most common presenting symptoms were breathlessness (90%), chest pain (74%), cough (70%), abdominal pain (61%) (presumed to be related to hepatic congestion), and unexplained fever (28%). In the 12 cases of tuberculous pericarditis, nine occurred in patients of Indo-Asian origin, and three in patients of Afro-Caribbean origin. Fever, night sweats, and weight loss were common among these patients, occurring in over 80% of cases of tuberculous pericarditis. Pulsus paradoxus was the most specific sign (100%) for the presence of echocardiographic features of tamponade, with strongest positive predictive value (100%). Although malignancy remains the most common cause in developed countries, tuberculous disease should be considered in patients from areas where tuberculosis is endemic. Percutaneous pericardiocentesis remains an effective measure for the immediate relief of symptoms in patients with cardiac tamponade, although its diagnostic yield in tuberculous pericarditis is relatively low.


Keywords: tuberculosis; pericardial effusions; percutaneous pericardiocentesis PMID:11085787

  6. Right half of CO17229. Fitzsimons General Hospital, Bounded by ...

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

    Right half of CO-172-29. - Fitzsimons General Hospital, Bounded by East Colfax to south, Peoria Street to west, Denver City/County & Adams County Line to north, & U.S. Route 255 to east, Aurora, Adams County, CO

  7. Antidepressants in the general hospital.

    PubMed Central

    Gelenberg, A. J.

    1979-01-01

    An approach to the use of antidepressant medication in the general hospital is presented. The type of depression most likely to respond to chemotherapy is described, categories of available antidepressant agents are discussed, and relevant pharmacologic aspects are outlined. This paper suggests clinical guidelines for the use of these drugs, particularly in medical and surgical patients. PMID:455184

  8. 3. Hospital Point, general view toward Portsmouth Naval Hospital Building ...

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

    3. Hospital Point, general view toward Portsmouth Naval Hospital Building showing cannon (at left) and Saunders Monument (at right in distance), view to southwest - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  9. 25. 'VIEW OF CITY HOSPITAL DISTRICT, BLACKWELL'S ISLAND, FROM MANHATTAN ...

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

    25. 'VIEW OF CITY HOSPITAL DISTRICT, BLACKWELL'S ISLAND, FROM MANHATTAN SHORE.' (Source: New York City Department of Public Finance, Real Estate Owned by the City of New York Under Jurisdiction of the Department of Public Charities, 1909.) - Island Hospital, Roosevelt Island, New York County, NY

  10. [Pericarditis in a general hospital].

    PubMed

    Faintuch, J J; Friedmann, A A

    1996-01-01

    The authors studied 57 patients with pericarditis in the Ward of Internal Medicine of the University of São Paulo from January 1993 through May 1995. A comparison was made with the results of a similar study performed in the same hospital in 1989. Increasing frequency of pericarditis was verified. Tuberculosis, formerly the most frequent etiologic agent, decreased while neoplastic diseases became more common.

  11. Examining General Hospitals' Smoke-Free Policies

    ERIC Educational Resources Information Center

    Whitman, Marilyn V.; Harbison, Phillip Adam

    2010-01-01

    Purpose: This paper aims to examine the level of smoke-free policies in general hospitals and the barriers faced in implementing restrictive policies banning smoking inside buildings and on surrounding grounds. Design/methodology/approach; A survey was developed to gather data on hospitals' current smoke-free policies, including the challenges…

  12. Massachusetts General Hospital starts own degree programs.

    PubMed

    1979-01-01

    Massachusetts General Hospital has established a new Education Division that administers various degree programs in seven professional fields. Major emphasis is on interdisciplinary study and integration of the academic and the clinical components of training.

  13. 1. GENERAL PERSPECTIVE VIEW OF TOWN OF ATLANTIC CITY, LOOKING ...

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

    1. GENERAL PERSPECTIVE VIEW OF TOWN OF ATLANTIC CITY, LOOKING NORTH FROM NINTH FLOOR OF CEASAR'S PARKING GARAGE ON KENTUCKY AVENUE - Town of Atlantic City, North end of Absecon Island, South of Absecon Channel, Atlantic City, Atlantic County, NJ

  14. HIV-1 seroprevalence in an inner-city public hospital.

    PubMed Central

    Nagachinta, T.; Brown, C. P.; Cheng, F.; Temple, W.; Kerndt, P. R.; Janssen, R. S.

    1994-01-01

    In a hospital-based seroprevalence survey for human immunodeficiency virus type 1 (HIV-1) infection, a stratified sampling method based on age and gender was used to collect 5429 blood samples at an inner-city hospital. Sentinel Hospital Surveillance System (SHSS) criteria developed by the Centers for Disease Control and Prevention were used to classify patient diagnoses into two categories by the likelihood of being associated with HIV-1 infection. The two categories were those with high likelihood of association with HIV-1 (SHSS-ineligible) and those with low likelihood of association with HIV-1 infection (SHSS-eligible). Of the 5429 blood samples, 4262 were SHSS-eligible and 1167 were SHSS-ineligible. After personal identifies were removed, specimens were tested by ELISA and confirmed by Western blot analysis. The overall prevalence rate of HIV-1 infection was 0.98%. The seroprevalence rate was almost 2.6 times higher in high-association patients compared with low-association patients (1.89% versus 0.73%, P < .001). Results from this study indicate a high unsuspected HIV-1 seroprevalence rate in a subpopulation (SHSS-eligible) considered to have diagnoses with low likelihood of association with HIV-1 infection. These patients may better approximate HIV-1 seroprevalence in the general population of the area served by the hospital than would a sample of all patients. Monitoring HIV-1 seroprevalence in the SHSS-eligible group will be a useful measure for community serosurveillance for HIV-1 infection. PMID:8046762

  15. Hathaway v. Worcester City Hospital. 22 Mar 1973.

    PubMed

    1973-01-01

    The arguments and findings in the case of Robbie Mae Hathaway, Plaintiff, Appellant, versus Worcester City Hospital et al., (Worcester, Massachusetts), Defendants, Appellees, are presented. The case was heard January 3, 1973 by the United States Court of Appeals, First Circuit, and was decided March 22, 1973. Hathaway's action challenged the city hospital policy barring the use of facilities in connection with consensual sterilization. The appellant, Hathaway, had 12 pregnancies resulting in 8 live children and maintained that her life would be jeopardized by future pregnancies. She challenged as unconstitutional the policy of the Worcester City Hospital barring the use of its facilities in connection with any consensual sterilization. Appellee administrator specifically refused appellant's request that the hospital allow her physicians to perform a tubal ligation at the time of the delivery of her 8th child in April 1971. Despite further requests, the operation was not performed after the delivery. In the interim, the instant suit was filed in the district court seeking declaratory and injunctive relief and damages. Th district court twice dismissed the complaint. The Assistant solicitor's opinion, on which the hospital's policy is based, was that the legality of sterilization procedures was "highly doubtful" in view of the Massachusetts statutes concerning birth control assistance. The U.S. Court of Appeals, First Circuit, reverses and remands for entry of an order declaring the Worceste City Hospital's policy against the use of its facilities in conjunction with sterilization operations unconstitutional and enjoining the individual appellees from enforcing the policy in the future.

  16. [Problems with pregnancy, delivery and puerperium in teenage girls hospitalized in a city hospital].

    PubMed

    Kukulski, P; Kwaśniewski, S; Szymański, J

    1993-08-01

    At the paper the problems of girls hospitalized at the Gynaecological and Obstetrician ward of the hospital situated on the border of city agglomeration were described. The data regards as pregnancy, delivery and puerperium and they were collected in last two years.

  17. 1. GENERAL VIEW OF ENTRANCE INTO ALUMINUM CITY TERRACE ALONG ...

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

    1. GENERAL VIEW OF ENTRANCE INTO ALUMINUM CITY TERRACE ALONG EAST HILL DRIVE. BUILDING 1 ON RIGHT, BUILDING 2 ON LEFT, FACING EAST. - Aluminum City Terrace, East Hill Drive, New Kensington, Westmoreland County, PA

  18. GENERAL HOSPITAL PSYCHIATRY : COST OF ONE VISIT

    PubMed Central

    Sarma, Gopala P.

    2000-01-01

    An analysis of patients attending general hospital psychiatry out-patient (OP) showed that cost of one visit was Rs. 201/- Management's contribution of the total expenditure was 68% and patients' 32%. Salaries accounted for the maximum-48%. This was followea by loss of earnings- 17%. Drugs accounted for less than 10%. If MCI norms are followed, cost of a visit would increase by 61%, drug supply and number of patient's visits remaining the same. PMID:21407953

  19. [Treatment with tuberculostatic drugs: compliance at a general hospital].

    PubMed

    Polo Friz, H; Kremer, L; Acosta, H; Abdala, O; Canova, S; Rojo, S; Roca, G; Daín, A

    1997-01-01

    The purpose of this study was to assess the compliance with tuberculostatic drugs treatment in a public hospital from Córdoba City and to establish the causes of noncompliance. All the patients to which treatment with tuberculostatic drugs was indicated from January 1991 up to December 1994 were included. 45 patients were included: 18 females (40%) and 29 males. Sixteen (35.6%) did not complete the time of treatment indicated. Nine (56.3%) abandoned the treatment 2 months after having initiated it. In the group that did not complete the treatment there was a higher percentage of female patients (62.5%) than in the group that did complete it (27.6%), p = 0.02. There were not statistically significant differences in age, percentages of pulmonar and extrapulmonar tuberculosis and months of treatment indicated between both groups. Thirty-six percent of the patients who abandoned the treatment referred having interrupted it due to their own negligency, knowing the risk of such behavior; 36% suffered side effects and did not come back to hospital; 21% referred having consulted another physician who indicated to interrupt the treatment without performing other tests; and 7% misunderstood the indications. It is concluded that in a general hospital from Córdoba City, the percentage of patients who abandoned tuberculostatic treatment is high. In most cases the cause was related to failures in the conduct of patients, physicians or both.

  20. Acute Surgical Unit at Auckland City Hospital: a descriptive analysis.

    PubMed

    Hsee, Li; Devaud, Marcelo; Middelberg, Lisa; Jones, Wayne; Civil, Ian

    2012-09-01

    Lack of timely assessment and access to acute operating rooms is a worldwide problem and also exists in New Zealand hospitals. To address these issues, an Acute Surgical Unit (ASU) was set up at Auckland City Hospital (ACH) in January 2009. This service has evolved and been modified to address the specific needs of acute surgical patients of ACH. Despite initial challenges inherent to setting up a new service, the Unit has been in steady operation and enhanced its performance over time. This paper is a descriptive analysis of the design of the ACH ASU and discusses some of the indications for streamlining acute surgical services at a large tertiary metropolitan hospital in New Zealand. Performance of the ASU has shown benefits for acute patients and the Hospital. The acute surgical rotation has also been beneficial for surgical training.

  1. [Insomnia: prevalence in Cordoba city hospital].

    PubMed

    Fernandez, M E; Lopez, S M; Cazaux, A; Cambursano, V H; Cortes, J R

    2012-01-01

    Introducción: Insomnio es el trastorno caracterizado por sueño deficiente o de mala calidad con consecuencias diurnas adversas. La prevalencia es 30-50% en adultos y puede llevar al desarrollo de depresión. A pesar de las altas tasas de prevalencia es una entidad poco reconocida, subdiagnosticada y subtratada. Poco se ha publicado acerca de la prevalencia en pacientes con enfermedades crónicas. Objetivos: conocer prevalencia y características clínicas del insomnio en pacientes ambulatorios con enfermedades crónicas. Materiales y métodos: Estudio prospectivo descriptivo observacional de corte transversal. Se definió insomnio en base a los criterios del ICSD-2. La obtención de los datos se realizó por un cuestionario autoadministrado. Resultados: Encuestamos a 100 pacientes que acudieron a la consulta de diferentes especialidades clínicas, edad promedio 50 años. El 57% mujeres. El 69% cumplía criterios de insomnio. Las enfermedades más prevalente fueron HTA: 57%; asma: 20%, diabetes: 18% e hipotiroidismo: 17%. Entre los pacientes con insomnio, el 62% fueron mujeres, el 35 % lo presentaban de manera aislada y el restante 65% presentaba condiciones asociadas a insomnio secundario (el 60% presentaban depresión). La cuarta parte de los pacientes consultó por insomnio alguna vez. La prevalencia de criterios de depresión en los enfermos crónicos analizados fue de 52%, y asciende a 63% en los pacientes que padecen insomnio. Discusión: La prevalencia de insomnio en pacientes con enfermedades crónicas es alta, siendo en pacientes ambulatorios con enfermedades crónicas del 69%, muy superior a la media descripta en la población general. Es una entidad subtratada. Conclusiones: La prevalencia de insomnio en pacientes con enfermedades crónicas es alta, está subdiagnosticada y subtratada. Presenta una asociación significativa con depresión.

  2. Nuclear medicine in district general hospitals.

    PubMed

    Croft, D

    1979-11-24

    Nuclear medicine is a recognised clinical specialty both nationally and internationally. Compared with other countries, it is inadequately developed in Britain, particularly in district general hospitals. To create clinical radioisotope services at district level physicians or radiologists with experience in nuclear medicine need to be trained and appointed. Such appointments would allow facilities to evolve that would provide either a comprehensive nuclear medicine service formed around a physician or an imaging service based on a radiologist. Such units would improve the care of patients at a reasonable recurring cost of 15 pounds--30 pounds per investigation.

  3. Tampa General Hospital "blows the whistle on violence".

    PubMed

    1995-01-01

    At Tampa General Hospital, the professionals in the marketing and media relations department know how to stage a press conference and to get the attention of the media. It goes to the adage when you're buying real estate: location, location, location. Once the journalists were assembled, Tampa General launched its campaign to fight street violence: "Blow the Whistle on Violence." Their timing was aided by the release of the FBI's annual Preliminary Crime Report citing Tampa as the second most dangerous city in which to live. Tampa General's news media specialist Stacey Winn reported that "the day went together just like a puzzle with all the pieces coming together." Those pieces and more are detailed in this issue's cover story on community involvement. Street crime and violence are not unique to Tampa, of course. But with so many victims ending up in Tampa General's emergency room, Winn noted that physicians and nurses felt personally responsible for contributing toward the prevention of cases ending up there. One important element in the hospital's press conference was an appearance by one of the victims of the violence they're striving to prevent. Her appearance and statement to the assembled media representatives significantly enhanced the presentation. "Blow the Whistle on Violence" was a low-cost program with a high return. The potential benefits are enormous.

  4. Changes in HIV-related hospitalizations during the HAART era in an inner-city hospital.

    PubMed

    Pulvirenti, Joseph; Muppidi, Uma; Glowacki, Robert; Cristofano, Michael; Baker, Laurie

    2007-08-01

    We evaluated admissions of HIV-positive persons to an inner-city hospital from 2000 to 2005. There was a decline in the number of substance abusers, homeless persons, injection drug abusers, and African Americans, and there was an increase in patients older than 50 years. There were no significant changes in CD4 counts or in utilization of highly active antiretroviral therapy,m but there were more admissions of persons with HIV RNA levels less than 1000 copies/mL, internal medicine problems, cancers, and skin infections. Changes in the demographics of this patient population may reflect external factors (eg, gentrification of low-income housing areas, opening of a new hospital). Lower viral loads suggest better response in those on a highly active antiretroviral regimen, and changes in diagnoses leading to hospitalization may reflect the aging of the HIV population.

  5. Fitzsimons General Hospital, Physiotherapy & Electrocardiograph Department Building, North of ...

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

    Fitzsimons General Hospital, Physiotherapy & Electrocardiograph Department Building, North of Building No. 516, East of corridor connecting Building No. 511 to Building No. 515, Aurora, Adams County, CO

  6. Environmental triggers of hospital admissions for school-age children with asthma in two British cities.

    PubMed

    Julious, Steven A; Jain, Ritika; Mason, Suzanne

    2012-10-01

    Research has reported seasonal peaks in asthma in school age asthmatic children. The study aimed to assess if hospital admissions could be predicted from the possible environmental triggers using data from two British cities: Aberdeen and Doncaster. However, there were no consistent patterns across the two cities with no clear evidence that hospital admissions could be predicted from environmental data.

  7. [Transparency in public sector acquisitions. The case of hospitals in the City of Buenos Aires].

    PubMed

    Rossi, T; Murillo Fort, C; Puente Karolys, J C

    2002-01-01

    This paper deals with corruption and the lack of transparency in public sector purchases as well as with the main instruments to obtain adequate results in purchase negotiation.Firstly, we discuss how corruption causes concern to national governments, international organizations, academic centers, non-governmental organizations and society in general. The consequences of corruption in Argentina and other Latin American countries are highlighted, especially the effect of corruption on economic growth and the way it creates economic inefficiency and inequality.Secondly, the database created by the Subsecretary of Strategic Management of the Autonomous Government of the City of Buenos Aires is analyzed. The central purpose of this study is to evaluate the impact of the Administrative Reform of 1998 on the prices of 24 products acquired by 13 general acute care hospitals from 1998-1999. The weighted prices, the number of units purchased and the total number of contracts given in this period, as well as the products with the greatest utilization rate, are analyzed. Multivariante analysis was used to identify hospitals with appropriate activity and efficient budget administration (activity and negotiation indicators). Price development was analyzed using the regression technique (ordinary least squares), which demonstrated an 8% reduction in prices for the year 1999. The contribution of each hospital to this variation is presented using dummy variables. Thus, six of the 13 hospitals significantly contributed to the decrease in prices. Of these six, three hospitals also contributed to reduction in price dispersion. The results obtained allow us to conclude that, if public hospitals have adequate purchase negotiation instruments and a uniform legal framework, they can achieve a good level of activity. Furthermore, public hospitals can contribute to reductions in price and price dispersion, at the same time as improving efficiency in the assignation and utilization of

  8. Costs of treating diarrhoea in a children's hospital in Mexico City.

    PubMed Central

    Phillips, M.; Kumate-Rodríguez, J.; Mota-Hernández, F.

    1989-01-01

    The treatment received by children aged under 5 years with diarrhoea was studied in the Hospital Infantil de México (Federico Goméz), Mexico City. The costs of treatment were calculated and estimates were made of how these had changed since the establishment of an oral rehydration unit in the hospital in 1985. The results indicate that drug treatment of outpatients was generally appropriate and inexpensive. In contrast, the cost of drugs for inpatients was considerably higher. The seriousness of the cases justified much of this additional expense for inpatients, but there is evidence that the costs could be reduced further without jeopardizing the quality of the care. Diagnostic tests were relatively expensive, frequently failed to identify diarrhoeal etiology, and their results correlated poorly with the treatment prescribed. The oral rehydration unit resulted in significant savings by causing a 25% fall in the number of inpatients with diarrhoea. PMID:2766450

  9. Definition of the Catchment Area for a Small Rural Hospital Near a Large City

    PubMed Central

    Hogg, William E.

    1984-01-01

    Practicing physicians, hospital directors, members of the hospital's board of directors and government health care planners can benefit from an accurate description of a hospital catchment area. The sociodemographic and geographic characteristics of the catchment area of Wakefield, PQ.'s 31-bed Gatineau Memorial Hospital (GMH) were studied. A randomized, door-to-door survey was conducted among permanent residents in the catchment area. The response rate was 96.1%. We found language to be an important and complex determinant of hospital utilization patterns. Orientation towards the city also affected the pattern of hospital use; those who lived between Wakefield and Ottawa-Hull were more likely to use a city hospital, as were those who had recently moved to the area, or who commuted to work in the city. ImagesFig. 1Fig. 2 PMID:21279011

  10. [Emergency Psychiatric Service in general hospitals: a retrospective study].

    PubMed

    de Sousa, Fernando Sérgio Pereira; da Silva, Cezar Augusto Ferreira; Oliveira, Eliany Nazaré

    2010-09-01

    The Emergency Psychiatric Service in General Hospitals (SEPHG, acronym in Portuguese) is a service included in the psychiatric reform movement. The purpose of the present study was to characterize patients with psychological distress treated at the Dr. Estevam SEPHG, located in Sobral, Cear state. This exploratory study was performed using documental analyses with a quantitative approach, and involved 191 clients treated at the referred SEPHG from January to December 2007. Data collection was performed using a client register book, which contained information obtained from the patients' medical record. There was a predominance of male patients (70.15%), aged 30-49 years (48.71%) and single (74.86%). Most patients were from the city of Sobral (69.64%). In 42.40% of cases, the diagnosis was of alcohol use/abuse. Most clients (66.50%) sought the service voluntarily. After being evaluated at the SEPHG, 43.45% of patients were referred to the local Center for Psychosocial Care-Alcohol and other Drugs. The results emphasize the importance of mental health.

  11. General Revenue Sharing in St. Louis City and County.

    ERIC Educational Resources Information Center

    Wilkinson, Etta Lou; Barnett, Malcolm Joel

    Unlike typical Federal catergorical grants which are highly specific, General Revenue Sharing grants (GRS) are free of restrictions or conditions. The Missouri Advisory Committee, in viewing the impact of GRS on St. Louis City and County, received evidence regarding: (1) the nature of GRS-funded expenditures; (2) the limits of citizen…

  12. 34. August, 1971. PHOTOCOPY: GENERAL VIEW OF CITY OF MERCUR ...

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

    34. August, 1971. PHOTOCOPY: GENERAL VIEW OF CITY OF MERCUR CA. 1910 (THIS HISTORIC VIEW IS TAKEN FROM A PUBLICATION BY UTAH POWER & LIGHT CO. CREDIT REQUESTED TO COMPANY.). (SEE UT-10-2 FOR PRESENT DAY VIEW). - DeLamar Mercur Mines Company, Golden Gate Mill, Ophir, Tooele County, UT

  13. Interior view of pool facing southeast Fitzsimons General Hospital, ...

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

    Interior view of pool facing southeast - Fitzsimons General Hospital, Swimming Pool, Southeast corner of East Nineteenth Place (formerly East McAfee Avenue) & Wheeling Street (formerly South Van Valzah Street), Aurora, Adams County, CO

  14. North side Fitzsimons General Hospital, Swimming Pool, Southeast corner ...

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

    North side - Fitzsimons General Hospital, Swimming Pool, Southeast corner of East Nineteenth Place (formerly East McAfee Avenue) & Wheeling Street (formerly South Van Valzah Street), Aurora, Adams County, CO

  15. Interior view of pool facing northwest Fitzsimons General Hospital, ...

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

    Interior view of pool facing northwest - Fitzsimons General Hospital, Swimming Pool, Southeast corner of East Nineteenth Place (formerly East McAfee Avenue) & Wheeling Street (formerly South Van Valzah Street), Aurora, Adams County, CO

  16. Pool area with mezzanine at rear Fitzsimons General Hospital, ...

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

    Pool area with mezzanine at rear - Fitzsimons General Hospital, Swimming Pool, Southeast corner of East Nineteenth Place (formerly East McAfee Avenue) & Wheeling Street (formerly South Van Valzah Street), Aurora, Adams County, CO

  17. South side facing north Fitzsimons General Hospital, Swimming Pool, ...

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

    South side facing north - Fitzsimons General Hospital, Swimming Pool, Southeast corner of East Nineteenth Place (formerly East McAfee Avenue) & Wheeling Street (formerly South Van Valzah Street), Aurora, Adams County, CO

  18. South side Fitzsimons General Hospital, Swimming Pool, Southeast corner ...

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

    South side - Fitzsimons General Hospital, Swimming Pool, Southeast corner of East Nineteenth Place (formerly East McAfee Avenue) & Wheeling Street (formerly South Van Valzah Street), Aurora, Adams County, CO

  19. Contextual view facing southeast Fitzsimons General Hospital, Swimming Pool, ...

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

    Contextual view facing southeast - Fitzsimons General Hospital, Swimming Pool, Southeast corner of East Nineteenth Place (formerly East McAfee Avenue) & Wheeling Street (formerly South Van Valzah Street), Aurora, Adams County, CO

  20. Front (west side) entrance bay Fitzsimons General Hospital, Swimming ...

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

    Front (west side) entrance bay - Fitzsimons General Hospital, Swimming Pool, Southeast corner of East Nineteenth Place (formerly East McAfee Avenue) & Wheeling Street (formerly South Van Valzah Street), Aurora, Adams County, CO

  1. North side facing south Fitzsimons General Hospital, Swimming Pool, ...

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

    North side facing south - Fitzsimons General Hospital, Swimming Pool, Southeast corner of East Nineteenth Place (formerly East McAfee Avenue) & Wheeling Street (formerly South Van Valzah Street), Aurora, Adams County, CO

  2. Rear (east) side Fitzsimons General Hospital, Swimming Pool, Southeast ...

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

    Rear (east) side - Fitzsimons General Hospital, Swimming Pool, Southeast corner of East Nineteenth Place (formerly East McAfee Avenue) & Wheeling Street (formerly South Van Valzah Street), Aurora, Adams County, CO

  3. East side facing west Fitzsimons General Hospital, Swimming Pool, ...

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

    East side facing west - Fitzsimons General Hospital, Swimming Pool, Southeast corner of East Nineteenth Place (formerly East McAfee Avenue) & Wheeling Street (formerly South Van Valzah Street), Aurora, Adams County, CO

  4. North side. Fitzsimons General Hospital, Physiotherapy & Electrocardiograph Department ...

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

    North side. - Fitzsimons General Hospital, Physiotherapy & Electrocardiograph Department Building, North of Building No. 516, East of corridor connecting Building No. 511 to Building No. 515, Aurora, Adams County, CO

  5. East and north sides. Fitzsimons General Hospital, Physiotherapy & ...

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

    East and north sides. - Fitzsimons General Hospital, Physiotherapy & Electrocardiograph Department Building, North of Building No. 516, East of corridor connecting Building No. 511 to Building No. 515, Aurora, Adams County, CO

  6. [The psychiatric emergency in the general hospital: an analysis of the indications for hospitalization].

    PubMed

    Lozano, M; O'Neill, A; Jorda, L; Vázquez, A

    1992-01-01

    The following is a study of psychiatric emergencies in a General Hospital in Madrid (Spain). The Psychiatric Emergency Service of the Ramón y Cajal Hospital in Madrid received a total of 3,693 patients in 1988. This was 3.4% of patients seen in the General Emergency Service. The study is based on an analysis of the variables that influence a recommendation of hospitalization and their statistical significance. Hospitalization was recommended more frequently in males and those with diagnoses of depression, alcoholism and schizophrenic or paranoid disorders.

  7. A system dynamics approach for hospital waste management in a city in a developing country: the case of Nablus, Palestine.

    PubMed

    Al-Khatib, Issam A; Eleyan, Derar; Garfield, Joy

    2016-09-01

    Hospitals and health centers provide a variety of healthcare services and normally generate hazardous waste as well as general waste. General waste has a similar nature to that of municipal solid waste and therefore could be disposed of in municipal landfills. However, hazardous waste poses risks to public health, unless it is properly managed. The hospital waste management system encompasses many factors, i.e., number of beds, number of employees, level of service, population, birth rate, fertility rate, and not in my back yard (NIMBY) syndrome. Therefore, this management system requires a comprehensive analysis to determine the role of each factor and its influence on the whole system. In this research, a hospital waste management simulation model is presented based on the system dynamics technique to determine the interaction among these factors in the system using a software package, ithink. This model is used to estimate waste segregation as this is important in the hospital waste management system to minimize risk to public health. Real data has been obtained from a case study of the city of Nablus, Palestine to validate the model. The model exhibits wastes generated from three types of hospitals (private, charitable, and government) by considering the number of both inpatients and outpatients depending on the population of the city under study. The model also offers the facility to compare the total waste generated among these different types of hospitals and anticipate and predict the future generated waste both infectious and non-infectious and the treatment cost incurred.

  8. General Surgery Programs in Small Rural New York State Hospitals: A Pilot Survey of Hospital Administrators

    ERIC Educational Resources Information Center

    Zuckerman, Randall; Doty, Brit; Gold, Michael; Bordley, James; Dietz, Patrick; Jenkins, Paul; Heneghan, Steven

    2006-01-01

    Context: Hospitals play a central role in small rural communities and are frequently one of the major contributors to the local economy. Surgical services often account for a substantial proportion of hospital revenues. The current shortage of general surgeons practicing in rural communities may further threaten the financial viability of rural…

  9. A STUDY OF PROBLEM DRINKERS IN A GENERAL HOSPITAL

    PubMed Central

    Babu, R. Sateesh; Sengupta, S.N.

    1997-01-01

    349 new admissions in the wards of Medicine, General Surgery & Orthopedics in a general hospital were screened with MAST & AUDIT for problem use of alcohol. Problem drinking was present in 14.6% of the inpatients. The severity and the need for additional treatment were measured with Addiction Severity Index (ASI). Majority of the patients had problems in more than one ar?a. Nevertheless, only one fourth of the patients were referred for psychiatric treatment. The findings indicate the need to develop services towards the recognition and referrals of the problem drinkers in general hospitals PMID:21584037

  10. The American General Hospital as a Complex Social System

    PubMed Central

    Georgopoulos, Basil S.; Matejko, Aleksander

    1967-01-01

    Based on data from and about the medical, nursing, and administrative staffs in a probability sample of general hospitals, involving 41 institutions and some 2,400 respondents, certain aspects of the hospital social system are examined in each of the following basic problem-areas: organizational and member goal attainment; availability and allocation of organizational resources; organizational coordination; social integration; intraorganizational strain; and organizational adaptation. These areas are examined separately and in relation to one another, as a basis for understanding and assessing the overall effectiveness of the hospital as a complex social organization. Hospital effectiveness is viewed in the context of open system theory, as a joint function of the relative success with which the organization handles its problems in these key areas. Findings concerning a number of social-psychological variables in each area are presented and discussed, with emphasis on the interdependence of the areas and on organizational issues and implications. The results show some of the basic strengths and weaknesses of the system. Important differences associated with hospital size and affiliation are also discussed to illustrate the typical profile of the American general hospital and significant variations from it. Similarly, differences among the principal groups in the system are presented, where appropriate. Finally, promising directions for future organizational research in the hospital field are briefly presented.

  11. [Current status and needs of the department of neurology as a specialized department of a general hospital].

    PubMed

    Yamane, K

    2000-12-01

    In this report, I have summarized the current situation surrounding diagnosis, treatment and related needs in the department of neurology in relation to postgraduate neurology training considered from the standpoint of a specialized department within a general hospital. This summary is based on the responses to a questionnaire that was sent to the persons in charge of education and training at 180 institutions affiliated with the Japanese Society of Neurology and 478 education and training institutions among Japanese city hospitals, excluding university hospitals and special research institutions. Replies were received from 305 hospitals, amounting to a response rate of 63.8%. The number of doctors working in the department of neurology was found to be low at 2 in 84 hospitals and 3 in 65 hospitals. The majority of neurologists at general hospitals are fully engaged in examining outpatients as well as inpatients, and they do not have adequate time for research, education and training and participation in the activities of academic associations. Of the 10 items cited in the questionnaire relating to the types of postgraduate neurology training desired by neurologists employed in general hospitals, the most common selections in order of decreasing frequency were improvement in the capacity to manage common disorders (such as headache, dizziness, numbness, etc.) diagnosed in the outpatient clinic, improvement in the capacity to diagnose the acute phase of cerebral apoplexy, further education about EEG (electroencephalogram) and EMG (electromyogram), and medical ethical issues such as informed consent. The views about postgraduate neurological education and training described in detail in writing by the respondents were as follows. 1) Neurologists required by a city general hospital Numerous respondents commented that the capacity to diagnose medical neurological diseases associated with internal (systemic) medical disorders is needed since there are remarkably few

  12. GENERAL VIEW LOOKING EAST, CITY FARM LANE OVERPASS OVER THE ...

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

    GENERAL VIEW LOOKING EAST, CITY FARM LANE OVERPASS OVER THE CONRAIL (RIGHT) AND CSX (LEFT) RIGHT OF WAYS. STRUCTURES IN FRONT OF TRESTLE INCLUDE (LEFT TO RIGHT): STOREHOUSE, CONSTRUCTION WAREHOUSE AND "HOLE IN THE WALL" (ARCH OPENING AT RIGHT). BEHIND BRIDGE ARE: MACHINE SHOP NO. 2, VERTICAL FURNACE BUILDING, AND PIT FURNACES OF THE STRUCTURAL MILL. STACKS OF THE CARRIE FURNACE CAN BE SEEN ACROSS THE RIVER AT RIGHT REAR. - U.S. Steel Homestead Works, Along Monongahela River, north of Eighth Avenue, Homestead, Allegheny County, PA

  13. The dynamics of psychiatric bed use in general hospitals

    PubMed Central

    Slade, Eric P; Goldman, Howard H

    2014-01-01

    This study examines general hospitals' adjustments in psychiatric bed utilization practices in response to increases in psychiatric inpatient admissions. Using panel data from 439 hospitals, monthly observations (N=7831) between 2007 and 2010 on psychiatric admissions, psychiatric bed occupancy rates, and average length-of-stay were created for psychiatric inpatients. In fixed-effects regressions, an increase in psychiatric admissions was associated with an increase in the probability of psychiatric bed use exceeding 100% occupancy and with a reduction of mean length-of-stay. These results were confirmed in instrumental variables models. General hospitals may dynamically adjust bed utilization practices in response to changing psychiatric bed needs. An implication of this dynamic adjustment model is that bed shortages are likely to be local, transitory events. PMID:24756929

  14. The dynamics of psychiatric bed use in general hospitals.

    PubMed

    Slade, Eric P; Goldman, Howard H

    2015-03-01

    This study examines general hospitals' adjustments in psychiatric bed utilization practices in response to increases in psychiatric inpatient admissions. Using panel data from 439 hospitals, monthly observations (N = 7,831) between 2007 and 2010 on psychiatric admissions, psychiatric bed occupancy rates, and average length-of-stay were created for psychiatric inpatients. In fixed-effects regressions, an increase in psychiatric admissions was associated with an increase in the probability of psychiatric bed use exceeding 100 % occupancy and with a reduction of mean length-of-stay. These results were confirmed in instrumental variables models. General hospitals may dynamically adjust bed utilization practices in response to changing psychiatric bed needs. An implication of this dynamic adjustment model is that bed shortages are likely to be local, transitory events.

  15. Maribor General Hospital from its foundation until World War II.

    PubMed

    Pivec, Gregor

    2006-01-01

    The author describes the history of Maribor General Hospital from its foundation in 1799 until the beginning of World War II. In 1799 the magistrate of the town of Maribor issued a memorandum regarding the establishment of a town hospital in the renovated building of the town hospice, providing space for 24 patients. The work of the hospital was carried out in the former hospice building until 1855. In the period between its establishment and eventual relocation 26 beds were added. The last two decades of the hospital's operation at the original location were marked by the assiduous work of the town's physicist, Dr. Anton Kuker. In the first half of the 19th century, the population of Maribor grew rapidly as a consequence of the construction of the Southern Railway. The town authorities therefore purchased the Prosenjak family villa in the Magdalena suburbs and relocated the hospital to it in 1855, providing 28 rooms for 110 patients. For a whole century, the care of patients was taken over by the Daughters of Charity of Saint Vincent de Paul. The hospital was soon admitting over 1000 patients a year, the most common complaints being pulmonary catarrh, gastritis and fever. In 1872, when the Master of Surgery Feliks Ferk joined the hospital, the internal "medical" and the "external" surgical departments were formed. Although medical studies were not easily accessible, there were a number of Slovene physicians working in the hospital and the town in that period. In the last decades of the 19th century, the hospital was often renovated and enlarged. The infrastructure (telephone, water supply system, heating, lighting) had also been modernized before World War I. In 1914, the first X-ray apparatus was purchased. Between the wars, the hospital's development was boosted by recruitment of the Slovene physicians Ivan Matko, Mirko Cernic, Janko Dernovsek and Hugon Robic. The initial external and medical departments split into several departments: internal medicine, surgery

  16. Psychiatry and the general hospital in an age of uncertainty

    PubMed Central

    LIPSITT, DON R

    2003-01-01

    General hospitals have had an illustrious role in the evolution of psychiatry. They have provided a rich soil for the growth of inpatient psychiatric units, consultation-liaison psychiatry, psychosomatic medicine, med-psych units, outpatient psychiatric clinics, emergency services and a whole spectrum of resources for the communities in which they dwell. In some respects, whether attached to universities or not, they have functioned as small colleges for the education and training of scores of health professionals. In the setting of the general hospital, psychiatry has had opportunities to become remedicalized and integrated into the mainstream of medicine. However, recent trends in health care run the risk of jeopardizing these accomplishments. Managed care has had a profound impact on the way psychiatry is practiced, taught, and reimbursed. Concerns about cost-containment have raised questions about whether the general hospital will remain the best and most economical setting for psychiatric services. If the primacy of the patient is lost, psychiatry's role in the general hospital will be uncertain. The need to safeguard psychiatry's achievements must be a worldwide endeavor. PMID:16946901

  17. Rethinking hospital general ward ventilation design using computational fluid dynamics.

    PubMed

    Yam, R; Yuen, P L; Yung, R; Choy, T

    2011-01-01

    Indoor ventilation with good air quality control minimises the spread of airborne respiratory and other infections in hospitals. This article considers the role of ventilation in preventing and controlling infection in hospital general wards and identifies a simple and cost-effective ventilation design capable of reducing the chances of cross-infection. Computational fluid dynamic (CFD) analysis is used to simulate and compare the removal of microbes using a number of different ventilation systems. Instead of the conventional corridor air return arrangement used in most general wards, air return is rearranged so that ventilation is controlled from inside the ward cubicle. In addition to boosting the air ventilation rate, the CFD results reveal that ventilation performance and the removal of microbes can be significantly improved. These improvements are capable of matching the standards maintained in a properly constructed isolation room, though at much lower cost. It is recommended that the newly identified ventilation parameters be widely adopted in the design of new hospital general wards to minimise cross-infection. The proposed ventilation system can also be retrofitted in existing hospital general wards with far less disruption and cost than a full-scale refurbishment.

  18. [Clinical and epidemiologic characteristics of acute diarrhea in adults at a hospital from Cordoba city].

    PubMed

    Polo Friz, H; Toloza, S; Acosta, H; Toloza, C; Unsain, F; Marconetto, G; Massanet, P; Canova, S; Celli, J; Abdala, O; Gandini, B

    1997-01-01

    The purpose of this work was to assess the clinical and epidemiologic presentation features of adult acute diarrhea in a general hospital form Córdoba City. All the patients older than 14 years old who assisted to the Hospital Nacional de Clínicas Central Guard for acute diarrhea, during the periods: A (15-12-89 to 15-03-90), B (15-12-93 to 15-03-94) and C (15-12-94 to 15-03-95), were included. 594 patients were studied: 337 female (56.7%) and 257 male, 143 in the period A, 250 in B and 201 in C. The means +/- SD age was 34.6 +/- 13.3 and stool loose per day at admission 7.3 +/- 4.7. Eighty six percent of patients presented liquid consistent stool, 89.6% abdominal pain, 44.7% vomiting and 18.8% bloody stools. The rate of patients who consulted Central Guard referring acute diarrhea increased from period A (2.4%) to B (3.61%); p = 0.002 and decreased form B to C (2.85%); p = 0.01. The mean (+/- SD) days transcurred from the beginning of diarrhea episode till consultation was 3.5 +/- 2.7; 2.7 +/- 2.3 y 2.9 +/- 3.5 in the periods A, B and C respectively, statistically significant difference between A and B, p < 0.01. Thirty six percent, 21.1% and 23.1% of patients presented mucus with their stools in the periods A, B and C (p = 0.01), and high temperature 61.1%, 48.1% and 48.5% respectively (p = 0.04). Twenty seven percent of stools samples cultures became positive in the periods A, 17.6% in B and 11.5% in C, statistically significant difference between A and C; p = 0.008. The results show that in a general hospital from Córdoba City the adult acute diarrhea is a frequent cause of consult. In the last years there were modifications in its clinical an epidemiologic presentation features.

  19. Martin Luther King, Jr., General Hospital and, Community Involvement

    PubMed Central

    Humphrey, M. Moss

    1973-01-01

    Community involvement is not just one facet of the new Martin Luther King, Jr., General Hospital's existence. It is the mainstream from which all other activities flow. In addition to meeting the conventional needs of a conventional hospital staff with the core collection of texts and journals, this library goes one step further. It acts as a resource for its community health workers, dietitians, and nurses in their various outreach programs. It serves as a stimulus for the high school or community college student who may be curious about a health career. It also finds time to provide reading material for its patients. PMID:4725343

  20. Martin Luther King, Jr., General Hospital and community involvement.

    PubMed

    Humphrey, M M

    1973-07-01

    Community involvement is not just one facet of the new Martin Luther King, Jr., General Hospital's existence. It is the mainstream from which all other activities flow. In addition to meeting the conventional needs of a conventional hospital staff with the core collection of texts and journals, this library goes one step further. It acts as a resource for its community health workers, dietitians, and nurses in their various outreach programs. It serves as a stimulus for the high school or community college student who may be curious about a health career. It also finds time to provide reading material for its patients.

  1. New ad campaign for St. Mark's Hospital in Salt Lake City: nursing is a calling, not just a career.

    PubMed

    2006-01-01

    A recent advertising campaign for St. Mark's Hospital in Salt Lake City focuses on the hospital's compassion and impeccable nurse care. The effort illustrates that nursing is not just a career, but a calling.

  2. [Evaluation of customer satisfaction with the hospital catering system in the city of Palermo (Italy)].

    PubMed

    Firenze, Alberto; Morici, Mariagrazia; Calamus, Giuseppe; Gelsomino, Viviana; Aprea, Luigi; Di Benedetto, Antonino; Muangala, Muana A Luila; Centineo, Giovanni; Romano, Nino

    2009-01-01

    The aim of the study was to evaluate patients' customer satisfaction with the hospital catering services of two public hospitals and one private sector hospital in the city of Palermo (Italy). A multiple choice questionnaire was administered by face-to-face interview to 207 of 227 hospitalized patients. Positive responses regarding the perceived quality of food were given especially by patients of the private sector hospital, 80% of which reported being satisfied with the catering service. A higher percentage of patients in the private sector hospital were satisfied with the food distribution modalities with respect to the two public hospitals. Only 3% of patients in the private sector hospital required their families to bring food from home, with respect to 7.9% and 30% respectively in the two public hospitals. Private sector patients also reported appreciating the wide availability of food and the help given by health care workers (79% vs a mean of 55% in the two public hospitals). No differences were found amongst hospitals with regards to the hygienic characteristics of meals. The results of this study indicate the need to make changes in the management of the catering service of one of the involved public hospitals especially.

  3. [Hospital information system--project of implementation of SAP information system at Sveti Duh General Hospital].

    PubMed

    Pale, Ivica

    2005-01-01

    Nowadays, as medical and hospital institutions have been facing a growing need of a more efficient provision of healthcare services to patients, with simultaneous complete monitoring of the successfulness of business activities, integrated information systems appear as the logical choice for the support to hospital business processes. The integrated business information system implemented at Sveti Duh General Hospital is a comprehensive system that supports all hospital, clinical and administrative processes, while providing the basis for decision making regarding the patients and hospital management. The system also enables transfer of all data with specific medical business segments such as laboratory device management. The project for the implementation of the information system was realized in accordance with the requests from the Ministry of Health, applying the proven methodology for the execution of such complex projects. The project team consisted of a number of consultants from b4b Co. from Zagreb, as well as Hospital employees. The new information system is completely ready for going live; however, the necessary decisions have to be made first. The application of the system gives the medical staff more time for their professional work with patients, and through longterm collection and analysis of data on symptoms, illnesses and medical treatments, the information system becomes an important tool for the improvement of health and quality of healthcare system in general.

  4. First 101 Robotic General Surgery Cases in a Community Hospital

    PubMed Central

    Robertson, Jarrod C.; Alrajhi, Sharifah

    2016-01-01

    Background and Objectives: The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Methods: Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Results: Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. Conclusion: A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy. PMID:27667913

  5. Hospital morbidity in a medium-sized city: differentials between men and women

    PubMed Central

    de Arruda, Guilherme Oliveira; Molena-Fernandes, Carlos Alexandre; Mathias, Thais Aidar de Freitas; Marcon, Sonia Silva

    2014-01-01

    Objective characterize the hospital morbidity of adults living in the city of Maringá, PR, Brazil, between 2000 and 2011, focusing on the differential between men and women. Method this descriptive study was developed based on data from the Hospital Information System of the Unified Health System in order to investigate the association between groups of hospitalization causes and the average length of hospitalization per gender, in three-year periods. Results the main groups of hospitalization causes for men were: mental disorders, lesions and circulatory diseases; and, among women: tumors, circulatory and genitourinary diseases. Mental disorders and lesions, tumors, circulatory and genitourinary diseases were significantly associated with the female and male genders across the study period. Although not significant, the mean length of hospitalization dropped across the four three-year periods, and only showed a significant difference between men and women in the second triennium. Conclusion differences in the hospital morbidity profile between men and women underline the need for specific health and nursing actions, especially in primary health care, with a view to reducing hospitalizations due to the main groups of causes in the city. PMID:24553699

  6. [Use of antibiotics in a general hospital (author's transl)].

    PubMed

    Escolar, A; Gómez, J; Andreo, J; García-Estany, J; Espi, F; Amorós, T

    1980-10-25

    The utilization of antibiotics at a general hospital has been assessed by retrospectively studying the clinical histories of all patients admitted during the month of April 1978 to the Residencia General de la Ciudad Sanitaria Virgen de la Arrixaca (Murcia, Spain). Medical records were reviewed according to a preestablished protocol. Out of 1.057 patients admitted antibiotics were used in 419 (46%), of whom 189 belonged to the medical services and 302 to the surgical ones. Overall, the surgical services utilized more antibiotics and had less bacteriologic data on their patients. Antibiotics more utilized were ampicillin, which use was generally correct, followed by gentamicin, the G-penicillins, and trimethoprim-sulfamethoxazol. Undesirable side-effects of antibiotic treatment were found in 13 cases (2,6%). Infectious disease of bacterial origin was correctly diagnosed in 40% of the cases, while the diagnosis was doubtful or incorrect in the remaining 60% of cases treated with antibiotics. Appropriate bacteriological data were obtained only in 164 cases (33,4%), with positive results in 75 (49,9%). Independent antibiotics were given in association in 157 cases (31,9%). From this study it can be concluded that the more frequent causes of improper antibiotic utilization were the incorrect clinical diagnosis of bacterial infectious disease, the prophylactic use of antibiotics and the scarcity of bacteriological data. It is therefore suggested that systems of supervision of in-hospital antibiotic prescription be updated and continuous education programs for hospital staff be instituted.

  7. Risk and outcome of aspiration pneumonia in a city hospital.

    PubMed Central

    Jones, J.

    1993-01-01

    Because aspiration pneumonia contributes significantly to morbidity and mortality in hospitalized patients, this study was undertaken to identify risk factors for morbidity and mortality associated with aspiration pneumonia. Patients with a discharge diagnosis of aspiration pneumonia in 1985 and 1990 were studied. Factors associated with death from aspiration pneumonia were: altered mental status, cerebrovascular accident, endotracheal intubation, tachycardia, and hypoxemia. Fever, cough, and unilateral infiltrates on chest radiograph were associated with survival. Attention to proper positioning of comatose patients, aggressive treatment of gastroesophageal reflux, and strict attention to endotracheal tubes and tracheostomies should decrease the morbidity and mortality associated with aspiration pneumonia. PMID:8350375

  8. Abusive Head Trauma at a Tertiary Care Children's Hospital in Mexico City. A Preliminary Study

    ERIC Educational Resources Information Center

    Diaz-Olavarrieta, Claudia; Garcia-Pina, Corina A.; Loredo-Abdala, Arturo; Paz, Francisco; Garcia, Sandra G.; Schilmann, Astrid

    2011-01-01

    Objectives: Determine the prevalence, clinical signs and symptoms, and demographic and family characteristics of children attending a tertiary care hospital in Mexico City, Mexico, to illustrate the characteristics of abusive head trauma among this population. Methods: This is a cross-sectional descriptive study of infants and children under 5,…

  9. Etiology and outcome of chronic renal failure in hospitalized children in Ho Chi Minh City, Vietnam.

    PubMed

    Mong Hiep, Tran Thi; Janssen, Françoise; Ismaili, Khalid; Khai Minh, Dang; Vuong Kiet, Doan; Robert, Annie

    2008-06-01

    The aim of this study was to investigate the etiology and treatment modalities and to determine mortality risks in hospitalized children with chronic renal failure (CRF) in Ho Chi Minh City, Vietnam. We reviewed the records of 310 children with CRF hospitalized in Ho Chi Minh City from January 2001 to December 2005. The average annual number cases was 4.8 per million child population native to Ho Chi Minh City. Median age was 14 years; 85% of patients were in end-stage renal failure. Associated illnesses were anemia (96%), hypertension (74%), and cardiopulmonary diseases (39%). Causes of included glomerulonephritis (30%) and congenital/hereditary anomalies (20%), but in 50% of children, the etiology was unavailable. Seventy-three percent of cases with end-stage renal failure did not benefit from renal replacement therapy. During hospitalization, 47 patients (15%) died. Mortality risks were higher in young children (1-4 years), in boys, and in patients with acquired pathologies. Severe metabolic acidosis was the main predictive factor of mortality by multivariate regression analysis. Our data shows a poor outcome due to late referral and limited facilities for renal replacement therapy in children with CRF hospitalized in Ho Chi Minh City.

  10. Risk Factors for Nonelective Hospitalization in Frail and Older Adult, Inner-City Outpatients.

    ERIC Educational Resources Information Center

    Damush, Teresa M.; Smith, David M.; Perkins, Anthony J.; Dexter, Paul R.; Smith, Faye

    2004-01-01

    Purpose: In our study, we sought to improve the accuracy of predicting the risk of hospitalization and to identify older, inner-city patients who could be targeted for preventive interventions. Design and Methods: Participants (56% were African American) in a randomized trial were from a primary care practice and included 1,041 patients living in…

  11. Comparative Investigation of Health Literacy Level of Cardiovascular Patients Hospitalized in Private and Educational Hospitals of Kerman City, Iran

    PubMed Central

    Malekzadeh, Sajedeh; Azami, Mohammad; Mirzaei, Moghadameh; Motamedi, Fatemeh

    2016-01-01

    Introduction: literacy involves a complex set of abilities to understand and use symbolic systems of a culture for personal development and social development in a diverse set of skills required as an adult to exercise behavior are considered in society Objectives: The aim of this study was to evaluate Comparative investigation of health literacy level of cardiovascular patients hospitalized in private and public educational hospitals of Kerman city Methods: This study used survey methods, analytical and cross-sectional manner. Data was collected through questionnaires distributed among 200 patients of cardiovascular-hospitalization took place in the city of Kerman. To analyze the data in the description of the mean, standard deviation and frequency distribution tables and the level of analysis to determine the relationship between gender and marital status of health literacy test or nonparametric test Mann-Whitney T-Test and, for the relationship between group employment and residence, a one-way analysis of variance or Kruskal-Wallis test, to evaluate the relationship between age and income, Pearson and Spearman correlation to investigate the relationship between level of education and health literacy of SPPS software version 21 was used. Results: The results showed that 10% of patients at educational hospitals in Kerman adequate health literacy, and 48% of patients in private hospitals had adequate health literacy. As a result, there is a significant difference of health literacy between the two types of hospital (p-value <0/0001). Conclusions: The results showed that most patients had inadequate and border health literacy have been. Health plans, preparation of simple educational system and understanding, spending more time and have a discussion with the lower speed In connection with the patient’s doctor and medical staff, Including ways to help patients with low health literacy and improve their health literacy is. PMID:27041812

  12. Analysis of hospitalization occurred due to motorcycles accidents in São Paulo city

    PubMed Central

    Gorios, Carlos; Armond, Jane de Eston; Rodrigues, Cintia Leci; Pernambuco, Henrique; Iporre, Ramiro Ortiz; Colombo-Souza, Patrícia

    2015-01-01

    OBJECTIVE: To characterize the motorcycle accidents occurred in the city of São Paulo, SP, Brazil in the year 2013, with emphasis on information about hospital admissions from SIH/SUS. METHODS: This is a retrospective cross-sectional study. The study covered 5,597 motorcyclists traumatized in traffic accident during the year 2013 occurred in the city of São Paulo. A survey was conducted using secondary data from the Information System of Hospitalization Health System (SIH/SUS). RESULTS: In 2013, in the city of São Paulo there were 5,597 admissions of motorcyclists traumatized in traffic accidents, of which 89.8% were male. The admission diagnosis were: leg fracture, femur fracture, and intracranial injury. CONCLUSION: This study confirms other preliminary studies on several points, among which stands out the highest prevalence of male young adults. Level of Evidence II, Retrospective Study. PMID:26327804

  13. Hospital waste management system - a case study of a south Indian city.

    PubMed

    Hanumantha Rao, P

    2009-06-01

    It is more than 5 years since the prescribed deadline, 30 December 2002, for all categories of towns covered by the Biomedical Waste Management (BMW) Rules 1998 elapsed. Various reports indicate that the implementation of the BMW Rules is not satisfactory even in the large towns and cities in India. Few studies have looked at the ;macro system' of the biomedical waste management in India. In this context the present study describes the role of the important stakeholders who comprise the 'macrosystem' namely the pollution control board, common waste management facilities, municipal corporation, state government (Directorate of Medical Education and Health Systems Development Project), professional agencies such as the India Medical Association and non-governmental organizations, in the implementation of BMW rules in a capital city of a state in south India. Brief descriptions of the ;micro-system' (i.e. biomedical waste management practices within a hospital) of six hospitals of different types in the study city are also presented.

  14. Do university hospitals perform better than general hospitals? A comparative analysis among Italian regions

    PubMed Central

    Grillo Ruggieri, Tommaso; Podetti, Silvia

    2016-01-01

    Objective The aim of this research was to investigate how university hospitals (UHs) perform compared with general hospitals (GHs) in the Italian healthcare system. Design and setting 27 indicators of overall performance were selected and analysed for UHs and GHs in 10 Italian regions. The data refer to 2012 and 2013 and were selected from two performance evaluation systems based on hospital discharge administrative data: the Inter-Regional Performance Evaluation System developed by the Management and Health Laboratory of the Scuola Superiore Sant'Anna of Pisa and the Italian National Outcome Evaluation Programme developed by the National Agency for Healthcare Services. The study was conducted in 2 stages and by combining 2 statistical techniques. In stage 1, a non-parametric Mann-Whitney U test was carried out to compare the performance of UHs and GHs on the selected set of indicators. In stage 2, a robust equal variance test between the 2 groups of hospitals was carried out to investigate differences in the amount of variability between them. Results The overall analysis gave heterogeneous results. In general, performance was not affected by being in the UH rather than the GH group. It is thus not possible to directly associate Italian UHs with better results in terms of appropriateness, efficiency, patient satisfaction and outcomes. Conclusions Policymakers and managers should further encourage hospital performance evaluations in order to stimulate wider competition aimed at assigning teaching status to those hospitals that are able to meet performance requirements. In addition, UH facilities could be integrated with other providers that are responsible for community, primary and outpatient services, thereby creating a joint accountability for more patient-centred and integrated care. PMID:27507233

  15. The impact of heat, cold, and heat waves on hospital admissions in eight cities in Korea.

    PubMed

    Son, Ji-Young; Bell, Michelle L; Lee, Jong-Tae

    2014-11-01

    Although the impact of temperature on mortality is well documented, relatively fewer studies have evaluated the associations of temperature with morbidity outcomes such as hospital admissions, and most studies were conducted in North America or Europe. We evaluated weather and hospital admissions including specific causes (allergic disease, asthma, selected respiratory disease, and cardiovascular disease) in eight major cities in Korea from 2003 to 2008. We also explored potential effect modification by individual characteristics such as sex and age. We used hierarchical modeling to first estimate city-specific associations between heat, cold, or heat waves and hospitalizations, and then estimated overall effects. Stratified analyses were performed by cause of hospitalization, sex, and age (0-14, 15-64, 65-74, and ≥75 years). Cardiovascular hospitalizations were significantly associated with high temperature, whereas hospitalizations for allergic disease, asthma, and selected respiratory disease were significantly associated with low temperature. The overall heat effect for cardiovascular hospitalization was a 4.5% (95% confidence interval 0.7, 8.5%) increase in risk comparing hospitalizations at 25 to 15 °C. For cold effect, the overall increase in risk of hospitalizations comparing 2 with 15 °C was 50.5 (13.7, 99.2%), 43.6 (8.9, 89.5%), and 53.6% (9.8, 114.9%) for allergic disease, asthma, and selected respiratory disease, respectively. We did not find statistically significant effects of heat waves compared with nonheat wave days. Our results suggest susceptible populations such as women and younger persons. Our findings provide suggestive evidence that both high and low ambient temperatures are associated with the risk of hospital admissions, particularly in women or younger person, in Korea.

  16. Cervical cytology screening: experience of a general hospital.

    PubMed Central

    Sargeant, E. J.; Qizilbash, A. H.; Johnson, F. L.

    1977-01-01

    At Henderson General Hospital, Hamilton, a program was introduced whereby cervical smears were taken routinely for cytologic study from all women admitted aged 17 years or older. The procedure was performed by a specially trained nurse. In a 5-year period 53% of eligible patients were screened. Of these, 32% had not had a cervical smear taken before. In 7681 smears nine instances of invasive disease were discovered: three of the cervix, three of the endometrium and three metastatic. There were 20 cases of carcinoma in situ and 2 of severe dysplasia. Evidence of infection was present in a high percentage of the smears. Hospital admission affords an excellent opportunity of applying this valuable screening procedure. PMID:912627

  17. Undertaking capacity assessments for people with dementia in general hospitals.

    PubMed

    Murray, Aileen

    2016-08-01

    Ensuring that older patients are discharged from hospital in a safe and appropriate manner is a fundamental aspect of nursing care. However, it is clear from the literature and clinical practice that determining people's capacity and whether they are able to decide where they live on discharge is a significant challenge. There is variation in practice despite the legal framework provided by the Mental Capacity Act (MCA) 2005, covering England and Wales, which raises questions about adherence to the legislation. Using a case study, this article explores aspects of the MCA and clinical practice that affect older patients' outcomes on discharge from general hospital settings. It demonstrates how effective multidisciplinary working, using the legal frameworks available, can ensure that an individual's independence and well-being are maintained.

  18. [The home palliative care transition manual for the regional cooperation from the general ward at Shizuoka Red Cross Hospital].

    PubMed

    Shiraishi, Ko

    2007-12-01

    Recently, a home palliative care has been recommended for terminal stage cancer patients. However, a few clinics are available providing a home palliative care. As a result of that, there have been many cases of the terminal stage cancer patients who could not receive a peace of mind care and die peacefully at home. Home palliative care has been promoted in Shizuoka City by starting Shizuoka city regional cooperation conference of cancer management with a help from Shizuoka city medical association and the general hospital. It is important to have the knowledge and technique put into practice by clinics and home visiting nurses for a further improvement of the palliative care. In order to transfer patient smoothly, the palliative care team conference is held in the general ward and the homecare transition manual is used at the hospital. An application of homecare insurance, the visiting doctor and nurse are arranged in parallel to management of physical and psychological symptoms of the patient, the visiting doctor and nurse are arranged. Before a patient is discharged from the hospital, the meeting will be held among the ward staff, visiting nurse and the patient's family. We intervened 8 cases from April to July 2007. Six out of 8 cases were transferred to home, and 2 patients were died at home. The home care transition manual will be shared with other hospitals from now on.

  19. Bacteremia in a general hospital. A prospective study of 102 consecutive cases.

    PubMed

    Jepsen, O B; Korner, B

    1975-01-01

    A prospective clinical-bacteriological study of 102 consecutive cases of confirmed bacteremia at a Copenhagen City general hospital was carried out during 5 months of 1973 with special concern given to focus of infection and acquisition of microorganisms. Valid positive cultures were obtained from 7.2 patients per 1000 admissions. 50 of the 102 bacteremias were by all probability acquired in the hospital, mainly due to transurethral manipulations or intravenous lines. Pneumonia and hepatobiliary infections accounted for most of the non-hospital acquired bacteremias. 26/102 patients died in relation to the bacteremia. Escherichia coli and Staphylococcus aureus caused more than half of the infections. Bacteremia caused by proteus, klebsiella, enterobacter species of staphylococci was in most cases nosocomial and carried the highest mortality, i.e. 40%, verus 15% when other organisms were responsible. It is concluded that nosocomial bacteremia is a frequent and life-endangering complication which is often preceded by certain diagnostic or therapeutic procedures, not invariably linked to severe underlying diseases. Consequently, attempts to reduce bacteremic episodes should include surveillance of ecological factors and certain hospital procedures.

  20. Metformin associated lactic acidosis in Auckland City Hospital 2005 to 2009

    PubMed Central

    Haloob, Imad; de Zoysa, Janak R

    2016-01-01

    AIM: To determine the incidence, clinical characteristics and outcomes of patients with metformin associated lactic acidosis (MALA). METHODS: Auckland City Hospital drains a population of just over 400000 people. All cases presenting with metabolic acidosis between July 2005 and July 2009 were identified using clinical coding. A retrospective case notes review identified patients with MALA. Prescribing data for metformin was obtained from the national pharmaceutical prescribing scheme. RESULTS: There were 42 cases of metabolic lactic acidosis over 1718000 patient years. There were 51000 patient years of metformin prescribed to patients over the study period. There were thirty two cases of lactic acidosis due to sepsis, seven in patients treated with metformin. Ten cases of MALA were identified. The incidence of MALA was estimated at 19.46 per 100000 patient year exposure to metformin. The relative risk of lactic acidosis in patients on metformin was 13.53 (95%CI: 7.88-21.66) compared to the general population. The mean age of patients with MALA was 63 years, range 40-83 years. A baseline estimated glomerular filtration rate was obtained in all patients and ranged from 23-130 mL/min per 1.73 m2. Only two patients had chronic kidney disease G4. Three patients required treatment with haemodialysis. Two patients died. CONCLUSION: Lactic acidosis is an uncommon but significant complication of use of metformin which carries a high risk of morbidity. PMID:27458565

  1. Recurrence of inguinal hernias repaired in a large hernia surgical specialty hospital and general hospitals in Ontario, Canada

    PubMed Central

    Malik, Atiqa; Bell, Chaim M.; Stukel, Thérèse A.; Urbach, David R.

    2016-01-01

    Background The effect of hospital specialization on the risk of hernia recurrence after inguinal hernia repair is not well described. Methods We studied Ontario residents who had primary elective inguinal hernia repair at an Ontario hospital between 1993 and 2007 using population-based, administrative health data. We compared patients from a large hernia specialty hospital (Shouldice Hospital) with those from general hospitals to determine the risk of recurrence. Results We studied 235 192 patients, 27.7% of whom had surgery at Shouldice hospital. The age-standardized proportion of patients who had a recurrence ranged from 5.21% (95% confidence interval [CI] 4.94%–5.49%) among patients who had surgery at the lowest volume general hospitals to 4.79% (95% CI 4.54%–5.04%) who had surgery at the highest volume general hospitals. In contrast, patients who had surgery at the Shouldice Hospital had an age-standardized recurrence risk of 1.15% (95% CI 1.05%–1.25%). Compared with patients who had surgery at the lowest volume hospitals, hernia recurrence among those treated at the Shouldice Hospital was significantly lower after adjustment for the effects of age, sex, comorbidity and income level (adjusted hazard ratio 0.21, 95% CI 0.19–0.23, p < 0.001). Conclusion Inguinal hernia repair at Shouldice Hospital was associated with a significantly lower risk of subsequent surgery for recurrence than repair at a general hospital. While specialty hospitals may have better outcomes for treatment of common surgical conditions than general hospitals, these benefits must be weighed against potential negative impacts on clinical care and the financial sustainability of general hospitals. PMID:26574701

  2. Hospital distribution in a metropolitan city: assessment by a geographic information system grid modelling approach.

    PubMed

    Lee, Kwang-Soo; Moon, Kyeong-Jun

    2014-05-01

    Grid models were used to assess urban hospital distribution in Seoul, the capital of South Korea. A geographical information system (GIS) based analytical model was developed and applied to assess the situation in a metropolitan area with a population exceeding 10 million. Secondary data for this analysis were obtained from multiple sources: the Korean Statistical Information Service, the Korean Hospital Association and the Statistical Geographical Information System. A grid of cells measuring 1 × 1 km was superimposed on the city map and a set of variables related to population, economy, mobility and housing were identified and measured for each cell. Socio-demographic variables were included to reflect the characteristics of each area. Analytical models were then developed using GIS software with the number of hospitals as the dependent variable. Applying multiple linear regression and geographically weighted regression models, three factors (highway and major arterial road areas; number of subway entrances; and row house areas) were statistically significant in explaining the variance of hospital distribution for each cell. The overall results show that GIS is a useful tool for analysing and understanding location strategies. This approach appears a useful source of information for decision-makers concerned with the distribution of hospitals and other health care centres in a city.

  3. Improving general practitioners' knowledge regarding blood pressure measurement in selected cities of Pakistan through workshop.

    PubMed

    Mujtaba, Syed Hasnain; Ashraf, Tariq; Anjum, Qudsia

    2013-01-01

    The objective of this study was to evaluate enhancement in the knowledge of general practitioners (GPs), from the urban cities in the province of Sindh, Pakistan, regarding blood pressure measurement through workshop. This was a quasi-experimental study that involved GPs from 5 cities of Sindh province, Pakistan. The GPs were required to complete a pretested self-administered questionnaire before and after the workshop session. The questionnaire included few demographic variables and 17 questions based on the American Heart Association recommendations. The mean pretest and posttest scores were compared using Student's t test. A total of 350 GPs returned completed questionnaires, with a preponderance of males (n = 264, 75.4%) than females (n = 86, 24.6%). The mean correct responses increased significantly after the workshop session from 8 ± 2.1 to 14 ± 2.5 (P = .01). The knowledge of GPs was almost doubled after the workshop and was significantly different for variables such as qualification, affiliation with teaching hospital, and number of years of practice (P = .001). This survey, a representation of GPs from the Sindh province, indicated a significant doubling in knowledge after the workshop, proving that continuing medical education sessions play an important role in increasing awareness and staying updated.

  4. [Health anthropology and hospital archiving. The Museum of Pathological Anatomy of the City Hospital of Trieste].

    PubMed

    Braulin, F

    2001-10-01

    The preparations found in the Trieste Hospital Museum of Pathological Anatomy fit into the context of a medical semiotics which has its origins in the anatomical clinical method. The study of the practices involved in the museum preparation leads back to its purely diagnostic function inasmuch as it convalidates or contradicts the suppositions that, from the symptomatological case history, made from the study of the lesions and the diseased organ. This whole investigative process corresponds to a break in the field of scientific knowledge which marks the birth of a new approach to diagnosis and a new form of nosology, made possible by the great number of sick people and deaths available in a modern hospital. The Museum is permeated with empiricism, morphologism and localisation, and its exhibits fluctuate between macroscopic and microscopic anatomy, between organic and cellular pathology. In the exhibits of infectious and contagious diseases, one can see traces of the revolution brought about by bacteriology and laboratory techniques; in the considerable collection of malignant tumours, one can detect an oncological awareness which relates explicitly to a nosology based on the work of Virchow. The preparations which refer to pathologies that cannot be reduced simply to localisation illustrate an increasing awareness of functional medicine and clinical biochemistry. The Museum has the task of showing and teaching in order to train the hospital doctor. The Museum--through pathological anatomy--directed the community towards a knowledge of healthcare methods destined to change the morbidity and mortality rates due to a certain disease, in relation to those diseases typical of the times.

  5. Health services research in a quick and dirty world: the New York City hospital occupancy crisis.

    PubMed Central

    Myers, L P; Fox, K S; Vladeck, B C

    1990-01-01

    In 1987/1988, New York City experienced an unexpected health care crisis: a severe and prolonged communitywide shortage of inpatient hospital beds. A rapid rise in hospital occupancy rates dramatically ended a long-term decline in hospital utilization and left health care providers and policymakers baffled about both cause and remedy. This article describes the course of a short-term, intensive, midcrisis study that unraveled the reasons for the high occupancy rates. As a case study for a research effort that successfully yielded valid and timely results, this article illuminates the research design and methodological decisions that lay behind the findings and discusses the implications of those decisions. Key to the success of the study were a mandate to diagnose the crisis, a statewide patient discharge data base, our previous hands-on experience with that data base, active support for the study from the community of health care providers, and strong results. PMID:2254088

  6. An Intervention to Increase Availability of Healthy Foods and Beverages in New York City Hospitals: The Healthy Hospital Food Initiative, 2010–2014

    PubMed Central

    Krepp, Erica M.; Johnson Curtis, Christine; Lederer, Ashley

    2016-01-01

    Background Hospitals serve millions of meals and snacks each year; however, hospital food is often unhealthy. Hospitals are ideal settings for modeling healthy eating, but few programs have sought to improve nutrition in all venues where food is served. Community Context The New York City Department of Health and Mental Hygiene created the Healthy Hospital Food Initiative (HHFI) to improve the healthfulness of food served in hospitals. The HHFI built on prior work implementing mandatory nutrition standards for patient meals and vending in public hospitals. Public hospitals joined the HHFI by voluntarily adopting standards for cafeterias and cafés. Private hospitals joined by implementing nutrition standards for patient meals, food and beverage vending machines, and cafeterias and cafés. Methods Hospitals were recruited from 2010 through 2014 and provided technical assistance from health department staff. Implementation in each of the 4 areas was monitored through on-site assessments and menu review. Twenty-eight hospital cafeterias and cafés were evaluated at baseline and at the end of the HHFI to assess changes. Outcome Sixteen public hospitals and 24 private hospitals joined the HHFI. Most (n = 18) private hospitals implemented standards in at least 2 areas. In cafeterias, most hospitals introduced a healthy value meal (n = 19), removed unhealthy items from the entrance and checkout (n = 18), increased whole grains to at least half of all grains served (n = 17), and reduced calories in pastries and desserts (n = 15). Interpretation Most New York City hospitals joined the HHFI and voluntarily adopted rigorous nutrition standards. Partnerships between hospitals and local government are feasible and can lead to significant improvements in hospital food environments. PMID:27281392

  7. 42 CFR 412.370 - General provisions for hospitals located in Puerto Rico.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false General provisions for hospitals located in Puerto....370 General provisions for hospitals located in Puerto Rico. Except as provided in § 412.374, hospitals located in Puerto Rico are subject to the rules in this subpart governing the prospective...

  8. Increasing Prevalence of Electronic Cigarette Use Among Smokers Hospitalized in 5 US Cities, 2010–2013

    PubMed Central

    Harrington, Kathleen F.; Richter, Kimber; Fellows, Jeffrey L.; Sherman, Scott E.; Grossman, Ellie; Chang, Yuchiao; Tindle, Hilary A.; Ylioja, Thomas

    2015-01-01

    Introduction: Little is known about the pattern of electronic cigarette (e-cigarette) use over time or among smokers with medical comorbidity. Methods: We assessed current cigarette smokers’ use of e-cigarettes during the 30 days before admission to 9 hospitals in 5 geographically dispersed US cities: Birmingham, AL; Boston, MA; Kansas City, KS; New York, NY; and Portland, OR. Each hospital was conducting a randomized controlled trial as part of the NIH-sponsored Consortium of Hospitals Advancing Research on Tobacco (CHART). We conducted a pooled analysis using multiple logistic regression to examine changes in e-cigarette use over time and to identify correlates of e-cigarette use. Results: Among 4,660 smokers hospitalized between July 2010 and December 2013 (mean age 57 years, 57% male, 71% white, 56% some college, average 14 cigarettes/day), 14% reported using an e-cigarette during the 30 days before admission. The prevalence of e-cigarette use increased from 1.1% in 2010 to 10.3% in 2011, 10.2% in 2012, and 18.4% in 2013; the increase was statistically significant (p < .0001) after adjustment for age, sex, education, and CHART study. Younger, better educated, and heavier smokers were more likely to use e-cigarettes. Smokers who were Hispanic, non-Hispanic black, and who had Medicaid or no insurance were less likely to use e-cigarettes. E-cigarette use also varied by CHART project and by geographic region. Conclusions: E-cigarette use increased substantially from 2010 to 2013 among a large sample of hospitalized adult cigarette smokers. E-cigarette use was more common among heavier smokers and among those who were younger, white, and who had higher socioeconomic status. PMID:25168031

  9. 42 CFR 412.22 - Excluded hospitals and hospital units: General rules.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... status. A satellite of a long-term care hospital that occupies space in a building used by another..., a hospital that occupies space in a building also used by another hospital, or in one or more... from the governing body of the hospital occupying space in the same building or on the same campus....

  10. Social responsibility of the hospitals in Isfahan city, Iran: Results from a cross-sectional survey

    PubMed Central

    Keyvanara, Mahmoud; Sajadi, Haniye Sadat

    2015-01-01

    Background: Changes in modern societies develop the perception that the external environment is essential in organization’s practices, especially in the way they deal with aspects such as human rights, community needs, market demands and environmental interests. These issues are usually under the umbrella of the concept of social responsibility. Given the importance of this concept in the context of health care delivery, suggesting a new paradigm in hospital governance, the aim of this study was to measure the social responsibility in hospitals. Methods: A cross-sectional survey was employed to collect data from a sample of 946 hospital staff of Isfahan city. Data was obtained by structured and valid self-administrated questionnaire and analyzed by descriptive and analytic statistics using SPSS. Results: The mean score of hospitals’ social responsibility was 3.0 compared with the justified range from 1.0 to 5.0. Results showed that there was a significant relationship between social responsibility score and hospitals’ ownership (public or private). Also, there was no significant relationship between social responsibility and type of hospital specialty. Conclusion: It is recommended that hospital managers develop and apply appropriate policies and strategies to improve their hospitals’ social responsibility level, especially through concentrating on their staff’s working environment. PMID:26340391

  11. Biological aging and social characteristics: gerontology, the Baltimore city hospitals, and the National Institutes of Health.

    PubMed

    Park, Hyung Wook

    2013-01-01

    The intramural gerontological research program in the National Institutes of Health underwent a substantial growth after its creation within the precincts of the Baltimore City Hospitals in 1940. This paper analyzes its development and the associated problems of its early years. Gerontologists aimed at improving the social and economic life of the elderly through scientific research. With this aim in mind, they conducted various investigations using the indigent aged patients of the Baltimore City Hospitals. Yet the scientists of aging, who hoped to eliminate negative social factors that might bias their research and heighten the confusion between pathology and aging per se, eventually stopped using these patients in the hospital as human subjects. Instead they sought educated affluent subjects in order to eliminate the impact of poverty. By doing so, however, they introduced a new source of social bias to their work, especially within the novel project begun in 1958, the Baltimore Longitudinal Study of Aging. This article thus examines the context of the development of gerontologists' research by analyzing their agenda, institutional environment, and research subjects in the 1940s and the 1950s.

  12. Seroepidemiology of Toxoplasma gondii infection in general population in a Northern Mexican city

    Technology Transfer Automated Retrieval System (TEKTRAN)

    There is a lack of information about the seroepidemiology of T. gondii infection in the general population of Durango City, Mexico. Anti-T. gondii IgG and IgM antibodies were sought in 974 inhabitants in Durango City, Mexico using enzyme-linked immunoassays. In total, 59 (6.1%) of 974 participants (...

  13. The Occupational Structure of New York City Municipal Hospitals. Health Services Mobility Study. Text and Appendixes. Research Report Number 2.

    ERIC Educational Resources Information Center

    Gilpatrick, Eleanor, G.; Corliss, Paul K.

    This two volume report is the first of a five-part study to determine ways and means of facilitating horizontal and vertical mobility within New York City's Health Services Administration and selected private hospitals. It seeks to answer two questions: (1) Does the structure of the municipal hospital system permit the efficient planning,…

  14. Are general paediatric surgery outcomes comparable between district general hospital and regional referral centres?

    PubMed Central

    Prieto, MC Hart; Jones, PA

    2011-01-01

    INTRODUCTION This study recorded the complication rates for general paediatric surgery undertaken in our district general hospital (DGH) and compared them with the limited amount of data published in this field. There has been a gradual diminution in the numbers of general paediatric surgeons throughout the UK. The Royal College of Surgeons of England has produced guidelines to safeguard the provision of paediatric surgery in DGHs. There are minimal data on the acceptable outcomes and complication rates for elective general paediatric operations. METHODS The following operations undertaken by the paediatric urologist in our unit between November 2006 and May 2010 were scrutinised: orchidopexy, laparoscopy for undescended testes, herniotomy and circumcision. The results were compared to those in the literature and current guidelines. Complications were recorded via audit records, clinic letters or records of attendance at the accident and emergency department. RESULTS A total of 306 paediatric operations (125 orchidopexies, 28 laparoscopies, 41 herniotomies and 51 circumcisions) were undertaken over the 42-month study period. Only 4.5% of cases experienced post-operative complications. The majority of these were testicular atrophy and infection. There were no intra-operative complications. CONCLUSIONS In our DGH the complication rates for general paediatric operations compare favourably with those set out by the literature and guidelines, which support the training and delivery of general paediatric surgery within DGHs. PMID:22004639

  15. Connection: Schwartz Center Rounds at Massachusetts General Hospital Cancer Center

    PubMed Central

    Schapira, Lidia; Mack, Sally; Stanzler, Marjorie; Lynch, Thomas J.

    2010-01-01

    Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital, founded the Kenneth B. Schwartz Center®, a nonprofit organization dedicated to supporting and advancing compassionate health care. The Center sponsors Schwartz Rounds®, a multidisciplinary forum in which doctors, nurses, chaplains, social workers, and other staff reflect on important psychosocial issues that arise in caring for patients. Attendees participate in an interactive discussion about issues anchored in a case presentation and share their experiences, thoughts, and feelings. The patient narratives may center on wonderful events and transcendent experiences or tragic stories, during which staff can only bear witness to the suffering. The Rounds focus on caregivers' experiences, and encourage staff to share insights, own their vulnerabilities, and support each other. The primary objective is to foster healing relationships and provide support to professional caregivers, enhance communication among caregivers, and improve the connection between patients and caregivers. Currently, >50,000 clinicians attend monthly Schwartz Rounds at 195 sites in 31 states, numbers that are rapidly growing. In this article we explore the reasons that contribute to the success of this model of multidisciplinary reflection. PMID:20584809

  16. A Most Unusual Patient at the Massachusetts General Hospital

    PubMed Central

    Ruhnke, Gregory W.; Warshaw, Andrew L.

    2016-01-01

    This year marks 200 years of patient care at the Massachusetts General Hospital (MGH). In celebration of this milestone, a unique Grand Rounds case is presented. A 450-year-old rotund man admitted 60 times presents with a classic triad of periumbilical pain, bilateral plantar burns, and a frozen scalp. Although this triad may at first strike a cord of familiarity among seasoned clinicians, the disease mechanism is truly noteworthy, being clarified only after a detailed occupational history. Ergo, the lessons hark back to the days of yesteryear, when the history and physical served as the cornerstone of Yuletide clinical diagnosis. A discussion of epidemiology and prognosis accompanies a detailed examination of the pathophysiholiday. Although some consider this patient uncouth, as you will see, he is quite a medical sleuth. The long-standing relationship between this patient and the MGH prompted his family to write a letter of appreciation, which will remind the reader of the meaning that our care brings to patients and their families. Harvey Cushing, who completed his internship at the MGH in 1895, professed “A physician is obligated to consider more than a diseased organ, more even than the whole man—he must view the man in his world.” We hope this unusual Grand Rounds case intrigues you as it reminds you of Cushing’s lesson and wishes you a joyous holiday season. PMID:22107737

  17. [Bacteriologic diagnosis of extrapulmonary tuberculosis in a general hospital].

    PubMed

    Peluffo, G; de Kantor, I N

    1982-01-01

    In a study performed in a general hospital within a period of 19 months, a total of 233 specimens of extrapulmonary origin and 543 lung secretions were tested for mycobacteria. The biopsy and punction fluid specimens were cultured without previous decontaminating treatment in Lowenstein Jensen, Stonebrink, Middlebrook 7H9, 7H10, 7H11 media and inoculated into guinea pigs (Table 1). Urine and lung secretion specimens were decontaminated and cultured in Lowenstein Jensen and Stonebrink media. No inoculation into guinea pigs was performed with these samples. The percentages of positivity by culture were: 11.2% for all extrapulmonary specimens (15% excluding 66 urine samples) and 22.5% for the lung secretions. Positive results were obtained in direct smear examinations in 82% of all positive-culture lung secretions and in 8% of the extrapulmonary specimens. Inoculation into guinea pigs gave less positive results than cultures. On the basis of the present study, it is recommended to culture every extrapulmonary specimens for mycobacteria. These samples should be processed immediately after collection and, if possible, without previous decontamination to assure the best test sensitivity. Eight percent of the strains obtained from extrapulmonary specimens were typed as M. bovis.

  18. "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.

  19. Accreditation of Management Communication and Information Systems in Public Hospitals of Sabzevar City, Iran

    PubMed Central

    Farzianpour, Fereshteh; Shojaei, Saeed; Arab, Mohammad; Foroushani, Abbas Rahimi

    2016-01-01

    Objective: Information systems are “computer systems that collect, store, process, retrieve, show, and provide timely information required in practice, education, management, and research”. The purpose of these systems is to support hospital activities in practical, tactical, and strategic levels in order to provide better service to patients. This study aimed to evaluate the communication and information system (MCI) in public hospitals in Sabzevar city in 2014 from the perspective of human resources according to international standards of the Joint Commission Accreditation Hospital (JCAH). Methods: This study was a practical, descriptive, cross-sectional study. The study population consisted of Sabzevar nurses who used hospital information system. Sampling was done by classification method and in proportion to the number of nurses in each health care units in hospitals in 2014. The sample size was 200 and after referring to hospitals, 200 questionnaires were completed. Sample size was calculated by the formula n=Z2P (1-P)/d2 with P=0.5, α=0.05, d=0.05, and Z=1.96. Data collection tool was the questionnaire of assessment of hospital information systems of JCAH, which has 124 specific questions, including 6 areas. To assess the effect of demographic variables with MCI standards of two questionnaires (feasibility and implementation), the following steps were taken. 1. Kolmogorov-Smirnov test was used to determine whether responses were normal or not. 2. In case of normal data, t-test was used for dual groups and one-way ANOVA test for groups of three or more. 3. If not normal, Mann-Whitney test was used for dual groups and Kruskal-Wallis test for groups of three or more. Results: Research findings show the mean results of feasibility and implementation of all 6 areas of international standards MCI have feasibility in three hospitals in Sabzevar in 20 sections (H1=105.01±10.468), (H1=196.31±4.662), (H2=104.26±9.099), (H2=195.33±3.778) (H3=106.48±11.545) and

  20. Challenges of nurses' deployment to other New York City hospitals in the aftermath of Hurricane Sandy.

    PubMed

    VanDevanter, Nancy; Kovner, Christine T; Raveis, Victoria H; McCollum, Meriel; Keller, Ronald

    2014-08-01

    On October 29, 2012, a 12-ft storm surge generated by Hurricane Sandy necessitated evacuation and temporary closure of three New York City hospitals including NYU Langone Medical Center (NYULMC). NYULMC nurses participated in the evacuation, and 71 % were subsequently deployed to area hospitals to address patient surge for periods from a few days up to 2 months when NYULMC reopened. This mixed methods study explored nurses' experience in the immediate disaster and the subsequent deployment. More than 50 % of deployed nurse participants reported the experience to be extremely or very stressful. Deployed nurses encountered practice challenges related to working in an unfamiliar environment, limited orientation, legal concerns about clinical assignments. They experienced psychosocial challenges associated with the intense experience of the evacuation, uncertainty about future employment, and the increased demands of managing the deployment. Findings provide data to inform national and regional policies to support nurses in future deployments.

  1. Determinants of hospital closure in South Korea: use of a hierarchical generalized linear model.

    PubMed

    Noh, Maengseok; Lee, Youngjo; Yun, Sung-Cheol; Lee, Sang-Il; Lee, Moo-Song; Khang, Young-Ho

    2006-11-01

    Understanding causes of hospital closure is important if hospitals are to survive and continue to fulfill their missions as the center for health care in their neighborhoods. Knowing which hospitals are most susceptible to closure can be of great use for hospital administrators and others interested in hospital performance. Although prior studies have identified a range of factors associated with increased risk of hospital closure, most are US-based and do not directly relate to health care systems in other countries. We examined determinants of hospital closure in a nationally representative sample: 805 hospitals established in South Korea before 1996 were examined-hospitals established in 1996 or after were excluded. Major organizational changes (survival vs. closure) were followed for all South Korean hospitals from 1996 through 2002. With the use of a hierarchical generalized linear model, a frailty model was used to control correlation among repeated measurements for risk factors for hospital closure. Results showed that ownership and hospital size were significantly associated with hospital closure. Urban hospitals were less likely to close than rural hospitals. However, the urban location of a hospital was not associated with hospital closure after adjustment for the proportion of elderly. Two measures for hospital competition (competitive beds and 1-Hirshman--Herfindalh index) were positively associated with risk of hospital closure before and after adjustment for confounders. In addition, annual 10% change in competitive beds was significantly predictive of hospital closure. In conclusion, yearly trends in hospital competition as well as the level of hospital competition each year affected hospital survival. Future studies need to examine the contribution of internal factors such as management strategies and financial status to hospital closure in South Korea.

  2. Revoking hospital privileges: new directions in Ontario. Dr. N. v. Brantford General Hospital.

    PubMed

    Liswood, J; McClure, A E

    1993-01-01

    Recent decisions by the Ontario Hospital Appeal Board have helped hospital boards understand the importance of due process when revoking a physician's hospital privileges. The authors illustrate the need to have a mechanism to suspend privileges immediately but which also provides physicians with the opportunity to respond to allegations. The article outlines 11 clauses that serve as a practical guide to due process and can be added to hospital by-laws.

  3. Hospitable archean climates simulated by a general circulation model.

    PubMed

    Wolf, E T; Toon, O B

    2013-07-01

    Evidence from ancient sediments indicates that liquid water and primitive life were present during the Archean despite the faint young Sun. To date, studies of Archean climate typically utilize simplified one-dimensional models that ignore clouds and ice. Here, we use an atmospheric general circulation model coupled to a mixed-layer ocean model to simulate the climate circa 2.8 billion years ago when the Sun was 20% dimmer than it is today. Surface properties are assumed to be equal to those of the present day, while ocean heat transport varies as a function of sea ice extent. Present climate is duplicated with 0.06 bar of CO2 or alternatively with 0.02 bar of CO2 and 0.001 bar of CH4. Hot Archean climates, as implied by some isotopic reconstructions of ancient marine cherts, are unattainable even in our warmest simulation having 0.2 bar of CO2 and 0.001 bar of CH4. However, cooler climates with significant polar ice, but still dominated by open ocean, can be maintained with modest greenhouse gas amounts, posing no contradiction with CO2 constraints deduced from paleosols or with practical limitations on CH4 due to the formation of optically thick organic hazes. Our results indicate that a weak version of the faint young Sun paradox, requiring only that some portion of the planet's surface maintain liquid water, may be resolved with moderate greenhouse gas inventories. Thus, hospitable late Archean climates are easily obtained in our climate model.

  4. Effect of Cause-of-Death Training on Agreement Between Hospital Discharge Diagnoses and Cause of Death Reported, Inpatient Hospital Deaths, New York City, 2008–2010

    PubMed Central

    Ong, Paulina; Gambatese, Melissa; Begier, Elizabeth; Zimmerman, Regina; Soto, Antonio

    2015-01-01

    Introduction Accurate cause-of-death reporting is required for mortality data to validly inform public health programming and evaluation. Research demonstrates overreporting of heart disease on New York City death certificates. We describe changes in reported causes of death following a New York City health department training conducted in 2009 to improve accuracy of cause-of-death reporting at 8 hospitals. The objective of our study was to assess the degree to which death certificates citing heart disease as cause of death agreed with hospital discharge data and the degree to which training improved accuracy of reporting. Methods We analyzed 74,373 death certificates for 2008 through 2010 that were linked with hospital discharge records for New York City inpatient deaths and calculated the proportion of discordant deaths, that is, death certificates reporting an underlying cause of heart disease with no corresponding discharge record diagnosis. We also summarized top principal diagnoses among discordant reports and calculated the proportion of inpatient deaths reporting sepsis, a condition underreported in New York City, to assess whether documentation practices changed in response to clarifications made during the intervention. Results Citywide discordance between death certificates and discharge data decreased from 14.9% in 2008 to 9.6% in 2010 (P < .001), driven by a decrease in discordance at intervention hospitals (20.2% in 2008 to 8.9% in 2010; P < .001). At intervention hospitals, reporting of sepsis increased from 3.7% of inpatient deaths in 2008 to 20.6% in 2010 (P < .001). Conclusion Overreporting of heart disease as cause of death declined at intervention hospitals, driving a citywide decline, and sepsis reporting practices changed in accordance with health department training. Researchers should consider the effect of overreporting and data-quality changes when analyzing New York City heart disease mortality trends. Other vital records jurisdictions

  5. Predicting Tests Ordered in Hospital Laboratories using Generalized Linear Modeling.

    PubMed

    Leaven, Laquanda T

    2016-01-01

    Laboratory services in healthcare systems play a vital role in inpatient care. Most hospital laboratories are facing the challenge of reducing cost and improving service quality. The author focuses on identifying test order patterns in a laboratory for a large urban hospital. The data collected from this facility consists of all tests ordered over a three-month time frame and contains test orders for approximately 17,500 patients. Poisson and negative binomial regression models are used to determine how well patient characteristics (patient length of stay and the medical units in which patients are placed) will predict the number of tests being ordered. The test order prediction model developed in this study will aid the management and phlebotomists in the hospital laboratory in securing methods to satisfy the test order demand. By implementing the recommendations of this study, hospital laboratories should see significant improvements in phlebotomist productivity and resource utilization, implementation of which could result in cost savings.

  6. Readmissions due to traffic accidents at a general hospital 1

    PubMed Central

    Paiva, Luciana; Monteiro, Damiana Aparecida Trindade; Pompeo, Daniele Alcalá; Ciol, Márcia Aparecida; Dantas, Rosana Aparecida Spadotti; Rossi, Lídia Aparecida

    2015-01-01

    Abstract Objective: to verify the occurrence and the causes of hospital readmissions within a year after discharge from hospitalizations due to traffic accidents. Methods: victims of multiple traumas due to traffic accidents were included, who were admitted to an Intensive Care Unit. Sociodemographic data, accident circumstances, body regions affected and cause of readmission were collected from the patient histories. Results: among the 109 victims of traffic accidents, the majority were young and adult men. Most hospitalizations due to accidents involved motorcycle drivers (56.9%). The causes of the return to the hospital were: need to continue the surgical treatment (63.2%), surgical site infection (26.3%) and fall related to the physical sequelae of the trauma (10.5%). The rehospitalization rate corresponded to 174/1,000 people/year. Conclusion: the hospital readmission rate in the study population is similar to the rates found in other studies. Victims of severe limb traumas need multiple surgical procedures, lengthier hospitalizations and extended rehabilitation. PMID:26444172

  7. Annual economic burden of hepatitis B virus-related diseases among hospitalized patients in twelve cities in China.

    PubMed

    Zhang, S; Ma, Q; Liang, S; Xiao, H; Zhuang, G; Zou, Y; Tan, H; Liu, J; Zhang, Y; Zhang, L; Feng, X; Xue, L; Hu, D; Cui, F; Liang, X

    2016-03-01

    A nationwide survey of hepatitis B virus (HBV)-associated economic burden has not previously been performed in China. The purpose of this study was to examine the direct, indirect, and intangible costs of HBV-related diseases within the span of one year. A random sample was taken from specialty and general hospitals across 12 cities in six provinces of China. Intangible costs were estimated based on willingness to pay or open-ended answers provided by patients. The results showed that 27 hospitals were enrolled, with a sample population of 4726 patients (77.7% response rate). The average annual costs were $4454.0 (direct), $924.3 (indirect), and $6611.10 (intangible), corresponding to 37.3%, 7.7%, and 55.1% of the total costs, respectively. The direct medical fees were substantially greater than the non-medical fees. Annual indirect costs were divided into outpatient ($112.9) and inpatient ($811.40) loss of income. The intangible costs of chronic HBV were notably higher than either the direct or indirect costs, consistent with the social stigma in China. The comparison amongst individual cities for the average ratio of direct to indirect costs revealed that the sizes of ratios were negatively correlated with the socioeconomic status of the regions. This study suggested that as a whole in China, the HBV-related diseases caused a heavy financial burden which was positively associated with disease severity. Although the intangible costs coincided with a high prevalence of discrimination against CHB patients in Chinese society, our study may serve as future reference for detailed exploration.

  8. Prevalence trends of oral squamous cell carcinoma. Mexico City’s General Hospital experience

    PubMed Central

    Hernández-Guerrero, Juan C.; Jacinto-Alemán, Luís F.; Jiménez-Farfán, María D.; Macario-Hernández, Alejandro; Hernández-Flores, Florentino

    2013-01-01

    Objective: Recent reports suggest an increase in oral squamous cell carcinoma (OSCC) frequency. To improve programs in public health, it is necessary to understand the epidemiological conditions. The aim of this study was to analyze the trend in gender, age, anatomic zone and OSCC stage from Mexico City’s General Hospital patients from 1990 to 2008. Study design: A retrospective review of all OSCC cases diagnosed by the Pathology Department of the Mexico City General Hospital was performed. Demographic data, in addition to anatomic zone and histological degree of differentiation were obtained. Central tendency, dispersion and prevalence rate per 100,000 individuals were determined. Results: A total of 531 patients were diagnosed with OSCC; 58.4% were men, giving a male:female ratio of 1.4:1, and the mean age was 62.5 ± 14.9 years. The predominant anatomic zone was the tongue (44.7%), followed by the lips (21.2%) and gums (20.5%). The most frequent histological degree was moderately differentiated in 325 cases (61.2%). The rates of OSCC prevalence showed similar patterns in terms across time. A significant correlation (P = 0.007) between anatomic zone and age was observed. Conclusion: According to our results, the prevalence of OSCC does not show important variations; however, a relationship between age and anatomic zone was observed. These data could be used as parameters for the diagnosis of OSCC as well as for the development and dissemination of preventive programs for the early detection of oral cancer. Key words:Oral squamous cell carcinoma, prevalence, histology degree and anatomic zone. PMID:23385493

  9. [Prevalence and associated factors of hospital malnutrition in a general hospital; Perú, 2012].

    PubMed

    Veramendi-Espinoza, L E; Zafra-Tanaka, J H; Salazar-Saavedra, O; Basilio-Flores, J E; Millones-Sánchez, E; Pérez-Casquino, G A; Quispe-Moore, L M; Tapia-Vicente, M E; Ticona-Rebagliati, D I; Asato N, B; Quispe-Calderón, L; Ruiz García, H J; Chia-Gil, A; Rey-Rodríguez, D E; Surichaqui B, T; Whittembury, Á

    2013-01-01

    Introducción: La desnutrición hospitalaria es un problema prevalente que genera mayor morbi-mortalidad, peor respuesta al tratamiento, mayor estancia y costo hospitalario. Objetivos: Determinar la prevalencia y factores asociados a desnutrición hospitalaria en un hospital general peruano. Métodos: Estudio analítico transversal de 211 pacientes en servicios de Medicina y Cirugía. Se analizó variables demográficas, clínicas e indicadores antropométricos. El análisis multivariado fue de regresión logística binaria. El nivel de significancia fue 5% (p < 0,05). Resultados: La prevalencia de desnutrición hospitalaria fue 46.9% y las de desnutrición calórica y proteica fueron 21,3% y 37,5% respectivamente. En el análisis bivariado, estar hospitalizado en el servicio de Cirugía se asoció a un mayor riesgo de desnutrición calórica (OR = 4,41, IC 95% [1,65-11,78]) y proteica (OR = 2,52, IC 95% [1,30-4,90]). Hubo asociación significativa entre el número de comorbilidades del paciente y desnutrición calórica (p = 0,031), y el tiempo de cambio de ingesta alimentaria y presencia de desnutrición proteica (p = 0,031). El análisis multivariado mostró asociación significativa entre el diagnóstico de neoplasia y la presencia de desnutrición calórica (OR = 5,22, IC 95% [1,43-19,13]). Conclusiones: La prevalencia de desnutrición hospitalaria fue cerca del 50%, coincidiendo con estudios similares. Las prevalencias de desnutrición calórica/proteica halladas difieren de las de un estudio anterior en este hospital, explicándose por parámetros de diagnóstico diferentes y características particulares de las poblaciones, como el servicio de procedencia y comorbilidades. Se encontró asociación entre desnutrición proteica/calórica y estar hospitalizado en el servicio de Cirugía; las razones deben investigarse en estudios posteriores.

  10. [National Program of Continuous Academic Development for the General Physician (PRONADAMEG). The Chihuahua City experience].

    PubMed

    Ramos-Martínez, Ernesto

    2004-01-01

    The aim of this work is to report on the experience obtained during 8 years of the Programa Nacional de Actualización y Desarrollo Académico para el Medico General (PRONADAMEG) in Chihuahua City in Northern Mexico. During this period, 276 general physicians enrolled in PRONADAMEG and 140 concluded their training, with end effectiveness of 50.7%.

  11. 42 CFR 412.22 - Excluded hospitals and hospital units: General rules.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Hospital Services Subject to and Excluded From the Prospective Payment Systems for Inpatient Operating... excluded from the prospective payment systems specified in § 412.1(a)(1) of this part if it meets...

  12. General Breast Cancer Awareness among Women in Riyadh City

    PubMed

    Al Otaibi, Shibl; Al Harbi, Mutaz; Al Kahmoas, Abdulaziz; Al Qhatani, Fahad; Al Mutairi, Fahad; Al Mutairi, Talal; Al Ajmi, Refan; Al Mousawi, Fatimah

    2017-01-01

    Breast cancer is the most common cancer among women globally as well as in Saudi Arabia. Early diagnosis can improve prognosis and breast self-examination (BSE) may be a cost effective way to achieve this. In Saudi Arabia, only a few studies have been conducted to address breast cancer awareness. Most showed a suboptimal level of understanding. During the last few years, Saudi Arabia has established many national campaigns to increase awareness of the disease and facilitate learning about different diagnostic procedures. This cross-sectional survey study was conducted in accordance to assess the current knowledge and practices of women regarding breast self-examination and mammography screening in Riyadh, Saudi Arabia. The sample comprised of 137 females aged 18 and older. Data were collected using face-to-face interviews with a modified Arabic version of a validated questionnaire and analyzed using SPSS. Similar to previous studies’, the results were suboptimal. Out of the 137, about 54% claimed they are aware of breast cancer and BSE, however, only 62% of them knew how to conduct self-examination. Far fewer were aware of mammography screening (38%). When asked about the source of breast cancer information, most of the women answered awareness campaigns (39%) while school/university and TV (22% each) were the sources for others. This highlights the importance and urgent need for continued awareness campaigns. Moreover, special awareness sessions need to be conducted in institutions like colleges, universities, and hospitals where the proportion of females is higher.

  13. Can We Humanize Dying in the General Hospital?

    ERIC Educational Resources Information Center

    Fleming, Stephen

    This paper reviews the literature on the behavior and attitudes of medical-nursing personnel toward the dying person and illustrates the frequent conflict between hospital staff and the needs of dying. Inner perturbation stemming from feelings of vicarious suffering, vicarious disintegration, or personal anxiety about death, education deficiencies…

  14. 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.

  15. 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

  16. An indoor radon survey of the X-ray rooms of Mexico City hospitals

    SciTech Connect

    Juarez, Faustino; Reyes, Pedro G.; Espinosa, Guillermo

    2013-07-03

    This paper presents the results of measurements of indoor radon concentrations in the X-ray rooms of a selection of hospitals in the metropolitan area of Mexico City. The metropolitan area of Mexico City is Mexico's largest metropolitan area by population; the number of patients requiring the use of X-rays is also the highest. An understanding of indoor radon concentrations in X-ray rooms is necessary for the estimation of the radiological risk to which patients, radiologists and medical technicians are exposed. The indoor radon concentrations were monitored for a period of six months using nuclear track detectors (NTD) consisting of a closed-end cup system with CR-39 (Lantrack Registered-Sign ) polycarbonate as detector material. The indoor radon concentrations were found to be between 75 and 170 Bq m{sup -3}, below the USEPA-recommended indoor radon action level for working places of 400 Bq m{sup -3}. It is hoped that the results of this study will contribute to the establishment of recommended action levels by the Mexican regulatory authorities responsible for nuclear safety.

  17. The Epidemiology of Hospital-Referred Head Injury in Ardabil City

    PubMed Central

    Farzaneh, Esmaeil; Abbasi, Vahid; Kahnamouei-aghdam, Fariba; Molaei, Behnam; Iziy, Elham; Ojaghi, Habib

    2017-01-01

    Background and Purpose. Trauma is the leading cause of death for youth in developing countries. Given the prevalence of head trauma (HT) in society and its complication and burden, the epidemiologic study of head trauma is necessary and is the main aim of this study. Materials and Methods. This retrospective population-based survey describes the epidemiology of head injury in a defined population in Ardabil city. It includes all 204 patients with head injury referred to the University Hospital of Ardabil, Iran, during 2013-2014. Data were collected by a checklist and analyzed by statistical methods in SPSS.19. Significance level p < 0.05 was considered. Results. Of all registered cases, 146 (71.6%) were male and the rest of them were female. Most of HT patients lived in Ardabil city (60.8%). The mean age of patients was 22.6 ± 25.9 and most of victims were young. 24.5% of traumatic patients have injuries in severe to critical level (grade 3-4). The most cause of trauma was accidents (41.7%). Most of injuries occurred in night (55.9%) and in summer season (42.2%). Causes were traffic accident in 41.7%. Conclusion. Results showed that the leading cause of head trauma especially in the warm seasons is accidents and so, designing programs to reduce road accidents can dramatically reduce the rate of trauma in the future in Ardabil province. PMID:28255457

  18. An indoor radon survey of the X-ray rooms of Mexico City hospitals

    NASA Astrophysics Data System (ADS)

    Juárez, Faustino; Reyes, Pedro G.; Espinosa, Guillermo

    2013-07-01

    This paper presents the results of measurements of indoor radon concentrations in the X-ray rooms of a selection of hospitals in the metropolitan area of Mexico City. The metropolitan area of Mexico City is Mexico's largest metropolitan area by population; the number of patients requiring the use of X-rays is also the highest. An understanding of indoor radon concentrations in X-ray rooms is necessary for the estimation of the radiological risk to which patients, radiologists and medical technicians are exposed. The indoor radon concentrations were monitored for a period of six months using nuclear track detectors (NTD) consisting of a closed-end cup system with CR-39 (Lantrack®) polycarbonate as detector material. The indoor radon concentrations were found to be between 75 and 170 Bq m-3, below the USEPA-recommended indoor radon action level for working places of 400 Bq m-3. It is hoped that the results of this study will contribute to the establishment of recommended action levels by the Mexican regulatory authorities responsible for nuclear safety.

  19. Donor blood procurement and utilisation at the University of Benin Teaching Hospital, Benin City.

    PubMed

    Enosolease, M E; Imarengiaye, C O; Awodu, O A

    2004-08-01

    Banked blood is a limited resource in Nigeria. We sought to evaluate factors that may further limit the effective utilisation of donor blood in a tertiary hospital in Benin City. The records of the blood transfusion unit of the hospital were studied to identify the methods of blood procurement and utilisation from January 1, 2000 to December 31, 2002. A total of 11,021 units of blood were received in the blood transfusion unit within this period out of which 1491 (13.5%) donor blood samples were found unfit for transfusion and, hence, discarded. Commercial blood donation accounted for 95.3%, compared to 4.7% from replacement and volunteer donors. Commercial blood donation was a major risk factor for likely disposal of donor blood (chi2 = 74.3, p < 0.0001, OR = 21.1. 95% CI = 7.8-56.7). Expired units of blood with low PCV were discarded for lack of infrastructure to fractionate and store them. Over 0.8million naira (US$6000.00) is wasted annually on discarded units of donor blood mainly from commercial donors. A policy on blood procurement to include subgroup selection of donors and improved funding of blood banking services may enhance efficient and effective utilisation of donor blood.

  20. Citrobacter infections in a general hospital: characteristics and outcomes.

    PubMed

    Samonis, G; Karageorgopoulos, D E; Kofteridis, D P; Matthaiou, D K; Sidiropoulou, V; Maraki, S; Falagas, M E

    2009-01-01

    In this investigation, we sought to investigate the characteristics of Citrobacter spp. infections. A retrospective cohort study in a 700-bed, tertiary care, university hospital was carried out during the period from June 1994 to January 2006. Seventy-eight patients (70 adults) with Citrobacter spp. isolates were identified. C. freundii was more common (71.8%), followed by C. koseri (23.1%) and C. braakii (3.8%). The most common associated clinical syndromes were urinary tract infections (52.6% of cases, including eight cases of asymptomatic bacteriuria), as well as intra-abdominal (14.1%), surgical site (7.7%), skin and soft tissue (6.4%), and respiratory tract infections (6.4%). In 29.5% of patients, Citrobacter spp. isolates were associated to polymicrobial infections, principally at sites other than the urinary tract. Antibiograms of 38 consecutive Citrobacter spp. isolates (29 C. freundii) were available. Most active agents were colistin (100%), fosfomycin (100%), imipenem (97.4%), gentamicin (89.5%), nitrofurantoin (89.5%), ciprofloxacin (80.6%), and cefepime (73.7%). Most patients (82.1%) had at least one underlying illness. Combination antimicrobial therapy was administered in 28.2% of cases. One patient died during hospitalization. The length of hospital stay was longer in patients with polymicrobial compared to monomicrobial infections (23 versus 13 days, respectively, p = 0.02). The isolation of Citrobacter species, although rather infrequent, was clinically relevant in the great majority of cases. Further attention should be paid to these pathogens.

  1. Association between PM10 and respiratory hospital admissions in different seasons in heavily polluted Lanzhou City.

    PubMed

    An, Xingqin; Yan, Tao; Mi, Shengquan; Sun, Zhaobin; Hou, Qing

    2015-01-01

    Exposure-response relationship between particulate matter less than 10 μm in diameter (PM10) and human health in different seasons from 2001 to 2005 was examined based on hospital admissions data of respiratory system diseases from four major hospitals in Lanzhou, China. To quantify associations of respiratory system diseases with multiple air pollutants and meteorological conditions, a semiparametric generalized additive model was used in the authors' study by implementing daily ambient sulfur dioxide, nitrogen dioxide, and PM10 data collected from the Lanzhou Environmental Monitoring Station and daily meteorological data from Lanzhou Meteorological Bureau. Results showed that daily averaged PM10 increased per interquartile range the hospital admissions number of respiratory diseases by 3.3% in spring, 1.4% in summer, 3.6% in autumn, and 4.0% in winter from a single-pollutant model, or 3.1%, 1.4%, 3.0%, and 4.0% from a multi-pollutant model, respectively. The effect of PM10 on respiratory hospital admissions was lowest in summer and highest in winter. The relative risks of PM10 on female or the elderly (≥ 65 yrs.) were higher, showing a stronger association of PM10 with respiratory diseases in female and elderly groups than in males and people younger than 65.

  2. Appropriateness of hospitalization for CAP-affected pediatric patients: report from a Southern Italy General Hospital

    PubMed Central

    Antonelli, Fabio; De Brasi, Daniele; Siani, Paolo

    2009-01-01

    Background Community-acquired pneumonia (CAP) is a common disease, responsible for significant healthcare expenditures, mostly because of hospitalization. Many practice guidelines on CAP have been developed, including admission criteria, but a few on appropriate hospitalization in children. The aim of this study was to evaluate appropriate hospital admission for CAP in a pediatric population. Methods We evaluated appropriate admission to a Pediatric Unit performing a retrospective analysis on CAP admitted pediatric patients from a Southern Italy area. Diagnosis was made based on clinical and radiological signs. Appropriate hospital admission was evaluated following clinical and non-clinical international criteria. Family ability to care children was assessed by evaluating social deprivation status. Results In 2 winter seasons 120 pediatric patients aged 1-129 months were admitted because of CAP. Median age was 28.7 months. Raised body temperature was scored in 68.3% of patients, cough was present in 100% of cases, and abdominal pain was rarely evidenced. Inflammatory indices (ESR and CRP) were found elevated in 33.3% of cases. Anti-Mycoplasma pneumoniae antibodies were found positive in 20.4%. Trans-cutaneous (TC) SaO2 was found lower than 92% in 14.6%. Dyspnoea was present in 43.3%. Dehydration requiring i.v. fluid supplementation was scored in 13.3%. Evaluation of familial ability to care their children revealed that 76% of families (derived from socially depressed areas) were "at social risk", thus not able to appropriately care their children. Furthermore, analysis of CAP patients revealed that "at social risk" people accessed E.D. and were hospitalized more frequently than "not at risk" patients (odds ratio = 3.59, 95% CI: 1,15 to 11,12; p = 0.01), and that admitted "at social risk" people presented without clinical signs of severity (namely dyspnoea, and/or SaO2 ≤ 92%, and/or dehydration) more frequently than "not at risk" population (p = 0.005). Conclusion

  3. Legal implications of hospital resales of pharmaceuticals. American Hospital Association Office of General Counsel.

    PubMed

    1986-08-01

    The legal implications of and restrictions on hospital resales of pharmaceuticals are analyzed to help hospital managers distinguish between legitimate drug redistribution and illegal drug diversion and, thus, enable them to conform to the law in their own resale practices. The requirements of the Robinson-Patman Act regarding resales are discussed, and the application of those requirements is explained. Particular attention is given to descriptions of dispensations that are permissible, those that are not permissible, and those that result from group purchasing arrangements. Other legal issues that must also be considered as possible problems are breach of contract suits; fraud, not only according to state law but also under the Racketeer Influenced and Corrupt Organizations Act; exposure to product liability; adverse tax consequences; and violations of the Federal Food, Drug and Cosmetic Act. Many resale practices are legitimate, but others may constitute illegal drug diversion. Hospital managers should review their institutions' procedures and correct those activities that may be inappropriate or questionable. At a time when concern is being focused on potential public-health risks created by illegal drug diversion, hospitals must play a constructive role in helping to solve the diversion problem.

  4. Who's in charge here? The General Hospital School of Nursing, St. John's, Newfoundland, 1903-30.

    PubMed

    White, L

    1994-01-01

    This essay examines the effect of the political economy of the General Hospital, St. John's, Newfoundland, on the development of the General Hospital School of Nursing from 1903 to 1930. The General Hospital was the only government-funded hospital in Newfoundland providing health care for the entire colony of 124,000 people. The School of Nursing was the only nurses' training program in Newfoundland until 1929 when a second school opened. Two conflicting personalities who played an important role in the development of nursing at these institutions were Mary Southcott, Superintendent of Nurses from 1903 to 1916, and Lawrence Keegan, Medical Superintendent of the hospital. The resulting tension between these two people led to a major crisis at the hospital in 1914 with the government instigating a Royal Commission to examine the struggle between the nurses and the administration (doctors and government officials) over who had the power and authority to determine the nurses' role and status within the hospital. After a year of investigation, the Royal Commission agreed with Keegan's view and subsequently organized the hospital along new lines. Southcott was fired and a new, more compliant nurse put in her place. The second period, 1916 to 1930, saw the recommendations of the Royal Commission implemented, including establishment of a Board of Governors to run the hospital on a more businesslike footing.

  5. Optimization Evaluation, General Motors Former AC Rochester Facility, Sioux City, Iowa

    EPA Pesticide Factsheets

    The General Motors (GM) Former AC Rochester Facility (site) is located within the valley of the Missouri River in Sioux City, Iowa and is bounded by a steep loess bluff to the north, commercial properties to the east, and undeveloped properties to the...

  6. 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

  7. Implementation of a Prototype Generalized Network Technology for Hospitals *

    PubMed Central

    Tolchin, S. G.; Stewart, R. L.; Kahn, S. A.; Bergan, E. S.; Gafke, G. P.; Simborg, D. W.; Whiting-O'Keefe, Q. E.; Chadwick, M. G.; McCue, G. E.

    1981-01-01

    A demonstration implementation of a distributed data processing hospital information system using an intelligent local area communications network (LACN) technology is described. This system is operational at the UCSF Medical Center and integrates four heterogeneous, stand-alone minicomputers. The applications systems are PID/Registration, Outpatient Pharmacy, Clinical Laboratory and Radiology/Medical Records. Functional autonomy of these systems has been maintained, and no operating system changes have been required. The LACN uses a fiber-optic communications medium and provides extensive communications protocol support within the network, based on the ISO/OSI Model. The architecture is reconfigurable and expandable. This paper describes system architectural issues, the applications environment and the local area network.

  8. Periodontal Health among Non-Hospitalized Chronic Psychiatric Patients in Mangaluru City-India

    PubMed Central

    Singh, Rashmi; Kota, Keshava Pai

    2016-01-01

    Introduction A substantial section of society constituting the mentally ill and psychiatric patients deserve special attention. Evidence has suggested that psychological factors have contributed to an increase in the susceptibility to periodontal disease. Aim The aim of the study was to evaluate the gingival and periodontal health of chronically non-hospitalized psychiatric patients in Mangaluru city, India. Materials and Methods Forty one psychiatric patients having chronic psychiatric illness and on neuroleptic medications for a minimum of 2 years were included in the study. The control group consisted of 41 healthy dental patients who were selected to match the study group by age and gender, and for both groups 20 teeth excluding the third molars should be present. Demographic characteristics, dental examination including gingival index and periodontal health according to the community periodontal index were recorded for each patient in both the groups. Results In the psychiatric patient group (Group A) 47.1% subjects were suffering from schizophrenia and 17.6% subjects were having mood disorder. Gingivitis varied from mild to severe among the patients of both the groups. Bleeding on probing (CPI 1) was recorded in 23.5% in Group A and 14.6% in Group B. Dental calculus (CPI 2) in 38.2% in Group A and 58.5% in Group B of the subjects, 20.6% with at least one 4mm to 5mm pocket (CPI 3), and 17.6% with at least one 6mm pocket (CPI 4). Conclusion The present study underlines a considerable need for prevention and treatment of periodontal disease among chronic psychiatric patients in Mangaluru city. Every effort should be made to increase the awareness of this cohort regarding the importance of oral hygiene practices and on the early diagnosis of periodontal problems. PMID:27656561

  9. Levels of organic compounds in interiors (school, home, university and hospital) of Ouargla city, Algeria

    NASA Astrophysics Data System (ADS)

    Boudehane, A.; Lounas, A.; Moussaoui, Y.; Balducci, C.; Cecinato, A.

    2016-11-01

    Indoor environments are affected by a number of organic contaminants, whose concentrations can exceed by orders of magnitude those found outdoors in external air. At this regard, polycyclic aromatic hydrocarbons (PAHs) deserve a special concern. PAHs occur in the air both in the gaseous and particulate forms; they are associated to fine aerosols and soil dust, and deposit on surfaces. Nonetheless, scarce information exists about the PAH pollution of indoor locations in Northern Africa. PAHs were first investigated in dust of interiors in Ouargla (Saharan Algeria), concurrently with n-alkanes and polar organics. Settled dust was collected from pre-cleaned surfaces (0.5 m2 each) at 7 internal locations in total from a school, the city hospital and university, and a home. Three sample series were collected 15, 30 days and random after the preliminary cleaning of surfaces. Contemporarily, organic compounds were collected at 15 locations of the target sites by deploying diffusive samplers over the whole study period to obtain molecular signatures of semi-volatile organic fraction. A consolidated procedure consisting of ultra-sonic bath extraction, semi-preparative column chromatography and gas chromatographic - mass spectrometric analysis was applied for chemical characterization of dusts. n-Alkanes ranged from 3.8 to 41 μg/m2 in dust and 0.17-2.42 μg/m3 in gas phase. PAHs concentrations were 17-89 ng/m2 and 45-182 ng/m3, respectively. Caffeine and nicotine were found both in dust (63-2,02 ng/m2 and 7-284 ng/m2, respectively) and as vapors in air (4-416 ng/m3 and 3.5-60 ng/m3). Two sites were affected by cannabinoids, while traces of nonylphenols occurred at all locations. External air was, on the average, more affected by PAHs than the interiors of school and hospital, but not of university. The compound concentrations show that Ouargla city is seriously polluted and requires actions to improve air quality.

  10. [Patient satisfaction with anesthesia care in a general hospital].

    PubMed

    Moura, Ana Catarina; Ferreira, Maria Amélia; Barbosa, Joselina; Mourão, Joana

    2014-01-01

    Introdução: O nível de satisfação com os cuidados de saúde reflete a qualidade dos cuidados prestados segundo a perspetiva do doente. O objetivo do estudo é avaliar a satisfação dos doentes com os cuidados anestésicos num hospital central português através da aplicação do questionário “Heidelberg Peri-anaesthetic Questionnaire”.Material e Métodos: O questionário foi traduzido e testado segundo critérios de qualidade psicométrica numa amostra de 107 doentes submetidos a cirurgia eletiva com internamento no Hospital de São João. A satisfação total e para cada dimensão foram calculadas. Analisámos as diferenças entre doentes com diferentes níveis de satisfação, identificando potenciais fatores de confundimento.Resultados: A versão portuguesa do questionário é constituída por 32 itens distribuídos por três dimensões: ‘equipa’, ‘desconforto’ e ‘medo’. Os valores médios de satisfação para cada dimensão foram 83,4%; 66,8% e 65,9%, respetivamente. A consistência interna foi demonstrada através de valores alfa de Cronbach de 0,776 a 0,875 nas três dimensões. Os doentes de satisfeitos e insatisfeitos diferiram nas três dimensões, com uma diferença menor em ‘equipa’. Na análise multivariada encontrámos influência significativa do género na dimensão ‘desconforto’.Discussão: O questionário apresentou boas características psicométricas. A dimensão ‘equipa’ inclui três domínios do questionário original.Conclusões: A sua aplicação revelou elevados níveis de satisfação com a equipa profissional. A insatisfação é sobretudo um reflexo das dimensões ‘medo’ e ‘desconforto’, sendo este significativamente menor nos homens.

  11. Satisfaction degree evaluation of the users of "Attikon" University General Hospital's library.

    PubMed

    Stamouli, Maria-Aggeliki; Balis, Charalampos; Georgakopoulou, Konstantina-Maria

    2013-01-01

    The ability of hospital medical libraries to meet users' needs is a complicated issue and has been examined by many surveys. The aim of this study is to evaluate the satisfaction degree of the users of "Attikon" University General Hospital's medical library. A questionnaire was used to collect the necessary information Although, in general, the users seems to be satisfied, some adjustments, such as up-to-date books, journals and computers, have to be made.

  12. A methodology model for quality management in a general hospital.

    PubMed

    Stern, Z; Naveh, E

    1997-01-01

    A reappraisal is made of the relevance of industrial modes of quality management to the issues of medical care. Analysis of the nature of medical care, which differentiates it from the supplier-client relationships of industry, presents the main intrinsic characteristics, which create problems in application of the industrial quality management approaches to medical care. Several examples are the complexity of the relationship between the medical action and the result obtained, the client's nonacceptance of economic profitability as a value in his medical care, and customer satisfaction biased by variable standards of knowledge. The real problems unique to hospitals are addressed, and a methodology model for their quality management is offered. Included is a sample of indicator vectors, measurements of quality care, cost of medical care, quality of service, and human resources. These are based on the trilogy of planning quality, quality control, and improving quality. The conclusions confirm the inadequacy of industrial quality management approaches for medical institutions and recommend investment in formulation of appropriate concepts.

  13. Injectional anthrax at a Scottish district general hospital.

    PubMed

    Inverarity, D J; Forrester, V M; Cumming, J G R; Paterson, P J; Campbell, R J; Brooks, T J G; Carson, G L; Ruddy, J P

    2015-04-01

    This retrospective, descriptive case-series reviews the clinical presentations and significant laboratory findings of patients diagnosed with and treated for injectional anthrax (IA) since December 2009 at Monklands Hospital in Central Scotland and represents the largest series of IA cases to be described from a single location. Twenty-one patients who fulfilled National Anthrax Control Team standardized case definitions of confirmed, probable or possible IA are reported. All cases survived and none required limb amputation in contrast to an overall mortality of 28% being experienced for this condition in Scotland. We document the spectrum of presentations of soft tissue infection ranging from mild cases which were managed predominantly with oral antibiotics to severe cases with significant oedema, organ failure and coagulopathy. We describe the surgical management, intensive care management and antibiotic management including the first description of daptomycin being used to treat human anthrax. It is noted that some people who had injected heroin infected with Bacillus anthracis did not develop evidence of IA. Also highlighted are biochemical and haematological parameters which proved useful in identifying deteriorating patients who required greater levels of support and surgical debridement.

  14. Evaluation of Outpatient Antibiotic Use in Beijing General Hospitals in 2015

    PubMed Central

    Yang, Chuan; Cai, Wen-Qiang; Zhou, Zi-Jun

    2017-01-01

    Background: Medical misuse of antibiotics is associated with the acquisition and spread of antibiotic resistance, resulting in a lack of effective drugs and increased health-care cost. Nevertheless, inappropriate antibiotic use in China remains common and the situation requires urgent improvement. Here, we analyzed the prescriptions of antibiotics and evaluated the rationality of antibiotic use among outpatients in Beijing general hospitals during 2015. Methods: We collected basic medical insurance claim data from January 1, 2015 to December 31, 2015 in 507 general hospitals of Beijing. A descriptive analysis of outpatient antibiotic prescribing was performed. The Anatomical Therapeutic Chemical Classification/defined daily doses system was used to evaluate the rationality of antibiotic use. Results: Over the study, an estimated 721,930, 613,520, and 822,480 antibiotics were dispensed in primary, secondary, and tertiary general hospitals corresponding to 5.09%, 5.06%, and 2.53% of all prescriptions, respectively. Antibiotic combinations represented 2.95%, 7.74%, and 10.18% of the total antibiotic prescriptions, respectively. Expenditure for the top twenty antibiotics in primary, secondary, and tertiary general hospitals was RMB 42.92, 65.89, and 83.26 million Yuan, respectively. Cephalosporins were the most frequently prescribed class of antibiotic in clinical practice. The antibiotics used inappropriately included azithromycin enteric-coated capsules, compound cefaclor tablets and nifuratel nysfungin vaginal soft capsules in primary hospitals, amoxicillin and clavulanate potassium dispersible tablets (7:1) and cefonicid sodium for injection in secondary hospitals, cefminox sodium for injection and amoxicillin sodium and sulbactam sodium for injection in tertiary hospitals. Conclusions: Antibiotic use in Beijing general hospitals is generally low; however, inappropriate antibiotic use still exists. Inappropriately used antibiotics should be subject to rigorous

  15. Hepatitis E virus (HEV) in sewage from treatment plants of Messina University Hospital and of Messina City Council.

    PubMed

    La Fauci, V; Sindoni, D; Grillo, O C; Calimeri, S; Lo Giudice, D; Squeri, R

    2010-03-01

    Samples of sewage from treatment plants at the "G. Martino" University Hospital of Messina (AOU) and that of Messina City Council were analysed to detect the hepatits E virus. Samples were taken on sewage entering and exiting the treatment plants on a monthly basis over a one-year period from both the hospital plant (24 samples) and the municipal plant (22 samples). All sewage samples were pretreated by ultrafiltraton and concentration and finally processed by the PCR method to amplify gene material. A total of three samples tested positive: two (8.33%) entering the AOU treatment plant and one (4.5%) entering the municipal plant while no cases of HEV were detected in samples of treated sewage. These findings confirm the presence of the virus in the city of Messina and showed that the two treatment plants to be working efficiently when tested.

  16. [Pharmaceutical Service after the Fukushima Disaster: A Case Report of Soma General Hospital].

    PubMed

    Fukunaga, Hisanori; Momonoi, Toshiyuki; Kumakawa, Hiromi

    2016-01-01

      Despite being damaged by the 2011 Tohoku earthquake, tsunami, and nuclear disaster, Soma General Hospital, located approximately 40 km north of Fukushima Daiichi nuclear power plant, was able to fulfill its role as a key regional hospital in northeast Fukushima. To elucidate the pharmaceutical service in response to the disaster, we investigated the hospital's operations in 2011 according to the medical records and prescriptions. One of the difficulties that the department of pharmaceutical service faced at that time was the increase in emergency healthcare requests by evacuated patients from other hospitals and clinics. Herein, we propose the following countermeasures to be considered in future disaster preparations: (1) establishing a medical and pharmaceutical service coordinator for disaster relief; (2) sharing all local patients' medical information in emergencies (at least contraindicated drugs or allergy history); and (3) reviewing disaster stockpiles, especially pharmaceuticals (both at the hospital and in nearby locations).

  17. Causes of Hospitalization among Children Ages Zero to Nine Years Old in the City of São Paulo, Brazil

    PubMed Central

    Ferrer, Ana Paula Scoleze; Sucupira, Ana Cecília Silveira Lins; Grisi, Sandra Josefina Ferraz Ellero

    2010-01-01

    INTRODUCTION: The profile of child morbidity is an important parameter for defining and altering health policies. Studies about infant mortality are more numerous than those on morbidity, especially related to hospital admissions. The objective of this study is to describe the causes of admission in the public health system for children from zero to nine years of age in the city of São Paulo during the years 2002 to 2006 and compare these results to those from the national data. METHOD: Through a cross-sectional study, data were obtained from the Hospital Information System, which is available in the Information System of the Unified Health System - DATASUS. RESULTS: Within the period, 16% of the total admissions corresponded to children from zero to nine years of age, with most of the children being younger than one year of age. In the city of São Paulo, the admission coefficient increased 11%, and in Brazil, it decreased 14%. Respiratory diseases were the main causes of hospitalization. In São Paulo, the second most frequent causes of admission were diseases that originated during the perinatal period (15.9%), and in Brazil, the second most frequent cause of admission was infectious-parasitic diseases (21.7%). Admissions for perinatal diseases increased 32% in São Paulo and 6% in Brazil. While hospitalizations for diarrhea decreased in Brazil, an increase was recorded in the city of São Paulo for children under five years old. CONCLUSIONS: The findings of this study show a paradoxical increase in the number of hospitalizations during an expansion of primary attention, indicating that the rise was not associated with a significant improvement in the quality of service. PMID:20126344

  18. Control Costs, Enhance Quality, and Increase Revenue in Three Top General Public Hospitals in Beijing, China

    PubMed Central

    Zhao, Lue-Ping; Yu, Guo-Pei; Liu, Hui; Ma, Xie-Min; Wang, Jing; Kong, Gui-Lan; Li, Yi; Ma, Wen; Cui, Yong; Xu, Beibei; Yu, Na; Bao, Xiao-Yuan; Guo, Yu; Wang, Fei; Zhang, Jun; Li, Yan; Xie, Xue-Qin; Jiang, Bao-Guo; Ke, Yang

    2013-01-01

    Background With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. Methods We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS), cost per day (CPD), inpatient mortality rate (IMR), and length of stay (LOS), using a generalized additive model. Findings There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001), from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. Interpretations These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role. However, purely

  19. Influenza Hospitalizations Among American Indian/Alaska Native People and in the United States General Population

    PubMed Central

    Gounder, Prabhu P.; Callinan, Laura S.; Holman, Robert C.; Cheng, Po-Yung; Bruce, Michael G.; Redd, John T.; Steiner, Claudia A.; Bresee, Joseph; Hennessy, Thomas W.

    2014-01-01

    Background.  Historically, American Indian/Alaska Native (AI/AN) people have experienced a disproportionate burden of infectious disease morbidity compared with the general US population. We evaluated whether a disparity in influenza hospitalizations exists between AI/AN people and the general US population. Methods.  We used Indian Health Service hospital discharge data (2001–2011) for AI/AN people and 13 State Inpatient Databases (2001–2008) to provide a comparison to the US population. Hospitalization rates were calculated by respiratory year (July–June). Influenza-specific hospitalizations were defined as discharges with any influenza diagnoses. Influenza-associated hospitalizations were calculated using negative binomial regression models that incorporated hospitalization and influenza laboratory surveillance data. Results.  The mean influenza-specific hospitalization rate/100 000 persons/year during the 2001–2002 to 2007–2008 respiratory years was 18.6 for AI/AN people and 15.6 for the comparison US population. The age-adjusted influenza-associated hospitalization rate for AI/AN people (98.2; 95% confidence interval [CI], 51.6–317.8) was similar to the comparison US population (58.2; CI, 34.7–172.2). By age, influenza-associated hospitalization rates were significantly higher among AI/AN infants (<1 year) (1070.7; CI, 640.7–2969.5) than the comparison US infant population (210.2; CI, 153.5–478.5). Conclusions.  American Indian/Alaska Native people had higher influenza-specific hospitalization rates than the comparison US population; a significant influenza-associated hospitalization rate disparity was detected only among AI/AN infants because of the wide CIs inherent to the model. Taken together, the influenza-specific and influenza-associated hospitalization rates suggest that AI/AN people might suffer disproportionately from influenza illness compared with the general US population. PMID:25734102

  20. Components of Hospital Perioperative Infrastructure Can Overcome the Weekend Effect in Urgent General Surgery Procedures

    PubMed Central

    Kothari, Anai N.; Zapf, Matthew A.C.; Blackwell, Robert H.; Markossian, Talar; Chang, Victor; Mi, Zhiyong; Gupta, Gopal N.; Kuo, Paul C.

    2016-01-01

    Objective We hypothesized that perioperative hospital resources could overcome the “weekend effect” (WE) in patients undergoing emergent/urgent surgeries. Summary Background Data The WE is the observation that surgeon-independent patient outcomes are worse on the weekend compared with weekdays. The WE is often explained by differences in staffing and resources resulting in variation in care between the week and weekend. Methods Emergent/urgent surgeries were identified using the Healthcare Cost and Utilization Project State Inpatient Database (Florida) from 2007 to 2011 and linked to the American Hospital Association (AHA) Annual Survey Database to determine hospital level characteristics. Extended median length of stay (LOS) on the weekend compared with the weekdays (after controlling for hospital, year, and procedure type) was selected as a surrogate for WE. Results Included were 126,666 patients at 166 hospitals. A total of 17 hospitals overcame the WE during the study period. Logistic regression, controlling for patient characteristics, identified full adoption of electronic medical records (OR 4.74), home health program (OR 2.37), pain management program [odds ratio (OR) 1.48)], increased registered nurse-to-bed ratio (OR 1.44), and inpatient physical rehabilitation (OR 1.03) as resources that were predictors for overcoming the WE. The prevalence of these factors in hospitals exhibiting the WE for all 5 years of the study period were compared with those hospitals that overcame the WE (P <0.001). Conclusions Specific hospital resources can overcome the WE seen in urgent general surgery procedures. Improved hospital perioperative infrastructure represents an important target for overcoming disparities in surgical care. PMID:26366549

  1. The creation of a Dementia Nurse Specialist role in an acute general hospital.

    PubMed

    Elliot, R; Adams, J

    2011-09-01

    Older people form the largest group occupying acute hospital beds and many of them will have undiagnosed mental health problems. The creation of a Dementia Nurse Specialist role in a district general hospital provided the opportunity to assess the extent of the previously unmet need among patients, carers and nursing staff. Over 30 patients were seen each month, while around 6 to 12 were diagnosed as having dementia. Other activities undertaken as part of the role included providing information and support for carers, and advice on management of behaviours and support for ward staff. The role also involved policy writing, pathway and local strategy planning, care plan development, and formal and informal teaching on dementia. It is argued that this fixed-term post demonstrated that a Dementia Nurse Specialist could provide significant input in an acute hospital setting, by improving the experience of hospitalization for vulnerable older people and their carers.

  2. The association between job satisfaction and general health among employees of Golestan Hospital in Ahvaz, Iran

    PubMed Central

    Khiavi, Farzad Faraji; Dashti, Rezvan; Zergani, Nadia

    2016-01-01

    Introduction Job satisfaction is one of the most challenging organizational concepts, and it is the basis of management policies to increase productivity and efficiency of the organization. The general health rate may affect job satisfaction in several ways. This study aimed to determine the association between job satisfaction and general health among employees of Golestan Hospital in Ahvaz, Iran. Methods The study population of this cross-sectional research included 100 employees of Golestan Hospital in Ahvaz, Iran. The data collection instruments were the General Health Questionnaire (28-GHQ) and the Job Descriptive Index (JDI) questionnaire. The data were analyzed using Pearson’s product-moment correlation coefficient, independent samples t-test, and ANOVA statistical tests in SPSS software. Results The mean general health was calculated as 26.19 ± 11.04, which indicated a positive psychiatric condition. Job satisfaction with a mean score of 89.67 ± 23.3 was deemed to be relatively dissatisfied. A medium negative and significant association was observed between job satisfaction and general health and its subscales (physical health, anxiety, social, and depression). Conclusions General health subscales and job satisfaction are associated. Some actions must be planned to cope with the negative factors in general health in order to increase employees’ satisfaction in university educational hospitals. PMID:27280002

  3. Internal Revenue Service General Counsel's Memorandum threatens tax exemption for charitable hospitals.

    PubMed

    Ball, D W

    1992-01-01

    A recent memorandum from the General Counsel of the Internal Revenue Service changes the standard against which tax exempt entities will be measured, which change can adversely affect charitable hospitals' tax exempt status. In addition, the memorandum makes clear that a violation of the Anti-Kickback statute, discussed in Mr. Aaron's article, is inconsistent with tax exempt status.

  4. The Paradox of Nursing Terminal Patients in a Belgian General Hospital.

    ERIC Educational Resources Information Center

    Timmermans, Stefan

    1993-01-01

    Analyzed how nurses deal with terminal and dying patients in two inpatient wards in Belgian general hospital. Observed that nurses often felt dissatisfied with their terminal caregiving. Suggests terminal care include specific physical, social, religious, and psychological services, given to terminal patient and family, to obtain as high a level…

  5. Legal Outcomes of Sexually Abused Children Evaluated at the Philippine General Hospital Child Protection Unit

    ERIC Educational Resources Information Center

    Sugue-Castillo, Mariella

    2009-01-01

    Objectives: To describe the legal outcomes and factors associated with case reaching court and conviction for sexual abuse of children seen at the Philippine General Hospital Child Protection Unit (PGH-CPU) from 1997 to 2000. Methods: Mixed transdisciplinary research design combined longitudinal cohort with qualitative methods. Data were obtained…

  6. Critical care research in a district general hospital: the first year.

    PubMed

    Camsooksai, Julie; Barnes, Helena; Reschreiter, Henrik

    2013-09-01

    Until recently, research in critical care units has usually taken place in university teaching hospitals. The 'general' critical care unit patient population is broader than this and the research needs to reflect this. As a general critical care unit in a district general hospital we wanted to set-up research within our own department, as part of the critical care team and part of our culture. With extensive background communication, drive and hard work, the support of the hospital Research and Development department was gained and Comprehensive Local Research Network funding successfully applied for. A research team was established and a model for the Research Nurse role was developed and implemented. This model is described. Participation in national trials commenced and the research portfolio is growing. Networking with other teams also proved valuable. Research has been established as part of the 'culture' of the day-to-day work and the staff have embraced this. Dedicated Research Nurse posts and education of the whole team have ensured successful implementation and recruitment of the studies. Experiences of the first year are shared and discussed here. Sharing experience of developing research within a critical care unit in a district general hospital, and a suggested model for a new Research Nurse role, may benefit other similar units in their efforts to establish research.

  7. General paediatric surgery for patients aged under 5 years: a 5-year experience at a district general hospital

    PubMed Central

    Gordon, AC

    2016-01-01

    Introduction The gradual shift of general paediatric surgery (GPS) provision from district general hospitals (DGH) to specialised units is well recognised in the UK. The consequences of centralisation include a reduction in exposure to GPS for current surgical trainees. The GPS practice of a DGH is examined here. Methods All operations performed on children aged under 5 years over a 5-year period were identified using the local electronic operation database. Electronic hospital records and clinic letters were accessed to collect data on demographics, operations performed and outcome measures. Results 472 GPS operations were performed on children between the age of 22 days and 5 years between 2009 and 2014, of which 43 were on an emergency basis and 105 were performed on patients aged less than 1 year. Three patients were admitted following day case surgery. Six patients were readmitted within 30 days. Complication rates for all procedures and the four most common procedures were similar to those found in published literature. Conclusions GPS for patients aged less than 5 years is comparatively safe in the DGH setting. The training opportunities available at DGHs are invaluable to surgical trainees and vital for sustaining the future provision of GPS by such hospitals. PMID:27269243

  8. Short and medium-term outcomes for general surgery in nonagenarian patients in a district general hospital.

    PubMed

    Hayes, A J; Davda, A; El-Hadi, M; Murphy, P; Papettas, T

    2016-07-01

    Introduction Surgeons are increasingly performing surgery on older patients. There are currently no tools specifically for risk prediction in this group. The aim of this study was to review general surgical operations carried out on patients aged over 90 years and their outcome, before comparing these with predictors of morbidity and mortality. Methods A retrospective review was carried out at our district general hospital of all general surgery patients aged over 90 years who underwent a general surgical operation over a period of 14 years. Information collected included demographics, details of procedures, P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity), complications and outcomes. Results A total of 119 procedures were carried out, 72 involving entry into the peritoneal cavity. Overall, 14 patients (12%) died within 30 days and 34 (29%) died within one year. Postoperative complications included infection (56%), renal failure (24%), need for transfusion (17%) and readmission within 30 days (11%). Logistical regression analysis showed that the P-POSSUM correlated well with observed mortality and infection was a significant predictor of in-hospital mortality (p=0.003). Conclusions The P-POSSUM correlates significantly with outcome and should be used when planning major elective or emergency surgery in patients over 90 years of age. Infective complications appear to be a significant predictor of postoperative mortality. This study supports operative intervention as an option in this extreme age group but we emphasise the importance of appropriate patient selection and judicious clinical care.

  9. Convergence and divergence: assessing criteria of consumer satisfaction across general practice, dental and hospital care settings.

    PubMed

    Williams, S J; Calnan, M

    1991-01-01

    This paper describes the results of the first-stage of a study carried out in the spring of 1988 in the South East of England. The study looked at general and specific aspects of consumer satisfaction with general practitioner services, general dental care services and hospital in-patients care. It also examined which specific consumer criteria were the key predictors of overall satisfaction within each of these particular medical care settings. A related aim was to assess the degree of congruence or divergence of consumer criteria across these differing medical care settings. The evidence suggests that whilst general levels of consumer satisfaction are high (i.e. 83-97%), questions of a more detailed and specific nature revealed greater levels of expressed dissatisfaction (e.g. 38% of the sample felt that they could not discuss personal problems with their GP, 51% felt their dentist was not easy to reach at weekends/holidays, whilst 35% felt hospital doctors did not give sufficient information). Whilst different areas of dissatisfaction were found in each specific medical care setting examined, what was particularly striking was the degree of convergence of the key predictors of overall consumer satisfaction across the medical care settings. That is to say, our findings clearly suggest that issues concerning 'professional competence', together with the nature and quality of the patient-professional relationship, are the key predictors of overall consumer satisfaction with general practice, dental and hospital care [e.g. GP giving sufficient information correlated 0.64 (P less than 0.001) with overall GP satisfaction scores; competent dentist 0.52 (P less than 0.001) with overall dental satisfaction scores; and full confidence in hospital doctors 0.49 (P less than 0.001) with overall hospital satisfaction scores]. The theoretical importance and policy implications of these findings, particularly in the light of the recent NHS reforms, are discussed.

  10. Serratia marcescens: Biochemical, Serological, and Epidemiological Characteristics and Antibiotic Susceptibility of Strains Isolated at Boston City Hospital

    PubMed Central

    Wilfert, James N.; Barrett, Fred F.; Ewing, W. H.; Finland, Maxwell; Kass, Edward H.

    1970-01-01

    The biochemical, serological, and epidemiological characteristics of 95 strains of Serratia marcescens isolated at the Boston City Hospital were examined. Several strains were shown to be endemic, and the majority of isolates were cultured from urine or respiratory secretions. Serratia species were highly resistant to polymyxin B and the cephalosporins, and various proportions were also resistant to other antibiotics including kanamycin, but all of the isolates were sensitive to gentamicin. The appearance of resistance to kanamycin and nalidixic acid among endemic strains was demonstrated. The nosocomial nature of Serratia infections, particularly those involving the urinary tract, was confirmed. Many clinical bacteriology laboratories currently fail to identify the nonpigmented strains. PMID:4314379

  11. Correlates of Attempted Suicide from the Emergency Room of 2 General Hospitals in Montreal, Canada

    PubMed Central

    Low, Nancy C. P.; Lamarre, Suzanne; Daneau, Diane; Habel, Youssef; Turecki, Gustavo; Bonin, Jean-Pierre; Morin, Suzanne; Szkrumelak, Nadia; Singh, Santokh; Lesage, Alain

    2016-01-01

    Introduction: The epidemiology of attempted suicide has not been well characterized because of lack of national data or an International Classification of Diseases (ICD) code for suicide attempts. We conducted a retrospective chart review in 2 adult general hospitals (tertiary and community) in Montreal, Canada, in 2009-2010 to 1) describe the characteristics of men and women who presented to the emergency department (ED) and/or were hospitalized following a suicide attempt, 2) identify factors associated with attempts requiring hospitalizations, and 3) validate the use of International Classification of Diseases, 10th Revision (ICD-10) codes for “intentional self-harm” as a method to detect suicide attempts from hospital abstract summary records. Method: All potential suicide attempts were identified from hospital abstract summary records and ED nursing triage file using ICD-10 codes and keywords suggestive of suicide attempts. All identified charts were examined, and those with confirmed suicide attempts were fully reviewed. Results: Of the 5746 identified charts, 369 were fully reviewed. Of these, 176 were for suicide attempters treated in the ED and 193 for hospitalized attempters, of whom 46% had an ICD-10 code for intentional self-harm. Poisoning (46%) was the most frequent method of suicide used. Half of attempters were younger than 34 years, 53% were female, and 75% had a history of mental disorders. Conclusion: About half of individuals who seek medical care for attempted suicide are admitted to hospital. About half of attempters use poisoning as a method of suicide, and a quarter do not have a history of mental disorders. Intentional self-harm codes capture only about half of hospitalized attempters.

  12. 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

  13. Acute generalized weakness in patients referred to Amirkola Children’s Hospital from 2005 to 2010

    PubMed Central

    Salehiomran, Mohammad Reza; Naserkhaki, Somayeh; Hajiahmadi, Mahmoud

    2012-01-01

    Background: Diseases that cause acute flaccid paralysis (AFP) often progress rapidly, thus may cause life threatening complications, therefore, their diagnosis and cure are important. This study was carried out to investigate the causes of acute generalized weakness in children referred to Amirkola Children’s Hospital, in Babol, Iran. Methods: In this case series, the epidemiological causes of the disease and clinical features of 15 cases with acute generalized weakness from April 2005 to September 2010 were evaluated. The data were collected and analyzed. Results: The mean age of cases was 4.7±3.5 years. The male/female ratio was 2. Twenty cases had Guillain-Barre syndrome, two with myositis and one with periodic hyperkalemic paralysis. Conclusion: Guillain-Barre syndrome is the most common cause of AFP in children admitted due to acute generalized weakness in Amirkola Children’s Hospital. PMID:24358438

  14. A clinical decision support system for venous thromboembolism prophylaxis at a general hospital in a middle-income country *,**

    PubMed Central

    Fuzinatto, Fernanda; de Waldemar, Fernando Starosta; Wajner, André; Elias, Cesar Al Alam; Fernandez, Juliana Fernándes; Hopf, João Luiz de Souza; Barreto, Sergio Saldanha Menna

    2013-01-01

    OBJECTIVE: To determine the impact that implementing a combination of a computer-based clinical decision support system and a program of training seminars has on the use of appropriate prophylaxis for venous thromboembolism (VTE). METHODS: We conducted a cross-sectional study in two phases (prior to and after the implementation of the new VTE prophylaxis protocol) in order to evaluate the impact that the combined strategy had on the use of appropriate VTE prophylaxis. The study was conducted at Nossa Senhora da Conceição Hospital, a general hospital in the city of Porto Alegre, Brazil. We included clinical and surgical patients over 18 years of age who were hospitalized for ≥ 48 h. The pre-implementation and post-implementation phase samples comprised 262 and 261 patients, respectively. RESULTS: The baseline characteristics of the two samples were similar, including the distribution of patients by risk level. Comparing the pre-implementation and post-implementation periods, we found that the overall use of appropriate VTE prophylaxis increased from 46.2% to 57.9% (p = 0.01). Looking at specific patient populations, we observed that the use of appropriate VTE prophylaxis increased more dramatically among cancer patients (from 18.1% to 44.1%; p = 0.002) and among patients with three or more risk factors (from 25.0% to 42.9%; p = 0.008), two populations that benefit most from prophylaxis. CONCLUSIONS: It is possible to increase the use of appropriate VTE prophylaxis in economically constrained settings through the use of a computerized protocol adhered to by trained professionals. The underutilization of prophylaxis continues to be a major problem, indicative of the need for ongoing improvement in the quality of inpatient care. PMID:23670498

  15. Cases of hydatidosis in patients referred to Governmental hospitals for cyst removal in Sana'a City, Republic of Yemen.

    PubMed

    Al-Shibani, Latifa A N; Al-Eryani, Samira M A; Azazy, Ahmed A; Al-Mekhlafi, Abdulsalam M

    2012-03-01

    Hydatidosis is a parasitic infestation caused by Echinococcus granulosus. This disease is endemic in many countries including Yemen. The present review article aims to have a glimpse at the present status of hydatidosis in Yemen. This is the first descriptive study, investigating recorded cases of hydatidosis from the five main governmental hospitals in the capital Sana'a city, over a longer period starting from 2001 and ending in 2008. A total of 796 medical records of patients referred to the five main governmental hospitals in Sana'a city for cyst removal, were studied. Of these cases 482 were females and 314 were males. Their mean age was 30.0 ± 16.9 years. Information regarding the location of the cyst in the body, age, sex and residence of each patient was recorded. A higher infection rate was found in females than males (60.6% and 39.4%, respectively). Single organ involvement was observed in 98.6% cases, among which, the most frequent localizations were the liver (60.8%) followed by the lung (24.7%). Cases of hydatidosis appeared to increase during the period 2001-2008, with the lowest number (n=26) and the highest number (n=140) recorded in 2001 and 2007, respectively. We conclude that the risk of hydatidosis is still high in Yemen, where street or stray dogs move freely down town and the population should be aware about the role of dogs in the transmission of this disease. Hospital records provide a useful indication of infection expressed as annual rate of hospital cases. Finally, the collaboration of Public Health Authorities, the Veterinary Medical Authorities and the Environmental Affairs Authorities is a must to control this disease.

  16. Troponin T: role in altering patient management and enabling earlier discharge from a district general hospital.

    PubMed

    Owen, A; Khan, W; Griffiths, K D

    2001-03-01

    The use of troponin T to facilitate early patient discharge was investigated in a prospective study in a district general hospital. Troponin T was measured in 91 patients admitted over a period of 6 months with chest pain but without evidence of myocardial infarction. The main outcome measure was length of hospital stay. A negative troponin T was found in 70 patients. Fifty of these were discharged within 24 h of the troponin result being available and they had a significantly shorter hospital stay than a case control group and a historical control group from the previous 6 months. Troponin T measurement has a role in altering patient management by enabling early discharge, resulting in significant cost savings and increasing bed availability.

  17. Prevalence of Non-Tuberculous Mycobacteria in Hospital Waters of Major Cities of Khuzestan Province, Iran

    PubMed Central

    Khosravi, Azar Dokht; Hashemi Shahraki, Abdolrazagh; Hashemzadeh, Mohammad; Sheini Mehrabzadeh, Rasa; Teimoori, Ali

    2016-01-01

    Non-tuberculous mycobacteria (NTM) are among the emerging pathogens in immunocompromised individuals including hospitalized patients. So, it is important to consider hospitals water supplies as a source for infection. The aim of this study was to determine the prevalence of NTM in the hospital aquatic systems of Khuzestan, South west of Iran. In total, 258 hospital water samples were collected and examined. After initial sample processing, sediment of each sample were inoculated into two Lowenstein-Jensen medium. The positive cultures were studied with phenotypic tests including growth rate, colony morphology, and pigmentation, with subsequent PCR- restriction enzyme analysis (PRA) and rpoB gene sequence analysis. Mycobacterial strains were isolated from 77 samples (29.8%), comprising 52 (70.1%) rapid growing, and 25 (32.4%) slow growing mycobacteria. Based on the overall results, M. fortuitum (44.1%) was the most common mycobacterial species in hospital water samples, followed by M. gordonae (n = 13, 16.8%) and M. senegalense (n = 5, 7.7%). In conclusion, current study demonstrated the NTM strains as one of the major parts of hospital water supplies with probable potential source for nosocomial infections. This finding also help to shed light on to the dynamics of the distribution and diversity of NTM in the water system of hospitals in the region of study. PMID:27148491

  18. The definition of life: a survey of obstetricians and neonatologists in New York City hospitals regarding extremely premature births.

    PubMed

    Ramsay, Sharon M; Santella, Regina M

    2011-05-01

    Among obstetricians and neonatologists in administrative roles in New York City hospitals, a survey was initiated to compare the physicians' definitions of live birth and fetal death, the gestational age at which they consider infants viable, and the resuscitation practices of the neonatologists. The target survey population was 34 neonatologists, and 39 obstetricians representing 41 of the City's 43 maternity hospitals. A telephone survey was used to gather qualitative data from the physicians regarding their definitions of live birth, fetal death, and viability, and their practices regarding extremely premature births. Surveys were completed for 58 physicians, a response rate of 79% (94% for neonatologists and 67% for obstetricians). Physicians' definitions of live birth and fetal death varied, with almost a third (29%) of physicians including gestational age as part of their live birth criteria. Most of the physicians (90%) consider infants born at ≥23 weeks gestation viable. Most neonatologists (97%) said they always resuscitate infants born at ≥23 weeks gestation, and most (94%) said they would never resuscitate infants born at <20 weeks gestation. For infants born at 20-22 weeks gestation, there were differences in resuscitation practices. There is a gap between clinical practices and reporting requirements for live birth and fetal death. Whereas reporting requirements are based on definitions of live birth and fetal death, physicians make resuscitation and other clinical decisions regarding extremely premature infants based on definitions of viability.

  19. Ethical dilemmas in general hospitals: social workers' contribution to ethical decision-making.

    PubMed

    Landau, R

    2000-01-01

    Thirty-two hospital social workers, fourteen of them directors of social work services and eighteen direct practitioners, were interviewed about their perception of the factors influencing social workers' contribution to the resolution of ethical dilemmas in general hospitals in Israel. Findings revealed that while ethical decision-making in hospitals is an interdisciplinary process, social workers' contribution to the process is affected by rivalry between social workers and other members of the health team, personality differences, type of ward and the nature of the ethical dilemma. Participants of the study had quite a clear perception of their role and of the unique knowledge-base social work can offer, including knowledge of the individual and family life course, understanding and skills in coping with diseases, and systems thinking. In order to increase their influence in ethical decision-making, the hospital social workers felt they must put more effort into developing their relationships with the other professionals involved in ethical decision-making both by making themselves more indispensable and by making their contribution explicit through greater documentation of their activities. The findings also implied that in order to gain more power and be accepted as equal partners in multidisciplinary teams, hospital social workers should improve their communication skills when interacting with representatives of other heath care professions.

  20. The business case for a diabetes self-management intervention in a community general hospital.

    PubMed

    Micklethwaite, Ashley; Brownson, Carol A; O'Toole, Mary L; Kilpatrick, Kerry E

    2012-08-01

    There is a growing and increasingly compelling body of evidence that self-management interventions for persons with type 2 diabetes can be both effective and cost-effective from a societal perspective. Yet, the evidence is elusive that these interventions can produce a positive business case for a sponsoring provider organization in the short term. The lack of a business case limits the enthusiasm for provider organizations to implement these proven quality-enhancing interventions more widely. This article provides a case example of a self-management intervention in a community general hospital targeting an underserved population who have significant barriers to receiving regular health care. The 3-component program sought to improve meaningful access to care, increase health literacy related to type 2 diabetes, and partner with the enrollees to make long-term lifestyle changes. The intervention not only resulted in significant improvements in HbA1c levels (-0.77%) but saved the hospital an average of $551 per active patient per year, primarily by reducing hospital visits. With only 255 actively enrolled patients, the hospital can recover fully its total direct annual personnel and operating costs for the program. Because the program serves patients who would have been seen at other hospitals, it also enhanced care quality and reduced costs for the broader community in which the program is embedded.

  1. [Investigation into drinking problem of patients who visited a general hospital in central and northern Okinawa].

    PubMed

    Nakai, Minori; Hotta, Hiroshi; Ootsuru, Taku; Hiejima, Shigeto; Murakami, Masaru; Yuzuriha, Takefumi; Kondo, Tsuyoshi

    2013-04-01

    In Japan, many problems related to alcohol are pointed out from before. We believe that there is a unique drinking culture in Okinawa, such as a large amount of alcohol. Therefore, we estimate many people in Okinawa have a drinking problem. We conducted a survey of patients who visited general hospital (medical or surgical or orthopedic) in 2007. The purpose of this study is to collect basic data for introducing alcoholics to specialized treatment as early as possible, detecting the person who drink large amounts of alcohol, performing early intervention for people who drink large amount of alcohol, and advancing cooperation with specialized medical agencies of alcohol. As a result, Among the patients who visited general hospital in Okinawa, many problem drinkers are concentrated in the young age. and they have strong fears of health. The possibility of early intervention with intervention techniques, such as brief intervention, has been suggested.

  2. 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…

  3. Laboratory investigation of monoclonal gammopathy during 10 years of screening in a general hospital.

    PubMed Central

    Malacrida, V; De Francesco, D; Banfi, G; Porta, F A; Riches, P G

    1987-01-01

    Protein electrophoresis was carried out on 102,000 samples from the patients of a district general hospital over 10 years, and a monoclonal protein was detected in 730 cases; of these, 114 could be classified as B cell malignancies and 261 as monoclonal gammopathy of undefined significance (MGUS). The various clinical and laboratory features of monoclonal gammopathy were examined with respect to distinguishing the malignant conditions from MGUS at first presentation. PMID:3114329

  4. An Effective Outpatient Appointment System for General Leonard Wood Army Community Hospital

    DTIC Science & Technology

    1990-07-13

    Orthopedics, Pediatric , Physical Examination, xPodiatry, Surgical, Urology, Well Baby, Body Fat Evaluation, Nutrition , PFB, and Speech. 2. RESPONSIBILITIES. a...PROJECT TASK WvORK UNIT I1 I ILUE (include Securiy assicton) An Effective Outpatient Appointment System for Gen Leonard Wood Army Comunity Hospital 12...analysis. Thirty two variables were provided by the reports for the six following clinic; Internal Medicine, Pediatrics , General Outpatient, Family Practice

  5. Modeling air quality in main cities of Peninsular Malaysia by using a generalized Pareto model.

    PubMed

    Masseran, Nurulkamal; Razali, Ahmad Mahir; Ibrahim, Kamarulzaman; Latif, Mohd Talib

    2016-01-01

    The air pollution index (API) is an important figure used for measuring the quality of air in the environment. The API is determined based on the highest average value of individual indices for all the variables which include sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), and suspended particulate matter (PM10) at a particular hour. API values that exceed the limit of 100 units indicate an unhealthy status for the exposed environment. This study investigates the risk of occurrences of API values greater than 100 units for eight urban areas in Peninsular Malaysia for the period of January 2004 to December 2014. An extreme value model, known as the generalized Pareto distribution (GPD), has been fitted to the API values found. Based on the fitted model, return period for describing the occurrences of API exceeding 100 in the different cities has been computed as the indicator of risk. The results obtained indicated that most of the urban areas considered have a very small risk of occurrence of the unhealthy events, except for Kuala Lumpur, Malacca, and Klang. However, among these three cities, it is found that Klang has the highest risk. Based on all the results obtained, the air quality standard in urban areas of Peninsular Malaysia falls within healthy limits to human beings.

  6. Two decades of external peer review of cancer care in general hospitals; the Dutch experience.

    PubMed

    Kilsdonk, Melvin J; Siesling, Sabine; Otter, Rene; van Harten, Wim H

    2016-03-01

    External peer review was introduced in general hospitals in the Netherlands in 1994 to assess and improve the multidisciplinary team approach in cancer care. This paper aims to explore the value, perceived impact, and (future) role of external peer review in cancer care. Semistructured interviews were held with clinicians, oncology nurses, and managers from fifteen general hospitals that participated in three rounds of peer review over a period of 16 years. Interviewees reflected on the goals and expectations, experiences, perceived impact, and future role of external peer review. Transcriptions of the interviews were coded to discover recurrent themes. Improving clinical care and organization were the main motives for participation. Positive impact was perceived on multiple aspects of care such as shared responsibilities, internal prioritization of cancer care, improved communication, and a clear structure and position of cancer care within general hospitals. Establishing a direct relationship between the external peer review and organizational or clinical impact proved to be difficult. Criticism was raised on the content of the program being too theoretical and organization-focussed after three rounds. According to most stakeholders, external peer review can improve multidisciplinary team work in cancer care; however, the acceptance is threatened by a perceived disbalance between effort and visible clinical impact. Leaner and more clinically focused programs are needed to keep repeated peer reviews challenging and worthwhile.

  7. Knowledge and Attitude of 851 Nursing Personnel toward Depression in General Hospitals of Korea.

    PubMed

    Park, Seon-Cheol; Lee, Hwa-Young; Lee, Dong-Woo; Hahn, Sang-Woo; Park, Sang-Ho; Kim, Yeo-Ju; Choi, Jae Sung; Lee, Ho-Sung; Lee, Soyoung Irene; Na, Kyoung-Sae; Jung, Sung Won; Shim, Se-Hoon; Choi, Joonho; Paik, Jong-Woo; Kwon, Young-Joon

    2015-07-01

    Our study aimed to examine the knowledge and attitude of nursing personnel toward depression in general hospitals of Korea. A total of 851 nursing personnel enrolled at four university-affiliated general hospitals completed self-report questionnaires. Chi-square tests were used to compare the knowledge and attitude of registered or assistant nurses toward depression. In addition, binary logistic regression analysis was used to adjust for the following confounders: age-group and workplace. Registered and assistant nurses differed in their knowledge and attitude toward depression. The proportion of rational and/or correct responses were higher in registered nurses than assistant nurses for the following: constellation of depressive symptoms defined by DSM-IV (adjusted odds ratio [aOR], 3.876; P<0.001); suicide risk in depression recovery (aOR, 3.223; P=0.001) and psychological stress as a cause of depression (aOR, 4.370; P<0.001); the relationship between chronic physical disease and depression (aOR, 8.984; P<0.001); and other items. Our results suggest that in terms of the biological model of depression, the understanding of registered nurses is greater than that of assistant nurses. Moreover, specific psychiatric education programs for nursing personnel need to be developed in Korea. Our findings can contribute to the development of a general hospital-based model for early detection of depression in patients with chronic medical diseases.

  8. Perceived Transcultural Self-Efficacy of Nurses in General Hospitals in Guangzhou, China

    PubMed Central

    Li, Juan; He, Zhuang; Luo, Yong; Zhang, Rong

    2016-01-01

    Background Conflicts arising from cultural diversity among patients and hospital staff in China have become intense. Hospitals have an urgent need to improve transcultural self-efficacy of nurses for providing effective transcultural nursing. Objective The purpose of the research was to (a) evaluate the current status of perceived transcultural self-efficacy of nurses in general hospitals in Guangzhou, China; (b) explore associations between demographic characteristics of nurses and their perceived transcultural self-efficacy; and (c) assess the reliability and validity of scores on the Chinese version of the Transcultural Self-Efficacy Tool (TSET). Methods A cross-sectional survey of registered nurses from three general hospitals was conducted. Quota and convenience sampling were used. Participants provided demographic information and answered questions on the TSET. Results A total of 1,156 registered nurses took part. Most nurses had a moderate level of self-efficacy on the Cognitive (87.9%), Practical (87%), and Affective (89.2%) TSET subscales. Nurses who were older; who had more years of work experience, higher professional titles, higher incomes, and a minority background; and who were officially employed (not temporary positions) had higher perceived transcultural self-efficacy. Reliability estimated using Cronbach’s alpha was .99 for the total TSET score; reliability for the three subscales ranged from .97 to .98. Confirmatory factor analysis of TSET scores showed good fit with a three-factor model. Conclusion The results of this study can provide insights and guidelines for hospital nursing management to facilitate design of in-service education systems to improve transcultural self-efficacy of nurses. PMID:27454552

  9. [Porto and the construction of the modern city: the case of Hospital Geral de Santo António in the eighteenth and nineteenth centuries].

    PubMed

    da Silva, Helena

    2014-01-01

    During a period of demographic and urban growth of the city of Porto, the need arose for a new hospital. The Santa Casa da Misericórdia of Porto, in charge of erecting the new health facility, appointed the British architect John Carr to design the project. By means of the analysis of a set of archival sources and sundry literature on the topic, we examine the criteria chosen for the design and construction of Hospital Geral de Santo António and if it fulfilled expectations, becoming a special space in the city. This article opens up a perspective on the study of the development of the city and the creation of this health facility, contributing to the historical trajectory of hospital architecture.

  10. Antibiotic Resistance and Biofilm Production in Staphylococcus epidermidis Strains, Isolated from a Tertiary Care Hospital in Mexico City

    PubMed Central

    Cabrera-Contreras, Roberto; Morelos-Ramírez, Rubén; Galicia-Camacho, Ada Nelly; Meléndez-Herrada, Enrique

    2013-01-01

    Staphylococcus epidermidis strains isolated from nosocomial infections represent a serious problem worldwide. In various Mexican states several reports have shown isolates from hospitals with antibiotic resistance to methicillin. In Mexico City, there is scarce information on staphylococcal infections in hospitals. Here, our research findings are shown in a four-year period study (2006–2010) for Staphylococcus epidermidis strains. Susceptibility and/or resistance to antibiotics in SE strains were assessed by phenotypic and molecular methods as mecA gene by PCR, as well as the correlation with biofilm production for these isolates and the relationship to the infection site. Out of a total of 161 (66%) negative biofilm SE strains, just 103 (64%) SE strains were confirmed as MRSE by PCR to mecA gene. From 84 (34%) positive biofilm SE strains, 76 (91%) were confirmed as MRSE by PCR to mecA gene. Higher percentages of resistance to antibiotics and higher number of resistance markers were found in biofilm-forming clinical strains (9 to 14) than non-biofilm-forming SE strains (3 to 8). These research findings represent a guide to establish infection control programs for this hospital. PMID:23724338

  11. Informed consent: a survey of general dental practitioners in Belgaum city.

    PubMed

    Kotrashetti, Vijayalakshmi S; Kale, Alka D; Hebbal, Mamata; Hallikeremath, Seema R

    2010-01-01

    The informed consent process allows the patient or legal guardian to participate in and retain autonomy over the medical service received. Obtaining informed consent may also decrease the practitioner's liability from claims associated with miscommunication. The aim of this study was to assess knowledge and practices of general dental practitioners (GDPs) regarding informed consent. 118 GDPs in Belgaum city, Karnataka, India, were given questionnaires asking for information on their knowledge and practices related to informed consent. The questions covered general information, treatment-specific issues and the consent process. 80 responses were received out of which 44 were complete. 63.6% of GDPs reported that they obtained written consent. All of them reported that they obtained only general consent. 4 of them obtained written consent in the local language. 37 said they gave a detailed explanation of the procedure. 3 said they did not inform their patients on radiation exposure. Dentists should upgrade their knowledge regarding legal jurisprudence and legal medicine to avoid any litigation.

  12. Trauma services requirements in a district general hospital serving a rural area.

    PubMed Central

    Kinny, S J; Jones, D H

    1990-01-01

    OBJECTIVE--To assess the demands made on a regional trauma centre by a district trauma unit. DESIGN--Two part study. (1) Prospective analysis of one month's workload. (2) Retrospective analysis of one year's workload by using a computer based records system. Comparison of two sets of results. SETTING--Accident unit in Gwynedd Hospital, Bangor. PATIENTS--(1) All patients who attended the accident unit in August 1988. (2) All patients who attended the accident unit in the calendar year April 1988-April 1989. MAIN OUTCOME MEASURE--Workload of a district trauma unit. RESULTS--In August 1988 there were 2325 attendances; 2302 of these were analysed. In all, 1904 attendances were for trauma; 213 patients were admitted to the trauma ward and 103 required an operation that entailed incision. Patients who attended the unit had a mean (range) injury severity score of 2-13 (0-25). Only two patients had injuries that a district general hospital would not be expected to cope with (injury severity score greater than 20). In the year April 1988-April 1989, 21,007 patients attended the unit. In all, 17,958 attendances were for orthopaedic injuries or injuries caused by an accident; 1966 patients were admitted to the unit. CONCLUSIONS--Most trauma is musculoskeletal and relatively minor according to the injury severity score. All but a few injuries can be managed in district general hospitals. In their recent report the Royal College of Surgeons has overestimated the requirements that a British district general hospital would have of a regional trauma centre. PMID:2107928

  13. Physical Violence against General Practitioners and Nurses in Chinese Township Hospitals: A Cross-Sectional Survey

    PubMed Central

    Xing, Kai; Jiao, Mingli; Ma, Hongkun; Qiao, Hong; Hao, Yanhua; Li, Ye; Gao, Lijun; Sun, Hong; Kang, Zheng; Liang, Libo; Wu, Qunhong

    2015-01-01

    Purpose The purpose of this study is to identify risk factors of physical violence in Chinese township hospitals. Methods A cross-sectional survey was used in a sample of 442 general practitioners and 398 general nurses from 90 township hospitals located in Heilongjiang province, China (response rate = 84.8%). Results A total of 106 of the 840 (12.6%) respondents reported being physically attacked in their workplace in the previous 12 months. Most perpetrators were the patients’ relatives (62.3%), followed by the patient (22.6%); 73.6% of perpetrators were aged between 20 and 40 years. Of the physical violence incidents, about 56.6% (n = 60) resulted in a physical injury, and 45.4% of respondents took two or three days of sick leave. Reporting workplace violence in hospitals to superiors or authorities was low (9.4%). Most respondents (62.8%) did not receive training on how to avoid workplace violence. Logistic regression analyses indicated that general nurses, aged 35 years or younger, and with a higher-level professional title were more likely to experience physical violence. Healthcare workers with direct physical contact (washing, turning, lifting) with patients had a higher risk of physical violence compared to other health care workers. Procedures for reporting workplace violence were a protective factor for physical violence; when in place, reporting after psychological violence (verbal abuse, bullying/mobbing, harassment, and threats) was more protective than waiting until an instance of physical violence (beating, kicking, slapping, stabbing, etc.). Conclusions Physical violence in Chinese township hospitals is an occupational hazard of rural public health concern. Policies, procedures, and intervention strategies should be undertaken to manage this issue. PMID:26571388

  14. Preventable Hospitalization Rates and Neighborhood Poverty among New York City Residents, 2008-2013.

    PubMed

    Bocour, Angelica; Tria, Maryellen

    2016-12-01

    Knowing which demographic groups have higher rates of preventable hospitalizations can help identify geographic areas where improvements in primary care access and quality can be made. This study assessed whether preventable hospitalization rates by neighborhood poverty decreased from 2008 to 2013 and whether the gap between very high and low poverty neighborhoods changed. We examined trends in age-adjusted preventable hospitalization rates and rate ratios by neighborhood poverty overall and by sex using JoinPoint regression. Prevention Quality Indicators (PQIs) developed by the Agency for Healthcare Research and Quality were applied to inpatient hospitalization data from the New York State Department of Health's Statewide Planning and Research Cooperative System. PQIs were classified into composites. From 2008 to 2013, preventable hospitalization rates per 100,000 adults across each poverty group decreased. For very high poverty neighborhoods (ZIP codes with ≥30 % of persons living below the federal poverty level (FPL)), there were significant decreases overall (3430.56 to 2543.10, annual percent change [APC] = -5.91 %), for diabetes (676.15 to 500.83, APC = -5.75 %), respiratory (830.78 to 660.29, APC = -4.85 %), circulatory (995.69 to 701.81, APC = -7.24 %), and acute composites (928.18 to 680.17, APC = -5.62 %). The rate ratios also decreased over time; however, in 2013, the rates for very high poverty neighborhoods were two to four times higher than low poverty neighborhoods (ZIP codes with <10 % of persons below the FPL). While preventable hospitalization rates have decreased over time, disparities still exist. These findings underscore the need to ensure adequate access to quality and timely primary care among individuals living in high poverty neighborhoods.

  15. Rescue percutaneous coronary intervention for failed thrombolysis: results from a district general hospital

    PubMed Central

    Balachandran, K; Miller, J; Pell, A; Vallance, B; Oldroyd, K

    2002-01-01

    Objective: To assess the outcome of a policy of emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction and electrocadiographic (ECG) evidence of failed reperfusion after thrombolysis. Design: Observational study. Setting: District general hospital. Patients: A total of 109 consecutive patients with acute myocardial infarction who underwent emergency angiography and angioplasty for failed reperfusion diagnosed on the basis of standard ECG criteria. Main outcome measures: In-hospital mortality; death, infarct territory reinfarction, and reintervention by PCI or coronary artery bypass graft (CABG) during follow up; in-lab resource utilisation. Results: At initial angiography, 76 patients had Thrombolysis in Myocardial Infarction (TIMI) trial 0/1 flow and 33 had TIMI 2/3 flow. Fourteen patients were in cardiogenic shock. TIMI 3 flow was established or maintained in 93 patients (85%). Overall in-hospital mortality was 9%. It was 3% in non-shock patients, 50% in shocked patients, and 40% when the procedure was unsuccessful (TIMI 0/1 flow post-procedure). Over a mean follow up of 30 months (>12 months of follow up in all patients) there were 19 further events (one death, five reinfarctions, and 13 revascularisations (nine CABG and four PCI)). The cost of rescue PCI was not significantly higher than comparable elective interventions. Conclusion: A policy of emergency angiography and PCI for failed reperfusion in acute myocardial infarction can be carried out in a hospital without on-site surgical backup with good medium term clinical outcomes. PMID:12151685

  16. [Study of Staphylococcus aureus infections in a general acute care hospital (2002-2013)].

    PubMed

    Togneri, Ana M; Podestá, Laura B; Pérez, Marcela P; Santiso, Gabriela M

    2017-01-23

    A twelve-year retrospective review of Staphylococcus aureus infections in adult and pediatric patients (AP and PP respectively) assisted in the Hospital Interzonal General de Agudos Evita in Lanús was performed to determine the incidence, foci of infection, the source of infection and to analyze the profile of antimicrobial resistance. An amount of 2125 cases of infection in AP and 361 in PP were documented. The incidence in AP decreased significantly in the last three years (χi(2); p<0.05); in PP it increased significantly during the last five years (χ(2); p<0.0001). In both populations was detected a notable increase in skin infections and associated structures (PEA) in bacteremia to the starting point of a focus on PEA, and in total S. aureus infections of hospital-onset (χ(2); p < 0.005). Methicillin-resistance (MRSA) increased from 28 to 78% in PP; in AP it remained around 50%, with significant reduction in accompanying antimicrobial resistance to non-β-lactams in both groups of MRSA. In S. aureus documented from community onset infections (CO-MRSA) in the last three years, the percentage of methicillin-resistance was 57% in PP and 37% in AP; in hospital-onset infections it was 43% and 63% respectively. Although data showed that S. aureus remains a pathogen associated with the hospital-onset, there was an increase of CO-MRSA infections with predominance in PEA in both populations.

  17. The role of rotavirus associated with pediatric gastroenteritis in a general hospital in Lagos, Nigeria

    PubMed Central

    Anochie, Philip Ifesinachi; Onyeneke, Edwina Chinwe; Asowata, Emmanuel Osaretin; Afocha, Ebelechukwu; Onyeozirila, Anthony Chidiebere; Ogu, Angelina Chinyere; Onyeneke, Bestman Chukwuemeka

    2013-01-01

    Introduction Bacterial, viral and parasitic agents have been implicated and confirmed as causative agents of gastroenteritis in children with ages below 5 years old. The major role of rotavirus as causative agent is not widely recognized within the public health community, particularly in developing countries. This study examined the role of rotavirus as a causative agent of childhood gastroenteritis in infants and young children below 5 years of age in a General Hospital in Lagos, Nigeria. Methods Parents and caregivers of children admitted to the hospital were interviewed using a structured questionnaire. Viral RNA was extracted from the stool samples collected and analyzed using RT-PCR for genotyping and agarose gel electrophoresis for identification of rotavirus electrophoretypes. Results Out of the 71 samples analyzed, 16 (22.5%) were positive for rotavirus. A total of 12 (75%) males and 4 (25%) females were positive for rotavirus gastroenteritis with most cases (7, 43.8%) distributed to the 13-24 months age group, followed closely by the 1-6 months age group, with 6 cases, 37.5%. Rotavirus G2 genotype was the most prevalent strain in the hospital (10 patients, 62.5%) followed by G1 (6 patients, 37.5%). These were the only rotavirus genotypes detected in the hospital. PMID:24432291

  18. 42 CFR 412.370 - General provisions for hospitals located in Puerto Rico.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Capital Costs Special Rules for Puerto Rico Hospitals § 412... system for inpatient hospital capital-related costs....

  19. Air pollution and hospital admissions for asthma in a tropical city: Kaohsiung, Taiwan

    SciTech Connect

    Shang-Shyue Tsai; Meng-Hsuan Cheng; Hui-Fen Chiu; Trong-Neng Wu; Chun-Yuh Yang

    2006-07-15

    This study was undertaken to determine whether there is an association between air pollutants levels and hospital admissions for asthma in Kaohsiung, Taiwan. Hospital admissions for asthma and ambient air pollution data for Kaohsiung were obtained for the period from 1996 through 2003. The relative risk of hospital admission was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant models, on warm days ({>=}25{sup o}C) statistically significant positive associations were found in all pollutants except sulfur dioxide. On cool days ({<=} 25{sup o}C) all pollutants were significantly associated with asthma admissions. For the two pollutant models, CO and O{sub 3} were significant in combination with each of the other four pollutants on warm days. On cool days NO{sub 2} remained statistically significant in all the two-pollutant models. This study provides evidence that higher levels of ambient pollutants increase the risk of hospital admissions for asthma.

  20. Bacterial-resistance among outpatients of county hospitals in China: significant geographic distinctions and minor differences between central cities.

    PubMed

    Xiao, Yonghong; Wei, Zeqing; Shen, Ping; Ji, Jinru; Sun, Ziyong; Yu, Hua; Zhang, Tiantuo; Ji, Ping; Ni, Yuxing; Hu, Zhidong; Chu, Yunzhuo; Li, Lanjuan

    2015-06-01

    The purpose of this study was to survey antibacterial resistance in outpatients of Chinese county hospitals. A total of 31 county hospitals were selected and samples continuously collected from August 2010 to August 2011. Drug sensitivity testing was conducted in a central laboratory. A total of 2946 unique isolates were collected, including 634 strains of Escherichia coli, 606 Klebsiella pneumoniae, 476 Staphylococcus aureus, 308 Streptococcus pneumoniae, and 160 Haemophilus influenzae. Extended-spectrum β-lactamases were detected in E. coli (42.3% strains), K. pneumoniae (31.7%), and Proteus mirabilis (39.0%). Ciprofloxacin-resistance was detected in 51.0% of E. coli strains. Salmonella spp. and Shigella spp. were sensitive to most antibacterial agents. Less than 8.0% of Pseudomonas aeruginosa isolates were resistant to carbapenem. For S. aureus strains, 15.3% were resistant to methicillin, and some strains of S. pneumoniae showed resistance to penicillin (1.6%), ceftriaxone (13.0%), and erythromycin (96.4%). β-lactamase was produced by 96.5% of Moraxella catarrhalis strains, and 36.2% of H. influenzae isolates were resistant to ampicillin. Azithromycin-resistant H. influenzae, imipenem-resistant but meropenem-sensitive Proteus, and ceftriaxone- and carbapenem non-sensitive M. catarrhalis were recorded. In conclusion, cephalosporin- and quinolone-resistant strains of E. coli and Klebsiella pneumonia and macrolide-resistant Gram-positive cocci were relatively prominent in county hospitals. The antibacterial resistance profiles of isolates from different geographical locations varied significantly, with proportions in county hospitals lower than those in their tertiary counterparts in the central cities, although the difference is diminishing.

  1. Carbapenem-Resistant Klebsiella pneumoniae Infection in Three New York City Hospitals Trended Downwards From 2006 to 2014

    PubMed Central

    Liu, Jianfang; Furuya, E. Yoko; Larson, Elaine L.

    2016-01-01

    Background. Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is a rising public health threat since its first outbreaks in New York City (NYC) in the early 2000s. We investigated annual trends of CRKP infection in hospital-acquired infections (HAIs) and community-onset infections (COIs) treated in 3 NYC hospitals from 2006 to 2014. Methods. We extracted K pneumoniae infection data including carbapenem susceptibility and anatomical sites, compared clinical characteristics between CRKP and carbapenem-susceptible K pneumoniae infections, and determined CRKP infection proportions in total K pneumoniae infections in HAI and COI to identify statistically significant trends from 2006 to 2014 using the Cochran-Armitage trend test. Results. Carbapenem-resistant K pneumoniae contributed 17.3% (601 of 3477) of hospital-acquired K pneumoniae infection compared with 7.7% (149 of 1926) in COI from 2006 to 2014. Carbapenem-resistant K pneumoniae proportions in HAI and COI were positively correlated over time (r = 0.83, P < .01), and there were downward annual trends of CRKP proportions from 2006 to 2014 in both HAI and COI (25.8% to 10.5% in HAI, P < .001; 13.6% to 3.1% in COI, P < .001). By anatomical site, significant downward annual trends were present only in urinary tract infection (P < .001 for both HAI and COI) from 2006 to 2014. Conclusions. Annual trends of CRKP proportions from 2006 to 2014 were downward in both HAI and COI, and HAI and COI were positively correlated. Efforts to reduce and prevent CRKP infections in both hospital and community settings were successful and warrant continuation. PMID:27942542

  2. [Latent tuberculosis infection in healthcare personnel at a primary level general hospital in Catalonia, Spain].

    PubMed

    Sol Vidiella, Josep; Catalán Gómez, Teresa; Callau Casanova, Cristina; Lejeune, Marylène

    2014-01-01

    The aim was to analyze the prevalence of latent tuberculosis infection and associated risk factors in healthcare personnel at the Hospital de Tortosa Verge de la Cinta (Tarragona, Spain). This was a cross-sectional study of 398 workers at this hospital who underwent tuberculin skin testing for latent tuberculosis infection (LTBI) between 2001 and 2012.We also analyzed the relationship between LTBI and age, sex, job and work area according to their risk of exposure to tuberculosis(high, low, uncertain). The total prevalence of LTBI in our sample was 11.1% (95%CI 8.3%-14.5%). LBTI was associated with age and work area. Multivariate analysis showed that the risk of LTBI increased by 6.4% per 1 year increase in age. The prevalence of LTBI in this population approximates that of the general population in Spain.

  3. [Standardized management of acupuncture-moxibustion clinic in Singapore General Hospital].

    PubMed

    Cui, Shu-Li; Tan, Kian Hian; Ong, Biauw Chi; Lim, Shih hui; Yong, Yang; Seah, Cheng Ngee; Huang, Youyi; Han, Seong Ng

    2014-02-01

    The standardized management of acupuncture-moxibustion in Singapore General Hospital is introduced. With gradual improvement of outpatient infrastructure, re-training of medical staff, strict disinfection of manipulation, periodical inspection of medical instruments, unified management of writing, saving and processing in medical records and public education of TCM knowledge, a standardized management system in accordance with modernized hospital is gradually established. As a result, efficiency and quality of clinical treatment is continuously increasing. From April of 1998 to December of 2012, a total of 74 654 times of treatment were performed, and treatment amount per day is gradually increased. The unusual condition of acupuncture is avoided. Periodical strict inspection of joint committee authenticated by domestic and overseas medical health organization is repeatedly passed and accepted. Additionally, three clinical researches funded by Singapore Health-care Company are still in progress in acupuncture-moxibustion department.

  4. Is locating acute wards in the general hospital an essential element in psychiatric reform? The U.K. experience.

    PubMed

    Totman, Jonathan; Mann, Farhana; Johnson, Sonia

    2010-01-01

    Locating psychiatric wards in general hospitals has long been seen in many countries as a key element in the reform of services to promote community integration of the mentally ill. In the U.K., however, this is no longer a policy priority, and the recent trend has been towards small freestanding inpatient units, located either within the communities they serve, or on general hospital sites, but separate from the main building. Whether locating the psychiatric wards in the general hospital is essential to psychiatric reform has been little discussed, and we can find no relevant evidence. Perceived strengths of general hospital psychiatric wards are in normalisation of mental health problems, accessibility to local communities, better availability of physical health care resources, and integration of psychiatry with the rest of the medical profession, which may faclilitate recruitment. However, difficulties seem to have been encountered in establishing well-designed psychiatric wards with access to open space in general hospitals. Also, physical proximity may not be enough to achieve the desired reduction in stigma, and complaints from the general hospital may sometimes result in undue restrictions on psychiatric ward patients. There are strong arguments both for and against locating psychiatric wards in general hospitals: an empirical evidence base would be helpful to inform important decisions about the best setting for wards.

  5. [Genotyping of Cryptococcus neoformans/Cryptococcus gattii complex clinical isolates from Hospital "Dr. Julio C. Perrando", Resistencia city (Chaco, Argentina)].

    PubMed

    Cattana, Maria E; Tracogna, Maria F; Fernández, Mariana S; Carol Rey, Mariana C; Sosa, Maria A; Giusiano, Gustavo E

    2013-01-01

    Cryptococcosis is a fungal infection caused by yeast species of Cryptococcus genus, particularly Cryptococcus neoformans/Cryptococcus gattii species complex. The knowledge of the cryptococcosis casuistic in northeastern Argentina is scarce and there is no information about the molecular types circulating in this area. The aim of this study was to genotyping C. neoformans/C. gattii complex clinical isolates obtained at Hospital "Dr. Julio C. Perrando", Resistencia city (Chaco, Argentina), in order to determine species, variety and molecular type. During two years and one month 26 clinical isolates were studied. Using conventional and molecular methods one isolate was identified as C. gattii VGI type, and 25 isolates as C. neoformans var. grubii; 23 of these belonged to VNI type and two belonged to VNII type. This data is a contribution to the knowledge of cryptococcosis epidemiology in Argentina and the first report about C. neoformans/ C. gattii complex molecular types from clinical isolates in northeastern Argentina.

  6. Clostridium difficile-associated diarrhea from a general hospital in Argentina.

    PubMed

    Legaria, M C; Lumelsky, G; Rosetti, S

    2003-06-01

    Clostridium difficile is responsible for 15-25% of all cases of antibiotic associated diarrhea. The incidence of infection with this organism is increasing in hospitals worldwide, consequent to the widespread use of broad-spectrum antibiotics. Although the clinical and financial impact of nosocomial C. difficile infection is believed to be significant, only limited information is available on the importance of C. difficile as a cause of diarrhea in Argentina. The aim of the study was to evaluate the impact and diagnosis methods of CDAD from symptomatic patients in a general hospital from Argentina. Consecutive diarrheal stool samples from symptomatic patients from a General Hospital in Argentina were screened for toxigenic C. difficile between April 2000 and April 2001. Toxins were detected in stools by the Premier Cytoclone A+B EIA. Each specimen was examined for toxigenic C. difficile strains by culture. From 104 specimens, 40 (38.5%) [32 of 87 patients (36.8%)] were positive and 64 (61.5%) [55 of 87 patients (63.2%)] were negative by stool toxin assay and/or toxigenic culture. In 11 of 40 positives samples C. difficile toxins were detected only by toxigenic culture. Five (15.6%) patients presented with symptomatic recurrences. Toxin-negative strains were not isolated. This data indicates that the high prevalence of toxigenic strains of C. difficile is of concern in routine diagnostic testing for C. difficile toxins in our study population. Detection of toxins in stools by EIA, coupled with testing strains for toxigenicity only in those cases in which direct toxin assay produces negative results, may be a satisfactory strategy. CDAD is an emerging nosocomial problem in our hospital. It will be necessary to evaluate the epidemiology and measures to control nosocomial spread.

  7. Maximizing appropriate antibiotic prophylaxis for surgical patients: an update from LDS Hospital, Salt Lake City.

    PubMed

    Burke, J P

    2001-09-01

    Errors in antimicrobial prophylaxis for surgical patients remain one of the most frequent types of medication errors in hospitals. Failure to administer the first dose of antimicrobial prophylaxis within the 2-h window of time before incision is associated with 2- to 6-fold increases in rates of surgical site infection. Optimal use of antimicrobial prophylaxis includes proper case selection; use of appropriate agents; proper dosing, route of administration, timing, and duration; and intraoperative dosing when appropriate. Effective use of antimicrobial prophylaxis also requires monitoring of and feedback on patterns of use. Programs to improve antimicrobial prophylaxis should be multidisciplinary and should aim to improve use of medications, not simply to change physician practice patterns. The LDS Hospital experience demonstrates the clinical and financial benefits of such a program and also shows the pitfalls of and great difficulties associated with changing systems of care.

  8. [Frequency and antimicrobial resistance of Acinetobacter species in a university hospital of Buenos Aires City].

    PubMed

    Rodríguez, Carlos Hernán; Nastro, Marcela; Dabos, Laura; Vay, Carlos; Famiglietti, Angela

    2014-01-01

    Two-hundred Acinetobacter isolates belonging to 200 patients admitted to Hospital de Clínicas José de San Martín during the period March 2013-June 2014 were analyzed. The identification was performed by mass spectrometry and was confirmed by molecular methods. Susceptibility to antimicrobials was studied by the Vitek-2 system. A 94% correlation of both identification methods was found. Multidrug resistant Acinetobacter baumannii was the predominant genomic species (92.6%) in hospital-acquired infections, whereas Acinetobacter pitti and Acinetobacter nosocomialis accounted for 3.5% and 0.5% of the isolates recovered, respectively. In community-acquired infections a major predominance of the different genomic species was observed. Acinetobacter johnsonii and A. baumannii are the most frequent species, accounting for 45.9% of the isolates recovered. Resistance to carbapenems and minocycline was only observed in A. baumannii. Mass spectrophotometry was an effective tool for the identification of the different genomic species.

  9. [Optimization of hospital services extended to residents in a big industrial city].

    PubMed

    Gaĭdarov, G M; Kitsul, I S; Kulesh, D V

    2003-01-01

    Scientific approaches to optimizing the hospital medical care with respect to 3 healthcare levels (regional, municipal and departmental) are presented in the paper. An appropriate model of patient-care facilities aimed at solving the issues of intersectoral involvement of such regional, municipal and departmental institutions in implementing the Territorial Program of State Guarantees in Rendering the Free-Of-Charge Medical Care To Population is suggested.

  10. Outcomes of Patients With Cocaine Induced Chest Pain in An Inner City Hospital

    PubMed Central

    Atoui, Moustapha; Fida, Nadia; Nayudu, Suresh Kumar; Glandt, Mariela; Chilimuri, Sridhar

    2011-01-01

    Background Cocaine induced chest pain is a major reason for admission in Safety Net Hospitals in the United States. The majority of patients admitted undergo extensive work-up leading to enormous economic burden. We hypothesize that in individuals with low risk, cocaine does not further increase adverse cardiovascular outcomes. Methods We conducted a retrospective chart review of all patients admitted with chest pain to our hospital between 07/01/09 and 06/30/10. We excluded patients with modifiable risk factors for coronary artery disease (CAD). The study population was divided into cocaine and non-cocaine group based on urine drug screen. We analyzed data including demographic, laboratory, cardiac testing, detection of CAD, length of stay and mortality rates. Results A total of 426 individuals matched our inclusion and exclusion criteria and were considered to have no known modifiable cardiac risk factors; 54 in cocaine group and 372 in non-cocaine group. Based on physician discretion, 41(76%) in the cocaine group and 239(64%) in the non-cocaine group underwent various modalities of cardiac testing. Cardiac testing was positive in 6(2.5%) patients in non-cocaine group and none in the cocaine group (p=0.597). There was no significant difference between length of stay and in-hospital mortality between the two groups. Conclusions In individuals at low risk for CAD, cocaine use resulted in higher rate of cardiac testing. However, there is no difference in prevalence of CAD and in-hospital mortality between the two groups. We conclude that cocaine does not increase adverse outcomes in patients with low risk for CAD.

  11. Ecotoxicological and Genotoxic Evaluation of Buenos Aires City (Argentina) Hospital Wastewater

    PubMed Central

    Juárez, Ángela Beatriz; Dragani, Valeria; Saenz, Magalí Elizabeth; Moretton, Juan

    2014-01-01

    Hospital wastewater (HWW) constitutes a potential risk to the ecosystems and human health due to the presence of toxic and genotoxic chemical compounds. In the present work we investigated toxicity and genotoxicity of wastewaters from the public hospital of Buenos Aires (Argentina). The effluent from the sewage treatment plant (STP) serving around 10 million inhabitants was also evaluated. The study was carried out between April and September 2012. Toxicity and genotoxicity assessment was performed using the green algae Pseudokirchneriella subcapitata and the Allium cepa test, respectively. Toxicity assay showed that 55% of the samples were toxic to the algae (%I of growth between 23.9 and 54.8). The A. cepa test showed that 40% of the samples were genotoxic. The analysis of chromosome aberrations (CA) and micronucleus (MN) showed no significant differences between days and significant differences between months. The sample from the STP was not genotoxic to A. cepa but toxic to the algae (%I = 41%), showing that sewage treatment was not totally effective. This study highlights the need for environmental control programs and the establishment of advanced and effective effluent treatment plants in the hospitals, which are merely dumping the wastewaters in the municipal sewerage system. PMID:25214834

  12. 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

  13. Analysis of the organizational aspects of a clinical emergency department: a study in a General Hospital in Ribeirao Preto, SP, Brazil.

    PubMed

    Coelho, Mônica Franco; Chaves, Lucieli Dias Pedreschi; Anselmi, Maria Luiza; Hayashida, Miyeko; dos Santos, Claudia Benedita

    2010-01-01

    Demand for the Emergency Department (ED) has increased, making the organization of work difficult. This quantitative, descriptive and documental study identifies and analyzes the characteristics of clinical care in the ED of a General Hospital in Ribeirão Preto, SP, in 2007, according to organizational variables. The study population included all clinical care consultations registered in the Hospital Management Information System. Data were analyzed through descriptive statistics and discussed considering the theoretical framework of the Single Health System (SUS). A total of 5,285 consultations were registered in the period, which were more frequent in patients from the city itself, in January (10%), on Mondays (16%), from 12pm to 12am (67.1%). The main reason for discharge from the unit was hospitalization (63.8%) and the predominant length of stay in the unit was less than six hours (39.8%). The results support the management of human resources, materials and equipment, indicating the desirability of reorganizing emergency care in the hospital.

  14. Principal components and generalized linear modeling in the correlation between hospital admissions and air pollution

    PubMed Central

    de Souza, Juliana Bottoni; Reisen, Valdério Anselmo; Santos, Jane Méri; Franco, Glaura Conceição

    2014-01-01

    OBJECTIVE To analyze the association between concentrations of air pollutants and admissions for respiratory causes in children. METHODS Ecological time series study. Daily figures for hospital admissions of children aged < 6, and daily concentrations of air pollutants (PM10, SO2, NO2, O3 and CO) were analyzed in the Região da Grande Vitória, ES, Southeastern Brazil, from January 2005 to December 2010. For statistical analysis, two techniques were combined: Poisson regression with generalized additive models and principal model component analysis. Those analysis techniques complemented each other and provided more significant estimates in the estimation of relative risk. The models were adjusted for temporal trend, seasonality, day of the week, meteorological factors and autocorrelation. In the final adjustment of the model, it was necessary to include models of the Autoregressive Moving Average Models (p, q) type in the residuals in order to eliminate the autocorrelation structures present in the components. RESULTS For every 10:49 μg/m3 increase (interquartile range) in levels of the pollutant PM10 there was a 3.0% increase in the relative risk estimated using the generalized additive model analysis of main components-seasonal autoregressive – while in the usual generalized additive model, the estimate was 2.0%. CONCLUSIONS Compared to the usual generalized additive model, in general, the proposed aspect of generalized additive model − principal component analysis, showed better results in estimating relative risk and quality of fit. PMID:25119940

  15. The incidence of monoclonal proteins during 7 years of screening in a District General Hospital.

    PubMed Central

    Adams, R A; Smith, L; Pickering, P E

    1984-01-01

    The aim of this study was to assess the incidence of monoclonal proteins, during a 7-year period, in the population served by a typical District General Hospital. 183,300 sera were electrophoresed and 804 monoclonal proteins were detected. Various biochemical prognostic criteria, such as the concentration of monoclonal protein, incidence of Bence-Jones protein and the presence of reduced polyclonal immunoglobulins, were studied in an attempt to assess the benign or malignant nature of the monoclonal protein. In this study, 75% of the patients with monoclonal proteins fulfilled at least one of these criteria, demonstrating the importance of long-term monitoring. PMID:6698575

  16. Introducing an annualised contract for a consultant team in a district general hospital.

    PubMed

    Ayres, Lachlan; Hughes, Rebecca; Brooklyn, Trevor; Shaw, Ian; Valori, Roland

    2013-06-01

    The majority of physicians work a weekly timetable consisting of programmed activities (PAs) defined by the consultant contract. This paper describes the implementation of an annualised contract within a gastroenterology department, which is located across two district general hospital sites within the same trust. The perceived benefits of the system include the introduction of a new out-of-hours emergency endoscopy service, more efficient backfilling of vacant endoscopy lists and greater transparency of work patterns and workload between colleagues and within the trust.

  17. Doctors of Thoracic Surgery: The Division of Thoracic Surgery at Toronto General Hospital.

    PubMed

    Keshavjee, Shaf; Spatafora, Lisa

    2015-01-01

    The Division of Thoracic Surgery at Toronto General Hospital has a history of sustained excellence and commitment to patient care, research and innovation in Thoracic Surgery. Doctors of Thoracic Surgery (DOTSR) continues to be a leading thoracic division training surgeons who practice all over the world--impacting the treatment of patients with thoracic disease. Many leaders in our specialty worldwide have directly or indirectly trained in Toronto. At University Health Network and the University of Toronto, this academic division has continued to contribute and thrive in a highly supportive and productive research and clinical environment.

  18. When Suicide Is Not Suicide: Self-induced Morbidity and Mortality in the General Hospital

    PubMed Central

    Bostwick, J. Michael

    2015-01-01

    Suicidal phenomena in the general hospital can take a variety of forms that can be parsed by taking into account whether or not the patient 1) intended to hasten death, and 2) included collaborators, including family and health care providers, in the decision to act. These two criteria can be used to distinguish entities as diverse as true suicide, non-compliance, euthanasia/physician-assisted suicide, and hospice/palliative care. Characterizing the nature of “suicide” events facilitates appropriate decision-making around management and disposition. PMID:25973265

  19. [Treatment of Anorexia Nervosa Patients in General Hospitals with Psychiatric Wards Current Situation and Establishment of a Treatment System].

    PubMed

    Wada, Yoshihisa

    2015-01-01

    Patients with anorexia nervosa (AN) exhibit physical and psychiatric symptoms, in addition to their behavioral problems, and often require admission to a general hospital with a psychiatric ward. There are only a few general hospitals with psychiatric wards available, and patients with AN tend to be concentrated in a small number of such institutions. Thus, it is difficult to provide adequate support for the treatment of patients with AN. In Kyoto, the number of general hospitals with a psychiatric ward is small. Patients with AN tend to be treated at the two university hospitals. However, our University Hospital cannot accept all patients with AN, especially the emergency admissions. Therefore, with respect to the inpatient treatment of AN, we established a cooperation agreement with other psychiatric hospitals. We are planning to divide the inpatient treatment of AN between our university hospital and other psychiatric hospitals, depending on the stage of AN and the severity of the patients' physical condition. With respect to the treatment of AN, it is necessary to establish a treatment system with each hospital playing a role.

  20. A prospective multi-center observational study of children hospitalized with diarrhea in Ho Chi Minh City, Vietnam.

    PubMed

    Thompson, Corinne N; Phan, My V T; Hoang, Nguyen Van Minh; Minh, Pham Van; Vinh, Nguyen Thanh; Thuy, Cao Thu; Nga, Tran Thi Thu; Rabaa, Maia A; Duy, Pham Thanh; Dung, Tran Thi Ngoc; Phat, Voong Vinh; Nga, Tran Vu Thieu; Tu, Le Thi Phuong; Tuyen, Ha Thanh; Yoshihara, Keisuke; Jenkins, Claire; Duong, Vu Thuy; Phuc, Hoang Le; Tuyet, Pham Thi Ngoc; Ngoc, Nguyen Minh; Vinh, Ha; Chinh, Nguyen Tran; Thuong, Tang Chi; Tuan, Ha Manh; Hien, Tran Tinh; Campbell, James I; Chau, Nguyen Van Vinh; Thwaites, Guy; Baker, Stephen

    2015-05-01

    We performed a prospective multicenter study to address the lack of data on the etiology, clinical and demographic features of hospitalized pediatric diarrhea in Ho Chi Minh City (HCMC), Vietnam. Over 2,000 (1,419 symptomatic and 609 non-diarrheal control) children were enrolled in three hospitals over a 1-year period in 2009-2010. Aiming to detect a panel of pathogens, we identified a known diarrheal pathogen in stool samples from 1,067/1,419 (75.2%) children with diarrhea and from 81/609 (13.3%) children without diarrhea. Rotavirus predominated in the symptomatic children (664/1,419; 46.8%), followed by norovirus (293/1,419; 20.6%). The bacterial pathogens Salmonella, Campylobacter, and Shigella were cumulatively isolated from 204/1,419 (14.4%) diarrheal children and exhibited extensive antimicrobial resistance, most notably to fluoroquinolones and third-generation cephalosporins. We suggest renewed efforts in generation and implementation of policies to control the sale and prescription of antimicrobials to curb bacterial resistance and advise consideration of a subsidized rotavirus vaccination policy to limit the morbidity due to diarrheal disease in Vietnam.

  1. [Enrichment of the functions of the psychiatric department in a general hospital and collaboration within the area].

    PubMed

    Koishikawa, Hiraki; Ookami, Toshihiko

    2014-01-01

    Psychiatric disease has been included in the five main diseases, and a medical care plan is required. In it, there are many problems, for example, physical complications and which general hospital should chiefly deal with it. Here, we present a way to cope with these problems on the basis of achievements in the psychiatric department of Kameda General Hospital. Specifically, we would like to assert that creating a consultation-liaison team and enriching the section of clinical psychiatry are very important and effective. The activities of the consultation-liaison team, created to address various issues after establishing a psychiatric ward, have led to the possibility of a psychiatric department in a general hospital. Experience to date indicates that, in the context of a general hospital with a psychiatric inpatient unit, the existence of a multidisciplinary liaison team working across departmental boundaries is crucial to determining and managing the treatment of patients with psychiatric emergencies, as well as patients with psychiatric issues and physical complications. Additionally, in order to increase the effectiveness of the hospital liaison team, it is critical to realize seamless, prompt collaboration with facilities outside the hospital. In this respect, the role of a patient care coordinator is expected to become increasingly important. Additionally, enriching and guarding activities of clinical psychologists have contributed to the growth of psychiatric departments in general hospitals and proved to be effective in combination with activities of the consultation-liaison team.

  2. The implosion of the Calgary General Hospital: ambient air quality issues.

    PubMed

    Stefani, Dennis; Wardman, Dennis; Lambert, Timothy

    2005-01-01

    This paper discusses the implosion of a large inner-city hospital in Calgary, Alberta, Canada, on October 4, 1998. Stationary and mobile air monitoring conducted after the implosion indicated there were several short-term air quality issues, including significant temporal increases in total suspended particles, particulate matter (PM) with aerodynamic diameter less than or equal to 10 microm (PM10), PM with aerodynamic diameter less than or equal to 2.5 microm (PM2.5), asbestos, and airborne and settled lead. In addition, the implosion created a dust cloud that traveled much further than expected, out to 20 km. The ability of an implosion to effectively aerosolize building materials requires the removal of all friable and nonfriable forms of asbestos and all Pb-containing painted surfaces during pre-implosion preparatory work. Public advisories to mitigate personal exposure and indoor migration of the implosion dust cloud constituents should extend to 10 or 20 km around an implosion site. These findings point to a number of complex and problematic issues regarding implosions and safeguarding human health and suggest that implosions in metropolitan areas should be prohibited. Further work to characterize the public health risks of conventional versus implosion demolition is recommended.

  3. Psychopathology of the General Population Referred by Primary Care Physicians for Urgent Assessment in Psychiatric Hospitals

    PubMed Central

    McLenan, Judith; Lazzari, Carlo; McMillan, Gail; Mackie, Robert

    2016-01-01

    Objective: The aim of this study was to evaluate the type, severity and progression of psychiatric pathologies in a sample of 372 outpatients (age range 18–65 years) referred by their primary general practitioners (GPs) to an Urgent Referral Team (URT) based in a psychiatric hospital in Aberdeen, Scotland. This team offers immediate appointments (1- to 7-day delays) for rapid assessments and early interventions to the outpatients referred by their primary family doctors. Method: One-sample t-test and z statistic were used for data analysis. From the total population, a convenience sample of 40 people was selected and assessed to evaluate whether follow-up appointments after the first visit could reduce the severity of suicidal ideation, depression and anxiety in the outpatients seen by the URT. A two-sample t-test and a Wilcoxon signed-rank test were used to assess the variations in the scores during the follow-up visits. Results: We found a statistically significant prevalence of depressive disorders, comorbid with anxiety at first presentation in people who were females, white, never married, living with a partner, not studying and not in paid employment. The common presentation of borderline personality disorder and dysthymia in this population underscores its vulnerability to major socioeconomic challenges. Conclusion: The data confirmed the impact that primary care cooperation with psychiatric hospitals can have on the psychiatric system, and as a reflection, on the population’s mental health and well-being. In fact, active cooperation and early diagnosis and intervention will help detect cases at risk in the general population and reduce admissions into hospitals. PMID:28050179

  4. Preparation to care for confused older patients in general hospitals: a study of UK health professionals

    PubMed Central

    Griffiths, Amanda; Knight, Alec; Harwood, Rowan; Gladman, John R.F.

    2014-01-01

    Background and Objective: in the UK, two-thirds of patients in general hospitals are older than 70, of whom half have dementia or delirium or both. Our objective was to explore doctors, nurses and allied health professionals' perceptions of their preparation to care for confused older patients on general hospital wards. Methods: using a quota sampling strategy across 11 medical, geriatric and orthopaedic wards in a British teaching hospital, we conducted 60 semi-structured interviews with doctors, nurses and allied healthcare professionals and analysed the data using the Consensual Qualitative Research approach. Results: there was consensus among participants that education, induction and in-service training left them inadequately prepared and under-confident to care for confused older patients. Many doctors reported initial assessments of confused older patients as difficult. They admitted inadequate knowledge of mental health disorders, including the diagnostic features of delirium and dementia. Handling agitation and aggression were considered top priorities for training, particularly for nurses. Multidisciplinary team meetings were highly valued but were reported as too infrequent. Participants valued specialist input but reported difficulties gaining such support. Communication with confused patients was regarded as particularly challenging, both in terms of patients making their needs known, and staff conveying information to patients. Participants reported emotional and behavioural responses including frustration, stress, empathy, avoidance and low job satisfaction. Conclusion: our findings indicate that a revision of training across healthcare professions in the UK is required, and that increased specialist support should be provided, so that the workforce is properly prepared to care for older patients with cognitive problems. PMID:24165310

  5. Neurasthenia, Generalized Anxiety Disorder, and the Medicalization of Worry in a Vietnamese Psychiatric Hospital.

    PubMed

    Tran, Allen L

    2016-04-26

    This article examines two forms of the medicalization of worry in an outpatient psychiatric clinic in Ho Chi Minh City, Vietnam. Biomedical psychiatrists understand patients' symptoms as manifestations of the excessive worry associated with generalized anxiety disorder (GAD). Drawing on an ethnopsychology of emotion that reflects increasingly popular models of neoliberal selfhood, these psychiatrists encourage patients to frame psychic distress in terms of private feelings to address the conditions in their lives that lead to chronic anxiety. However, most patients attribute their symptoms to neurasthenia instead of GAD. Differences between doctors' and patients' explanatory models are not just rooted in their understandings of illness but also in their respective conceptualizations of worry in terms of emotion and sentiment. Patients with neurasthenia reject doctors' attempts to psychologize distress and maintain a model of worry that supports a sense of moral selfhood based on notions of obligation and sacrifice.

  6. Evaluating compliance to a cardiac rehabilitation program in a private general hospital

    PubMed Central

    Mair, Vanessa; Breda, Ana Paula; Nunes, Marcos Eduardo Boquembuzo; de Matos, Luciana Diniz Nagem Janot

    2013-01-01

    ABSTRACT Objective: Identify the primary factors that influenced the participant in our cardiovascular rehabilitation program towards missing their therapy sessions, and to correlate those factors with age, cardiovascular risk, and motivation of our population. Methods: We conducted a retrospective study with 42 patients (69.15±13.93 years) participating in the cardiac rehabilitation program at a general hospital in São Paulo, through the analysis of two scales applied during the initial evaluation: Cardiac Rehabilitation Barriers Scale and scale of the original provision. We used Spearman correlation to relate them to absenteeism, cardiovascular risk age and duration of cardiac rehabilitation. Results: The total score of barriers was 31±6 and the mean score of 1.47±0.31. The main barriers subscales were related to “travel/labor dispute” and “personal problems/family.” The percentage of absenteeism was 8.4% in the number of sessions that could be made in the month. The faults and cancellations were positively correlated with cardiovascular risk (p=0.01; r=0.4) and negatively with scale provision of baseline (p=0.03; r=-0.35) and age (p=0.02; r=-0.35). Conclusion: “Travel/labor dispute”, “personal/ family problems”, and low initial provision are the main factors absenteism in a cardiac rehabilitation program in a general hospital in São Paulo. PMID:24136752

  7. Imported Malaria over Fifteen Years in an Inner City Teaching Hospital of Washington DC.

    PubMed

    Yeruva, Sri Lakshmi Hyndavi; Sinha, Archana; Sarraf-Yazdy, Mariam; Gajjala, Jhansi

    2016-06-01

    As endemic malaria is not commonly seen in the United States, most of the cases diagnosed and reported are associated with travel to and from the endemic places of malaria. As the number of imported cases of malaria has been increasing since 1973, it is important to look into these cases to study the morbidity and mortality associated with this disease in the United States. In this study, we would like to share our experience in diagnosing and treating these patients at our institution. We did a retrospective chart review of 37 cases with a documented history of imported malaria from 1998 to 2012. Among them, 16 patients had complicated malaria during that study period, with a mean length of hospital stay of 3.5 days. Most common place of travel was Africa, and chemoprophylaxis was taken by only 11% of patients. Travel history plays a critical role in suspecting the diagnosis and in initiating prompt treatment.

  8. [Etiological agents of dermatomycoses isolated in a hospital of Santa Fe City, Argentina].

    PubMed

    Nardin, M E; Pelegri, D G; Manias, V G; Méndez, E de los A

    2006-01-01

    Superficial mycoses are limited to skin, hair, nails and mucous membranes. The most common etiological agents are dermatophytes and yeasts of Candida genus. The aim of this work was to know the etiological agents of dermatomycoses and their clinical presentation. Were analized 2073 samples of skin, hair, nails, and oral mucous membranes obtained from 1817 patients who attended the Microbiology Branch of the Central Laboratory at Dr. J. M. Cullen Hospital, since September 1999 to September 2003. The samples were examined and identified according to the localization and type of lesion. Out of the total samples 55.67% were positive; 63% were recovered from females, and 37% from males. The most common localization was the skin. Trichophyton rubrum was the most frequent dermatophyte, and among yeasts, Candida albicans was the prevalent species. Fourteen non-dermatophytic fungi (Fusarium spp. and Aspergillus spp.) were isolated, and considered emergent pathogens from superficial mycoses.

  9. Morbidity following Mexico City's 1985 earthquakes: clinical and epidemiologic findings from hospitals and emergency units.

    PubMed

    Sánchez-Carrillo, C I

    1989-01-01

    Medical records of 822 inpatients and outpatients cared for by the Department of the Federal District medical services during the 1985 Mexico City earthquakes were reviewed. Record incompleteness varied between 92.8 percent and 14.0 percent for the various study variables. No gender differences were detected among the groups; more than 70.0 percent of the patients were ages 15 to 64 years. Multiple traumatic injuries were frequent for inpatients across age groups, while simple contusions were more frequent among outpatients. Multiple head traumas, thorax-abdomen multiple traumas, and simple fractures of an arm or leg were more frequently recorded for inpatients than for outpatients. Head wounds with contusions; simple contusion of the thorax-abdomen, arms, and legs; and psychological trauma were more frequently recorded for outpatients. Although a great many records were incomplete, the data may reflect what actually happened to these patients, given the similarity of the findings with other reports of disasters. Improved record keeping during emergencies is needed to standardize the quantity and the reliability of the data so that statistical and medical care requirements are soundly based. The use of standard questionnaires for data collection is stressed to facilitate the management of clinical and epidemiologic activities. Longitudinal studies are needed to determine patterns of physical injuries, psychological trauma, and survival.

  10. Morbidity following Mexico City's 1985 earthquakes: clinical and epidemiologic findings from hospitals and emergency units.

    PubMed Central

    Sánchez-Carrillo, C I

    1989-01-01

    Medical records of 822 inpatients and outpatients cared for by the Department of the Federal District medical services during the 1985 Mexico City earthquakes were reviewed. Record incompleteness varied between 92.8 percent and 14.0 percent for the various study variables. No gender differences were detected among the groups; more than 70.0 percent of the patients were ages 15 to 64 years. Multiple traumatic injuries were frequent for inpatients across age groups, while simple contusions were more frequent among outpatients. Multiple head traumas, thorax-abdomen multiple traumas, and simple fractures of an arm or leg were more frequently recorded for inpatients than for outpatients. Head wounds with contusions; simple contusion of the thorax-abdomen, arms, and legs; and psychological trauma were more frequently recorded for outpatients. Although a great many records were incomplete, the data may reflect what actually happened to these patients, given the similarity of the findings with other reports of disasters. Improved record keeping during emergencies is needed to standardize the quantity and the reliability of the data so that statistical and medical care requirements are soundly based. The use of standard questionnaires for data collection is stressed to facilitate the management of clinical and epidemiologic activities. Longitudinal studies are needed to determine patterns of physical injuries, psychological trauma, and survival. PMID:2508177

  11. Using path analysis to examine causal relationships among balanced scorecard performance indicators for general hospitals: the case of a public hospital system in Taiwan.

    PubMed

    Yang, Ming-Chin; Tung, Yu-Chi

    2006-01-01

    Examining whether the causal relationships among the performance indicators of the balanced scorecard (BSC) framework exist in hospitals is the aim of this article. Data were collected from all twenty-one general hospitals in a public hospital system and their supervising agency for the 3-year period, 2000-2002. The results of the path analyses identified significant causal relationships among four perspectives in the BSC model. We also verified the relationships among indicators within each perspective, some of which varied as time changed. We conclude that hospital administrators can use path analysis to help them identify and manage leading indicators when adopting the BSC model. However, they should also validate causal relationships between leading and lagging indicators periodically because the management environment changes constantly.

  12. Genetic organization of transposase regions surrounding blaKPC carbapenemase genes on plasmids from Klebsiella strains isolated in a New York City hospital.

    PubMed

    Gootz, Thomas D; Lescoe, Mary Kay; Dib-Hajj, Fadia; Dougherty, Brian A; He, Wen; Della-Latta, Phyllis; Huard, Richard C

    2009-05-01

    Carbapenem-resistant Klebsiella strains carrying Klebsiella pneumoniae carbapenemases (KPC) are endemic to New York City and are spreading across the United States and internationally. Recent studies have indicated that the KPC structural gene is located on a 10-kb plasmid-borne element designated Tn4401. Fourteen Klebsiella pneumoniae strains and one Klebsiella oxytoca strain isolated at a New York City hospital in 2005 carrying either bla(KPC-2) or bla(KPC-3) were examined for isoforms of Tn4401. Ten of the Klebsiella strains contained a 100-bp deletion in Tn4401, corresponding to the Tn4401a isoform. The presence of this deletion adjacent to the upstream promoter region of bla(KPC) in Tn4401a resulted in a different -35 promoter sequence of TGGAGA than that of CTGATT present in isoform Tn4401b. Complete sequencing of one plasmid carrying bla(KPC) from each of three nonclonal isolates indicated the presence of genes encoding other types of antibiotic resistance determinants. The 70.6-kb plasmid from K. pneumoniae strain S9 carrying bla(KPC-2) revealed two identical copies of Tn4401b inserted in an inverse fashion, but in this case, one of the elements disrupted a group II self-splicing intron. In K. pneumoniae strain S15, the Tn4401a element carrying bla(KPC-2) was found on both a large 120-kb plasmid and a smaller 24-kb plasmid. Pulsed-field gel electrophoresis results indicate that the isolates studied represent a heterogeneous group composed of unrelated as well as closely related Klebsiella strains. Our results suggest that endemic KPC-positive Klebsiella strains constitute a generally nonclonal population comprised of various alleles of bla(KPC) on several distinct plasmid genetic backgrounds. This study increases our understanding of the genetic composition of the evolving and expanding role of KPC-producing, healthcare-associated, gram-negative pathogens.

  13. [Burnout syndrome in medical residents at the General Hospital of Durango, México].

    PubMed

    Terrones-Rodríguez, Jovany Francisco; Cisneros-Pérez, Vicente; Arreola-Rocha, José Jesús

    2016-01-01

    Introducción: el síndrome de burnout es frecuente en los trabajadores de la salud y educación debido a que se sienten presionados por las excesivas demandas en su espacio de trabajo. Se evalúan tres esferas: despersonalización, agotamiento emocional y realización personal. Métodos: para determinar la prevalencia del síndrome de burnout en los médicos residentes del Hospital General de Durango SSD, se diseñó un estudio descriptivo, transversal, prolectivo y se aplicó el cuestionario Maslach Burnout Inventory a los residentes de las diferentes especialidades del Hospital General de Durango SSD que aceptaron participar. Resultados: se encuestó a 116 residentes, el 43.1 % (50) mujeres y el 56.89 % (66) hombres. La prevalencia general fue de 89.66 % (IC 95 %: 82.63-94.54). Afectados en una esfera el 48.28 % (IC 95 %: 38.90-57.74), en dos esferas el 35.34 % (IC 95 %: 26.69-44.76) y en las tres esferas el 6.03 % (IC 95 %: 2.46-12.04). En las tres esferas, el agotamiento emocional alto fue del 41.38 % (IC 95 %: 32.31-50.90), alta despersonalización en el 54.31 % (IC 95 %: 44.81-63.59) y baja realización personal en el 41.38 % (IC 95 %: 32.31-50.90). Conclusiones: la prevalencia se encuentra por arriba de la reportada. La mayor frecuencia de afectados fue la de despersonalización, seguida por agotamiento emocional y al final la de realización personal. En las especialidades de ginecología y obstetricia, medicina interna, pediatría y ortopedia los residentes se encuentran afectados en el 100 % de su población.

  14. [Maternal mortality rate in the Aurelio Valdivieso General Hospital: a ten years follow up].

    PubMed

    Noguera-Sánchez, Marcelo Fidias; Arenas-Gómez, Susana; Rabadán-Martínez, Cesar Esli; Antonio-Sánchez, Pedro

    2013-01-01

    Antecedentes: en México, la mortalidad materna ha disminuido en las últimas décadas. En Oaxaca esto no se ha manifestado porque se incrementó la tasa de mortalidad materna. Este estado se ubica entre las entidades con más muertes maternas. Objetivo: analizar 10 años de mortalidad materna en el Hospital General Dr. Aurelio Valdivieso de los Servicios de Salud de Oaxaca, para conocer el comportamiento epidemiológico y caracterización de los decesos. Material y métodos: estudio retrospectivo, transversal y descriptivo efectuado mediante la revisión de expedientes clínicos de mortalidad materna en la División de Gineco-Obstetricia. Se consideraron variables sociales, obstétricas y circunstanciales y las comprobaciones se efectuaron con estadística general y descriptiva. Resultados: entre el 1 de enero de 2000 y el 31 de diciembre de 2009 se registraron 109 muertes maternas, excluidas dos que no fueron obstétricas; es decir, que hubo 107 muertes maternas: 75 directas y 32 indirectas. La tasa de mortalidad materna fue de 172.14 × 100,000 nacidos vivos. De las muertes maternas revisadas 89 pudieron evitarse (83%) y 18 no (17%), esto con base en el dictamen del Comité ad hoc del Hospital General Dr. Aurelio Valdivieso. La enfermedad hipertensiva aguda del embarazo fue la de mayor mortalidad; la escolaridad y el puerperio ueron el mayor riesgo. Conclusiones: las variables atribuibles a bajo índice de desarrollo humano, como: baja escolaridad y paridad elevada incrementaron el riesgo de mortalidad materna, que fue intrahospitalaria y durante el puerperio. La tasa de mortalidad materna fue la mayor encontrada en publicaciones nacionales con respecto a este referente.

  15. Falling through the cracks? Missed opportunities for earlier HIV diagnosis in a New York City Hospital.

    PubMed

    Nakao, Jolene H; Wiener, Dan E; Newman, David H; Sharp, Victoria L; Egan, Daniel J

    2014-10-01

    Summary Newly diagnosed HIV-positive patients have frequent health care encounters prior to diagnosis representing missed opportunities for diagnosis. This study determines the proportion of patients with new HIV diagnoses with encounters in the 3 years prior to diagnosis. We describe the characteristics of newly diagnosed patients and of "late testers" (CD4 <200 cells/mm(3) at the time of diagnosis). We identified all newly diagnosed with HIV in emergency department, inpatient, and outpatient settings between May 1, 2006, and December 31, 2009. Data abstractors searched hospital records to identify all emergency department, inpatient, and outpatient visits for the 3 years prior to diagnosis. In all, 23,271 HIV tests were performed and 253 persons were newly diagnosed (1.1%); 152 new positives (60.1%) made at least one prior visit. Of patients with CD4 counts available, 104/175 (59.4%) had CD4 <200 cells/mm(3). Patients with at least one prior visit had a median of three. There was no difference in numbers of visits between late testers and non-late testers, although late testers were more likely to have ED visits. Most newly diagnosed HIV-positive patients had multiple encounters prior to diagnosis. Many of these patients presented with CD4 counts below 200 cells/mm(3), indicating true missed opportunities for earlier diagnosis.

  16. Composition and production rate of pharmaceutical and chemical waste from Xanthi General Hospital in Greece

    SciTech Connect

    Voudrias, Evangelos; Goudakou, Lambrini; Kermenidou, Marianthi; Softa, Aikaterini

    2012-07-15

    Highlights: Black-Right-Pointing-Pointer We studied pharmaceutical and chemical waste production in a Greek hospital. Black-Right-Pointing-Pointer Pharmaceutical waste comprised 3.9% w/w of total hazardous medical waste. Black-Right-Pointing-Pointer Unit production rate for total pharmaceutical waste was 12.4 {+-} 3.90 g/patient/d. Black-Right-Pointing-Pointer Chemical waste comprised 1.8% w/w of total hazardous medical waste. Black-Right-Pointing-Pointer Unit production rate for total chemical waste was 5.8 {+-} 2.2 g/patient/d. - Abstract: The objective of this work was to determine the composition and production rates of pharmaceutical and chemical waste produced by Xanthi General Hospital in Greece (XGH). This information is important to design and cost management systems for pharmaceutical and chemical waste, for safety and health considerations and for assessing environmental impact. A total of 233 kg pharmaceutical and 110 kg chemical waste was collected, manually separated and weighed over a period of five working weeks. The total production of pharmaceutical waste comprised 3.9% w/w of the total hazardous medical waste produced by the hospital. Total pharmaceutical waste was classified in three categories, vial waste comprising 51.1%, syringe waste with 11.4% and intravenous therapy (IV) waste with 37.5% w/w of the total. Vial pharmaceutical waste only was further classified in six major categories: antibiotics, digestive system drugs, analgesics, hormones, circulatory system drugs and 'other'. Production data below are presented as average (standard deviation in parenthesis). The unit production rates for total pharmaceutical waste for the hospital were 12.4 (3.90) g/patient/d and 24.6 (7.48) g/bed/d. The respective unit production rates were: (1) for vial waste 6.4 (1.6) g/patient/d and 13 (2.6) g/bed/d, (2) for syringe waste 1.4 (0.4) g/patient/d and 2.8 (0.8) g/bed/d and (3) for IV waste 4.6 (3.0) g/patient/d and 9.2 (5.9) g/bed/d. Total chemical waste

  17. Mechanical circulatory support with the ABIOMED BVS 5000: The Toronto General Hospital experience

    PubMed Central

    Lad, Vidyadhar; Elhenawy, Abdelsalam; Harwood, Steve; MacIver, Jane; Badiwala, Mitesh V; Vallelonga, Mark; Yau, Terrence M; Cusimano, Robert J; Delgado, Diego H; Ross, Heather J; Rao, Vivek

    2010-01-01

    BACKGROUND Acute hemodynamic collapse resulting in cardiogenic shock and impending end-organ failure is usually associated with certain death. The introduction of short-term mechanical circulatory support (MCS) devices offers potential therapy to these critically ill patients. The BVS 5000 device (ABIOMED Inc, USA) is widely used in the United States, but rarely in Canada, where device reimbursement remains a barrier. OBJECTIVE To present the Toronto General Hospital’s (Toronto, Ontario) initial five-year experience with this device to highlight the indications for use, common complications and overall success rates. METHODS AND RESULTS The institutional MCS database from 2001 to 2006 was reviewed, and 18 patients who received 30 devices in a variety of configurations were identified. The most common support configuration consisted of biventricular support (n=12), followed by isolated left ventricular support (n=4) and isolated right ventricular support in two recipients of an implantable long-term left ventricular assist device. Overall survival to device explant or transplant was 55% (n=10), of which five (50%) were successfully discharged from the hospital. The overall survival from device implant to hospital discharge was 28% (five of 18). The most common cause of death was multisystem organ failure. CONCLUSIONS MCS with the ABIOMED BVS 5000 can successfully resuscitate critically ill patients; however, earlier institution of this device would avoid irreversible end-organ injury, and lead to higher rates of device explant and hospital discharge. Short-term MCS devices should be available in all cardiac surgical centres in Canada to permit stabilization and evaluation of the acutely ill cardiac patient and subsequent management in a heart transplant facility. PMID:21076718

  18. Non-Invasive Continuous Respiratory Monitoring on General Hospital Wards: A Systematic Review

    PubMed Central

    van Loon, Kim; van Zaane, Bas; Bosch, Els J.; Kalkman, Cor J.; Peelen, Linda M.

    2015-01-01

    Background Failure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality. Purpose In this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring improves early diagnosis of patient deterioration and reduces critical incidents on hospital wards. Data Sources Studies were retrieved from Medline, Embase, CINAHL, and the Cochrane library, searched from 1970 till October 25, 2014. Study Selection Electronic databases were searched using keywords and corresponding synonyms ‘ward’, ‘continuous’, ‘monitoring’ and ‘respiration’. Pediatric, fetal and animal studies were excluded. Data Extraction Since no validated tool is currently available for diagnostic or intervention studies with continuous monitoring, methodological quality was assessed with a modified tool based on modified STARD, CONSORT, and TREND statements. Data Synthesis Six intervention and five diagnostic studies were included, evaluating the use of eight different devices for continuous respiratory monitoring. Quantitative data synthesis was not possible because intervention, study design and outcomes differed considerably between studies. Outcomes estimates for the intervention studies ranged from RR 0.14 (0.03, 0.64) for cardiopulmonary resuscitation to RR 1.00 (0.41, 2.35) for unplanned ICU admission after introduction of continuous respiratory monitoring, Limitations The methodological quality of most studies was moderate, e.g. ‘before-after’ designs, incomplete reporting of primary outcomes, and incomplete clinical implementation of the monitoring system. Conclusions Based on the findings of this systematic review, implementation of routine continuous non-invasive respiratory monitoring on general hospital wards cannot yet be advocated as results are inconclusive, and methodological quality of the studies needs improvement. Future

  19. Profile of Vitamin D in patients attending at general hospital Mahad India

    PubMed Central

    Bawaskar, Parag Himatrao; Bawaskar, Himmatrao Saluba; Bawaskar, Pramodini Himmatrao; Pakhare, Abhijit Patilbuwa

    2017-01-01

    Background: Despite abundant sunshine, Vitamin D deficiency is prevalent in urban India. However, reports on analyzing Vitamin D status from rural Indian population are scanty. Here, we have evaluated Vitamin D status in patients attending outpatient department (OPD) in a rural Indian hospital setting. Methods: A hospital-based cross-sectional study was conducted at a secondary level rural hospital in patients attending medicine OPD. After obtaining informed consent, demographic information was collected from consecutive adult patients along with 3 ml blood sample for Vitamin D analysis using electro chemiluminescene on cobas elecys E411 fully automated system. Vitamin D levels were compared across various groups by using Mann–Whitney or Kruskal–Wallis tests, and multiple linear regression analysis was performed to identify the predictors of Vitamin D level. Results: A total of 640 patients were enrolled in the study, and the prevalence of Vitamin D deficiency (<20 ng/ml) was found to be 65.4% with 95% confidence interval of 61.7–69.1%. On univariate analysis, Vitamin D levels were statistically significantly lower among younger age group, those who have dark complexion, wearing Burkha (veil), and those who were not adequately exposed to sunlight. After multiple linear regressions, dark complexion, wearing Burkha, inadequate exposure to sunlight, and presence of diabetes were identified as statistically significant predictors of Vitamin D deficiency. Conclusion: We report a high prevalence of Vitamin-D deficiency in patients attending medicine OPD. Thus, patients with generalized complaints may be evaluated for serum Vitamin D levels. PMID:28217511

  20. Continuing education among Chinese nurses: A general hospital-based study

    PubMed Central

    Ni, Chunping; Hua, Yan; Shao, Pei; Wallen, Gwenyth R.; Xu, Shasha; Li, Lu

    2014-01-01

    SUMMARY Background Continuing education (CE) is increasingly critical for nurses to keep abreast of rapid changes in patient care due to advancements in knowledge and technology. Objective The objective of this study was to explore Chinese nurses’ perceptions on continuing education, how best CE practices meet their learning needs, and the motivation and barriers nurses face in completing CE. Methods A cross-sectional study of 2727 hospital-employed Chinese nurses from ten general hospitals was conducted from September to October 2010. Nurses’ perceptions on CE, as well as motivational and preventive factors in CE were assessed. Results The majority of nurses (97.3%) attended CE activities in the last twelve months. More than 92.2% of the nurses were familiar with the value of CE. Nurses expected CE activities to take place within a five-day period and to consist of 2 h per activity. The major factors that motivate nurses to participate in CE are the desire to gain and update their knowledge of the newest nursing development and procedures, to improve their practical skills and comprehensive qualities, to maintain professional status and to receive an academic degree. Factors that hindered nurses’ participation in CE included time constraints, work commitments, a lack of opportunity, cost of the courses and previous negative experiences with CE programs. Conclusion Chinese nurses considered CE an extremely important measure to further develop their professional competency. Nurses’ actual expectations for CE and the motivation and barriers for participation in CE from nurses’ individual, family and hospital perspective must be taken into the account in order to make CE programs more effective. PMID:23931929

  1. Normalising advance care planning in a general medicine service of a tertiary hospital: an exploratory study.

    PubMed

    Scott, Ian A; Rajakaruna, Nalaka; Shah, Darshan; Miller, Leyton; Reymond, Elizabeth; Daly, Michael

    2015-11-05

    Objective The aim of the present study was to develop, implement and explore the effects of a program in advance care planning (ACP) within a tertiary hospital general medicine service.Methods Before-after exploratory mixed-methods analysis was conducted of an ACP program comprising seven components designed to overcome well-documented barriers to ACP in clinical practice. The results of pre-ACP program audits performed in June 2014 were compared with those of post-ACP audits performed over 5 months from July to November 2014. The main outcome measure was the number of advance care plans completed in patients considered eligible for ACP based on a life expectancy of 12 months or less as assessed by two prognostication instruments. Questionnaire surveys ascertained staff perceptions of ACP and the usefulness of training and resources in ACP.Results Pre-ACP program analysis of 166 consecutive patients deemed eligible for ACP revealed that only 1% had a documented advance care plan. Following ACP implementation, 115 of 215 (53%) potentially eligible patients were considered able to participate in ACP discussions and were approached to do so before discharge, of whom 89 (77.4%) completed an advance care plan, whereas 26 (23.6%) declined. This equated to an overall completion rate for all potentially eligible patients of 41% compared to 1% pre-ACP (P < 0.001). Major barriers to ACP perceived by at least 30% of questionnaire respondents included the reluctance of patients and family to discuss ACP, insufficient time to initiate or complete ACP, patient and/or family factors that rendered ACP impractical, inadequate communication skills around end-of-life issues, confusion about who was primarily responsible for conducting ACP and difficulty using ACP documentation forms. Enabling factors included dedicated ACP workshops, facilitator and resource packages for staff, and ACP brochures for patients and family.Conclusion A multifaceted ACP program in a general medicine

  2. Infection control in general practices in Buffalo City and OR Tambo District Municipalities, South Africa

    PubMed Central

    2012-01-01

    Abstract Background Good infection control practices are effective in reducing rates of infection in health care settings. Studies in primary care in developed countries indicate that many general practitioners (GPs) do not comply with optimal infection control practices. There are no published studies from developing countries in Southern Africa. Objectives The aim of this study was to describe infection control practices in private GP surgeries in the Buffalo City and OR Tambo District Municipalities in the Eastern Cape Province, South Africa. Method A literature review was conducted to appraise current best practice with respect to Standard Infection Control and Transmission Based Precautions. A questionnaire, inquiring into GPs’ actual practices, was posted to each surgery. Results The valid response rate was 34% (47/140). Methods used to sterilise instruments in 40 practices were: ultraviolet sterilisation (23), chemical disinfection (14), boiling water (7), and steam autoclave (2). Compounds used for chemical disinfection included organotin quaternary, chlorhexidine and benzyl ammonium chloride with a quaternary complex. Twenty-two (47%) used a hand rub. Sixteen (35%) GPs stated that they had a policy to promptly triage patients who are coughing, and 23 (50%) had a policy for airflow movement in the surgery. All practices appropriately disposed of sharps. Thirty-seven (80%) expressed interest in a seminar on infection control. Conclusions Overall, GPs were aware of infection control precautions. Ultraviolet sterilisers and chlorhexidine are not recommended, however, for sterilisation or high level disinfection of medical instruments, and their use should be discontinued. Hand rubs are underutilised. GPs should implement Transmission Based Precautions to prevent airborne and droplet infections.

  3. Nutritional Status of Patients Admitted in a General Surgical Ward at a Tertiary Hospital of Punjab.

    PubMed

    Kamal, Faiza; Fazal, Muhammad Irfan; Cheema, Muhammad Arshad

    2016-04-01

    Nutritional assessment, as a method to identify malnourishment, has long been documented as an essential component of patient management which predicts adverse outcomes. The objective of the study was to find out the frequency of malnutrition and its association with the frequency of complications and deaths postoperatively. This study included all patients who were operated upon in a general surgical unit of Mayo Hospital, Lahore from June to August, 2013. Evaluation of 280 patients showed that 112 (40%) of the patients were malnourished, 90 (32%) were at risk of being malnourished and remaining 78 (28%) of the patients had normal nutritional status, according to the Subjective Global Assessment. Thirteen percent (13%) malnourished and 2 (3%) of the normally nourished patients died within 30 days of operation (p=0.001). Incidence of complications in malnourished patients was 23 (20.53%) as compared to normally nourished patients (5.12%, p=0.006). Malnutrition is very common in patients admitted to surgery wards of our hospitals. It adversely effects the outcome of surgical operations by increasing complications and mortality.

  4. The occurrence of Enterobacteriaceae producing KPC carbapenemases in a general hospital in Curacao

    PubMed Central

    2014-01-01

    Background Although the presence of Carbapenemase-producing Enterobacteriaceae (CPE) are extensively documented in North and South America. CPE have not been reported from Curacao. However, recently intercontinental spread was suggested of a KPC carbapenemase producing Klebsiella pneumoniae in a patient in the United Kingdom with previous admission to a hospital in Curacao in 2009. Findings After the introduction of the CLSI 2010 revised breakpoints, seven patients with carbapenemase-producing Enterobacteriaceae were found in a general hospital in Curacao over a period of 16 months. Four patients carried KPC-2 positive Klebsiella pneumoniae, ST11. Two patients carried KPC-3 positive Klebsiella pneumoniae ST258 and one patient carried a KPC-3 positive Citrobacter freundii. Furthermore, our Klebsiella pneumoniae KPC-2 ST11 strain was matched to the Klebsiella pneumoniae KPC-2 ST11 strain in the United Kingdom. Conclusions Introduction of new laboratory methods, and adoption of new guidelines and breakpoints led to the first detection of CPE in Curacao. By matching our Klebsiella pneumoniae KPC-2 ST11 strain to a Klebsiella pneumoniae KPC-2 ST11 strain in the United Kingdom, we suggest that carbapenemase-producing Enterobacteriaceae are probably more prevalent in Curacao than previously recognized. PMID:25132965

  5. The pattern of femoral diaphyseal fractures in children admitted in Sarawak General Hospital.

    PubMed

    Rasit, A H; Mohammad, A W; Pan, K L

    2006-02-01

    Trend towards changing the face of management for pediatric femoral fractures tends to advocate operative treatment. This study was undertaken to review our current practice in the wake of recent progress in the management of pediatric femoral fractures. Fifty patients with femoral diaphyseal fracture treated in Sarawak General Hospital were reviewed retrospectively after an average follow-up of 2.6 years. There were 36 boys and 14 girls, with a mean age of 6.2 years (range five months to 14 years). Children under six years of age constituted the majority of the patients. Half of the fractures were caused by road traffic accident. Nine patients had associated injuries. The most common site of fracture was at the middle third (N=31). The treatment regimens were delayed hip spica (DHS) in 16, immediate hip spica (IHS) in 24, plate osteosynthesis (PO) in five, titanium elastic nailing (TEN) in five, and external fixation (EF) in one. The minimum hospital stay was two days, and the maximum 33 days (mean, 9.7 days). Malunion was the commonest complication. Conservative treatment is the preferred option for children under six years of age. It is cost-effective with minimal complication. The other treatment options are reserved for specific indication in older children. Diaphyseal fractures of the femur in children can be adequately managed non-operatively.

  6. Large-eddy simulation of airflow and heat transfer in a general ward of hospital

    NASA Astrophysics Data System (ADS)

    Hasan, Md. Farhad; Himika, Taasnim Ahmed; Molla, Md. Mamun

    2016-07-01

    In this paper, a very popular alternative computational technique, the Lattice Boltzmann Method (LBM) has been used for Large-Eddy Simulation (LES) of airflow and heat transfer in general ward of hospital. Different Reynolds numbers have been used to study the airflow pattern. In LES, Smagorinsky turbulence model has been considered and a discussion has been conducted in brief. A code validation has been performed comparing the present results with benchmark results for lid-driven cavity problem and the results are found to agree very well. LBM is demonstrated through simulation in forced convection inside hospital ward with six beds with a partition in the middle, which acted like a wall. Changes in average rate of heat transfer in terms of average Nusselt numbers have also been recorded in tabular format and necessary comparison has been showed. It was found that partition narrowed the path for airflow and once the air overcame this barrier, it got free space and turbulence appeared. For higher turbulence, the average rate of heat transfer increased and patients near the turbulence zone released maximum heat and felt more comfortable.

  7. [Tetanus in Ho Chi Minh City, Vietnam: epidemiological, clinical and outcome features of 389 cases at the Hospital for Tropical Diseases].

    PubMed

    An, V T; Khue, P M; Yen, L M; Phong, N D; Strobel, M

    2015-12-01

    The objective of this study is to describe the different aspects of tetanus during the past recent years in southern Vietnam: epidemiology, clinical picture, management, and death risk factors. It is a retrospective study concerning 389 cases admitted in 2007 and 2008 at the reference Hospital for Tropical Diseases in Ho Chi Minh City. 93% of all cases were generalized tetanus, and 50% were severe cases. A majority of patients were adult males (medium age 43, M/ F sex-ratio 2.9). Half of them underwent tracheotomy and 39% assisted ventilation. Case fatality rate was 6.4%, the lowest reported rate worldwide in the last ten years. Fatalities resulted mainly from neuro-vegetative disorders, essentially cardiogenic shock (28% of all deaths) [OR = 16.95; p < 0.001], sepsis (24%) [OR = 3.25; (p < 0,114], and acute renal failure (16%) [OR = 7,22; p < 0.004]. Age over 60-year [OR = 4.53; p < 0.0001] and a leukocyte count>12.000/mm(3) [OR = 2.32; p < 0.020] were significantly associated with fatal outcome, contrarily to incubation and extension phase durations, or delayed serum administration. Systematic extension of vaccination to all adult males, and improved access to post exposure sero-immunization at all levels of health centres throughout the country may further reduce tetanus burden in Vietnam.

  8. Community-based medical systems advancement in a hospital-primary health care centre in Crete, Greece: concepts, methods, and the new role of the general practitioner.

    PubMed

    Chatziarsenis, M; Lionis, C; Faresjö, T; Fioretos, M; Trell, E

    1998-06-01

    Modern health systems research and development emphasize the transition from hospital to primary health care. Importantly, this transition is projected to be coordinated and interactive, as facilitated, e.g., by improved information systems and collaboration between the involved parties, including Universities and health authorities. An ideal combination of this might accordingly be offered by a synthesis of a basic hospital and primary health care center in an area of suitable site, size, and structure. We believe that our institution, Nosokomion Neapolis, in; the moderate-size Cretan township of Neapolis (New-city) offers an interesting model example of this, because of its affiliation with the University of Heraklion and its international and EU-supported project status. In the present report we want to emphasize the elements that are particularly well suited and manageable and in many ways both opportunistic and conscientious "back to the future" instances of a successful Hospital/Primary Health Care integration. Specifically, we think that the advantages in local area epidemiology, prevention, and quality assurance are apparent, and nurture a--rather renewed that new-role of the general practitioner as both a holistic population doctor and a health systems researcher for the year 2,000 and beyond.

  9. Study of dropouts from a psychiatric clinic of a general hospital.

    PubMed

    Gill, H P; Singh, G; Sharma, K C

    1990-04-01

    During the study period of three months, out of 425 patients attending the psychiatric clinic of a general hospital, for the first time, 165 (38.8%) did not complete the treatment as prescribed by the doctors and were considered as dropouts. They were contacted at their homes to find out the reasons of the dropping out, were compared with patients, who completed the treatment fully on socio-demographic variables and attitude towards treatment. Dropouts significantly differed from treatment acceptors regarding their income, place of domicile and occupation. Maximum number of patients (59.9%) dropped out after the first visit. Dropouts were the maximum among epileptics, and minimum among the mentally retarded patients. Dropouts were dissatisfied with their experience at the clinic as treatment advised was not of their choice, and they feared bad side effects from ECT and drugs. Long distance of residence from clinic was an important reason for dropping out, besides social and economic reasons.

  10. [Histrionic personality disorder in a psychiatry department at a general hospital].

    PubMed

    Abril, A; Valle, J; Moreno, D; de Miguel, D; Molina, D

    1991-01-01

    The personality disturbances imply problem within the psychiatric assistance, both for its difficult delimitation and classification and for the limited results and bad use obtained from therapeutic resources. We studied 402 patients psychiatric service of a general hospital over a period approximately 2 years, 70 (17.5%) were diagnosed DSM-III with Personality disturbances: 44 females (62.9%) and 26 males (37.1%), of an age group between 18 and 67 years old. The most frequent diagnosis was of histrionic of the personality followed by unspecific and border-line. Within the histrionic disturbance of the personality there was a clear predominance of women, whereas in the others types, no significant differences were observed.

  11. 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.

  12. [Professional practice of nurses who care for cancer patients in general hospitals].

    PubMed

    da Silva, Josiane Travençolo; Matheus, Maria Clara Cassuli; Fustinoni, Suzete Maria; de Gutiérrez, Maria Gaby Rivero

    2012-01-01

    The present article discusses a qualitative study which aimed to understand the typical of nurses' professional practice caring for patient with cancer in general hospitals. In order to find out the reasons that motivate nurse's action, and to put in evidence what is original, significant, specific and typical about this phenomenon, we have taken into consideration the premises of the philosopher Alfred Schütz, which provide us with subsidies to unveil them. The data collected through semi-structured interviews reported that nurses admit not having the required theoretical knowledge and experience or enough practice to take care of a cancer patient. Thus, they don't feel capable of developing actions which may positively influence care on patients and their family members.

  13. Stapedectomy at the Singapore General Hospital--use of functional hearing analysis.

    PubMed

    Huang, S C; Stanley, R E

    1995-04-01

    The results of stapedectomy surgery performed in Singapore General Hospital covering a period of over two years are reviewed. The diagnostic importance of selected clinical features and investigative procedures in otosclerosis is studied. The post-operative hearing status of twenty-six cases of primary stapedectomy is analysed using traditional audiometric and modern functional methods. Seventeen patients (65.4%) achieved closure of air-bone gap to less than 10 dB while the overall mean hearing gain was 28.6 dB. Using the Glasgow Plot parameter, 73.1% showed significant benefit from surgery, whilst the corresponding figure using the Belfast Rule of Thumb assessment technique was 57.7%. The validity of the foregoing evaluation techniques is compared. Different operative techniques, including variations in fenestra size and method of oval window seal showed statistically similar results. The scarcity of stapedectomy cases poses problems in the training of future specialists.

  14. Biomedical waste generation in Puducherry Government General Hospital and its management implications.

    PubMed

    Boss, U Jagadeesh Chandira; Moli, G Poyya; Roy, Goutam; Prasad, K V Devi

    2009-05-01

    In India, not much attention has been paid to the management of biomedical waste (BMW). The present paper describes the collection and disposal of BMW in the Government General Hospital (GH) of Puducherry, India. The authors document (a) the lack of segregation between infections and noninfectious BMW as well as a failure to implement the prescribed rules for proper management of BMW; (b) improper treatment and transportation and the final disposal of BMW along with municipal garbage; and (c) an inadequate training of personnel, insufficient personal protective equipment, and a lack of knowledge regarding the proper use of such equipment. The authors recommend the establishment of standards and periodic monitoring along with effective training of personnel.

  15. Intestinal helminth infections amongst HIV-infected adults in Mthatha General Hospital, South Africa

    PubMed Central

    Yogeswaran, Parimalaranie; Wright, Graham

    2015-01-01

    Background In South Africa, studies on the prevalence of intestinal helminth co-infection amongst HIV-infected patients as well as possible interactions between these two infections are limited. Aim To investigate the prevalence of intestinal helminth infestation amongst adults living with HIV or AIDS at Mthatha General Hospital. Setting Study participants were recruited at the outpatient department of Mthatha General Hospital, Mthatha, South Africa. Methods This cross-sectional study was conducted between October and December 2013 amongst consecutive consenting HIV-positive adult patients. Socio-demographic and clinical information were obtained using data collection forms and structured interviews. Stool samples were collected to investigate the presence of helminths whilst blood samples were obtained for the measurement of CD4+ T-cell count and viral load. Results Data were obtained on 231 participants, with a mean age of 34.9 years, a mean CD4 count of 348 cells/µL and a mean viral load of 4.8 log10 copies/mL. Intestinal helminth prevalence was 24.7%, with Ascaris Lumbricoides (42.1%) the most prevalent identified species. Statistically significant association was found between CD4 count of less than 200 cells/µL and helminth infection (p = 0.05). No statistically significant association was found between intestinal helminth infection and the mean CD4 count (p = 0.79) or the mean viral load (p = 0.98). Conclusion A high prevalence of intestinal helminth infections was observed amongst the study population. Therefore, screening and treatment of helminths should be considered as part of the management of HIV and AIDS in primary health care. PMID:26842519

  16. Causes of increased length of hospitalization on a general thoracic surgery service: a prospective observational study

    PubMed Central

    Irshad, Kashif; Feldman, Liane S.; Chu, Victor F.; Dorval, Jean-François; Baslaim, Ghassan; Morin, Jean E.

    2002-01-01

    Objective To characterize medical and nonmedical reasons for delayed discharge on a general thoracic surgery unit. Design A prospective observational cohort study. Setting A university-affiliated tertiary care institution. Patients Between February 1999 and July 2000, the in-hospital progress of 130 patients who had undergone an elective thoracic surgical procedure was evaluated prospectively. Baseline characteristics (age, sex, comorbid conditions and pulmonary function test results) were documented. Main outcome measures Complications that delayed the time when the patient was medically ready for discharge. The day the patient was deemed fit for discharge (medically required length of stay) was compared with the actual day of discharge (actual length of stay). Results The 3 most frequent complications that prevented discharge by postoperative day 6 were persistent air leaks, pulmonary infections and atrial fibrillation. The presence of a persistent air leak increased the medically required length of stay by a mean of 13.1 days (95% confidence interval [CI] 11.0–15.2 d), pneumonia by 9.6 days (95% CI 4.96–14.2 d) and atrial fibrillation by 2.4 days (95% CI −2.6 to 7.4 d). The mean medically required length of stay was 6.9 days, and this differed from the mean day on which the patient was actually discharged (7.35 d, p < 0.01), which contributed 44 excess days of hospitalization per 100 patients. The 2 most common causes of this discrepancy were the lack of home support (10.2% of patients) and the unavailability of convalescent facilities (7.1% of patients). Prolonged hospital stay for nonmedical reasons was associated with increased mean age (67.4 v. 60.7 yr, p = 0.05). Conclusions Length of hospitalization after elective thoracic surgery may be prolonged for medical or nonmedical reasons. Although complications like persistent air leak and pneumonia have an impact on medically required length of stay, social factors may also significantly delay discharge

  17. The burden of bone, native joint and soft tissue infections on orthopaedic emergency referrals in a city hospital.

    PubMed

    Howell, A; Parker, S; Tsitskaris, K; Oddy, M J

    2016-01-01

    Introduction Bone, native joint and soft tissue infections are frequently referred to orthopaedic units although their volume as a proportion of the total emergency workload has not been reported previously. Geographic and socioeconomic variation may influence their presentation. The aim of this study was to quantify the burden of such infections on the orthopaedic department in an inner city hospital, determine patient demographics and associated risk factors, and review our current utilisation of specialist services. Methods All cases involving bone, native joint and soft tissue infections admitted under or referred to the orthopaedic team throughout 2012 were reviewed retrospectively. Prosthetic joint infections were excluded. Results Almost 15% of emergency admissions and referrals were associated with bone, native joint or soft tissue infection or suspected infection. The cohort consisted of 169 patients with a mean age of 43 years (range: 1-91 years). The most common diagnosis was cellulitis/other soft tissue infection and the mean length of stay was 13 days. Two-thirds of patients (n=112, 66%) underwent an operation. Fifteen per cent of patients were carrying at least one blood borne virus, eleven per cent were alcohol dependent, fifteen per cent were using or had been using intravenous drugs and nine per cent were homeless or vulnerably housed. Conclusions This study has shown that a significant number of patients are admitted for orthopaedic care as a result of infection. These patients are relatively young, with multiple complex medical and social co-morbidities, and a long length of stay.

  18. Composition and production rate of pharmaceutical and chemical waste from Xanthi General Hospital in Greece.

    PubMed

    Voudrias, Evangelos; Goudakou, Lambrini; Kermenidou, Marianthi; Softa, Aikaterini

    2012-07-01

    The objective of this work was to determine the composition and production rates of pharmaceutical and chemical waste produced by Xanthi General Hospital in Greece (XGH). This information is important to design and cost management systems for pharmaceutical and chemical waste, for safety and health considerations and for assessing environmental impact. A total of 233 kg pharmaceutical and 110 kg chemical waste was collected, manually separated and weighed over a period of five working weeks. The total production of pharmaceutical waste comprised 3.9% w/w of the total hazardous medical waste produced by the hospital. Total pharmaceutical waste was classified in three categories, vial waste comprising 51.1%, syringe waste with 11.4% and intravenous therapy (IV) waste with 37.5% w/w of the total. Vial pharmaceutical waste only was further classified in six major categories: antibiotics, digestive system drugs, analgesics, hormones, circulatory system drugs and "other". Production data below are presented as average (standard deviation in parenthesis). The unit production rates for total pharmaceutical waste for the hospital were 12.4 (3.90) g/patient/d and 24.6 (7.48) g/bed/d. The respective unit production rates were: (1) for vial waste 6.4 (1.6) g/patient/d and 13 (2.6) g/bed/d, (2) for syringe waste 1.4 (0.4) g/patient/d and 2.8 (0.8) g/bed/d and (3) for IV waste 4.6 (3.0) g/patient/d and 9.2 (5.9) g/bed/d. Total chemical waste was classified in four categories, chemical reagents comprising 18.2%, solvents with 52.3%, dyes and tracers with 18.2% and solid waste with 11.4% w/w of the total. The total production of chemical waste comprised 1.8% w/w of the total hazardous medical waste produced by the hospital. Thus, the sum of pharmaceutical and chemical waste was 5.7% w/w of the total hazardous medical waste produced by the hospital. The unit production rates for total chemical waste for the hospital were 5.8 (2.2) g/patient/d and 1.1 (0.4) g/exam/d. The respective

  19. Impact of Tactile Stimulation on Neurobehavioral Development of Premature Infants in Assiut City

    ERIC Educational Resources Information Center

    Sayed, Atyat Mohammed Hassan; Youssef, Magda Mohamed E.; Hassanein, Farouk El-Sayed; Mobarak, Amal Ahmed

    2015-01-01

    Objective: To assess impact of tactile stimulation on neurobehavioral development of premature infants in Assiut City. Design: Quasi-experimental research design. Setting: The study was conducted in the Neonatal Intensive Care Unit at Assiut University Children Hospital, Assiut General Hospital, Health Insurance Hospital (ElMabarah Hospital) and…

  20. 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.

  1. The Treatment of Anorexia Nervosa in a General Hospital: A Case Vignette of a Multi-Disciplinary General Hospital-Based Approach.

    ERIC Educational Resources Information Center

    Kronenberg, J.; And Others

    1994-01-01

    Describes anorexia nervosa as condition variable in etiology and resistant to treatment, which may lead to mortality in 5% of treated cases. Notes that efforts have been made for treating disorder in nonstigmatizing medical units outside psychiatric hospitals. Describes, through presentation of short case vignette, advantages of treating…

  2. [What has happened to patient satisfaction with the care in general hospitals in the years from 1993-1995?].

    PubMed

    Berg, A; Yuval, D

    1998-03-01

    Patient satisfaction with the hospitalization process is an important element in the measurement of quality of care. Information from a survey of patients' experiences could therefore help hospitals improve their service, and provide decision-makers with relevant information. We present the findings of a study of some 4,500 patients, aged 18+, released from hospitals in the fall of 1993 and of 1995 from the wards of 9 acute care hospitals, psychiatric and geriatric wards excluded. Self-administered questionnaires were sent and returned by mail, with an overall response rate of 82%. Despite the many changes in Israel's health system in general and its hospital system in particular, and the social and demographic changes between those 2 periods, patient satisfaction remained constant. Of those discharged from medical or surgical wards, 70% were satisfied to a "great" or "ver great" extent with their hospital experience. There was improvement in most areas of hospitalization in the course of the 2 years. The greatest improvement was with regard to admission, nursing staff, hotel services, in patient satisfaction food and supplies. On the other hand there was deterioration in visiting conditions and hours. Satisfaction with physicians, nurses and hotel services had the strongest links with general satisfaction.

  3. Contribution of the outpatient surgery unit ITO the general surgery department of a district hospital.

    PubMed

    Carrasco; Flores; Aguayo; de Andres B; Moreno Egea A; Cartagena; De Vicente JP; Martin

    2000-07-01

    Introduction: The creation of Outpatient Surgery (OPS) units to combine the quality of medical attention and rationalize costs allows for greater efficiency in the use of resources. Aim: To report our series of patients undergoing surgery at the OPS units integrated into our Hospital (Type II): Patients and method: Between May 1994 and March 1998, 832 outpatients, of a total of 5230, underwent surgery at our General Surgery Unit. The criteria for exclusion from the programme depended on the patient and the enviroment or resulted from the operation itself. Results: Mean patient age was 47.5 years; there were 420 males and 412 females. Surgery was performed for 229 inguinofemoral hernias, 47 umbilical-epigastric hernias, nine incisional hernias, 193 pilonidal sinuses, 156 mammary nodules, 65 varicose veins, 64 arteriovenous fistulae and 69 proctology operations. The most common anesthesia techniques performed were rachianesthesia and local anesthesia. Eight point seven percent of the patients required admission (OPS failure), the most frequent causes being excessive pain, orthostatic-syncopal hypotension, nausea and vomiting and urine retention. There was no morbidity or mortality. Conclusion: OPS is a highly efficient procedure for resolving the most common pathologies in General Surgery. The anesthesia technique was an important factor in the rate of failure.

  4. Aspects of imported malaria at a district general hospital in non-endemic Kuwait, Arabian Gulf.

    PubMed

    Hira, P R; Al-Ali, F; Soriano, E B; Behbehani, K

    1988-06-01

    There is no indigenous mosquito-borne transmission of malaria in Kuwait. However, in a five year period at a district general hospital, the number of laboratory-diagnosed cases of malaria increased annually from 25 to 84, a rise of 336%. Except for two induced infections, all were imported, mainly from the Indian subcontinent. Plasmodium vivax was responsible for 87.29% of the cases; P.falciparum (12.05%), a mixed infection of P.vivax and P.falciparum (0.33%) and a case of P.ovale (0.33%) were also identified. Rapid preparation of acetone-fixed, Giemsa-stained thick blood films, a heightened awareness of the infection, examination of multiple samples of blood from patients and the general resurgence of malaria in endemic areas were some of the factors responsible for the high number of cases diagnosed. Most patients were young males and presented with clinical malaria due to P.vivax between May and October each year, an apparent seasonal peak. However, many were already resident in the country for a variable period. Patients with P.falciparum though, presented clinically within two weeks of arrival in the country. Parasite densities were calculated to monitor the progress of treatment and identify quickly any possible chloroquine-resistant P.falciparum strains. A policy of active prophylaxis is suggested to stem the tide of imported malaria.

  5. Effect of the Iranian hospital grading system on patients' and general practitioners' behaviour: an examination of awareness, belief and choice.

    PubMed

    Aryankhesal, Aidin; Sheldon, Trevor

    2010-08-01

    There is considerable international interest in the use of performance measurement and their public release in order to improve the quality of care. However, few studies have assessed stakeholders' awareness and use of performance data. Iranian hospitals have been graded annually since 1998 and hospital hotel charges vary by grade, but this system has never been evaluated. We conducted a cross-sectional survey of 104 outpatients at eight Teheran hospitals and 103 general practitioners (GPs) to assess the awareness of and attitudes towards hospital grading system. Only 5.8% of patients (95% CI: 1.3-10.3%) and 11.7% of GPs (95% CI: 5.5-17.9%) were aware of grading results. Patients' awareness was positively associated with their education level (P = 0.016). No patient used the grading results for choosing a hospital and only one GP (1%, 95% CI: 0-2%) reported using hospital grade to influence referral decisions. Patients were more influenced by hospitals' public reputation and that of their specialists. GPs believed that the grading system did not reflect the quality of care in hospitals. When developing performance measurement systems, public release of data should be accompanied by evaluation of its impact on awareness and health-care choices.

  6. Effects of short-term exposure to air pollution on hospital admissions of young children for acute lower respiratory infections in Ho Chi Minh City, Vietnam.

    PubMed

    Le, Truong Giang; Ngo, Long; Mehta, Sumi; Do, Van Dzung; Thach, T Q; Vu, Xuan Dan; Nguyen, Dinh Tuan; Cohen, Aaron

    2012-06-01

    There is emerging evidence, largely from studies in Europe and North America, that economic deprivation increases the magnitude of morbidity and mortality related to air pollution. Two major reasons why this may be true are that the poor experience higher levels of exposure to air pollution, and they are more vulnerable to its effects--in other words, due to poorer nutrition, less access to medical care, and other factors, they experience more health impact per unit of exposure. The relations among health, air pollution, and poverty are likely to have important implications for public health and social policy, especially in areas such as the developing countries of Asia where air pollution levels are high and many live in poverty. The aims of this study were to estimate the effect of exposure to air pollution on hospital admissions of young children for acute lower respiratory infection (ALRI*) and to explore whether such effects differed between poor children and other children. ALRI, which comprises pneumonia and bronchiolitis, is the largest single cause of mortality among young children worldwide and is responsible for a substantial burden of disease among young children in developing countries. To the best of our knowledge, this is the first study of the health effects of air pollution in Ho Chi Minh City (HCMC), Vietnam. For these reasons, the results of this study have the potential to make an important contribution to the growing literature on the health effects of air pollution in Asia. The study focused on the short-term effects of daily average exposure to air pollutants on hospital admissions of children less than 5 years of age for ALRI, defined as pneumonia or bronchiolitis, in HCMC during 2003, 2004, and 2005. Admissions data were obtained from computerized records of Children's Hospital 1 and Children's Hospital 2 (CH1 and CH2) in HCMC. Nearly all children hospitalized for respiratory illnesses in the city are admitted to one of these two pediatric

  7. 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

  8. Trauma patterns in patients attending the Emergency Department of Jazan General Hospital, Saudi Arabia

    PubMed Central

    Hokkam, Emad; Gonna, Abdelaziz; Zakaria, Ossama; El-shemally, Amany

    2015-01-01

    BACKGROUND: Modern civilization and the sharp rise in living standards have led to dramatic changes in trauma pattern in Saudi Arabia. This study aimed to describe the different patterns of injuries of patients attending the Emergency Department of Jazan General Hospital (JGH) in the southwest corner of Saudi Arabia. METHODS: A total number of 1 050 patients were enrolled in the study. A pre-organized data sheet was prepared for each patient attended the Emergency Department of JGH from February 2012 to January 2013. It contains data about socio-demographics, trauma data, clinical evaluation results, investigations as well as treatment strategies. RESULTS: The mean age of the patients was 25.3±16.8 years. Most (45.1%) of the patients were at age of 18–30 years. Males (64.3%) were affected by trauma more common than females. More than half (60.6%) of the patients were from urban areas. The commonest kind of injury was minor injury (60%), followed by blunt trauma (30.9%) and then penetrating trauma (9.1%). The mean time from the incident to arrival at hospital was 41.3±79.8 minutes. The majority (48.2%) of the patients were discharged after management of trivial trauma, whereas 2.3% were admitted to ICU, 7.7% transferred to inpatient wards, and 17.7% observed and subsequently discharged. The mortality rate of the patients was 2.6%. CONCLUSION: Trauma is a major health problem, especially in the young population in Saudi Arabia. Blunt trauma is more frequent than penetrating trauma, with road traffic accidents accounting for the majority. PMID:25802567

  9. Correlates of Stillbirths at Nyeri Provincial General Hospital, Kenya, 2009-2013: A Retrospective Study

    PubMed Central

    Cheptum, Joyce J.; Muiruri, Nelly; Mutua, Ernest; Gitonga, Moses; Juma, Mwangi

    2016-01-01

    Background: Death of a baby in-utero is a very devastating event to the mother and the family. Most stillbirths occur during labor and birth with other deaths occurring during the antenatal period. Millions of families experience stillbirths, yet these deaths remain uncounted, and policies have not been clearly stipulated to address this issue. The aim of the study was to identify the possible causes of stillbirths as recorded in the medical records. Methods: A retrospective study looking at medical records of women who experienced stillbirths between 1st January 2009 and 31st December 2013 at Nyeri Provincial General Hospital, Kenya. The hospital records containing cases of stillbirths were retrieved and data abstraction forms were used to collect data and information. Results: Both fresh and macerated stillbirths were equally common. The stillbirth rate was 12.2 per 1,000 births. There was significant association between stillbirths and the clients who were referred and reason for referral, (p=0.029) and (p=0.005), respectively. The number of ANC visits during pregnancy was also significant (p=0.05). Mode of delivery and the reason for cesarean section were significantly associated with stillbirths, (p=0.003) and (p=0.032), respectively. The type of labor and delivery complications experienced was associated with stillbirths (p= 0.022). Conclusion and Global Health Implications: There were several factors associated with stillbirths thus efforts should be made to establish approaches aimed at prevention. Addressing the causes of stillbirths will contribute to reduction of perinatal mortality. PMID:27622009

  10. Client perception of service quality at the outpatient clinics of a General hospital in Lagos, Nigeria

    PubMed Central

    Ogunnowo, Babatunde Enitan; Olufunlayo, Tolulope Florence; Sule, Salami Suberu

    2015-01-01

    Introduction Service quality assessments have assumed increasing importance in the last two decades. They are useful in identifying gaps in services been provided with the ultimate aim of guaranteeing quality assurance. The objective of this study was to assess the client perception of service quality at the outpatient clinics of Randle General hospital, Lagos. Methods A descriptive cross sectional study was conducted from March to May 2013. A multistage sampling technique was used to select respondents and data was collected with the aid of modified SERVQUAL questionnaires. The data was analysed with aid of EPI-INFO 2002 and statistical significance was set at a P value 0.05 for statistical significance. Results Total of 400 respondents were interviewed. The mean age was 40 years with a standard deviation of 15.2 yrs. The highest mean score of 4.35 out of a possible maximum of 5 was recorded in assurance domain while the lowest mean score of 4.00 was recorded in the responsiveness domain. The overall mean score of all the domains was 4.20 with standard deviation of 0.51. Overall majority (80.8%) of respondents rated the overall service quality as good/ very good. After linear regression, the assurance domain was the most important predictor of the overall perceived service quality (p< 0.001). Conclusion The overall perceived service quality was good. The major deficiencies were in the responsiveness domain and especially the waiting time. The hospital management should implement measures to improve the responsiveness of services by ensuring prompt delivery of services. PMID:26834921

  11. Global stability of a transport-related infection model with general incidence rate in two heterogeneous cities.

    PubMed

    Liu, Lili; Liu, Xianning

    2014-12-01

    To further understand the effects of travel on disease spread, a transport-related infection model with general incidence rate in two heterogeneous cities is proposed and analyzed. Some analytical results on the global stability of equilibria (including disease free equilibrium and endemic equilibrium) are obtained. The explicit formula for the basic reproduction number R0 is derived and it is proved to be a threshold for disease spread. To reveal how incidence rate and travel rate influence the disease spread, effects of general incidence rate and travel rate on the dynamics of system are shown via numeric simulations.

  12. Factors associated with the difficulty in hospital acceptance at the scene by emergency medical service personnel: a population-based study in Osaka City, Japan

    PubMed Central

    Katayama, Yusuke; Kitamura, Tetsuhisa; Kiyohara, Kosuke; Iwami, Taku; Kawamura, Takashi; Hayashida, Sumito; Yoshiya, Kazuhisa; Ogura, Hiroshi; Shimazu, Takeshi

    2016-01-01

    Objectives To investigate the association between the difficulty in hospital acceptance at the scene by emergency medical service (EMS) personnel and prehospital demographic factors and reasons for EMS calls. Design A retrospective, observational study. Setting Osaka City, Japan. Participants A total of 100 649 patients transported to medical institutions by EMS from January 2013 to December 2013. Primary outcome measurements The definition of difficulty in hospital acceptance at the scene was EMS personnel making ≥5 phone calls to medical institutions until a decision to transport was determined. Multivariable analysis was used to assess the relationship between difficulty in hospital acceptance and prehospital factors and reasons for EMS calls. Results Multivariable analysis showed the elderly, foreigners, loss of consciousness, holiday/weekend, and night-time to be positively associated with difficulty in hospital acceptance at the scene. As reasons for EMS calls, gas poisoning (adjusted OR 3.281, 95% CI 1.201 to 8.965), trauma by assault (adjusted OR 2.662, 95% CI 2.390 to 2.966), self-induced drug abuse/gas poisoning (adjusted OR 4.527, 95% CI 3.921 to 5.228) and self-induced trauma (adjusted OR 1.708, 95% CI 1.369 to 2.130) were positively associated with the difficulty in hospital acceptance at the scene. Conclusions Ambulance records in Osaka City showed that certain prehospital factors such as night-time were positively associated with difficulty in hospital acceptance at the scene, and reasons for EMS calls, such as self-induced drug abuse/gas poisoning, were also positive predictors for difficulty in hospital acceptance at the scene. PMID:27798040

  13. Meteorological Integration for the Biological Warning and Incident Characterization (BWIC) System: General Guidance for BWIC Cities

    SciTech Connect

    Shaw, William J.; Wang, Weiguo; Rutz, Frederick C.; Chapman, Elaine G.; Rishel, Jeremy P.; Xie, YuLong; Seiple, Timothy E.; Allwine, K Jerry

    2007-02-16

    The U.S. Department of Homeland Security (DHS) is responsible for developing systems to detect the release of aerosolized bioagents in urban environments. The system that accomplishes this, known as BioWatch, is a robust first-generation monitoring system. In conjunction with the BioWatch detection network, DHS has also developed a software tool for cities to use to assist in their response when a bioagent is detected. This tool, the Biological Warning and Incident Characterization (BWIC) System, will eventually be deployed to all BioWatch cities to aid in the interpretation of the public health significance of indicators from the BioWatch networks. BWIC consists of a set of integrated modules, including meteorological models, that estimate the effect of a biological agent on a city’s population once it has been detected. For the meteorological models in BWIC to successfully calculate the distribution of biological material, they must have as input accurate meteorological data, and wind fields in particular. The purpose of this document is to provide guidance for cities to use in identifying sources of good-quality local meteorological data that BWIC needs to function properly. This process of finding sources of local meteorological data, evaluating the data quality and gaps in coverage, and getting the data into BWIC, referred to as meteorological integration, is described. The good news for many cities is that meteorological measurement networks are becoming increasingly common. Most of these networks allow their data to be distributed in real time via the internet. Thus, cities will often only need to evaluate the quality of available measurements and perhaps add a modest number of stations where coverage is poor.

  14. Louse-borne relapsing fever profile at Felegehiwot referral hospital, Bahir Dar city, Ethiopia: a retrospective study

    PubMed Central

    2014-01-01

    Background Louse- borne relapsing fever is an acute febrile illness caused by Borrelia recurrentis and is transmitted by body lice, Pediculus humanus corporis. The disease has occurred as epidemic in different parts of the country.Therefore, the aim of this retrospective study was conducted to assess the LBRF profile for the last four years. Methods A retrospective study was conducted on patients with LBRF admitted from 2009–2012 at Felegehiwot referral hospital. The diagnosis was based on both clinical and laboratory methods. Patients with strong clinical suspicion of LBRF and positive for Borrelia species in their blood was diagnosed as LBRF cases. Data was collected from all patients with LBRF- like symptoms in their registration book. Data was checked for completeness, coded and analysed using SPSS version 16. P < 0.05 was considered significant for comparison. Results Of the 4559 patients admitted with LBRF- like symptoms, 4178 (91.6%) were males and 381 (8.4%) were females. Most of the patients (74.2%) were within age groups 11–20 years. The majority of patients (94.4%) were from urban residence. The overall prevalence of LBRF was 225 (4.9%) and the highest prevalence 171 (5.1%) was observed in age groups of 11–20 years. The association between seasonal variation and prevalence of LBRF showed that more patients with positive for Borrelia species were recorded in dry 27 (9.7%) than wet 198 (4.6%) seasons (P < 0.001). Finally, a trend in prevalence of LBRF for the last four years showed that the highest numbers of cases were documented in 2010. Conclusion The overall prevalence of LBRF was high and the highest prevalence was observed in young age groups. Moreover, most of the patients with LBRF were from urban dwellers. Therefore, health education should be delivered towards LBRF prevention in the city. PMID:24742342

  15. [Treatment of renal anemia in hemodialysis patients in General Hospital Bjelovar from 2007 to 2010].

    PubMed

    Lovcić, Vesna; Vujić, Jovana; Basić-Jukić, Nikolina; Kurtović, Ivana; Janković, Renata Ivanac; Lovcić, Petra; Dzapo, Marko

    2011-10-01

    Renal anemia is complication of chronic kidney disease. It is caused by crythropoietin deficency and is associated with adverse outcomes in CKD patients. Renal anemia should be treated with erythropoesis-stimulating agents (ESAs), supplementary iron, adequate dialysis, and if necessary with red blood cells transfusions. The main problem of treatment is how to determine target hemoglobin value and keep it within the constant range. Current guidelines recommend target hemoglobin level 110 - 120 g/l, but optimal value need to be adjusted for every patient individualy keeping in mind primary kidney disease, age, gender and comorbidities. In Department of Dialysis of General Hospital Bjelovar we carried out a retrospective study about treating renal anemia in 67 patients on chronic hemodialysis program during 36 months in a period from 2007. til 2010. We monitored hemoglobin, feritin, saturation of transferin (TSAT), dose of LSE, number of change in dosage and number of transfusion. Mean hemoglobin level was 107.8 g/l, feritin level 196.8 mcg/l, TSAT 24.16%, weekly dose of ESAs 5951.9 IU. in 53.7% patiens dose was changed 11 - 20 times during that period, and 34% of patiens was treated with at least 1 dose of transfusion of red blood cells. We conclude that better iron supplementation and moderately higher doses of FSAs correlate with higher hemoglobin value, and hemoglobin variations is still big problem in renal anemia treatment.

  16. Aetiological characteristics of adult acute diarrhoea in a general hospital of Shanghai.

    PubMed

    Zhao, X; Ni, B; Wang, Y; Shen, X; Zhang, C; Liu, J; Li, S

    2017-02-01

    Epidemic surveillance is an effective means to determine the characteristics of acute diarrhoea and the benefits of disease control and prevention. The epidemiological, clinical, and aetiological data of adult (aged ⩾15 years) acute diarrhoea in a general hospital in Shanghai were collected and analysed. Out of 2430 acute diarrhoea patients, 162 subjects were sampled (sample ratio 15:1). The sampled subjects had an average age (±s.d.) of 44 ± 18 years; 142 (87·7%) had a history that indicated ingestion of contaminated food; and 40 (24·7%), 54 (33·3%), and 73 (45·1%) patients had diarrhoea that was attributed to viral, bacterial, and unknown aetiological origins respectively. Viral diarrhoea is mainly prevalent during the winter and spring months, while bacterial and diarrhoea of unknown aetiology occur mainly in the summer months. The average age of the unknown aetiology group (48 ± 19 years) was significantly older than that of the viral diarrhoea group (39 ± 16 years). The number of patients with vomiting in the viral group (30·6%) was significantly higher than that in the bacterial (17·1%) and unknown aetiology (8·2%) groups. Viral and bacterial infections are the main cause of acute diarrhoea in Shanghai. However, further effective technological means are needed to improve the surveillance, control, and prevention of acute diarrhoea.

  17. A clinical appraisal of patients with psoriasis treated in Seremban General Hospital, Malaysia.

    PubMed

    Siow, K Y; Safdar, N A Mohd; Chong, K H; Chua, K B

    2004-08-01

    A prospective clinical study of 181 patients with psoriasis seen in Seremban General Hospital showed the incidence of psoriasis among dermatology outpatients was 2.15%. A significantly higher proportion of male patients were affected, with a male to female ratio of 1.7:1. Within the racial groups; 63 were Malays, 37 Chinese, and 81 Indians. There was a significantly higher proportion of Indians affected as compared with the races. The mean age of patients in this study was 43.7 years old but the mean age of onset of psoriasis in these patients was 33.1 years old. Thirty-one (17.1%) patients gave a positive family history of psoriasis and the mean age of onset of psoriasis was lower (29.3 years old) for patients with a positive family history. Plaque psoriasis was the commonest type of clinical presentation with the scalp being the commonest site affected. Psoriatic arthropathy was seen in 35 (19.3%) patients. Ninety-five (52.5%) patients gave a positive history of factors exacerbating their pre-existing disease and stress was singled out as the most common exacerbating factor.

  18. Factors Affecting the Agreement Between Emergency Psychiatrists and General Practitioners Regarding Involuntary Psychiatric Hospitalizations.

    PubMed

    Geoffroy, Pierre Alexis; Duhamel, Alain; Behal, Hélène; Zouitina-Lietaert, Nadia; Duthilleul, Julie; Marquette, Louise; Ducrocq, François; Vaiva, Guillaume; Rolland, Benjamin

    2016-06-21

    Important discrepancies exist between physicians in deciding when to perform involuntary hospitalization measures (IHMs). The factors underlying these differences are poorly known.We conducted a two-year single-center retrospective study in France on patients who were referred to the emergency department (ED) with an IHM certificate written by a private-practice General Practitioner (GP). For each consultation, the official IHM motive was categorized into four groups: Suicide; Psychosis, Mania, or Melancholia (PMM); Agitation; and Other. The alcohol status of the patient was also noted. The factors underlying the ED psychiatrists' confirmation of the use of IHMs were determined using a logistic regression model. One hundred eighty-nine cases were found (165 patients; 44.2 ± 16 years, 41.3% women). The ED psychiatrists confirmed the use of IHMs in 123 instances (65.1% agreement rate). Multivariate analyses found that IHM disagreement was significantly associated with patient alcohol status and the reason for referral. Specifically, there was an increased risk of IHM disagreement when the patient had an alcohol-positive status (OR = 15.80; 95% CI [6.45-38.67]; p < 0.0001) and when the motive for IHM was "agitation" compared with "suicide" (OR = 11.44; 95% CI[3.38-38.78]; p < 0.0001). These findings reflect significant disparities between GPs and ED psychiatrists regarding the decision to proceed to an IHM.

  19. Application of a neural network for gentamicin concentration prediction in a general hospital population.

    PubMed

    Corrigan, B W; Mayo, P R; Jamali, F

    1997-02-01

    Neural network (NN) computation is computer modeling based in part on simulation of the structure and function of the brain. These modeling techniques have been found useful as pattern recognition tools. In the present study, data including age, sex, height, weight, serum creatinine concentration, dose, dosing interval, and time of measurement were collected from 240 patients with various diseases being treated with gentamicin in a general hospital setting. The patient records were randomly divided into two sets: a training set of 220 patients used to develop relationships between input and output variables (peak and trough plasma concentrations) and a testing set (blinded from the NN) of 20 to test the NN. The network model was the back-propagation, feed-forward model. Various networks were tested, and the most accurate networks for peak and trough (calculated as mean percent error, root mean squared error of the testing group, and tau value between observed and predicted values) were reported. The results indicate that NNs can predict gentamicin serum concentrations accurately from various input data over a range of patient ages and renal function and may offer advantages over traditional dose prediction methods for gentamicin.

  20. Incidence and review of sessile serrated polyp reporting in a district general hospital in the UK.

    PubMed

    Dada, Mahomed; Wang, Lai Mun; Chetty, Runjan

    2013-11-01

    The aim of this 4-year audit was to establish whether sessile serrated polyps/adenomas (SSP/A) were diagnosed in a district general hospital in the UK. The study also explored whether SSP/A in the right colon were misdiagnosed as hyperplastic polyps. A retrospective search of the computer records from 2009 to 2012 inclusive for all lesions diagnosed and coded as SSP/A and/or hyperplastic polyps proximal to the splenic flexure was undertaken. All slides were reviewed and a diagnosis of SSP/A made using the criteria recently suggested by the American College of Gastroenterology. Over the study period, no cases of SSP/A were made. On review of all hyperplastic polyps proximal to the splenic flexure, 13/31 in 2009, 17/40 in 2010, 19/48 in 2011 and 16/48 in 2012 were re-classified as SSP/A. The most likely reason for the under-diagnosis of SSP/A is lack of awareness of the lesion both clinically and by pathologists. Adequate biopsies and deeper sections are important to help make the diagnosis of SSP/A. This study shows that SSP/A are reasonably frequently encountered in non-specialist practice settings and that both clinicians and pathologist in this setting need to be aware of its existence.

  1. Train crash disasters and emergency plans of suburban hospitals in the New York City and Washington, DC areas: what went right; what could have been improved.

    PubMed

    1996-06-01

    Two major train crashes in February--one in Northern New Jersey and the other in Silver Spring, MD, near Washington, DC--posed severe challenges to the disaster plans of area hospitals. The first crash involving two commuter trains near Secaucus, NJ, tested the effectiveness of emergency plans at the Jersey City Medical Center, Jersey City, NJ, and the Meadowlands Hospital Medical Center, Secaucus. The incident occurred at approximately 8:40 a.m. and resulted in three deaths and 162 injuries. The Silver Spring crash, which took place a week after the one in New Jersey, occurred in early evening and involved an Amtrak and a commuter train. It resulted in 11 deaths and 26 injuries. Holy Cross Hospital, Silver Spring, was the primary caregiver. In this report, we'll provide details on how the incidents impacted on nearby hospitals and their security staffs; how challenges, anticipated and unanticipated, were met; and what conclusions were reached in follow-up critiques.

  2. Do Alcohol Misuse, Service Utilisation, and Demographic Characteristics Differ between UK Veterans and Members of the General Public Attending an NHS General Hospital?

    PubMed Central

    Murphy, Dominic; Palmer, Emily; Westwood, Greta; Busuttil, Walter; Greenberg, Neil

    2016-01-01

    The aim of this paper was to provide insights into alcohol misuse within UK veterans to inform as to whether their presentations differ from the general public. This was done by exploring differences in the severity of alcohol misuse between UK veterans and the general public admitted to a general NHS hospital over an 18 month period using retrospective data. All patients admitted to the hospital were screened for alcohol misuse. Those deemed as experiencing problems were referred for specialist nurse-led support. A total of 2331 individuals were referred for this supported and administered with a standardised assessment that included measures of the severity of alcohol difficulties (AUDIT), dependency levels (LDQ), and assessed for the presence of withdrawal symptoms (CIWA-Ar). In addition, information was collected on service utilisation, referral category (medical or mental health), other substance misuse, and demographic characteristics. No differences were found between the severity of reported alcohol difficulties between veterans and non-veterans. Evidence was found to suggest that veterans were more likely to be referred for support with alcohol difficulties at an older age and to be admitted to hospital for longer periods of time. This could have considerable cost implications for the NHS. It was more common for veterans to present at hospital with physical health difficulties prior to being referred for support for alcohol. PMID:27827830

  3. Prevalence of Drug Resistance Mycobacterium Tuberculosis among Patients Seen in Coast Provincial General Hospital, Mombasa, Kenya

    PubMed Central

    Ombura, Ida Pam; Onyango, Noel; Odera, Susan; Mutua, Florence; Nyagol, Joshua

    2016-01-01

    Background Although prevention and control of spread of multi-drug resistant tuberculosis strains is a global challenge, there is paucity of data on the prevalence of DR-TB in patients diagnosed with TB in referral hospitals in Kenya. The present study assessed patients’ characteristics and prevalence of drug resistant TB in sputa smear positive TB patients presenting to Coast Provincial General Hospital (CPGH) in Mombasa, Kenya. Methods Drug resistance was evaluated in 258 randomly selected sputa smear TB positive cases between the periods of November 2011 to February 2012 at the CPGH-Mombasa. Basic demographic data was obtained using administered questionnaires, and clinical history extracted from the files. For laboratory analyses, 2mls of sputum was obtained, decontaminated and subjected to mycobacteria DNA analyses. Detection of first line drug resistance genes was done using MDRTDR plus kit. This was followed with random selection of 83 cases for second line drug resistance genes testing using Genotype MDRTBsl probe assay kit (HAINS Lifesciences, GmbH, Germany), in which ethambutol mutation probes were included. The data was then analyzed using SPSS statistical package version 19.0. Results Male to female ratio was 1:2. Age range was 9 to 75 years, with median of 30 years. New treatment cases constituted 253(98%), among which seven turned out to be PTB negative, and further grouped as 4 (1.6%) PTB negative and 3(1.1%) NTM. 237(91.7%) new cases were fully susceptible to INH and RIF. The remaining, 8 (3.1%) and 1(0.4%) had mono- resistance to INH and RIF, respectively. All the retreatment cases were fully susceptible to the first line drugs. HIV positivity was found in 48 (18.6%) cases, of which 46(17.8%) were co-infected with TB. Of these, 44 (17.1%) showed full susceptibility to TB drugs, while 2 (0.8%) were INH resistant. For the second line drugs, one case each showed mono resistance to both and FQ. Also, one case each showed drug cross poly resistance to

  4. 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

  5. The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts

    PubMed Central

    Ferri, Paola; Guadi, Matteo; Marcheselli, Luigi; Balduzzi, Sara; Magnani, Daniela; Di Lorenzo, Rosaria

    2016-01-01

    Background Shift work is considered necessary to ensure continuity of care in hospitals and residential facilities. In particular, the night shift is one of the most frequent reasons for the disruption of circadian rhythms, causing significant alterations of sleep and biological functions that can affect physical and psychological well-being and negatively impact work performance. Objectives The aim of this study was to highlight if shift work with nights, as compared with day work only, is associated with risk factors predisposing nurses to poorer health conditions and lower job satisfaction. Methods This cross-sectional study was conducted from June 1, 2015 to July 31, 2015 in 17 wards of a general hospital and a residential facility of a northern Italian city. This study involved 213 nurses working in rotating night shifts and 65 in day shifts. The instrument used for data collection was the “Standard Shift Work Index,” validated in Italian. Data were statistically analyzed. Results The response rate was 86%. The nurses engaged in rotating night shifts were statistically significantly younger, more frequently single, and had Bachelors and Masters degrees in nursing. They reported the lowest mean score in the items of job satisfaction, quality and quantity of sleep, with more frequent chronic fatigue, psychological, and cardiovascular symptoms in comparison with the day shift workers, in a statistically significant way. Conclusion Our results suggest that nurses with rotating night schedule need special attention due to the higher risk for both job dissatisfaction and undesirable health effects. PMID:27695372

  6. An Investigation of Nursing Staff Attitudes and Emotional Reactions towards Patients with Intellectual Disability in a General Hospital Setting

    ERIC Educational Resources Information Center

    Lewis, Sharna; Stenfert-Kroese, Biza

    2010-01-01

    Background: It has been suggested that inequalities in health care for people with intellectual disabilities may be partly explained by negative attitudes of health professionals. This study aimed to investigate the attitudes and emotional reactions reported by nursing staff working in general hospitals towards caring for patients with…

  7. A survey of Papua New Guinean parturients at the Port Moresby General Hospital: sociodemographic and reproductive characteristics.

    PubMed

    Klufio, C A; Amoa, A B; Kariwiga, G

    1994-04-01

    A survey of 673 consecutive Papua New Guinea parturients carried out at the Port Moresby General Hospital between May and June 1990 showed that socioeconomic and educational factors played a part in predicting perinatal death. Mothers who have previously experienced a perinatal death are more likely to experience a second one.

  8. 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...

  9. [Frequency of cancer in a specialty hospital in Mexico City. Implications for the development of early detection methods].

    PubMed

    Herrera-Torre, Analy; García-Rodríguez, Francisco Mario; García, Rebeca Gil; Jiménez-Villanueva, Xicoténcatl; Hernández-Rubio, Angela; Aboharp-Hasan, Ziad

    2014-01-01

    Antecedentes: el cáncer es la segunda causa de muerte en México. El Hospital Juárez de México es una institución general de alta especialidad, por lo que la frecuencia de pacientes con cáncer atendidos en su Unidad de Oncología es una muestra representativa de la frecuencia de cáncer en el país. Objetivo: conocer la estadística de tumores diagnosticados en un hospital de tercer nivel. Material y métodos: estudio retrospectivo efectuado con base en la revisión de los expedientes guardados en los archivos de Anatomía Patológica de pacientes atendidos entre los años 2006 y 2010. Se registraron todos los casos positivos a cáncer de material obtenido mediante biopsia o pieza quirúrgica. Se agruparon por edad, sexo y sitios anatómicos. Resultados: se identificaron las 10 neoplasias más frecuentes en uno y otro sexo, los grupos de edad, y sexo más afectado. Conclusiones: la información obtenida refleja la realidad del país de población abierta no derechohabiente. En México, las mujeres padecen más cáncer que los hombres; las neoplasias de mama y tracto genital son las más frecuentes. Deben reforzarse los sistemas de detección oportuna para que la identificación de casos tempranos sea mayor en nuestra población.

  10. Borderline Personality Disorder and Posttraumatic Stress Disorder at Psychiatric Discharge Predict General Hospital Admission for Self-Harm.

    PubMed

    Mellesdal, Liv; Gjestad, Rolf; Johnsen, Erik; Jørgensen, Hugo A; Oedegaard, Ketil J; Kroken, Rune A; Mehlum, Lars

    2015-12-01

    We investigated whether posttraumatic stress disorder (PTSD) was predictor of suicidal behavior even when adjusting for comorbid borderline personality disorder (BPD) and other salient risk factors. To study this, we randomly selected 308 patients admitted to a psychiatric hospital because of suicide risk. Baseline interviews were performed within the first days of the stay. Information concerning the number of self-harm admissions to general hospitals over the subsequent 6 months was retrieved through linkage with the regional hospital registers. A censored regression analysis of hospital admissions for self-harm indicated significant associations with both PTSD (β = .21, p < .001) and BPD (β = .27, p < .001). A structural model comprising two latent BPD factors, dysregulation and relationship problems, as well as PTSD and several other variables, demonstrated that PTSD was an important predictor of the number of self-harm admissions to general hospitals(B = 1.52, p < .01). Dysregulation predicted self-harm directly (B = 0.28, p < .05), and also through PTSD [corrected]. These results suggested that PTSD and related dysregulation problems could be important treatment targets for a reduction in the risk of severe self-harm in high-risk psychiatric patients.

  11. Parallel rapid HIV testing in pregnant women at Tijuana General Hospital, Baja California, Mexico.

    PubMed

    Viani, Rolando M; Araneta, Maria Rosario G; Spector, Stephen A

    2013-03-01

    The objectives of this study were to evaluate the performance of parallel rapid HIV testing and the presence of HIV-associated risk factors in pregnant women with unknown HIV status in Baja California, Mexico. Pregnant women attending the delivery unit or the prenatal clinic at Tijuana General Hospital had blood drawn for parallel rapid HIV testing with Determine™ HIV-1/2 and Uni-Gold™ Recombigen(®) HIV. The parallel rapid HIV test performance was compared to the enzyme immunoassay (EIA) and western blot. From September 2007 to July 2008, 1,383 (94%) of 1,464 women in labor and 1,992 (96%) of 2,075 women in prenatal care were enrolled. The HIV seroprevalence among women screened during labor (19/1,383, 1.37%, 95% CI: 0.85-2.18%) was significantly higher compared to those seeking prenatal care (5/1,992, 0.25%, 95% CI: 0.09-0.62%; p<0.001). Of 25 pregnant women testing positive by parallel rapid HIV testing 24 had a positive confirmatory western blot and one (0.03%) was confirmed as false positive. Additionally, two (0.06%) women had parallel rapid HIV discordant testing results; both tested negative by western blot. All women who tested negative by rapid testing had negative results on pooled EIA antibody testing. The overall sensitivity, specificity, and positive and negative predictive values of parallel rapid HIV testing were 100%, 99.9%, 96%, and 100%, respectively. These findings document a very high acceptance rate and an excellent performance of the parallel rapid HIV testing strategy during pregnancy.

  12. Laparoscopic incisional and ventral hernia repair in a district general hospital

    PubMed Central

    Mann, CD; Luther, A; Hart, C

    2015-01-01

    Introduction The laparoscopic approach to repairing ventral and incisional hernias has gained increasing popularity worldwide. We reviewed the experience of laparoscopic ventral hernia repair at a district general hospital in the UK with particular reference to patients with massive defects (diameter ≥15cm) and the morbidly obese. Methods A total of 144 patients underwent laparoscopic ventral (incisional or umbilical/paraumbilical) hernia repair between April 2007 and September 2012. Results The prevalence of conversion to open surgery was 2.8%. The prevalence of postoperative complications was 3.5%. Median postoperative follow-up was 30.2 months. A total of 5.6% cases suffered late complications and 2.8% developed recurrence. Thirty-four patients underwent repair of defects ≥10cm in diameter with a prevalence of recurrence of 5.6%. Sixteen patients underwent repair of ‘massive’ incisional hernia (diameter ≥15cm) with a prevalence of recurrence of 12.5%. Sixteen patients with a body mass index (BMI) ≥40kg/m2 (range, 40–61kg/m2) underwent laparoscopic repair with a prevalence of recurrence of 6.3% (p>0.05 vs BMI <40kg/m2). Conclusions Laparoscopic ventral hernia repair can be carried out safely with a low prevalence of recurrence. It may have advantages in morbidly obese patients in whom open repair would represent a significant undertaking. Laparoscopic ventral hernia repair may be used in cases of large and massive hernias, in which the risk of recurrence increases but is comparable with open repair and associated with low morbidity. PMID:25519261

  13. Primates as pets in Mexico City: an assessment of the species involved, source of origin, and general aspects of treatment.

    PubMed

    Duarte-Quiroga, Alejandra; Estrada, Alejandro

    2003-10-01

    The large human populations in cities are an important source of demand for wildlife pets, including primates, and not much is known about the primate species involved in terms of their general origin, the length of time they are kept as pets, and some of the maintenance problems encountered with their use as pets. We report the results of a survey conducted in Mexico City among primate pet owners, which was aimed at providing some of the above information. We used an ethnographic approach, and pet owners were treated as informants to gain their trust so that we could enter their homes and learn about the life of their primate pets. We surveyed 179 owners of primate pets, which included 12 primate species. Of these, three were native species (Ateles geoffroyi, Alouatta pigra, and A. palliata). The rest were other neotropical primate species not native to Mexico, and some paleotropical species. Spider monkeys and two species of howler monkeys native to Mexico accounted for 67% and 15%, respectively, of the primate cases investigated. The most expensive primate pets were those imported from abroad, while the least expensive were the Mexican species. About 45% of the native primate pets were obtained by their owners in a large market in Mexico City, and the rest were obtained in southern Mexico. Although they can provide companionship for children and adults, primate pets are subject to a number of hazards, some of which put their lives at risk. The demand by city dwellers for primate pets, along with habitat destruction and fragmentation, exerts a significant pressure on wild populations in southern Mexico.

  14. Consultation-liaison service in the general hospital: effects of cognitive-behavioral therapy in patients with physical nonspecific symptoms.

    PubMed

    Ehlert, U; Wagner, D; Lupke, U

    1999-11-01

    Nearly 15% of patients referred to a general hospital psychological medicine consultation service met DSM criteria for somatoform disorders or showed psychological factors affecting physical conditions. In a case-control control study of patients meeting these diagnostic criteria. outcomes were compared of 21 consecutively referred patients who received a course of cognitive-behavioral therapy (CBT) in addition to standard hospital treatment (SHT) and another 21 patients who received SHT alone. Compared with the SHT group, those who received CBT treatment showed significantly decreased bodily complaints and negative mood, better insight into the psychosomatic causes of their complaints, and a high motivation for subsequent psychotherapy.

  15. Junior doctor dementia champions in a district general hospital (innovative practice).

    PubMed

    Wilkinson, Iain; Coates, Anna; Merrick, Sophie; Lee, Chooi

    2016-03-01

    Dementia is a common condition in the UK with around 25% of patients in acute hospitals having dementia. In the UK, there is national guidance on the assessment of cognitive impairment in acute hospitals. This article is a qualitative study of junior doctors' experiences as part of a dementia and delirium team involved in changing the care of patients with dementia in a hospital in the UK. It draws on data from a focus group and follow-up questionnaire in two hospital trusts. We examine what drives doctors to become involved in such projects and the effects of this experience upon them. We suggest a typology for getting junior doctors involved in projects generating change when working with patients with dementia. Being more actively involved in caring for and developing services for patients with dementia may represent the crossing of an educational threshold for these junior doctors.

  16. A generalized approach for historical mock-up acquisition and data modelling: Towards historically enriched 3D city models

    NASA Astrophysics Data System (ADS)

    Hervy, B.; Billen, R.; Laroche, F.; Carré, C.; Servières, M.; Van Ruymbeke, M.; Tourre, V.; Delfosse, V.; Kerouanton, J.-L.

    2012-10-01

    Museums are filled with hidden secrets. One of those secrets lies behind historical mock-ups whose signification goes far behind a simple representation of a city. We face the challenge of designing, storing and showing knowledge related to these mock-ups in order to explain their historical value. Over the last few years, several mock-up digitalisation projects have been realised. Two of them, Nantes 1900 and Virtual Leodium, propose innovative approaches that present a lot of similarities. This paper presents a framework to go one step further by analysing their data modelling processes and extracting what could be a generalized approach to build a numerical mock-up and the knowledge database associated. Geometry modelling and knowledge modelling influence each other and are conducted in a parallel process. Our generalized approach describes a global overview of what can be a data modelling process. Our next goal is obviously to apply this global approach on other historical mock-up, but we also think about applying it to other 3D objects that need to embed semantic data, and approaching historically enriched 3D city models.

  17. Factors influencing integration of TB services in general hospitals in two regions of China: a qualitative study

    PubMed Central

    2012-01-01

    Background In the majority of China, the Centre for Disease Control (CDC) at the county level provides both clinical and public health care for TB cases, with hospitals and other health facilities referring suspected TB cases to the CDC. In recent years, an integrated model has emerged, where the CDC remains the basic management unit for TB control, while a general hospital is designated to provide clinical care for TB patients. This study aims to explore the factors that influence the integration of TB services in general hospitals and generate knowledge to aid the scale-up of integration of TB services in China. Methods This study adopted a qualitative approach using interviews from sites in East and West China. Analysis was conducted using a thematic framework approach. Results The more prosperous site in East China was more coordinated and thus had a better method of resource allocation and more patient-orientated service, compared with the poorer site in the West. The development of public health organizations appeared to influence how effectively integration occurred. An understanding from staff that hospitals had better capacity to treat TB patients than CDCs was a strong rationale for integration. However, the economic and political interests might act as a barrier to effective integration. Both sites shared the same challenges of attracting and retaining a skilled workforce for the TB services. The role of the health bureau was more directive in the Western site, while a more participatory and collaborative approach was adopted in the Eastern site. Conclusion The process of integration identifies similarities and differences between sites in more affluent East China and poorer West China. Integration of TB services in the hospitals needs to address the challenges of stakeholder motivations and resource allocation. Effective inter-organizational collaboration could help to improve the efficiency and quality of TB service. Key words: TB control, service

  18. Surgical management of pneumothorax: significance of effective admission or communication strategies between the district general hospitals and specialized unit.

    PubMed

    Aslam, Muhammad I; Martin-Ucar, Antonio E; Nakas, Apostolos; Waller, David A

    2011-11-01

    A preoperative delay in emergency surgery for spontaneous pneumothorax is associated with a poor outcome after surgery and a prolonged hospital stay. To reduce preoperative delays, all tertiary referrals from district general hospitals to our thoracic surgery unit were processed through a 'clinical decisions unit' (CDU). Prior to the establishment of the CDU, these patients were added to a waiting list for a surgical bed. This study has reviewed the effect of this change in admission policy on the efficiency of treatment for non-elective spontaneous pneumothorax. An intergroup comparison (pre-CDU group vs. post-CDU group) was made of the following parameters: referral to transfer time, transfer to surgery time and length of inpatient stay in the referring and tertiary hospitals. There were no significant differences in gender, diagnosis, treatment in the referring hospitals, postoperative clinical outcome, or indications for or type of surgery. The total length of inpatient stay in the referring and tertiary hospitals was significantly reduced for the post-CDU group (12 vs. 15 days; P<0.001), which was attributed to the earlier transfer of patients (18 vs. 78 hours; P<0.001) hours. Allowing surgical access to a traditional medical admission unit is therefore, cost-effective and significantly improves the efficiency of non-elective pneumothorax surgery.

  19. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status

    PubMed Central

    Mattioli, Stefano; Baldasseroni, Alberto; Curti, Stefania; Cooke, Robin MT; Bena, Antonella; de Giacomi, Giovanna; dell'Omo, Marco; Fateh-Moghadam, Pirous; Melani, Carla; Biocca, Marco; Buiatti, Eva; Campo, Giuseppe; Zanardi, Francesca; Violante, Francesco S

    2008-01-01

    Background Carpal tunnel syndrome (CTS) is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status. Methods Seven regions were considered (overall population, 14.9 million) over 3–6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare). Incidence rates of in-hospital cases of CTS were estimated based on 1) codified demographic, diagnostic and intervention data in obligatory discharge records from all Italian public/private hospitals, archived (according to residence) on regional databases; 2) demographic general population data for each region. We compared (using the χscore test) age-sex-specific rates between married, unmarried, divorced and widowed subsets of the general population. We calculated standardized incidence ratios (SIRs) for married/unmarried men and women. Results Age-standardized incidence rates (per 100,000 person-years) of in-hospital cases of CTS were 166 in women and 44 in men (106 overall). Married subjects of both sexes showed higher age-specific rates with respect to unmarried men/women. SIRs were calculated comparing married vs unmarried rates of both sexes: 1.59 (95% confidence interval [95% CI], 1.57–1.60) in women, and 1.42 (95% CI, 1.40–1.45) in men. As compared with married women/men, widows/widowers both showed 2–3-fold higher incidence peaks during the fourth decade of life (beyond 50 years of age, widowed subjects showed similar trends to unmarried counterparts). Conclusion This large population-based study illustrates distinct age-related trends in men and women, and also raises the question whether marital status could be associated with CTS in the general population. PMID:18957090

  20. Vascular disease in women: comparison of diagnoses in hospital episode statistics and general practice records in England

    PubMed Central

    2012-01-01

    Background Electronic linkage to routine administrative datasets, such as the Hospital Episode Statistics (HES) in England, is increasingly used in medical research. Relatively little is known about the reliability of HES diagnostic information for epidemiological studies. In the United Kingdom (UK), general practitioners hold comprehensive records for individuals relating to their primary, secondary and tertiary care. For a random sample of participants in a large UK cohort, we compared vascular disease diagnoses in HES and general practice records to assess agreement between the two sources. Methods Million Women Study participants with a HES record of hospital admission with vascular disease (ischaemic heart disease [ICD-10 codes I20-I25], cerebrovascular disease [G45, I60-I69] or venous thromboembolism [I26, I80-I82]) between April 1st 1997 and March 31st 2005 were identified. In each broad diagnostic group and in women with no such HES diagnoses, a random sample of about a thousand women was selected for study. We asked each woman’s general practitioner to provide information on her history of vascular disease and this information was compared with the HES diagnosis record. Results Over 90% of study forms sent to general practitioners were returned and 88% of these contained analysable data. For the vast majority of study participants for whom information was available, diagnostic information from general practice and HES records was consistent. Overall, for 93% of women with a HES diagnosis of vascular disease, general practice records agreed with the HES diagnosis; and for 97% of women with no HES diagnosis of vascular disease, the general practitioner had no record of a diagnosis of vascular disease. For severe vascular disease, including myocardial infarction (I21-22), stroke, both overall (I60-64) and by subtype, and pulmonary embolism (I26), HES records appeared to be both reliable and complete. Conclusion Hospital admission data in England provide

  1. Factors affecting morbidity, mortality and survival in patients undergoing surgery for rectal cancer in a district general hospital.

    PubMed Central

    Macadam, Robert; Yeomans, Neil; Wilson, Jonathan; Case, William; White, Clive; Lovegrove, John; Lyndon, Philip

    2005-01-01

    INTRODUCTION: This is a review of elective rectal cancer surgery during 1993-1999 at a single district general hospital to investigate the variables that affected the care of these patients. PATIENTS AND METHODS: A retrospective study of patients presenting with rectal adenocarcinoma to a district general hospital where total mesorectal excision was practiced over a 7-year period was performed to identify factors associated with complications, death and disease recurrence. RESULTS: Sixty-one patients developed a total of 89 complications and 30-day mortality was 8.3%. Overall, 81% of all resections and 86% of potentially curative resections were free of tumour at the circumferential resection margin. A positive circumferential resection margin and 30-day mortality were both associated with increased postoperative blood transfusion volume. Twenty-nine recurrences were detected during the follow-up period (mean, 21.7 months) and circumferential margin involvement by tumour, Dukes' stage, pre-operative functional status (ASA grade) and length of hospital stay correlated with disease-free survival. CONCLUSIONS: Surgical outcomes in lower volume hospitals are comparable with those reported by larger centres. PMID:16176691

  2. 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.

  3. What is the current state of care for older people with dementia in general hospitals? A literature review.

    PubMed

    Dewing, Jan; Dijk, Saskia

    2016-01-01

    This paper summarises a literature review focusing on the literature directly pertaining to the acute care of older people with dementia in general hospitals from 2007 onwards. Following thematic analysis, one overarching theme emerged: the consequences of being in hospital with seven related subthemes. Significantly, this review highlights that overall there remains mostly negative consequences and outcomes for people with dementia when they go into general hospitals. Although not admitted to hospital directly due to dementia, there are usually negative effects on the dementia condition from hospitalisation. The review suggests this is primarily because there is a tension between prioritisation of acute care for existing co-morbidities and person-centred dementia care. This is complicated by insufficient understanding of what constitutes person-centred care in an acute care context and a lack of the requisite knowledge and skills set in health care practitioners. The review also reveals a worrying lack of evidence for the effectiveness of mental health liaison posts and dementia care specialist posts in nursing. Finally, although specialist posts such as liaison and clinical nurse specialists and specialist units/shared care wards can enhance quality of care and reduce adverse consequences of hospitalisation (they do not significantly) impact on reducing length of stay or the cost of care.

  4. A strategy for enhancing financial performance: a study of general acute care hospitals in South Korea.

    PubMed

    Choi, Mankyu; Lee, Keon-Hyung

    2008-01-01

    In this study, the determinants of hospital profitability were evaluated using a sample of 142 hospitals that had undergone hospital standardization inspections by the South Korea Hospital Association over the 4-year period from 1998 to 2001. The measures of profitability used as dependent variables in this study were pretax return on assets, after-tax return on assets, basic earning power, pretax operating margin, and after-tax operating margin. Among those determinants, it was found that ownership type, teaching status, inventory turnover, and the average charge per adjusted inpatient day positively and statistically significantly affected all 5 of these profitability measures. However, the labor expenses per adjusted inpatient day and administrative expenses per adjusted inpatient day negatively and statistically significantly affected all 5 profitability measures. The debt ratio negatively and statistically significantly affected all 5 profitability measures, with the exception of basic earning power. None of the market factors assessed were shown to significantly affect profitability. In conclusion, the results of this study suggest that the profitability of hospitals can be improved despite deteriorating external environmental conditions by facilitating the formation of sound financial structures with optimal capital supplies, optimizing the management of total assets with special emphasis placed on inventory management, and introducing efficient control of fixed costs including labor and administrative expenses.

  5. [The insigne and suntuoso Royal Hospital of Granada (I). Royal foundations and the hospital regrouping (1501-1526)].

    PubMed

    Valenzuela Candelario, José

    2003-01-01

    In the 1520s the local authorities planned to set up a new modern hospital in the city of Granada by combining two existing Royal Hospitals: Alhambra and Reyes. As a public institution and as a new building, the new hospital could develop the mandates of the original foundation and extend its care to become a general hospital. In this way it would strengthen its status as a charitable undertaking and legacy of the Catholic Monarchs and, secondly, as a great architectural monument.

  6. [Mortality associated with nosocomial infection, occurring in a general hospital of Sumaré-SP, Brazil].

    PubMed

    Guimarães, Aline Caixeta; Donalisio, Maria Rita; Santiago, Thaiana Helena Roma; Freire, June Barreiros

    2011-01-01

    This study investigated the socio-demographic profile, clinical procedures and etiology of nosocomial infection associated with deaths in the Hospital Estadual Sumaré, state of São Paulo, Brazil, from 2007 to 2008. The retrospective study of medical records (n = 133) revealed an average of 35 days of hospitalization. Most patients (97%) underwent some invasive procedure associated with nosocomial infection (p ≤ 0.05), including: 90 (67.7%) pneumonia, 62 (46.6%), urinary infections and 97 (73%) septicemia. Infection was the leading cause of death in 75 (56.4%) cases, with defined etiology in 110 (82.7%); 34 (30.9%) because of microorganisms that were multidrug-resistant. The most common was Staphylococcus aureus (25%), related to pneumonia and blood stream infection. The monitoring of hospital infection contributed to intervention at risk situation and death.

  7. A tale of two cities: effects of air pollution on hospital admissions in Hong Kong and London compared.

    PubMed

    Wong, Chit-Ming; Atkinson, Richard W; Anderson, H Ross; Hedley, Anthony Johnson; Ma, Stefan; Chau, Patsy Yuen-Kwan; Lam, Tai-Hing

    2002-01-01

    The causal interpretation of reported associations between daily air pollution and daily admissions requires consideration of residual confounding, correlation between pollutants, and effect modification. If results obtained in Hong Kong and London--which differ in climate, lifestyle, and many other respects--were similar, a causal association would be supported. We used identical statistical methods for the analysis in each city. Associations between daily admissions and pollutant levels were estimated using Poisson regression. Nonparametric smoothing methods were used to model seasonality and the nonlinear dependence of admissions on temperature, humidity, and influenza admissions. For respiratory admissions (> or = 65 years of age), significant positive associations were observed with particulate matter < 10 microm in aerodynamic diameter (PM(10), nitrogen dioxide, sulfur dioxide, and ozone in both cities. These associations tended to be stronger at shorter lags in Hong Kong and at longer lags in London. Associations were stronger in the cool season in Hong Kong and in the warm season in London, periods during which levels of humidity are at their lowest in each city. For cardiac admissions (all ages) in both cities, significant positive associations were observed for PM(10), NO(2), and SO(2) with similar lag patterns. Associations tended to be stronger in the cool season. The associations with NO(2) and SO(2) were the most robust in two-pollutant models. Patterns of association for pollutants with ischemic heart disease were similar in the two cities. The associations between O(3) and cardiac admissions were negative in London but positive in Hong Kong. We conclude that air pollution has remarkably similar associations with daily cardiorespiratory admissions in both cities, in spite of considerable differences between cities in social, lifestyle, and environmental factors. The results strengthen the argument that air pollution causes detrimental short

  8. Sentinel node biopsy in the surgical management of breast cancer: experience in a general hospital with a dedicated surgical team.

    PubMed

    Merson, M; Fenaroli, P; Gianatti, A; Virotta, G; Giuliano, L G; Bonasegale, A; Bambina, S; Pericotti, S; Guerra, U; Tondini, C

    2004-06-01

    The aims of this study were to analyse the feasibility and accuracy of the sentinel lymph node biopsy (SLNB) procedure as performed in a general hospital compared with the literature results; to report on the organizational aspects of planning surgical time with higher accuracy of pathological analysis; and to verify that there is a real advantage of SLNB in the surgical management of breast cancer. From October 1999 to September 2000, 371 consecutive patients with T1-2N0 breast lesions underwent SLNB. The immunoscintigraphic method of sentinel node identification was the main one used, the blue dye method being used only when the lymphoscintigraphic method was unsuccessful in identifying sentinel nodes. SLNB was done under either general or local anaesthesia, depending on how the surgical procedure was organized and clinically planned. SLNB was successful in 99% of these T1-2N0 breast cancer cases, and in 71% no metastases were found in the sentinel node. In 47% of cases with axillary metastasis only the sentinel node was involved. Nodal involvement was not present in any case of microinvasive or in situ carcinoma. In T1 cancers nodal involvement was present in 21%; in T2 cases the corresponding rate reached 51%. The results obtained with the SLNB procedure at Bergamo Hospital are similar to the literature data. When a dedicated surgical team, the nuclear medicine department and the pathology department work together, a general hospital can provide breast cancer patients with appropriate surgical treatment.

  9. Etiology of Sudden Cardiac Arrest in Patients with Epilepsy: Experience of Tertiary Referral Hospital in Sapporo City, Japan

    PubMed Central

    MIYATA, Kei; OCHI, Satoko; ENATSU, Rei; WANIBUCHI, Masahiko; MIKUNI, Nobuhiro; INOUE, Hiroyuki; UEMURA, Shuji; TANNO, Katsuhiko; NARIMATSU, Eichi; MAEKAWA, Kunihiko; USUI, Keiko; MIZOBUCHI, Masahiro

    2016-01-01

    It has been reported that epilepsy patients had higher risk of sudden death than that of the general population. However, in Japan, there is very little literature on the observational research conducted on sudden fatal events in epilepsy. We performed a single-center, retrospective study on all the out-of-hospital cardiac arrest (OHCA) patients treated in our emergency department between 2007 and 2013. Among the OHCA patients, we extracted those with a history of epilepsy and then analyzed the characteristics of the fatal events and the background of epilepsy. From 1,823 OHCA patients, a total of 10 cases were enrolled in our study. The median age was 34 years at the time of the incident [9–52 years; interquartile range (IQR), 24–45]. We determined that half of our cases resulted from external causes of death such as drowning and suffocation and the other half were classified as sudden unexpected death in epilepsy (SUDEP). In addition, asphyxia was implicated as the cause in eight cases. Only the two near-drowning patients were immediately resuscitated, but the remaining eight patients died. The median age of first onset of epilepsy was 12 years (0.5–30; IQR, 3–21), and the median disease duration was 25 years (4–38; IQR, 6–32). Patients with active epilepsy accounted for half of our series and they were undergoing poly anti-epileptic drug therapy. The fatal events related to epilepsy tended to occur in the younger adult by external causes. An appropriate therapeutic intervention and a thorough observation were needed for its prevention. PMID:26948699

  10. We Are Lost: Measuring the Accessibility of Signage in Public General Hospitals

    ERIC Educational Resources Information Center

    Schuster, Michal; Elroy, Irit; Elmakais, Ido

    2017-01-01

    Hospital signage is a critical element in the patients' and visitors understanding of directions, instructions and warnings in the facility. In multilingual environments organizations need to make sure that the information is accessible in the languages of the people who consume their services. As part of a large-scale study that examined the…

  11. Twenty four hour care in inner cities: two years' out of hours workload in east London general practice.

    PubMed Central

    Livingstone, A. E.; Jewell, J. A.; Robson, J.

    1989-01-01

    Two inner city general practices in east London jointly provide care outside normal working hours without using deputising services for about 14,000 patients. The statistics on workload were reviewed for 1987 and 1988. An overall rate of face to face consultations of 4.1 per patient per year was recorded, there being 115,965 consultations over two years for a mean list size of 14,174 patients. Four per cent (4737) of such consultations were outside normal working hours. The annual rate of visiting outside normal hours was 128.1 per 1000 patients in 1987 (1793 visits) and 131.5 per 1000 in 1988 (1888 visits). The rates of night visiting were 18.8 (262 visits) and 18.9 (271 visits) per 1000 patients in 1987 and 1988 respectively. Only 24% of all the requests for medical help out of hours (1483/6220) were dealt with by advice given on the telephone. The high rates of consultation outside normal working hours with only a small proportion being dealt with on the telephone alone may be explained by indices of deprivation. Local rotas for out of hours work are a good compromise between meeting the needs of patients and doctors in deprived areas, but there are financial implications for inner cities. PMID:2506972

  12. Environmental Assessment for Proposed General Purpose Warehouse Construction at Defense Distribution Officer Oklahoma City, Oklahoma (DDOO)

    DTIC Science & Technology

    2008-05-01

    Alternative (A3), the Tinker AFB Defense Reutilization and Marketing Service (DRMS) site; and Alternative (A4), a soil remediation site located 0.3 mile...Defense DRMS Defense Reutilization and Marketing Service EA Environmental Assessment EIAP Environmental Impact Analysis Process EPA U.S...General Purpose Warehouse HAZMAT hazardous material HMMP Hazardous Materials Management Program HRMA Housing Requirements and Market Analysis HWSF

  13. The impact of environmental and climatic variation on the spatiotemporal trends of hospitalized pediatric diarrhea in Ho Chi Minh City, Vietnam.

    PubMed

    Thompson, Corinne N; Zelner, Jonathan L; Nhu, Tran Do Hoang; Phan, My Vt; Hoang Le, Phuc; Nguyen Thanh, Hung; Vu Thuy, Duong; Minh Nguyen, Ngoc; Ha Manh, Tuan; Van Hoang Minh, Tu; Lu Lan, Vi; Nguyen Van Vinh, Chau; Tran Tinh, Hien; von Clemm, Emmiliese; Storch, Harry; Thwaites, Guy; Grenfell, Bryan T; Baker, Stephen

    2015-09-01

    It is predicted that the integration of climate-based early warning systems into existing action plans will facilitate the timely provision of interventions to diarrheal disease epidemics in resource-poor settings. Diarrhea remains a considerable public health problem in Ho Chi Minh City (HCMC), Vietnam and we aimed to quantify variation in the impact of environmental conditions on diarrheal disease risk across the city. Using all inpatient diarrheal admissions data from three large hospitals within HCMC, we developed a mixed effects regression model to differentiate district-level variation in risk due to environmental conditions from the overarching seasonality of diarrheal disease hospitalization in HCMC. We identified considerable spatial heterogeneity in the risk of all-cause diarrhea across districts of HCMC with low elevation and differential responses to flooding, air temperature, and humidity driving further spatial heterogeneity in diarrheal disease risk. The incorporation of these results into predictive forecasting algorithms will provide a powerful resource to aid diarrheal disease prevention and control practices in HCMC and other similar settings.

  14. The impact of environmental and climatic variation on the spatiotemporal trends of hospitalized pediatric diarrhea in Ho Chi Minh City, Vietnam

    PubMed Central

    Thompson, Corinne N.; Zelner, Jonathan L.; Nhu, Tran Do Hoang; Phan, My VT; Hoang Le, Phuc; Nguyen Thanh, Hung; Vu Thuy, Duong; Minh Nguyen, Ngoc; Ha Manh, Tuan; Van Hoang Minh, Tu; Lu Lan, Vi; Nguyen Van Vinh, Chau; Tran Tinh, Hien; von Clemm, Emmiliese; Storch, Harry; Thwaites, Guy; Grenfell, Bryan T.; Baker, Stephen

    2015-01-01

    It is predicted that the integration of climate-based early warning systems into existing action plans will facilitate the timely provision of interventions to diarrheal disease epidemics in resource-poor settings. Diarrhea remains a considerable public health problem in Ho Chi Minh City (HCMC), Vietnam and we aimed to quantify variation in the impact of environmental conditions on diarrheal disease risk across the city. Using all inpatient diarrheal admissions data from three large hospitals within HCMC, we developed a mixed effects regression model to differentiate district-level variation in risk due to environmental conditions from the overarching seasonality of diarrheal disease hospitalization in HCMC. We identified considerable spatial heterogeneity in the risk of all-cause diarrhea across districts of HCMC with low elevation and differential responses to flooding, air temperature, and humidity driving further spatial heterogeneity in diarrheal disease risk. The incorporation of these results into predictive forecasting algorithms will provide a powerful resource to aid diarrheal disease prevention and control practices in HCMC and other similar settings. PMID:26402922

  15. 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.

  16. Frequency of cancer in children residing in Mexico City and treated in the hospitals of the Instituto Mexicano del Seguro Social (1996–2001)

    PubMed Central

    Juárez-Ocaña, Servando; González-Miranda, Guadalupe; Mejía-Aranguré, Juan Manuel; Rendón-Macías, Mario Enrique; Martínez-García, María del Carmen; Fajardo-Gutiérrez, Arturo

    2004-01-01

    Background The objective of this article is to present the frequency of cancer in Mexican children who were treated in the hospitals of the Instituto Mexicano del Seguro Social in Mexico City (IMSS-MC) in the period 1996–2001. Methods The Registry of Cancer in Children, started in 1996 in the IMSS-MC, is an on-going, prospective register. The data from 1996 through 2001 were analyzed and the different types of cancer were grouped according to the International Classification for Cancer in Children (ICCC). From this analysis, the general and specific frequencies by age and by sex were obtained for the different groups of neoplasms. Also, the frequency of the stage of the disease that had been diagnosed in cases of children with solid tumors was obtained. Results A total of 1,702 new cases of children with cancer were registered, with the male/female ratio at 1.1/1. Leukemias had the highest frequency with 784 cases (46.1%) and, of these, acute lymphoblastic leukemias were the most prevalent with 614 cases (78.3%). Thereafter, in descending order of frequency, were tumors of the central nervous system (CNST) with 197 cases (11.6%), lymphomas with 194 cases (11.4%), germinal cell tumors with 110 cases (6.5%), and bone tumors with 97 cases (5.7%). The highest frequency of cancer was found in the group of one to four year-olds that had 627 cases (36.8%). In all the age groups, leukemias were the most frequent. In the present work, the frequency of Hodgkin's disease (~4%) was found to be lower than that (~10%) in previous studies and the frequency of tumors of the sympathetic nervous system was low (2.3%). Of those cases of solid tumors for which the stage of the disease had been determined, 66.9% were diagnosed as being Stage III or IV. Conclusions The principal cancers in the children treated in the IMSS-MC were leukemias, CNST, and lymphomas, consistent with those reported by developed countries. A 2.5-fold reduction in the frequency of Hodgkin's disease was found

  17. Statistical Analysis Aiming at Predicting Respiratory Tract Disease Hospital Admissions from Environmental Variables in the City of São Paulo

    PubMed Central

    de Sousa Zanotti Stagliorio Coêlho, Micheline; Luiz Teixeira Gonçalves, Fabio; do Rosário Dias de Oliveira Latorre, Maria

    2010-01-01

    This study is aimed at creating a stochastic model, named Brazilian Climate and Health Model (BCHM), through Poisson regression, in order to predict the occurrence of hospital respiratory admissions (for children under thirteen years of age) as a function of air pollutants, meteorological variables, and thermal comfort indices (effective temperatures, ET). The data used in this study were obtained from the city of São Paulo, Brazil, between 1997 and 2000. The respiratory tract diseases were divided into three categories: URI (Upper Respiratory tract diseases), LRI (Lower Respiratory tract diseases), and IP (Influenza and Pneumonia). The overall results of URI, LRI, and IP show clear correlation with SO2 and CO, PM10 and O3, and PM10, respectively, and the ETw4 (Effective Temperature) for all the three disease groups. It is extremely important to warn the government of the most populated city in Brazil about the outcome of this study, providing it with valuable information in order to help it better manage its resources on behalf of the whole population of the city of Sao Paulo, especially those with low incomes. PMID:20706674

  18. [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.

  19. Isolation and Identification of Pathogenic Filamentous Fungi and Yeasts From Adult House Fly (Diptera: Muscidae) Captured From the Hospital Environments in Ahvaz City, Southwestern Iran.

    PubMed

    Kassiri, Hamid; Zarrin, Majid; Veys-Behbahani, Rahele; Faramarzi, Sama; Kasiri, Ali

    2015-11-01

    Musca domestica L., 1758 is capable of transferring a number of pathogenic viruses, bacteria, fungi, and parasites to animals and humans. The objective of this study was to isolate and identify medically important filamentous fungi and yeasts from adult M. domestica collected from two wards of three hospital environments in Ahvaz city, Khuzestan Province, southwestern Iran. The common house flies were caught by a sterile net. These insects were washed in a solution of 1% sodium hypochlorite for 3 min and twice in sterile distilled water for 1 min. The flies were individually crushed with sterile swabs in sterile test tubes. Then 2 ml of sterile normal saline (0.85%) was added to each tube, and the tube was centrifuged for 5 min. The supernatant was then discarded, and the remaining sediment was inoculated with a sterile swab in the Sabouraud's dextrose agar medium containing chloramphenicol. Isolation and identification of fungi were made by standard mycological methods. In this research, totally 190 M. domestica from hospital environments were captured. In total, 28 fungal species were isolated. The main fungi isolated were Aspergillus spp. (67.4%), Penicillium sp. (11.6%), Mucorales sp. (11%), Candida spp. (10.5%), and Rhodotorula sp. (8.4%). Among the house flies caught at the hospitals, about 80% were found to carry one or more medically important species of fungi. This study has established that common house flies carry pathogenic fungi in the hospital environments of Ahvaz. The control of M. domestica in hospitals is essential in order to control the nosocomial fungal infections in patients.

  20. Prevalence of Urinary Tract Infection Among Pregnant Women and its Complications in Their Newborns During the Birth in the Hospitals of Dezful City, Iran, 2012 - 2013

    PubMed Central

    Amiri, Marziyeh; Lavasani, Zohreh; Norouzirad, Reza; Najibpour, Reza; Mohamadpour, Masoomeh; Nikpoor, Amin Reza; Raeisi, Mohammad; Zare Marzouni, Hadi

    2015-01-01

    Background: Urinary tract infection (UTI) is the most common disorder caused by bacterial agents in pregnancy, which can lead to important complications in newborn of such mothers in case of inappropriate diagnosis and treatment. Objectives: The purpose of this study was to study the prevalence of UTI among pregnant women and its complications in their newborns during the birth in the hospitals of Dezful City, Iran, during 2012 - 2013. Patients and Methods: In this cross-sectional retrospective study, 1132 women admitted to Dr. Ganjavian and Ayatollah Nabavi Hospitals in Dezful City, Iran, during 2012 - 2013 were randomly allocated into the case and control groups and were matched based on their age, numbers of pregnancy, sex and diseases of their children. UTI was the only difference between the two groups. Results: Twenty-two thousand six hundred deliveries occurred within the course of this study. Due to UTI, 5% of deliveries led to hospitalization of mothers (1132 patients).Weight and height of newborn infants of mothers afflicted with UTI (P < 0.001) were significantly lower compared to newborns of healthy women (P < 0.001). There was a significant association between the two groups of pregnant women with UTI in terms of type of delivery (normal and caesarean section) (P < 0.008). Conclusions: The lower incidence of UTI in pregnant women compared to other areas of Iran represents the role of climate and weather in the prevalence of UTI. In addition, the increased number of low-birth-weight infants had a remarkable correlation with UTI, which can influence the health of the next generation. PMID:26430526

  1. 78 FR 28733 - Medical Devices; General Hospital and Personal Use Monitoring Devices; Classification of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-16

    ... Adverse tissue reaction Biocompatibility Testing. Labeling (dose limits). Systemic toxicity Toxicology.... FDA believes that the following special controls, in addition to the general controls, address...

  2. [Chronic Chagas cardiomyopathy detected in patients at the Regional General Hospital O'Horan, Merida, Yucatan, Mexico].

    PubMed

    Zavala-Castro, J E; Gutiérrez-Flota, H; Barrera-Pérez, M A; Bolio-Solís, A de J; Zavala-Velázquez, J E

    1995-01-01

    The purpose of this study was to determine the frequency of cardiopathy due to Chagas' disease in 36 patients of the cardiology department at the Regional General Hospital O'Horan in Merida, Yucatan. All patients included in the study had cardiac involvement compatible with acute or chronic stages of Chagas' disease. Medical records prepared for each one of the patients included a Chagas' disease targeted clinical history, chest X-ray, electrocardiogram, blood culture and serology using indirect immunofluorescence test. Out of the 36 patients studied, 7 were diagnosed as having Chagas' disease cardiopathy. Grade II cardiomegaly was established in 2 patients while the remaining 5 had grade III cardiomegaly. Conduction abnormalities were established in 6 patients while 2 of these had evidence of necrosis and/or ischemia. Chagas' disease cardiopathy, as our results suggest, is not a rare event in the cardiology ward at the O'Horan Hospital.

  3. Building Clean. The Control of Crime, Corruption, and Racketeering in the Public Construction Markets of New York City. A Preliminary Assessment of Efforts Made by the Office of the Inspector General, New York City School Construction Authority.

    ERIC Educational Resources Information Center

    Moore, Mark H.; Tumin, R. Zachary

    The Office of the Inspector General of the New York City School Construction Authority (SCA) is attempting to secure the School Construction Authority and its building program from crime, corruption, and racketeering. This report is a preliminary assessment of this effort. It sets forth for practitioners and theorists the strategy that guided the…

  4. Photograph of model projected new hospital building and new landscaping ...

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

    Photograph of model projected new hospital building and new landscaping for area north of building 500. Model displayed on the mezzanine level of building 500. - Fitzsimons General Hospital, Bounded by East Colfax to south, Peoria Street to west, Denver City/County & Adams County Line to north, & U.S. Route 255 to east, Aurora, Adams County, CO

  5. Pseudomonas aeruginosa: study of antibiotic resistance and molecular typing in hospital infection cases in a neonatal intensive care unit from Rio de Janeiro City, Brazil.

    PubMed

    Loureiro, M M; de Moraes, B A; Mendonca, V L F; Quadra, M R R; Pinheiro, G S; Asensi, M D

    2002-04-01

    This study had the objective of to analyze the demographic and bacteriologic data of 32 hospitalized newborns in an neonatal intensive care unit of a public maternity hospital in Rio de Janeiro city, Brazil, seized by Pseudomonas aeruginosa sepsis during a period ranged from July 1997 to July 1999, and to determine the antimicrobial resistance percentage, serotypes and pulsed field gel electrophoresis (PFGE) patterns of 32 strains isolated during this period. The study group presented mean age of 12.5 days, with higher prevalence of hospital infection in males (59.4%) and vaginal delivery (81.2%), than females (40.6%) and cesarean delivery (18.8%), respectively. In this group, 20 (62.5%) patients received antimicrobials before positive blood cultures presentation. A total of 87.5% of the patients were premature, 62.5% presented very low birth weight and 40.6% had asphyxia. We detected high antimicrobial resistance percentage to b-lactams, chloramphenicol, trimethoprim/sulfamethoxazole and tetracycline among the isolated strains. All isolated strains were classified as multi-drug resistant. Most strains presented serotype O11 while PFGE analysis revealed seven distinct clones with isolation predominance of a single clone (75%) isolated from July 1997 to June 1998.

  6. An analysis of the inpatient charge and length of stay for patients with joint diseases in Korea: specialty versus small general hospitals.

    PubMed

    Kim, Sun Jung; Park, Eun-Cheol; Jang, Sung In; Lee, Minjee; Kim, Tae Hyun

    2013-11-01

    In 2011, the Korean government designated hospitals with certain structural characteristics as specialty hospitals. This study compared the inpatient charges and length of stay of patients with joint diseases treated at these specialty hospitals with those of patients treated at small general hospitals. In addition, the study investigated whether the designation of certain hospitals as specialty hospitals had an effect on inpatient charges and length of stay. Multi-level models were used to perform regression analyses on inpatient claims data (N=268,809) for 2010-2012 because of the hierarchical structure of the data. The inpatient charge at specialty hospitals was 19% greater than that at small general hospitals, but the length of stay was 21% shorter. After adjusting for patient and hospital level confounders, specialty hospitals had a higher inpatient charge (34.6%) and a reduced length of stay (31.7%). However, the effect of specialty hospital designation on inpatient charge (2.7% higher) and length of stay (2.3% longer) was relatively smaller. Among the patient characteristics, female gender, age, and severity of illness were positively associated with inpatient charge and length of stay. In terms of location, hospitals in metropolitan area had higher inpatient charges (5.5%), but much shorter length of stay (-14%). Several structural factors, such as occupancy rate, bed size, number of outpatients and nurses were positively associated with both inpatient charges and length of stay. However, number of specialists was positively associated with inpatient charges, but negatively associated with length of stay. In sum, this study found that specialty hospitals treating joint diseases tend to incur higher charges but produce shorter length of stay, compared to their counterparts. Specialty hospitals' overcharging behaviors, although shorter length of stay, suggest that policy makers could introduce bundled payments for the joint procedures. To promote a successful

  7. A Comparison of Patients with Intellectual Disability Receiving Specialised and General Services in Ontario's Psychiatric Hospitals

    ERIC Educational Resources Information Center

    Lunsky, Y.; Bradley, E.; Durbin, J.; Koegl, C.

    2008-01-01

    Background: Over the years, the closure of institutions has meant that individuals with intellectual disabilities (IDs) must access mainstream (i.e. general) mental health services. However, concern that general services may not adequately meet the needs of patients with ID and mental illness has led to the development and implementation of more…

  8. Who needs chaplain's visitation in general hospitals? Assessing patients with psychosocial and religious needs.

    PubMed

    Winter-Pfändler, Urs; Morgenthaler, Christoph

    2011-01-01

    Owing to the declining length of patients' hospital stay in recent years, chaplains need evidence-based criteria to decide which patients are likely to have the greatest psychosocial and/or religious-spiritual needs. Therefore, the present pilot study aims at sorting out evidence-based criteria to assess patients with lack of coping resources. A total of 610 patients in the German-speaking part of Switzerland were surveyed with regard to their psychosocial health. The results suggest that lack of vitality (including health condition), lack of support and lack of faith (including spiritual struggle) are valid and reliable criteria for chaplains as internal triggers for pastoral visitation.

  9. The dilemma of a practice: experiences of abortion in a public maternity hospital in the city of Salvador, Bahia.

    PubMed

    McCallum, Cecilia; Menezes, Greice; Reis, Ana Paula Dos

    2016-01-01

    The article discusses abortion and miscarriage from the perspective of women admitted to a public maternity hospital in Salvador (BA), Brazil. Based on qualitative and quantitative research, it draws on participant observation of everyday hospital life. Taking an ethnographic approach, it addresses the hospital experiences of women who had miscarriages or induced abortions, also presenting the views of health professionals. It argues that the way the institution structures care for abortion and miscarriage involves symbolic processes that profoundly affect women's experiences. The discrimination against women who have had abortions/miscarriages is an integral part of the structure, organization and culture of these institutions, and does not derive solely from the individual actions of healthcare personnel.

  10. The Use of Mobile Phone and Medical Apps among General Practitioners in Hangzhou City, Eastern China

    PubMed Central

    Liu, Ying; Ren, Wen; Qiu, Yan; Liu, Juanjuan; Yin, Pei

    2016-01-01

    Background Mobile phones and mobile phone apps have expanded new forms of health professionals’ work. There are many studies on the use of mobile phone apps for different specialists. However, there are no studies on the current use of mobile phone apps among general practitioners (GPs). Objective The objective of the study was to investigate the extent to which GPs own smartphones with apps and use them to aid their clinical activities. Methods A questionnaire survey of GPs was undertaken in Hangzhou, Eastern China. Data probing GPs’ current use of medical apps in their clinical activities and factors influencing app use were collected and analyzed Results 125 GPs participated in the survey. 90.4% of GPs owned a mobile phone, with 48.7% owning an iPhone and 47.8% owning an Android phone. Most mobile phone owners had 1-3 medical-related apps, with very few owning more than 4. There was no difference in number of apps between iPhone and Android owners (χ2=1.388, P=0.846). 36% of GPs reported using medical-related apps on a daily basis. The majority of doctors reported using apps to aid clinical activities less than 30 minutes per day. Conclusions A high level of mobile phone ownership and usage among GPs was found in this study, but few people chose medical-related apps to support their clinical practice. PMID:27220417

  11. Bare Below the Elbows: A comparative study of a tertiary and district general hospital.

    PubMed

    Collins, A M; Connaughton, J; Ridgway, P F

    2013-10-01

    A 'Bare Below the Elbows' (BBTE) dress code policy has been introduced by the majority of NHS trusts in the UK. The aim of this Irish study was to evaluate the impact of an educational intervention on perception of medical attire. The study was carried out in two centres: a tertiary referral centre (Beaumont Hospital) and a district hospital (MRH, Portlaoise). Two questionnaires, incorporating photographic evaluation of appropriate attire for consultants and junior doctors, were completed pre and post BBTE education. One hundred and five patients participated. Analysis pre BBTE education indicated patients considered formal attire and white coats most appropriate for consultants and junior doctors respectively. Post-intervention analysis revealed a significant reduction in the popularity of both (p <0.001), with scrubs and smart casual attire gaining significant support in both cohorts (p <0.001). Our findings demonstrated that patient opinion on medical attire is malleable. The support of such a policy may be achieved if patients are informed that the aim is to reduce the spread of healthcare-associated infections.

  12. Coarse Particulate Air Pollution Associated with Increased Risk of Hospital Admissions for Respiratory Diseases in a Tropical City, Kaohsiung, Taiwan

    PubMed Central

    Cheng, Meng-Hsuan; Chiu, Hui-Fen; Yang, Chun-Yuh

    2015-01-01

    This study was undertaken to determine whether there was an association between coarse particles (PM2.5–10) levels and frequency of hospital admissions for respiratory diseases (RD) in Kaohsiung, Taiwan. Hospital admissions for RD including chronic obstructive pulmonary disease (COPD), asthma, and pneumonia, and ambient air pollution data levels for Kaohsiung were obtained for the period from 2006 to 2010. The relative risk of hospital admissions for RD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single pollutant model (without adjustment for other pollutants), increased rate of admissions for RD were significantly associated with higher coarse PM levels only on cool days (<25 °C), with a 10 µg/m3 elevation in PM2.5–10 concentrations associated with a 3% (95% CI = 1%–5%) rise in COPD admissions, 4% (95% CI = 1%–7%) increase in asthma admissions, and 3% (95% CI = 2%–4%) rise in pneumonia admissions. No significant associations were found between coarse particle levels and the number of hospital admissions for RD on warm days. In the two-pollutant models, PM2.5–10 levels remained significantly correlated with higher rate of RD admissions even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. This study provides evidence that higher levels of PM2.5–10 enhance the risk of hospital admissions for RD on cool days. PMID:26501308

  13. Comparison of two different running models for the shock wave lithotripsy machine in Taipei City Hospital: self-support versus outsourcing cooperation.

    PubMed

    Huang, Chi-Yi; Chen, Shiou-Sheng; Chen, Li-Kuei

    2009-10-01

    To compare two different running models including self-support and outsourcing cooperation for the extracorporeal shock wave lithotripsy (SWL) machine in Taipei City Hospital, we made a retrospective study. Self-support means that the hospital has to buy an SWL machine and get all the payment from SWL. In outsourcing cooperation, the cooperative company provides an SWL machine and shares the payment with the hospital. Between January 2002 and December 2006, we used self-support for the SWL machine, and from January 2007 to December 2008, we used outsourcing cooperation. We used the method of full costing to calculate the cost of SWL, and the break-even point was the lowest number of treatment sessions of SWL to make balance of payments every month. Quality parameters including stone-free rate, retreatment rate, additional procedures and complication rate were evaluated. When outsourcing cooperation was used, there were significantly more treatment sessions of SWL every month than when utilizing self-support (36.3 +/- 5.1 vs. 48.1 +/- 8.4, P = 0.03). The cost of SWL for every treatment session was significantly higher using self-support than with outsourcing cooperation (25027.5 +/- 1789.8 NT$ vs. 21367.4 +/- 201.0 NT$). The break-even point was 28.3 (treatment sessions) for self-support, and 28.4 for outsourcing cooperation, when the hospital got 40% of the payment, which would decrease if the percentage increased. No significant differences were noticed for stone-free rate, retreatment rate, additional procedures and complication rate of SWL between the two running models. Besides, outsourcing cooperation had lower cost (every treatment session), but a greater number of treatment sessions of SWL every month than self-support.

  14. Perioperative risk factors for mortality and length of hospitalization in mares with dystocia undergoing general anesthesia: a retrospective study.

    PubMed

    Rioja, Eva; Cernicchiaro, Natalia; Costa, Maria Carolina; Valverde, Alexander

    2012-05-01

    This study investigated associations between perioperative factors and probability of death and length of hospitalization of mares with dystocia that survived following general anesthesia. Demographics and perioperative characteristics from 65 mares were reviewed retrospectively and used in a risk factor analysis. Mortality rate was 21.5% during the first 24 h post-anesthesia. The mean ± standard deviation number of days of hospitalization of surviving mares was 6.3 ± 5.4 d. Several factors were found in the univariable analysis to be significantly associated (P < 0.1) with increased probability of perianesthetic death, including: low preoperative total protein, high temperature and severe dehydration on presentation, prolonged dystocia, intraoperative hypotension, and drugs used during recovery. Type of delivery and day of the week the surgery was performed were significantly associated with length of hospitalization in the multivariable mixed effects model. The study identified some risk factors that may allow clinicians to better estimate the probability of mortality and morbidity in these mares.

  15. Cardiopulmonary resuscitation in a district general hospital: increased success over 7 years.

    PubMed Central

    Thomas, R D; Waites, J H; Hubbard, W N; Wicks, M

    1990-01-01

    In a 12-month prospective survey of CPR (cardiopulmonary resuscitation), 32 out of 192 patients (16.6%) survived to go home. This is a clear improvement compared with 7 years previously. This is attributed to better training in the use and management of CPR and more widespread availability of defibrillators. Certain patients could not be resuscitated--those with electromechanical dissociation, carcinoma, or multiple pathology. Age by itself was not a bar to resuscitation. There is still a high rate of inappropriate calls, often because of uncertainty by nurses about the use of CPR. This could be improved with clearer guidelines in hospitals about the value of CPR in selected patients. PMID:2152462

  16. POST DISCHARGE DROPOUT OF ALCOHOLICS - A NATURALISTIC STUDY IN A GENERAL HOSPITAL SETTING

    PubMed Central

    Sengupta, Somnath; Kar, N.; Sharma, P.S.V.N.; Rao, Gaunasagari

    2001-01-01

    In a naturalistic longitudinal design 133 consecutive inpatients with alcohol dependence syndrome were followed up for one year following discharge from the hospital. 59 patients (group 1) paid follow up visit at regular intervals whereas 28 subjects (group 2)never returned despite three consecutive postal intimations. Rest of the patient were irregular in follow up. The individuals in group 1 were compared with those in group 2 on various sociodemographic and clinical variables with the aim of delineating the characteristics that could define the alcoholics who dropped out following discharge. It was found that such patient were relatively younger with lower level of education, less frequently married, had earlier onset of problem drinking with poor social support and higher rates of mental problems. It was concluded that post discharge attrition of alcoholics could be a social as well as a clinical problem in any setting rendering long treatment for alcoholism. PMID:21407859

  17. Surveillance of Methicillin-Resistant Staphylococcus aureus in a Pediatric Hospital in Mexico City during a 7-Year Period (1997 to 2003): Clonal Evolution and Impact of Infection Control

    PubMed Central

    Velazquez-Meza, M. E.; Aires de Sousa, M.; Echaniz-Aviles, G.; Solórzano-Santos, F.; Miranda-Novales, G.; Silva-Sanchez, J.; de Lencastre, H.

    2004-01-01

    Between 1997 and 2000 a single multidrug-susceptible methicillin-resistant Staphylococcus aureus clone, M (sequence type 30 [ST30]-staphylococcal cassette chromosome mec [SCCmec] type IV), was present in a pediatric hospital in Mexico City, Mexico. In 2001 the international multidrug-resistant New York-Japan clone (ST5-SCCmec type II) was introduced into the hospital, completely replacing clone M by 2002. PMID:15297554

  18. Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: a longitudinal cohort study

    PubMed Central

    Sampson, Elizabeth L.; White, Nicola; Lord, Kathryn; Leurent, Baptiste; Vickerstaff, Victoria; Scott, Sharon; Jones, Louise

    2015-01-01

    Abstract Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen–Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (β = 0.20, 95% confidence interval [CI] = 0.07-0.32, P = 0.002) and at rest (β = 0.41, 95% CI = 0.14-0.69, P = 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia. PMID:25790457

  19. Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: a longitudinal cohort study.

    PubMed

    Sampson, Elizabeth L; White, Nicola; Lord, Kathryn; Leurent, Baptiste; Vickerstaff, Victoria; Scott, Sharon; Jones, Louise

    2015-04-01

    Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen-Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (β = 0.20, 95% confidence interval [CI] = 0.07-0.32, P = 0.002) and at rest (β = 0.41, 95% CI = 0.14-0.69, P = 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia.

  20. A Study to Identify the Optimum Method of Providing Biomedical Engineering/Maintenance Support of Radiologic Equipment at General Leonard Wood Army Community Hospital

    DTIC Science & Technology

    1988-01-01

    This study was done to determine the optimum method of providing biomedical engineering /maintenance support of diagnostic radiologic equipment at...General Leonard Wood Army Community Hospital (GLWACH). The study concluded that the optimum method of providing biomedical engineering /maintenance

  1. The Role of Psychiatric Emergency Services in Aiding Community Alternatives to Hospitalization in an Inner-City Population

    PubMed Central

    Bell, Carl C.

    1978-01-01

    In the proper political/economic environment, Crisis Intervention Programs can reduce the recidivism rate of patients who suffer from recurrent intermittent acute psychotic episodes. The author seeks to outline such a program and demonstrate its effectiveness in providing an alternative to brief hospitalization. It is believed that this form of management of the psychiatric emergency aids the practice of community psychiatry and supports the use of day treatment facilities, outpatient clinics, emergency housing, family therapy, and other community support systems. PMID:731721

  2. A Comparison of Outpatients with Intellectual Disability Receiving Specialised and General Services in Ontario's Psychiatric Hospitals

    ERIC Educational Resources Information Center

    Lunsky, Y.; Gracey, C.; Bradley, E.; Koegl, C.; Durbin, J.

    2011-01-01

    Background: This study compares outpatients with intellectual disability (ID) receiving specialised services to outpatients with ID receiving general services in Ontario's tertiary mental healthcare system in terms of demographics, symptom profile, strengths and resources, and clinical service needs. Methods: A secondary analysis of Colorado…

  3. Intra-oral cancer at the Massachusetts General Hospital. Squamous cell carcinoma of the floor of the mouth.

    PubMed Central

    Ildstad, S T; Bigelow, M E; Remensnyder, J P

    1983-01-01

    A retrospective review of 163 consecutive patients with biopsy-proven, invasive squamous cell carcinoma of the floor of the mouth who underwent inpatient treatment at the Massachusetts General Hospital during the 15-year period from January 1962 through December 1976 is presented. The stage at first presentation, clinical features of the disease, incidence of second primary tumors, analysis of therapeutic modalities, and survival statistics are compared with reports from other large centers. Floor of mouth tumors comprised 28%, (163/592) of oral squamous cell carcinomas seen at the Massachusetts General Hospital during that time period. Seventy-one per cent of floor of mouth tumors were in men and 29% in women; women tended to present earlier in the course of their disease. Thirty-seven patients (23%) developed a secondary primary malignancy, and four of these 37 patients developed two second primaries. Distant metastatic disease appeared in 6% of patients with Stage I, II, or III disease and 26% of patients with Stage IV disease. Radiation therapy alone and surgery alone resulted in equivalent long-term survival rates for early stage disease. In more advanced stages (III and IV), a combined approach utilizing surgery and radiation therapy obtained superior results for short-term survival than either modality alone. The importance of early diagnosis and treatment and suggestions for development of cooperative protocols in an attempt to improve salvage of patients with this disease is discussed. PMID:6848053

  4. [Epidemiological aspects of ciprofloxacin-resistant Escherichia coli at a general hospital].

    PubMed

    Serrano, F J; Muñoz, R M; Vidal, S S; Morán, F G; García, C B; Aznar, A B

    2000-03-01

    The susceptibility to ciprofloxacin of 7288 Escherichia coli clinical isolates from 5667 patients was determined over a 4-year period (1995-1998). Information about the patients' age, sex, specimen type, date, origin and susceptibility to Escherichia coli isolates was studied, and the c2 test was used for statistical comparison. Overall, 1003 (17.70%) patients out of the 5667 included in the study presented ciprofloxacin resistance. The annual resistance observed over this 4-year period was not considered statistically significant. The resistant isolates were more frequent among men, in urine specimens and in outpatients, and increased with different age groups. The average age of patients with resistant isolates was 61.29 years (SD 21.56) and that of patients with susceptible isolates was 39.76 years (SD 27.41). A similar rate of resistance was observed among outpatients from health centers and those from hospital outpatient services. The higher resistance rates were found in outpatients from the urology department. The resistance to other fluoroquinolones remained the same and was not significant for norfloxacin; it increased starting from 1997 for pefloxacin at the expense of ciprofloxacin-sensitive isolates.

  5. [Epidemiological aspects of ciprofloxacin-resistant Escherichia coli in a general hospital

    PubMed

    Serrano; Muñoz; Vidal; Morán; García; Aznar

    2000-03-01

    The susceptibility to ciprofloxacin of 7288 Escherichia coli clinical isolates from 5667 patients was determined over a 4-year period (1995-1998). Information about the patients' age, sex, specimen type, date, origin and susceptibility to Escherichia coli isolates was studied, and the c2 test was used for statistical comparison. Overall, 1003 (17.70%) patients out of the 5667 included in the study presented ciprofloxacin resistance. The annual resistance observed over this 4-year period was not considered statistically significant. The resistant isolates were more frequent among men, in urine specimens and in outpatients, and increased with different age groups. The average age of patients with resistant isolates was 61.29 years (SD 21.56) and that of pacients with susceptible isolates was 39.76 years (SD 27.41). A similar rate of resistance was observed among outpatients from health centers and those from hospital outpatient services. The higher resistance rates were found in outpatients from the urology department. The resistance to other fluoroquinolones remained the same and was not significant for norfloxacin; it increased starting from 1997 for pefloxacin at the expense of ciprofloxacin-sensitive isolates.

  6. Risk factors of stroke patients admitted to a general hospital in Kuwait.

    PubMed

    Ashkanani, Abdulaziz; Hassan, Khalid Ali; Lamdhade, Shekhar

    2013-02-01

    There are limited data on stroke incidence in the Middle East, and only one study from Kuwait. The aim of this study was to establish a baseline status of stroke in Kuwait. We performed a retrospective chart review of all patients admitted from January 1st to December 31st, 2008 to the Amiri Hospital, Kuwait, who either were discharged or passed away with a diagnosis of stroke. Documented risk factors for stroke were analyzed for the total cohort and for male and female subgroups. Stroke subtypes were defined in accordance with the Trial of Org 10172 in acute stroke treatment (TOAST) criteria. There were 151 cases of stroke, of which 90.1% were ischemic. Eighty-five (56.3%) of the patients had diabetes mellitus, 86 (57.0%) had hyperlipidemia, and 104 (68.9%) had hypertension. Statins were used by 42.4% of the 86 hyperlipidemic patients prior to their presentation, and only 66 hypertensive patients (63.5%) were receiving treatment for hypertension prior to their presentation. Atrial fibrillation was diagnosed in 4% of the patients prior to their presentation, and 4% more were diagnosed afterward. History of ischemic heart disease was present in 28.5% of the subjects. This study shows similar rates of risk factors to regionally published reports and provides an updated picture of stroke in Kuwait.

  7. Assessment of leadership training needs of internal medicine residents at the Massachusetts General Hospital.

    PubMed

    Fraser, Traci N; Blumenthal, Daniel M; Bernard, Kenneth; Iyasere, Christiana

    2015-07-01

    Internal medicine (IM) physicians, including residents, assume both formal and informal leadership roles that significantly impact clinical and organizational outcomes. However, most internists lack formal leadership training. In 2013 and 2014, we surveyed all rising second-year IM residents at a large northeastern academic medical center about their need for, and preferences regarding, leadership training. Fifty-five of 113 residents (49%) completed the survey. Forty-four residents (80% of respondents) reported a need for additional formal leadership training. A self-reported need for leadership training was not associated with respondents' gender or previous leadership training and experience. Commonly cited leadership skill needs included "leading a team" (98% of residents), "confronting problem employees" (93%), "coaching and developing others" (93%), and "resolving interpersonal conflict" (84%). Respondents preferred to learn about leadership using multiple teaching modalities. Fifty residents (91%) preferred to have a physician teach them about leadership, while 19 (35%) wanted instruction from a hospital manager. IM residents may not receive adequate leadership development education during pregraduate and postgraduate training. IM residents may be more likely to benefit from leadership training interventions that are physician-led, multimodal, and occur during the second year of residency. These findings can help inform the design of effective leadership development programs for physician trainees.

  8. Cost accounting of radiological examinations. Cost analysis of radiological examinations of intermediate referral hospitals and general practice.

    PubMed

    Lääperi, A L

    1996-01-01

    The purpose of this study was to analyse the cost structure of radiological procedures in the intermediary referral hospitals and general practice and to develop a cost accounting system for radiological examinations that takes into consideration all relevant cost factors and is suitable for management of radiology departments and regional planning of radiological resources. The material comprised 174,560 basic radiological examinations performed in 1991 at 5 intermediate referral hospitals and 13 public health centres in the Pirkanmaa Hospital District in Finland. All radiological departments in the hospitals were managed by a specialist in radiology. The radiology departments at the public health care centres operated on a self-referral basis by general practitioners. The data were extracted from examination lists, inventories and balance sheets; parts of the data were estimated or calculated. The radiological examinations were compiled according to the type of examination and equipment used: conventional, contrast medium, ultrasound, mammography and roentgen examinations with mobile equipment. The majority of the examinations (87%) comprised conventional radiography. For cost analysis the cost items were grouped into 5 cost factors: personnel, equipment, material, real estate and administration costs. The depreciation time used was 10 years for roentgen equipment, 5 years for ultrasound equipment and 5 to 10 years for other capital goods. An annual interest rate of 10% was applied. Standard average values based on a sample at 2 hospitals were used for the examination-specific radiologist time, radiographer time and material costs. Four cost accounting versions with varying allocation of the major cost items were designed. Two-way analysis of variance of the effect of different allocation methods on the costs and cost structure of the examination groups was performed. On the basis of the cost analysis a cost accounting program containing both monetary and

  9. FUNGEMIA CAUSED BY Candida SPECIES IN A CHILDREN'S PUBLIC HOSPITAL IN THE CITY OF SÃO PAULO, BRAZIL: STUDY IN THE PERIOD 2007-2010

    PubMed Central

    Oliveira, Vanessa Kummer Perinazzo; Ruiz, Luciana da Silva; Oliveira, Nélio Alessandro Jesus; Moreira, Débora; Hahn, Rosane Christine; Melo, Analy Salles de Azevedo; Nishikaku, Angela Satie; Paula, Claudete Rodrigues

    2014-01-01

    Candidemia remains a major cause of morbidity and mortality in the health care environment. The epidemiology of Candida infection is changing, mainly in relation to the number of episodes caused by species C. non-albicans. The overall objective of this study was to evaluate the frequency of yeasts of the genus Candida, in a four-year period, isolated from blood of pediatric patients hospitalized in a public hospital of the city of São Paulo, Brazil. In this period, yeasts from blood of 104 patients were isolated and, the identified species of Candida by phenotypic and genotypic methods were: C. albicans (39/104), C. tropicalis (25/104), C. parapsilosis (23/104), Pichia anomala (6/104), C. guilliermondii (5/104), C. krusei (3/104), C. glabrata (2/104) and C. pararugosa (1/104). During the period of the study, a higher frequency of isolates of C. non-albicans (63.55%) (p = 0.0286) was verified. In this study we verified the increase of the non-albicans species throughout the years (mainly in 2009 and 2010). Thus, considering the peculiarities presented by Candida species, a correct identification of species is recommended to lead to a faster diagnosis and an efficient treatment. PMID:25076430

  10. Pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China

    PubMed Central

    Jiang, Bin; Ru, Xiaojuan; Sun, Haixin; Liu, Hongmei; Sun, Dongling; Liu, Yunhai; Huang, Jiuyi; He, Li; Wang, Wenzhi

    2016-01-01

    This study aimed to explore pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China. The rates of delay greater than or equal to 2 hours were calculated and factors associated with delays were determined by non-conditional binary logistic regression, after adjusting for different explanatory factors. Among the 403 cases of stroke with an accurate documented time of prehospital delay, the median time (interquartile range) was 4.00 (1.50–14.00) hours. Among the 544 cases of stroke with an estimated time range of prehospital delay, 24.8% of patients were transferred to the emergency department or hospital within 2 hours, only 16.9% of patients with stroke were aware that the initial symptom represented a stroke, only 18.8% used the emergency medical service and one-third of the stroke cases were not identified by ambulance doctors. In the multivariate analyses, 8 variables or sub-variables were identified. In conclusion, prehospital delay of stroke was common in communities. Thus, intervention measures in communities should focus on education about the early identification of stroke and appropriate emergency medical service (EMS) use, as well as the development of organized stroke care. PMID:27411494

  11. [Diarrhea associated with Clostridium difficile: one-year experience in a general hospital].

    PubMed

    Bouza, E; Padilla, B; Catalán, P; Sánchez-Carrillo, C; Blázquez, R; Peláez, T

    1996-07-01

    Clostridium difficile is considered the most common cause of nosocomial acquired diarrhoea, with frequencies differing widely from one institution to another. So far, it is a scarcely reported condition in Spain. In the present study 129 episodes of Clostridium difficile associated diarrhoea (CDAD) occurred in 120 patients in a 2,000-bed hospital in 1994 is reported. All cases were diagnosed by demonstrating cytotoxicity on cellular lines (MRC-5) from feces or from the strain isolated from a culture medium (CCFA). The overall incidence was 2.4 episodes every 1,000 admissions. Twenty-eight out of the 120 patients (23%) were HIV-positive patients, that is, an incidence of 30 episodes every 1,000 admissions. No significant differences were observed regarding the presentation and clinical course between HIV-positive and HIV-negative patients, with the exception of the antimicrobial agents used previously. Forty-two percent of patients had undergone surgery and 97% had received antimicrobials in the 8 weeks before the CDAD episode, with an average of 3.3 antibiotics per patient. Out of the 129 episodes, 72.8% were treated correctly. A total of 11.7% of patients responded exclusively to the discontinuation of the antimicrobials that were being administered. Eighty-three patients were treated with specific antibiotics, 59 with oral vancomycin, and 24 with metronidazole. Seventy-six patients (91.5%) responded to the initial therapy, 5 relapsed (6%), and 2 (2.5%) failed. The associated mortality rate was 0.7%. C. difficile can be a relevant cause of nosocomial diarrhoea in our setting, particularly in HIV-positive patients, but also in other patients. Its early diagnosis and appropriate therapy can contribute to decrease a relevant cause of morbidity in inpatients.

  12. Intimate partner violence among female drug users admitted to the general hospital: screening and prevalence.

    PubMed

    Caldentey, Clara; Tirado Muñoz, Judit; Ferrer, Tessie; Fonseca Casals, Francina; Rossi, Paola; Mestre-Pintó, Juan Ignacio; Torrens Melich, Marta

    2016-09-29

    Intimate partner violence (IPV) is a public health problem worldwide. Several factors have been found to be associated with an increased prevalence of IPV, such as substance use. A cross-sectional study was conducted with the aim of determining the prevalence of IPV among women entering Hospital del Mar (Barcelona) for any medical/surgical reason, and who had a diagnosis of substance use disorder. Secondly, it was intended to psychometrically validate the Spanish version of the Hurt, Insulted, Threatened with Harm, Screamed (HITS) questionnaire. All patients were assessed by two IPV questionnaires, the Composite Abuse Scale (CAS) and HITS. Out of 52 patients interviewed, 46 answered both questionnaires. According to the CAS questionnaire, 23 patients (50%) experienced IPV at some point in their lives and 11 (23.9%) in the last year. Cannabis consumption was also associated with an increased severity of IPV (95% CI 3.5-28.9, p = .013).According to the HITS questionnaire, there was a prevalence of 39.1% (18 patients) in the last 12 months. HITS had a specificity of 100% and a sensitivity of 78% relative to the CAS questionnaire. A cut-off score x∈ [6.7], derived through ROC analysis, correctly discriminated 91% of the victims and 100% of the non-victims. The results obtained showed that the prevalence of IPV was very high among women who suffered from more than one substance use disorder. Therefore, it is highly recommended to systematically screen for IPV victimization by putting the HITS questionnaire into practice.

  13. DELirium Prediction Based on Hospital Information (Delphi) in General Surgery Patients.

    PubMed

    Kim, Min Young; Park, Ui Jun; Kim, Hyoung Tae; Cho, Won Hyun

    2016-03-01

    To develop a simple and accurate delirium prediction score that would allow identification of individuals with a high probability of postoperative delirium on the basis of preoperative and immediate postoperative data.Postoperative delirium, although transient, is associated with adverse outcomes after surgery. However, there has been no appropriate tool to predict postoperative delirium.This was a prospective observational single-center study, which consisted of the development of the DELirium Prediction based on Hospital Information (Delphi) score (n = 561) and its validation (n = 533). We collected potential risk factors for postoperative delirium, which were identified by conducting a comprehensive review of the literatures.Age, low physical activity, hearing impairment, heavy alcoholism, history of prior delirium, intensive care unit (ICU) admission, emergency surgery, open surgery, and increased preoperative C-reactive protein were identified as independent predictors of postoperative delirium. The Delphi score was generated using logistic regression coefficients. The maximum Delphi score was 15 and the optimal cut-off point identified with the Youden index was 6.5. Generated area under the (AUC) of the receiver operating characteristic (ROC) curve was 0.911 (95% CI: 0.88-0.94). In the validation study, the calculated AUC of the ROC curve based on the Delphi score was 0.938 (95% Cl: 0.91-0.97). We divided the validation cohort into the low-risk group (Delphi score 0-6) and high-risk group (7-15). Sensitivity of Delphi score was 80.8% and specificity 92.5%.Our proposed Delphi score could help health-care provider to predict the development of delirium and make possible targeted intervention to prevent delirium in high-risk surgery patients.

  14. Intravenous midazolam sedation in pediatric diagnostic upper digestive endoscopy. A prospective study in a general hospital.

    PubMed

    Verhage, Jan; Mulder, Chris J J; Willekens, Frans L A

    2003-12-01

    The positive role of benzodiazepines (Midazolam) in conscious sedation in pediatric patients is widely known. However, problems concerning the role of sedation in diagnostic upper endoscopy are a matter for debate as little is known about dosage and timing. We prospectively evaluated the efficacy, safety and optimal intravenous sedation dosage of midazolam in 257 consecutive patients, aged 2 months to 18 years old, who underwent upper endoscopy of the gastrointestinal tract. The initial midazolam dosage was 0.2 mg/kg Bw (Body weight) i.v. for 1 minute and, if necessary, another 0.1 mg/kg Bw was administered 5 minutes later. If sedation was sufficient, the procedure would be started 4-5 minutes later; if not, another 0.1 - 0.2 mg/kg Bw would be administered. All procedures were performed by a pediatrician together with a gastroenterologist. No serious complications occurred in any of the procedures. Oxygen saturation (OS) was maintained at over 90%, if necessary with blowby oxygen. Flumazenil was administered to 7 children (OS < 90%). Endoscopy could not be completed in 1 child. All endoscopies were completed within 10 minutes. No unexpected hospital admissions were necessary. The mean midazolam dosage was 0.4 mg/kg Bw in patients up to 6 years, for the over 6 years-olds the mean dosage was decreased to 0,2 mg/kg Bw. Particular attention was paid to the importance of informing patients before the procedure. Endoscopic diagnostic procedures can be performed safely and effectively in children with intravenous sedation in a well equipped pediatric endoscopy unit.

  15. Association between Daily Hospital Outpatient Visits for Accidents and Daily Ambient Air Temperatures in an Industrial City.

    PubMed

    Chau, Tang-Tat; Wang, Kuo-Ying

    2016-01-01

    An accident is an unwanted hazard to a person. However, accidents occur. In this work, we search for correlations between daily accident rates and environmental factors. To study daily hospital outpatients who were admitted for accidents during a 5-year period, 2007-2011, we analyzed data regarding 168,366 outpatients using univariate regression models; we also used multivariable regression models to account for confounding factors. Our analysis indicates that the number of male outpatients admitted for accidents was approximately 1.31 to 1.47 times the number of female outpatients (P < 0.0001). Of the 12 parameters (regarding air pollution and meteorology) considered, only daily temperature exhibited consistent and significant correlations with the daily number of hospital outpatient visits for accidents throughout the 5-year analysis period. The univariate regression models indicate that older people (greater than 66 years old) had the fewest accidents per 1-degree increase in temperature, followed by young people (0-15 years old). Middle-aged people (16-65 years old) were the group of outpatients that were more prone to accidents, with an increase in accident rates of 0.8-1.2 accidents per degree increase in temperature. The multivariable regression models also reveal that the temperature variation was the dominant factor in determining the daily number of outpatient visits for accidents. Our further multivariable model analysis of temperature with respect to air pollution variables show that, through the increases in emissions and concentrations of CO, photochemical O3 production and NO2 loss in the ambient air, increases in vehicular emissions are associated with increases in temperatures. As such, increases in hospital visits for accidents are related to vehicular emissions and usage. This finding is consistent with clinical experience which shows about 60% to 80% of accidents are related to traffic, followed by accidents occurred in work place.

  16. Association between Daily Hospital Outpatient Visits for Accidents and Daily Ambient Air Temperatures in an Industrial City

    PubMed Central

    Chau, Tang-Tat; Wang, Kuo-Ying

    2016-01-01

    An accident is an unwanted hazard to a person. However, accidents occur. In this work, we search for correlations between daily accident rates and environmental factors. To study daily hospital outpatients who were admitted for accidents during a 5-year period, 2007–2011, we analyzed data regarding 168,366 outpatients using univariate regression models; we also used multivariable regression models to account for confounding factors. Our analysis indicates that the number of male outpatients admitted for accidents was approximately 1.31 to 1.47 times the number of female outpatients (P < 0.0001). Of the 12 parameters (regarding air pollution and meteorology) considered, only daily temperature exhibited consistent and significant correlations with the daily number of hospital outpatient visits for accidents throughout the 5-year analysis period. The univariate regression models indicate that older people (greater than 66 years old) had the fewest accidents per 1-degree increase in temperature, followed by young people (0–15 years old). Middle-aged people (16–65 years old) were the group of outpatients that were more prone to accidents, with an increase in accident rates of 0.8–1.2 accidents per degree increase in temperature. The multivariable regression models also reveal that the temperature variation was the dominant factor in determining the daily number of outpatient visits for accidents. Our further multivariable model analysis of temperature with respect to air pollution variables show that, through the increases in emissions and concentrations of CO, photochemical O3 production and NO2 loss in the ambient air, increases in vehicular emissions are associated with increases in temperatures. As such, increases in hospital visits for accidents are related to vehicular emissions and usage. This finding is consistent with clinical experience which shows about 60% to 80% of accidents are related to traffic, followed by accidents occurred in work place. PMID

  17. Estimation of the Demand for Hospital Care After a Possible High-Magnitude Earthquake in the City of Lima, Peru.

    PubMed

    Bambarén, Celso; Uyen, Angela; Rodriguez, Miguel

    2017-02-01

    Introduction A model prepared by National Civil Defense (INDECI; Lima, Peru) estimated that an earthquake with an intensity of 8.0 Mw in front of the central coast of Peru would result in 51,019 deaths and 686,105 injured in districts of Metropolitan Lima and Callao. Using this information as a base, a study was designed to determine the characteristics of the demand for treatment in public hospitals and to estimate gaps in care in the hours immediately after such an event.

  18. The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: a comparison of London and New York City.

    PubMed

    Curtis, Sarah; Copeland, Alison; Fagg, James; Congdon, Peter; Almog, Michael; Fitzpatrick, Justine

    2006-03-01

    We report on comparative analyses of small area variation in rates of acute hospital admissions for psychiatric conditions in Greater London around the year 1998 and in New York City (NYC) in 2000. Based on a theoretical model of the factors likely to influence psychiatric admission rates, and using data from the most recent population censuses and other sources, we examine the association with area indicators designed to measure access to hospital beds, socio-economic deprivation, social fragmentation and ethnic/racial composition. We report results on admissions for men and women aged 15-64 for all psychiatric conditions (excluding self-harm), drug-related substance abuse/addiction, schizophrenia and affective disorders. The units of analysis in NYC were 165 five-digit Zip Code Areas and, in London, 760 electoral wards as defined in 1998. The analysis controls for age and sex composition and, as a proxy for access to care, spatial proximity to hospitals with psychiatric beds. Poisson regression modeling incorporating random effects was used to control for both overdispersion in the counts of admissions and for the effects of spatial autocorrelation. The results for NYC and London showed that local admission rates for all types of condition were positively and significantly associated with deprivation and the association is independent of demographic composition or 'access' to beds. In NYC, social fragmentation showed a significant association with admissions due to affective disorders and schizophrenia, and for drug dependency among females. Racial minority concentration was significantly and positively associated with admissions for schizophrenia. In London, social fragmentation was associated positively with admissions for men and women due to schizophrenia and affective disorders. The variable measuring racial/ethnic minority concentration for London wards showed a negative association with admission rates for drug dependency and for affective disorders. We

  19. Is Walk Score associated with hospital admissions from chronic diseases? Evidence from a cross-sectional study in a high socioeconomic status Australian city-state

    PubMed Central

    Mazumdar, Soumya; Learnihan, Vincent; Cochrane, Thomas; Phung, Hai; O'Connor, Bridget; Davey, Rachel

    2016-01-01

    Objectives To explore patterns of non-communicable diseases (NCDs) in the Australian Capital Territory (ACT).To ascertain the effect of the neighbourhood built environmental features and especially walkability on health outcomes, specifically for hospital admissions from NCDs. Design A cross-sectional analysis of public hospital episode data (2007–2013). Setting Hospitalisations from the ACT, Australia at very small geographic areas. Participants Secondary data on 75 290 unique hospital episodes representing 39 851 patients who were admitted to ACT hospitals from 2007 to 2013. No restrictions on age, sex or ethnicity. Main exposure measures Geographic Information System derived or compatible measures of general practitioner access, neighbourhood socioeconomic status, alcohol access, exposure to traffic and Walk Score walkability. Main outcome measures Hospitalisations of circulatory diseases, specific endocrine, nutritional and metabolic diseases, respiratory diseases and specific cancers. Results Geographic clusters with significant high and low risks of NCDs were found that displayed an overall geographic pattern of high risk in the outlying suburbs of the territory. Significant relationships between neighbourhood walkability as measured by Walk Score and the likelihood of hospitalisation with a primary diagnosis of myocardial infarction (heart attack) were found. A possible relationship was also found with the likelihood of being hospitalised with 4 major lifestyle-related cancers. Conclusions Our research augments the growing literature underscoring the relationships between the built environment and health outcomes. In addition, it supports the importance of walkable neighbourhoods, as measured by Walk Score, for improved health. PMID:27932340

  20. Causes of Death in an Acute Psychiatric Inpatient Unit of a Portuguese General Hospital.

    PubMed

    Barbosa, Sofia; Sequeira, Márcia; Castro, Sara; Manso, Rita; Klut Câmara, Catarina; Trancas, Bruno; Borja-Santos, Nuno; Maia, Teresa

    2016-08-01

    Introdução: Os doentes afectos de patologia psiquiátrica apresentam maior risco de morte, tanto por causas naturais como não naturais. Este estudo avalia as causas de morte de todos os doentes de uma unidade de internamento de agudos de Psiquiatria num hospital geral em Portugal, ao longo de dezasseis anos (de 1998 a 2013). Material e Métodos: Vinte e um doentes morreram na unidade de internamento de doentes agudos entre 1998 e 2013 (média 1,3 por ano). As características demográficas, os diagnósticos médicos e psiquiátricos foram recolhidos através de um estudo retrospectivo que consistiu na análise dos processos clínicos da amostra selecionada. Os doentes transferidos para outras enfermarias durante o internamento não foram incluídos no estudo. Resultados: As doenças do sistema circulatório foram as causas de morte mais prevalentes, ocorrendo em 2/3 dos doentes, incluindo embolismo pulmonar (n = 6), acidente vascular cerebral (n = 3), arritmia cardíaca (n = 2), enfarte agudo do miocárdio (n = 1), rutura de aneurisma da aorta abdominal (n = 1) e insuficiência cardíaca (n = 1). Dois doentes morreram de pneumonia e em quatro casos a causa de morte foi indeterminada. Apenas um caso de suicídio foi registado. Discussão: As doenças do aparelho circulatório foram as causas de morte mais frequentes nesta unidade de agudos. O suicídio em doentes internados, apesar de constituir um evento raro, é uma realidade que comporta consequências complexas para os profissionais de saúde, familiares e restantes doentes, devendo permanecer como foco de prevenção continuada. Conclusão: Os estudos de mortalidade são importantes para determinar a qualidade dos cuidados de saúde e criar recomendações para medidas preventivas.

  1. Midazolam sedation to produce complete amnesia for bronchoscopy: 2 years' experience at a district general hospital.

    PubMed

    Williams, T J; Bowie, P E

    1999-05-01

    Patients may find bronchoscopy without sedation unpleasant. There is some evidence that patient satisfaction correlates with amnesia for the procedure. For several years we have used doses of midazolam sufficient to put patients lightly asleep hoping to produce complete amnesia. We looked at practical aspects of this technique over a 2-year period. We studied 337 consecutive patients. They were 219 men and 118 women of mean age 63 +/- 12.4 (SD). Sixty-seven patients were aged 75 years or over and the eldest was 86. Sixty-three patients were already hospital inpatients but the remainder were seen as day cases. Midazolam was given by slow i.v. injection over several minutes until the patient was judged to be lightly asleep. Patients were given supplemental oxygen (3 l min-1) and monitored by ECG and pulse oximetry. A note was made of the time at which they awakened, defined as when nursing staff felt the patients were awake enough to have a cup of tea and toast. Patients were asked if they had any memory of the procedure both on awakening and when seen a few days later to discuss the results. The procedures were carried out in a well-staffed Day Case Unit with a recovery area. The mean dose of midazolam used was 10.8 mg (mean +/- SD = 0.16 +/- 0.095 mg kg-1). The midazolam was given over a median of 4 min (range 1-15 min). Patients took 59 +/- 45 min (mean +/- SD) to wake up. Twenty-eight patients were given flumazanil to reverse the sedation (11 for concern over bleeding following biopsies, three for desaturation during and three after procedure, four as they were frail, two as they were restless, two as they were hypotensive after procedure and three for miscellaneous reasons). Only nine patients could remember any part of the procedure. Incremental doses of midazolam given slowly until patients are lightly asleep almost invariably produce complete amnesia for bronchoscopy. This is a safe technique but patients need careful monitoring and may require reversal of

  2. Are patients with newly diagnosed breast cancer getting appropriate DEXA scans? A District General Hospital experience.

    PubMed

    Dong, Huan; Dayananda, Pete; Preece, Shay-Anne; Carmichael, Amtul

    2015-01-01

    Breast cancer patients are often at high risk of fragility fractures partly due to adjuvant endocrine therapy such as aromatase inhibitors and chemotherapy. Baseline dual energy X-ray absorptiometry (DEXA) scanning is recommended as a standard of care in identifying patients who are at risk so they can be commenced on bone protective therapy. NICE guideline 80 - "Early and locally advanced breast cancer"[1] states that patients with early invasive breast cancer should have a baseline DEXA scan to assess BMD before the commencement of aromatase inhibitor treatment; if patients have treatment-induced menopause or are starting ovarian ablation/suppression therapy. We have audited the performance of a DGH against these guidelines with a target of 100% concordance. During a one year period (April 2012-April 2013), 100 patients with a new diagnosis of breast cancer were selected at random from the hospital coding database. 100 patients were chosen as this was a convenient sample size. We gathered information for these patients using electronic records, letters, and imaging. This showed a poor compliance of 38% against NICE guidelines. This in turn means that patients with low BMD at diagnosis of breast cancer are being under diagnosed and under treated, resulting in increased potential morbidity associated with fragility fractures. The interventions that resulted from this audit were: dissemination of these results to surgical and oncology departments, posters summarising the guidelines put up in breast clinics, and breast MDTs to discuss the need for DEXA scans for patients with breast cancer. A re-audit was performed for patients diagnosed with early, invasive breast cancer in January 2014 where a compliance of 90% was achieved. This represents a huge improvement in compliance from the baseline measure of 38%. In order to show that this improvement could be sustained, two further cycles were performed in February and March 2014, where the compliance was 92% and 100

  3. Prevalence and factors associated with diabetic retinopathy among diabetic patients at Arbaminch General Hospital, Ethiopia: Cross sectional study

    PubMed Central

    Chisha, Yilma; Terefe, Wondwossen; Assefa, Huruy; Lakew, Serawit

    2017-01-01

    Background Currently 93 million people are estimated as living with diabetic retinopathy worldwide. The prevalence and risk factors of diabetic retinopathy in developed countries have been well documented; but in Ethiopia, data on prevalence and associated factors of diabetic retinopathy is lacking. Objective To determine prevalence and factors associated with development of diabetic retinopathy among diabetic patients at Arbaminch General Hospital, Ethiopia. Method Cross-sectional study design with record review of 400 diabetic patients was conducted at Arbaminch General Hospital from November to January 2015. Among 400 diabetic patients, 270 patients with baseline information and without history of hypertension at baseline were included in this study. But patients with gestational diabetes and with retinopathy at baseline were excluded from the study. Consecutive sampling technique was applied to select study participants. Data of cohorts was extracted from medical record using pre tested structured extraction check list. Data cleaning, coding, categorizing, merging and analysis carried out by STATA version 12. Descriptive statistics was done and presented accordingly. Bivariate binary logistic regression analysis was done to select potential candidates for the full model at P-value cutoff point ≤ 0.25 and multivariable binary logistic regression analysis was made to estimate the independent effect of predictors on the occurrence of diabetic retinopathy. Model diagnostic tests were done, final model fitness was checked using Hosmer and Lemeshow chi square test. Finally, statistical significance was tested at P-value <0.05. Result Prevalence of diabetic retinopathy among diabetic patients at Arbaminch General Hospital was 13%. Adjusted analysis showed that the odds of diabetic retinopathy were statistically and significantly associated with baseline age (AOR = 6.06: 95%CI; 2.42, 15.21), baseline systolic blood pressure level (AOR = 4.38: 95%CI; 1.64, 11

  4. Evaluation of demographic characteristics, and general disease state of patients affliated with home health care unit of Malatya State Hospital

    PubMed Central

    Oksuz, Ersoy; Onat, Elif; Shahzadi, Andleeb; Yazici, Zeliha; Cetin, Cumali

    2015-01-01

    OBJECTIVE: Home Health Care Unit a unit provides health services for elderly, bedridden and individuals with chronic diseases at home along within the frame of the diagnosis, and treatments of the relevant experts. Therefore, it is intended to reduce the probable physical and emotional burden related to the patient that arise by commuting to the hospital, to increase the number of empty beds for other patients and to improve the living standard by reducing the risk of hospital infection. In this study, the demographic characteristics of housebound patients, their general disease and its relationship with age and gender was investigated. METHODS: The following study was performed on 626 active patients of Malatya State Hospital Home Health Care Unit from January to November 2014. Data were analyzed using Microsoft Excel Program. RESULTS: The study included 60.5% (n=379) female and 39.5% (n=247) male patients. The highest group consisted of patients with 80 years or above 37.7% (n=236). Cerebrovascular disease (CVD) (n=95; 25.0%), senility (n=56; 14.8%) and Alzheimer’s disease (n=50; 13.2%) were commonly observed in women. Male patients had CVD (n=54; 21.8%), femur fracture or gonarthrosis which required surgery (n=28; 11.3%), and fracture due to trauma or traffc accidents (n=28; 11.3%), senility and Alzheimer’s disease (n=218.5%). CONCLUSION: In recent years home health care units became even more important after the gradual increase in the elderly population and injuries due to accidents. This study can help to provide home health care units in a more effcient manner by educating the staff and relatives who take care of the patients. PMID:28058324

  5. Geriatric day hospital: opportunity or threat? A qualitative exploratory study of the referral behaviour of Belgian general practitioners

    PubMed Central

    2010-01-01

    Background In order to address the challenges of an ageing population the Belgian government decided to allocate resources to the creation of geriatric day hospitals (GDHs). Although GDHs are meant to be a strategy to support general practitioners (GPs) caring for the frail elderly, few Belgian GPs seem to refer to a GDH. This study aims to explore the barriers and facilitating factors of GPs' referral to GDHs. Methods A qualitative study using focus group discussions (FGDs) was conducted. Fifteen FGDs were organized in the different Belgian regions (Flanders, Wallonia, Brussels). Results Contextual factors such as the unsatisfactory cooperation between hospital and GPs and organizational barriers such as the lack of communication on referral procedures between hospital and primary health care (PHC) were identified. Lack of basic knowledge about the concept or the local organization of GDH seemed to be a problem. Unclear task descriptions, responsibilities and activities of a GDH formed prominent points of discussion in all FGDs. Nevertheless a lot of possible advantages and disadvantages of GDHs for the patient and for the GP were mentioned. Conclusions In the case of poor referral to GDHs, focusing on improving overall collaboration between primary and secondary health care is essential. This can be achieved by actively delivering adequate information, permanent communication and more involvement of PHC in the organization and functioning of GDHs. The absence of a transparent health care system with delineated role definitions, seems to hinder the integration of new initiatives like GDHs in the care process. Strategies to enhance referral to GDHs should use a comprehensive approach. PMID:20619001

  6. A randomised trial deploying a simulation to investigate the impact of hospital discharge letters on patient care in general practice

    PubMed Central

    Jiwa, Moyez; Meng, Xingqiong; O'Shea, Carolyn; Magin, Parker; Dadich, Ann; Pillai, Vinita

    2014-01-01

    Objective To determine how the timing and length of hospital discharge letters impact on the number of ongoing patient problems identified by general practitioners (GPs). Trial design GPs were randomised into four groups. Each viewed a video monologue of an actor-patient as he might present to his GP following a hospital admission with 10 problems. GPs were provided with a medical record as well as a long or short discharge letter, which was available when the video was viewed or 1 week later. GPs indicated if they would prescribe, refer or order tests for the patient's problems. Methods Setting Primary care. Participants Practising Australian GPs. Intervention A short or long hospital discharge letter enumerating patient problems. Outcome measure Number of ongoing patient problems out of 10 identified for management by the GPs. Randomisation 1:1 randomisation. Blinding (masking) Single-blind. Results Numbers randomised 59 GPs. Recruitment GPs were recruited from a network of 102 GPs across Australia. Numbers analysed 59 GPs. Outcome GPs who received the long letter immediately were more satisfied with this information (p<0.001). Those who received the letter immediately identified significantly more health problems (p=0.001). GPs who received a short, delayed discharge letter were less satisfied than those who received a longer delayed letter (p=0.03); however, both groups who received the delayed letter identified a similar number of health problems. GPs who were older, who practised in an inner regional area or who offered more patient sessions per week identified fewer health problems (p values <0.01, <0.05 and <0.05, respectively). Harms Nil. Conclusions Receiving information during patient consultation, as well as GP characteristics, influences the number of patient problems addressed. Trial registration number ACTRN12614000403639. PMID:25005597

  7. Inguinal hernia repair: are the results from a general hospital comparable to those from dedicated hernia centres?

    PubMed Central

    Cheong, Kai Xiong; Lo, Hong Yee; Neo, Jun Xiang Andy; Appasamy, Vijayan; Chiu, Ming Terk

    2014-01-01

    INTRODUCTION We aimed to report the outcomes of inguinal hernia repair performed at Tan Tock Seng Hospital and compare them with those performed at dedicated hernia centres. METHODS We retrospectively analysed the medical records and telephone interviews of 520 patients who underwent inguinal hernia repair in 2010. RESULTS The majority of the patients were male (498 [95.8%] men vs. 22 [4.2%] women). The mean age was 59.9 ± 15.7 years. Most patients (n = 445, 85.6%) had unilateral hernias (25.8% direct, 64.3% indirect, 9.9% pantaloon). The overall recurrence rate was 3.8%, with a mean time to recurrence of 12.0 ± 8.6 months. Risk factors for recurrence included contaminated wounds (odds ratio [OR] 50.325; p = 0.004), female gender (OR 8.757; p = 0.003) and pantaloon hernias (OR 5.059; p = 0.013). Complication rates were as follows: chronic pain syndrome (1.2%), hypoaesthesia (5.2%), wound dehiscence (0.4%), infection (0.6%), haematoma/seroma (4.8%), urinary retention (1.3%) and intraoperative visceral injury (0.6%). Most procedures were open repairs (67.7%), and laparoscopic repair constituted 32.3% of all the inguinal hernia repairs. Open repairs resulted in longer operating times than laparoscopic repairs (86.6 mins vs. 71.6 mins; p < 0.001), longer hospital stays (2.7 days vs. 0.7 days; p = 0.020) and a higher incidence of post-repair hypoaesthesia (6.8% vs. 1.8%; p = 0.018). However, there were no significant differences in recurrence or other complications between open and laparoscopic repair. CONCLUSION A general hospital with strict protocols and teaching methodologies can achieve inguinal hernia repair outcomes comparable to those of dedicated hernia centres. PMID:24763834

  8. Adaptation and validation of a questionnaire assessing patient satisfaction with pharmacy services in general hospitals

    PubMed Central

    Al-Jumah, Khalaf Ali; Hassali, Mohamed Azmi; Al-Zaagi, Ibrahem

    2014-01-01

    Objective The aim of this study was to cross-culturally adapt the Armando Patient Satisfaction Questionnaire into Arabic and validate its use in the general population. Methods The translation was conducted based on the principles of the most widely used model in questionnaire translation, namely Brisling’s back-translation model. A written authorization allowing translation into Arabic was obtained from the original author. The Arabic version of the questionnaire was distributed to 480 participants to evaluate construct validity. Statistical Package for Social Sciences version 17.0 for Windows was used for the statistical analysis. Results The response rate of this study was 96%; most of the respondents (52.5%) were female. Internal consistency was assessed using Cronbach’s α, which showed that this questionnaire provides a high reliability coefficient (reaching 0.9299) and a high degree of consistency and thus can be relied upon in future patient satisfaction research. PMID:24707170

  9. An audit of lamotrigine, levetiracetam and topiramate usage for epilepsy in a district general hospital.

    PubMed

    Chappell, Brian; Crawford, Pamela

    2005-09-01

    The aim of this audit was to ascertain outcomes for people who had taken or who were still taking three "new generation" broad-spectrum antiepileptic drugs (AEDs), namely lamotrigine, levetiracetam and topiramate. Thirteen percent of people became seizure free and approximately, one-third had a reduction of greater than 50% in their seizures. Two-thirds of people were still taking their audit AED. In addition, approximately one-third of people with a learning disability derived substantial benefit, although the rate of seizure freedom was lower. All three AEDs were most successful at treating primary generalised epilepsy and least successful with symptomatic generalised epilepsy. With some reservations the data suggests that levetiracetam and topiramate are the most efficacious AEDs, but topiramate is the least well tolerated. These results mean consideration of a "general prescribing policy" is important when using and choosing these AEDs. We conclude that lamotrigine, levetiracetam and topiramate are useful additions to the armamentarium of AEDs.

  10. Epidemiological characteristics of Pseudomonas aeruginosa strains causing infection in an Italian general hospital. A one-year surveillance.

    PubMed

    Grigis, A; Farina, C; Moioli, F; Parea, M; Cirillo, D M; Goglio, A; Marchiaro, G

    1995-06-01

    During the 1989 calendar year, P. aeruginosa caused clinical infections in 0.46% of patients admitted to Ospedali Riuniti (a general hospital), Bergamo, Italy. Strains (n = 267) of P. aeruginosa were collected during this period, and epidemiological characteristics were studied. The mean prevalence of P. aeruginosa infection in inpatients was 1.1% (range 0.06-7.3), whereas outpatients showed a significantly lower prevalence of infection (0.05%). Strains were recovered from inpatients of surgical wards (n = 126; 47.2%), and outpatients (n = 15; 5.6%). Males were more often affected than females (2.7:1). Infection of the urinary tract was the most common (34.1%). Pseudomonas aeruginosa was also involved in lower respiratory tract infections (18.7%) and septicaemia (17.6%). Four typing methods were performed, i.e. serotyping, antibiotyping, pyocin typing, and restriction endonuclease analysis (REA). Serotypes O:11 and O:6 were endemic in the hospital. Some serotypes correlated with specific clinical wards. Pyocin typing was an unreliable epidemiological tool. However, antibiotyping showed the presence of some epidemic clusters, probably related to the antibiotic consumption of the patients. REA suggested the circulation of edemic P. aeruginosa strains in both the obstetrics and neurosurgery wards.

  11. The effect of a whole-system approach in an antimicrobial stewardship programme at the Singapore General Hospital.

    PubMed

    Teo, J; Kwa, A L H; Loh, J; Chlebicki, M P; Lee, W

    2012-06-01

    Inappropriate antibiotic use contributes to antimicrobial resistance. Multi-faceted antimicrobial stewardship programmes (ASPs) are recommended for sustainable changes in prescribing practices. A multi-disciplinary ASP was established in October 2008 and piloted in the Departments of General Surgery, Renal Medicine and Endocrinology sequentially. To improve the quality of patient care via optimising the (1) choice, (2) dose, (3) route and (4) duration of antibiotics, a "whole-system" approach incorporating prospective review with immediate concurrent feedback (ICF), prescriber education (public or individualised), de-escalation of therapy, dose optimisation and parenteral-to-oral conversion, while recognising the autonomy of primary prescribers, was adopted. The audited department received a quarterly outcomes report and any common unaccepted practices would be addressed. Outcomes were analysed for 12 months post-ASP implementation. A total of 1,535 antibiotic prescriptions were reviewed. Antimicrobial use in 376 (24.5%) prescriptions was inappropriate. Of 596 interventions made, 70.2% were accepted. A reduction in audited antibiotics consumption resulted in acquisition cost savings of S$198,575 for the hospital. Patients' cost-savings attributable to ASP-initiated interventions were $91,194. The overall all-cause mortality rate and median monthly inpatient-days pre- and post-intervention remained stable. A "whole-system" ASP was effective in optimising antibiotic use in our hospital, without compromising clinical outcomes.

  12. Review of cases of hyponatraemia in the Port Moresby General Hospital between August 1993 and June 1995.

    PubMed

    Kende, M; Ray, U; Hanhupa, B

    1999-01-01

    Hyponatraemia (serum sodium level below 130 mmol/l) is a common electrolyte abnormality in a hospital population. It can be associated with dehydration, overhydration or normal hydration. Clinically, it is important to recognize the common diseases associated with hyponatraemia since correct treatment in terms of fluid replacement is essential in preventing complications of low serum sodium. We have reviewed results of serum sodium tested from patients admitted to the Port Moresby General Hospital between 1993 and 1995. This was aimed at identifying the most common features associated with low sodium. Clinical information and diagnosis were obtained by looking through a series of request forms. Of the approximately 30,000 blood samples taken over 23 months, the percentage of samples with hyponatraemia was about 1%. Hyponatraemia was more common in medical (38%) and paediatric (35%) cases and at the extremes of ages, ie, under the age of 6 years and above 40 years. Over a quarter of the hyponatraemic patients had severe hyponatraemia (serum sodium below 120 mmol/l). Clinical conditions commonly associated with hyponatraemia, in descending order of importance, were diarrhoea and vomiting, renal failure, central nervous system infections and trauma, pulmonary infections, oedematous states (eg, nephrotic syndrome) and diabetes mellitus.

  13. [Profile and sensitivity to antibiotics of 115 staphylococcal strains implicated in septicemia in a Tunisian general hospital].

    PubMed

    Boukadida, J; Ben Abdallah, H; Boukadida, N

    2003-11-01

    Staphylococci remain among the main responsible bacteria for septicemia. The resistance to antibiotics already makes a prognosis difficult. We carried out a study on Staphylococcus isolated from blood culture on 3 years in general hospital in Tunisia. We present the different species and their sensitivity to antibiotics. S. aureus is the predominant isolated species. S. epidermidis is essentially isolated in newborn intensive care unit. The meticillino-resistance concerns 14% of the whole strains and 5.2 of the S. aureus. No resistance is found as regard the vancomycin and the pristinamycin; ofloxacine is inactive on 14.8% of strains and the gentamicine on 11.3%. The resistance of staphylococci of our study is lower than the rates reported in southern Europe and in North America.

  14. Psychiatric liaison consultations of patients without psychiatric illness in a general hospital in Germany: a retrospective analysis.

    PubMed

    Fißler, Maria; Quante, Arnim

    2015-11-01

    The aim of the study was to explore the utilization of consultation-liaison psychiatric (CLP) service among nonpsychiatric patients in a general hospital. A retrospective analysis was conducted on all patients seen by the CLP in 2013. In 66 (5.9 %) of these 1112 consultations, no psychiatric diagnosis could be identified. These cases were analyzed by department of referral, assumed psychiatric symptoms, consensus with the symptoms found by the CLP, and recommended procedures. Assumed depressive symptoms, suicidal ideations and "difficult" behavior were the predominant reasons for CLP referrals. As the results suggest, CLP service was mostly "overprovided" because of uncertainty about the working areas of psychiatrists or overestimation of the severity of symptoms. These findings emphasize the importance to develop more precise guidelines for CLP services and that it could be worth striving for a more profound psychiatric training for nonpsychiatric physicians to achieve an optimal treatment for patients.

  15. Anxiety and depressive disorders in an emergency department ward of a general hospital: a control study

    PubMed Central

    Marchesi, C; Brusamonti, E; Borghi, C; Giannini, A; Di, R; Minneo, F; Quarantelli, C; Maggini, C

    2004-01-01

    Objective: In this study anxiety and depressive disorders were evaluated in patients admitted to an emergency department (ED) or to a medical department (MD). Methods: The General Health Questionnaire-30 (GHQ-30) was administered to screen all patients (n = 719) consecutively admitted to an ED (n = 556) and to MD (n = 163) in a 120 day period. All GHQ-30 positive (score>4) underwent the Mini International Neuropsychiatric Interview, a structured interview to diagnose mental disorders according to DSM-IV criteria. Results: Subjects positive to GHQ-30 were 264 (47%) in ED and 88 (54%) in MD. A mental disorder was diagnosed in 233 ED patients (42%) and in 77 MD patients (47%) (p = 0.70). The most frequent disorders were anxiety disorders in ED patients (18.1%) and depressive disorders in MD patients (21%) (p = 0.04). Conclusions: Anxious patients more frequently seek attention at ED, whereas patients with depressive disorders are more often observed in medical units. The improvement of quality of care, the waste of healthcare resources through unnecessary medical care, and the well known efficacy of appropriate treatments in patients with anxiety and depressive disorders make the diagnosis of these patients particularly important. PMID:14988342

  16. Antinuclear antibody prevalence in a general pediatric cohort from Mexico City: discordance between immunofluorescence and multiplex assays

    PubMed Central

    Somers, Emily C; Monrad, Seetha U; Warren, Jeffrey S; Solano, Maritsa; Schnaas, Lourdes; Hernandez-Avila, Mauricio; Tellez-Rojo, Martha Maria; Hu, Howard

    2017-01-01

    Objective To characterize antinuclear antibody (ANA) prevalence according to distinct assay methodologies in a pediatric cohort from Mexico City, and to further examine associations with age and sex. Methods Serum ANA were measured by indirect immunofluorescence assay (IFA) and multiplex immunoassay in 114 children aged 9–17 years. IFA was considered positive at a cutoff titer of ≥1:80. Agreement between assay methods was assessed by kappa statistic. Sensitivity, specificity, and 95% confidence intervals (CIs) of the multiplex were computed with IFA as the reference standard. Results Of the 114 children (mean age 14.7 [standard deviation 2.1] years; 54 [47%] female), 18 of 114 (15.8%) were ANA positive by IFA, and 11 of 114 (9.6%) by 11-antigen multiplex assay. ANA prevalence was higher in females compared with males by both of the methods (ratios 1.6–1.9 to 1). Agreement between tests was classified as slight by kappa (κ=0.177 [95% CI −0.051, 0.406]). The multiplex immunoassay had sensitivity of 22.2% (95% CI 6.4, 47.6) and specificity of 92.7% (95% CI 85.6, 97.0), and failed to capture 3 of 4 (75%) of the high-titer (≥1:1280) IFA-positives. Conclusion Up to 15% of children in this general population cohort were ANA positive, with a higher rate of positivity among females according to both assay methods. Substantial discordance in ANA results was found between IFA and multiplex methods, even for high-titer IFA positives. These findings underscore the need to sufficiently account for assay characteristics when interpreting ANA test results, and support IFA as the more appropriate assay for studies of subclinical autoimmunity. PMID:28053555

  17. Workplace violence in different settings and among various health professionals in an Italian general hospital: a cross-sectional study

    PubMed Central

    Ferri, Paola; Silvestri, Monica; Artoni, Cecilia; Di Lorenzo, Rosaria

    2016-01-01

    Background Workplace violence (WPV) against health professionals is a global problem with an increasing incidence. The aims of this study were as follows: 1) to examine the frequency and characteristics of WPV in different settings and professionals of a general hospital and 2) to identify the clinical and organizational factors related to this phenomenon. Methods The study was cross-sectional. In a 1-month period, we administered the “Violent Incident Form” to 745 professionals (physicians, head nurses, nurses, nursing assistants), who worked in 15 wards of a general hospital in northern Italy. Results With a response rate of 56%, 45% of professionals reported WPV. The most frequently assaulted were nurses (67%), followed by nursing assistants (18%) and physicians (12%). The first two categories were correlated, in a statistically significant way, with the risk of WPV (P=0.005, P=0.004, multiple logistic regression). The violent incidents more frequently occurred in psychiatry department (86%), emergency department (71%), and in geriatric wards (57%). The assailants more frequently were males whereas assaulted professionals more often were females. Men committed physical violence more frequently than women, in a statistically significant way (P=0.034, chi-squared test). Verbal violence (51%) was often committed by people in a lucid and normal state of consciousness; physical violence (49%) was most often perpetrated by assailants affected by dementia, mental retardation, drug and substance abuse, or other psychiatric disorders. The variables positively related to WPV were “calling for help during the attack” and “physical injuries suffered in violent attack” (P=0.02, P=0.03, multiple logistic regression). Conclusion This study suggests that violence is a significant phenomenon and that all health workers, especially nurses, are at risk of suffering aggressive assaults. WPV presented specific characteristics related to the health care settings, where

  18. Attitudes and Relationship between Physicians and the Pharmaceutical Industry in a Public General Hospital in Lima, Peru

    PubMed Central

    De Ferrari, Aldo; Gentille, Cesar; Davalos, Long; Huayanay, Leandro; Malaga, German

    2014-01-01

    Background The interaction between physicians and the pharmaceutical industry influences physicians' attitudes and prescribing behavior. Although largely studied in the US, this topic has not been well studied in resource-poor settings, where a close relationship between physicians and industry still exists. Objective To describe physician interactions with and attitudes towards the pharmaceutical industry in a public general hospital in Lima, Peru. Design Descriptive, cross-sectional study through an anonymous, self-filled questionnaire distributed among faculty and trainee physicians of five different clinical departments working in a Peruvian public general hospital. A transcultural validation of an existing Spanish questionnaire was performed. Exposure to marketing activities, motivations to contact pharmaceutical representatives and attitudes towards industry were studied. Collected data was analyzed by degree of training, clinical department, gender and teaching status. Attitudes were measured on a four-point LIKERT scale. Results 155 physicians completed the survey, of which 148 were included in the study sample. 94.5% of attending physicians reported ongoing encounters with pharmaceutical representatives. The most common industry-related activities were receiving medical samples (91.2%), promotional material (87.8%) and attending meetings in restaurants (81.8%). Respondents considered medical samples and continuing medical education the most ethically acceptable benefits. We found significant differences between attendings and residents, and teaching and non-teaching attendings. An association between the amount of encounters with pharmaceutical representatives, and attitudes towards industry and acceptance of medical samples was found. Conclusions A close physician-industry relationship exists in the population under study. The contact is established mainly through pharmaceutical representatives. Medical samples are the most received and ethically accepted

  19. Clinical Characteristics of Patients with Adrenal Insufficiency in a General Hospital

    PubMed Central

    Lee, Ye Yeon; Cho, Nan Hee; Lee, Jong Won; Kim, Nam Kyung; Kim, Hye Soon

    2017-01-01

    Background Adrenal insufficiency (AI) is a life-threatening disorder caused by the deficiency of adrenal steroid hormones. This retrospective cross-sectional study investigated the characteristics of patients with AI in Korea. Methods All consecutive patients with suspected AI who received care at a tertiary referral center in Korea in 2014 and underwent adrenocorticotropic hormone stimulation or insulin-tolerance testing were identified through a review of medical charts. Patients diagnosed with AI were enrolled. Their demographic, clinical, and treatment details were extracted. Results Of 771 patients with suspected AI, 183 (23.7%) received a definitive diagnosis. The most common reason for testing was the presence of suspicious AI-related symptoms (30.0%), followed by a history of steroid medications (23.5%). Their mean age was 66.7 years, and females predominated (67.8%). The most common symptoms were general weakness, anorexia, arthralgia, and fever. Approximately half (53.6%) had a history of steroid use. Hydrocortisone was the most common treatment (71.6%), with most patients taking a 30 mg dose (44.2%). The most common dose frequency was twice a day (78.6%). Fourteen patients were treated for adrenal crisis (n=10, 5.5%) or an intercurrent illness (n=4, 2.2%). Conclusion AI may have been caused by steroid medication use in many of the patients included in this study. The detection of AI can be improved by careful history-taking and being alert to the possibility that a patient has used steroids. PMID:28256113

  20. Economic Evaluation of a General Hospital Unit for Older People with Delirium and Dementia (TEAM Randomised Controlled Trial)

    PubMed Central

    Tanajewski, Lukasz; Franklin, Matthew; Gkountouras, Georgios; Berdunov, Vladislav; Harwood, Rowan H.; Goldberg, Sarah E.; Bradshaw, Lucy E.; Gladman, John R. F.; Elliott, Rachel A.

    2015-01-01

    Background One in three hospital acute medical admissions is of an older person with cognitive impairment. Their outcomes are poor and the quality of their care in hospital has been criticised. A specialist unit to care for older people with delirium and dementia (the Medical and Mental Health Unit, MMHU) was developed and then tested in a randomised controlled trial where it delivered significantly higher quality of, and satisfaction with, care, but no significant benefits in terms of health status outcomes at three months. Objective To examine the cost-effectiveness of the MMHU for older people with delirium and dementia in general hospitals, compared with standard care. Methods Six hundred participants aged over 65 admitted for acute medical care, identified on admission as cognitively impaired, were randomised to the MMHU or to standard care on acute geriatric or general medical wards. Cost per quality adjusted life year (QALY) gained, at 3-month follow-up, was assessed in trial-based economic evaluation (599/600 participants, intervention: 309). Multiple imputation and complete-case sample analyses were employed to deal with missing QALY data (55%). Results The total adjusted health and social care costs, including direct costs of the intervention, at 3 months was £7714 and £7862 for MMHU and standard care groups, respectively (difference -£149 (95% confidence interval [CI]: -298, 4)). The difference in QALYs gained was 0.001 (95% CI: -0.006, 0.008). The probability that the intervention was dominant was 58%, and the probability that it was cost-saving with QALY loss was 39%. At £20,000/QALY threshold, the probability of cost-effectiveness was 94%, falling to 59% when cost-saving QALY loss cases were excluded. Conclusions The MMHU was strongly cost-effective using usual criteria, although considerably less so when the less acceptable situation with QALY loss and cost savings were excluded. Nevertheless, this model of care is worthy of further evaluation

  1. Risk factors associated with calcium oxalate urolithiasis in dogs evaluated at general care veterinary hospitals in the United States.

    PubMed

    Okafor, Chika C; Lefebvre, Sandra L; Pearl, David L; Yang, Mingyin; Wang, Mansen; Blois, Shauna L; Lund, Elizabeth M; Dewey, Cate E

    2014-08-01

    Calcium oxalate urolithiasis results from the formation of aggregates of calcium salts in the urinary tract. Difficulties associated with effectively treating calcium oxalate urolithiasis and the proportional increase in the prevalence of calcium oxalate uroliths relative to other urolith types over the last 2 decades has increased the concern of clinicians about this disease. To determine factors associated with the development of calcium oxalate urolithiasis in dogs evaluated at general care veterinary hospitals in the United States, a retrospective case-control study was performed. A national electronic database of medical records of all dogs evaluated between October 1, 2007 and December 31, 2010 at 787 general care veterinary hospitals in the United States was reviewed. Dogs were selected as cases at the first-time diagnosis of a laboratory-confirmed urolith comprised of at least 70% calcium oxalate (n=452). Two sets of control dogs with no history of urolithiasis diagnosis were randomly selected after the medical records of all remaining dogs were reviewed: urinalysis examination was a requirement in the selection of one set (n=1808) but was not required in the other set (n=1808). Historical information extracted included urolith composition, dog's diet, age, sex, neuter status, breed size category, hospital location, date of diagnosis, and urinalysis results. Multivariable analysis showed that the odds of first-time diagnosis of calcium oxalate urolithiasis were significantly (P<0.05) greater for dogs<7 years, males (OR: 7.77, 95% CI: 4.93-12.26), neutered (OR: 2.58, 1.44-4.63), toy- vs. medium-sized breeds (OR: 3.15, 1.90-5.22), small- vs. medium-sized breeds (OR: 3.05, 1.83-5.08), large- vs. medium-sized breeds (OR: 0.05, 0.01-0.19), and those with a diagnosis of cystitis within the previous year (OR: 6.49, 4.14-10.16). Urinary factors significantly associated with first-time diagnosis of calcium oxalate urolithiasis were acidic vs. basic pH (OR: 1.94, 1

  2. Reshaping Care for Older People: Trends in emergency admissions to hospital during a period of simultaneous interventions in Glasgow City, April 2011-March 2015.

    PubMed

    Levin, Kate A; Crighton, Emilia M

    2016-12-01

    This study describes trends in emergency admissions (EAs) in Glasgow City during a period when interventions were designed and implemented, aimed at shifting the balance from institutional to community-based care. Standardised monthly rates of EAs between April 2011 and March 2015 were calculated, for residents of Glasgow City aged 65 years and over. Multilevel zero-inflated Negative Binomial models for EAs nested by datazone were created, adjusting for sex, 5-year age group, area-level deprivation (SIMD quintile), season, month and month squared. Models were also run for EAs by cause, for three causes: chronic obstructive pulmonary disease (COPD), falls and dementia. The rate of EAs first rose then fell during the study period. When modelled, RRs for month (RR for month 12 relative to month 1 and 95% CI=1.02 (0.99, 1.06)) and month squared (RR=0.999 (0.998, 0.999)) indicated a rise in admissions until February 2012, followed by a fall. Risk of admission was greater for males and increased with increasing age group. The risk of going into hospital for those from SIMD 5 (most affluent) was 0.58 (0.56, 0.59) relative to those from SIMD 1 (most deprived). Socioeconomic inequalities were particularly great for COPD-related admissions, where RR for SIMD 5 was 0.25 (0.23, 0.28) times that of SIMD 1. An interaction term between month and SIMD was not significant for any outcome. For dementia-related EAs there was a suggestion that inequalities may be reducing over time. EAs for those aged 65 years and more reduced during the Change Fund period, with similar relative reductions observed across all deprivation quintiles.

  3. Bacterial and viral pathogen spectra of acute respiratory infections in under-5 children in hospital settings in Dhaka city

    PubMed Central

    Bhuyan, Golam Sarower; Hossain, Mohammad Amir; Sarker, Suprovath Kumar; Rahat, Asifuzzaman; Islam, Md Tarikul; Haque, Tanjina Noor; Begum, Noorjahan; Qadri, Syeda Kashfi; Muraduzzaman, A. K. M.; Islam, Nafisa Nawal; Islam, Mohammad Sazzadul; Sultana, Nusrat; Jony, Manjur Hossain Khan; Khanam, Farhana; Mowla, Golam; Matin, Abdul; Begum, Firoza; Shirin, Tahmina; Ahmed, Dilruba; Saha, Narayan; Qadri, Firdausi

    2017-01-01

    The study aimed to examine for the first time the spectra of viral and bacterial pathogens along with the antibiotic susceptibility of the isolated bacteria in under-5 children with acute respiratory infections (ARIs) in hospital settings of Dhaka, Bangladesh. Nasal swabs were collected from 200 under-five children hospitalized with clinical signs of ARIs. Nasal swabs from 30 asymptomatic children were also collected. Screening of viral pathogens targeted ten respiratory viruses using RT-qPCR. Bacterial pathogens were identified by bacteriological culture methods and antimicrobial susceptibility of the isolates was determined following CLSI guidelines. About 82.5% (n = 165) of specimens were positive for pathogens. Of 165 infected cases, 3% (n = 6) had only single bacterial pathogens, whereas 43.5% (n = 87) cases had only single viral pathogens. The remaining 36% (n = 72) cases had coinfections. In symptomatic cases, human rhinovirus was detected as the predominant virus (31.5%), followed by RSV (31%), HMPV (13%), HBoV (11%), HPIV-3 (10.5%), and adenovirus (7%). Streptococcus pneumoniae was the most frequently isolated bacterial pathogen (9%), whereas Klebsiella pneumaniae, Streptococcus spp., Enterobacter agglomerans, and Haemophilus influenzae were 5.5%, 5%, 2%, and 1.5%, respectively. Of 15 multidrug-resistant bacteria, a Klebsiella pneumoniae isolate and an Enterobacter agglomerans isolate exhibited resistance against more than 10 different antibiotics. Both ARI incidence and predominant pathogen detection rates were higher during post-monsoon and winter, peaking in September. Pathogen detection rates and coinfection incidence in less than 1-year group were significantly higher (P = 0.0034 and 0.049, respectively) than in 1–5 years age group. Pathogen detection rate (43%) in asymptomatic cases was significantly lower compared to symptomatic group (P<0.0001). Human rhinovirus, HPIV-3, adenovirus, Streptococcus pneumonia, and Klebsiella pneumaniae had

  4. Higher cost sharing for visiting general hospitals and the changing trend in the first-visited healthcare organization among newly diagnosed hypertension patients

    PubMed Central

    Shin, Jaeyong; Choi, Young; Lee, Sang Gyu; Kim, Tae Hyun; Park, Eun-Cheol

    2016-01-01

    Abstract Unnecessary use of high-quality resources in general hospitals hinders treatment of patients with urgent and complicated conditions. Thus, the Korean Government has sought to reduce general hospital visiting of patients with 52 mild diseases, including hypertension. The higher cost sharing for medical expenses and medications from general hospitals were enacted in 2009 and 2011, respectively. We determined whether these regulations were effective through evaluating changing trends in first-visited healthcare organizations and defined the first visiting healthcare organization level (primary clinics, hospital, and general hospital) as an outcome measure. Data of 32,830 mild hypertension patients from 2004 to 2013 were retrieved from the Korean National Health Insurance Service National Sample Cohort. This was a retrospective study involving a large national cohort with patient samples (representing 2% of the total Korean population) stratified on the basis of sociodemographic information. Mutinomial logistic regression were performed for the first visiting to different health organizations, compared to the first visiting to primary clinics. Patients in 2012 and 2013 had significantly lower odds (“2012”: 0.68, 95% confidence interval [CI]: 0.56–0.81/“2013”: 0.66, 95% CI 0.54–0.81) of first visiting general hospitals compared with those in 2008, although decreased tendencies (albeit nonsignificant) were already evident in 2010 and 2011. Thus, government health policies for cost-containment seem effective in decreasing first visiting of general hospitals among patients with mild essential hypertension. These policies have since extended to Medical Aid beneficiaries; thus, it is needed to continue monitor their results carefully. PMID:27749543

  5. Higher cost sharing for visiting general hospitals and the changing trend in the first-visited healthcare organization among newly diagnosed hypertension patients.

    PubMed

    Shin, Jaeyong; Choi, Young; Lee, Sang Gyu; Kim, Tae Hyun; Park, Eun-Cheol

    2016-10-01

    Unnecessary use of high-quality resources in general hospitals hinders treatment of patients with urgent and complicated conditions. Thus, the Korean Government has sought to reduce general hospital visiting of patients with 52 mild diseases, including hypertension. The higher cost sharing for medical expenses and medications from general hospitals were enacted in 2009 and 2011, respectively.We determined whether these regulations were effective through evaluating changing trends in first-visited healthcare organizations and defined the first visiting healthcare organization level (primary clinics, hospital, and general hospital) as an outcome measure.Data of 32,830 mild hypertension patients from 2004 to 2013 were retrieved from the Korean National Health Insurance Service National Sample Cohort. This was a retrospective study involving a large national cohort with patient samples (representing 2% of the total Korean population) stratified on the basis of sociodemographic information.Mutinomial logistic regression were performed for the first visiting to different health organizations, compared to the first visiting to primary clinics.Patients in 2012 and 2013 had significantly lower odds ("2012": 0.68, 95% confidence interval [CI]: 0.56-0.81/"2013": 0.66, 95% CI 0.54-0.81) of first visiting general hospitals compared with those in 2008, although decreased tendencies (albeit nonsignificant) were already evident in 2010 and 2011.Thus, government health policies for cost-containment seem effective in decreasing first visiting of general hospitals among patients with mild essential hypertension. These policies have since extended to Medical Aid beneficiaries; thus, it is needed to continue monitor their results carefully.

  6. Physicians' attitude towards tobacco dependence in a private hospital in the city of São Paulo, Brazil

    PubMed Central

    Julião, Alessandra Maria; Camargo, Ana Luiza Lourenço Simões; Cítero, Vanessa de Albuquerque; Maranhão, Mara Fernandes; Maluf, Alfredo; Paes, Ângela Tavares; Glezer, Milton; Cendoroglo, Miguel; Schvartsman, Cláudio

    2013-01-01

    ABSTRACT Objective: To investigate how often physicians identify and treat tobacco dependence and whether characteristics as gender, age, marital status, medical specialty and smoking status can influence their attitude towards this question. Methods: A cross-sectional study was performed on 515 physicians working in a private hospital in São Paulo, Brazil, using a confidential voluntary questionnaire sent and answered electronically. Results: We found that 89% of physicians who answered the research questionnaire often or always asked their patients about smoking habits, but only 39% often or always treated patients' tobacco dependence. In our sample, 5.8% of individuals were current smokers. Tobacco dependent physicians provided less treatment for smoking dependence compared with those who had never smoked, or were former smokers. Being a clinician was associated with higher probability to treat tobacco dependence. Conclusion: Physicians should not only address patients' smoking habits but also provide treatment whenever tobacco dependence is diagnosed. To understand physicians' attitude towards smoking may help to develop strategies to stimulate patients' treatment. The development of smoking cessation programs meant specifically for physicians may also be a strategy to enhance patients' treatment. PMID:23843054

  7. [Characteristics of health seeking behaviors for patients with psoriasis in a general hospital].

    PubMed

    Li, Xia; Luo, Dan; Qiu, Yangyang; Chen, Mingliang; Su, Juan; Yi, Mei

    2016-06-28

    目的:了解某综合医院银屑病患者的求医行为特征及其影响因素,为促进银屑病患者形成规范的求医行为、提高其临床治疗效果及生活质量提供参考资料。方法:在横断面研究设计下,以中南地区某大型三级甲等综合医院皮肤性病科门诊作为研究现场,连续收集于2014年4月1日至9月30日期间,前来该门诊就诊且被有资质的皮肤性病专科医生诊断患有银屑病的门诊患者作为研究对象。对愿意参与研究的200名患者样本以面对面问卷调查方式,采用自编一般情况问卷、求医行为调查表和相关知识问卷了解患者社会人口学特征、求医行为情况以及相关知识知晓程度;采用国际通用的银屑病皮损面积和严重程度指数(Psoriasis Area and Severity Index,PASI)、病人健康问卷抑郁量表(Patient Health Questionnaire Depression Module,PHQ-9)和广泛性焦虑量表(Generalized Anxiety Disorder Scale,GAD-7)分别评定患者的疾病严重程度和情绪状态。结果:70.5%(141/200)的患者有转诊经历。在首诊过程中,91.0%(182/200)出现症状后选择县级及县级以上医疗机构接受治疗,其余9.0%(18/200)选择去乡镇卫生院或街道/社区门诊、私人门诊看病;在去县级及以上级别医疗机构就诊的患者中,51.0%的患者首诊医疗机构为地市级医院,其次为省级医院(35.0%)。91.0%的患者是与配偶或亲友商量后做出的首诊决定。有50名(25%)患者存在不规范求医行为。logistic回归分析结果显示:家庭人均月收入低于3 000元(OR=2.232,95% CI: 1.086~4.585)、初觉症状后由自己决定就医(OR=3.016, 95% CI: 1.023~8.893)、银屑病严重程度评分高(OR=1.043,95% CI: 1.001~1.088)与患者的不规范求医行为有统计学意义的关联。结论:在银屑病的临床诊疗中,医护人员应特别关注收入状况、求治过程等个人背景特征对其规范就

  8. Community-Academic Partnership to Investigate Low Birth Weight Deliveries and Improve Maternal and Infant Outcomes at a Baltimore City Hospital.

    PubMed

    Harvey, Elizabeth M; Strobino, Donna; Sherrod, Leslie; Webb, Mary Catherine; Anderson, Caroline; White, Jennifer Arice; Atlas, Robert

    2017-02-01

    Purpose Mercy Medical Center (MMC), a community hospital in Baltimore Maryland, has undertaken a community initiative to reduce low birth weight (LBW) deliveries by 10 % in 3 years. MMC partnered with a School of Public Health to evaluate characteristics associated with LBW deliveries and formulate collaborations with obstetricians and community services to improve birth outcomes. Description As part of the initiative, a case control study of LBW was undertaken of all newborns weighing <2500 grams during June 2010-June 2011 matched 2:1 with newborns ≥2500 grams (n = 862). Assessment Logistic regression models including maternal characteristics prior to and during pregnancy showed an increased odds of LBW among women with a previous preterm birth (aOR 2.48; 95 % CI: 1.49-4.13), chronic hypertension (aOR: 2.53; 95 % CI: 1.25-5.10), hospitalization during pregnancy (aOR: 2.27; 95 % CI:1.52-3.40), multiple gestation (aOR:12.33; 95 % CI:5.49-27.73) and gestational hypertension (aOR: 2.81; 95 % CI: 1.79-4.41). Given that both maternal pre-existing conditions and those occurring during pregnancy were found to be associated with LBW, one strategy to address pregnant women at risk of LBW infants is to improve the intake and referral system to better triage women to appropriate services in the community. Meetings were held with community organizations and feedback was operationalized into collaboration strategies which can be jointly implemented. Conclusion Education sessions with providers about the referral system are one ongoing strategy to improve birth outcomes in Baltimore City, as well as provision of timely home visits by nurses to high-risk women.

  9. Reliability of Reported Maternal Smoking: Comparing the Birth Certificate to Maternal Worksheets and Prenatal and Hospital Medical Records, New York City and Vermont, 2009.

    PubMed

    Howland, Renata E; Mulready-Ward, Candace; Madsen, Ann M; Sackoff, Judith; Nyland-Funke, Michael; Bombard, Jennifer M; Tong, Van T

    2015-09-01

    Maternal smoking is captured on the 2003 US Standard Birth Certificate based on self-reported tobacco use before and during pregnancy collected on post-delivery maternal worksheets. Study objectives were to compare smoking reported on the birth certificate to maternal worksheets and prenatal and hospital medical records. The authors analyzed a sample of New York City (NYC) and Vermont women (n = 1,037) with a live birth from January to August 2009 whose responses to the Pregnancy Risk Assessment Monitoring System survey were linked with birth certificates and abstracted medical records and maternal worksheets. We calculated smoking prevalence and agreement (kappa) between sources overall and by maternal and hospital characteristics. Smoking before and during pregnancy was 13.7 and 10.4% using birth certificates, 15.2 and 10.7% using maternal worksheets, 18.1 and 14.1% using medical records, and 20.5 and 15.0% using either maternal worksheets or medical records. Birth certificates had "almost perfect" agreement with maternal worksheets for smoking before and during pregnancy (κ = 0.92 and 0.89) and "substantial" agreement with medical records (κ = 0.70 and 0.74), with variation by education, insurance, and parity. Smoking information on NYC and Vermont birth certificates closely agreed with maternal worksheets but was underestimated compared with medical records, with variation by select maternal characteristics. Opportunities exist to improve birth certificate smoking data, such as reducing the stigma of smoking, and improving the collection, transcription, and source of information.

  10. Seizure treatment in Angelman syndrome: A case series from the Angelman Syndrome Clinic at Massachusetts General Hospital.

    PubMed

    Shaaya, Elias A; Grocott, Olivia R; Laing, Olivia; Thibert, Ronald L

    2016-07-01

    Epilepsy is a common feature of Angelman syndrome (~80-90%), with the most common seizure types including myoclonic, atonic, atypical absence, focal, and generalized tonic-clonic. Seizure types are similar among the various genetic subtypes, but epilepsy in those with maternal deletions is more frequent and more refractory to medication. Treatment with older antiepileptic drugs such as valproic acid and clonazepam is effective, but these medications tend to have less favorable side effect profiles in Angelman syndrome compared with those in newer medications. This study aimed to assess the use of newer antiepileptic drug therapies in individuals with Angelman syndrome followed at the Angelman Syndrome Clinic at the Massachusetts General Hospital. Many of the subjects in this study were on valproic acid therapy prior to their initial evaluation and exhibited increased tremor, decreased balance, and/or regression of motor skills, which resolved after tapering off of this medication. Newer antiepileptic drugs such as levetiracetam, lamotrigine, and clobazam, and to a lesser extent topiramate, appeared to be as effective - if not more so - as valproic acid and clonazepam while offering more favorable side effect profiles. The low glycemic index treatment also provided effective seizure control with minimal side effects. The majority of subjects remained on combination therapy with levetiracetam, lamotrigine, and clobazam being the most commonly used medications, indicating a changing trend when compared with prior studies.

  11. Bigger is not always better: what the National Health and Hospitals Reform Commission report means for general practice.

    PubMed

    Kidd, Michael R

    2009-10-19

    The National Health and Hospitals Reform Commission report has a focus on building on "the vital role of general practice", to strengthen primary health care as the "cornerstone of our future health system". The report proposes Comprehensive Primary Health Care Centres and Services that will deliver "one-stop" primary health care; but in health care, bigger is not always better. The biggest challenge for the reform process may well be bringing together the different cultures of the largely private primary health care services, funded by the federal government, and the public, primary and community health services, funded by the states and territories. The report pays little real attention to the reforms needed to address the social determinants of health. There is a clear need for action now on the report's most urgent recommendations for Aboriginal and Torres Strait Islander health, mental health, dental health and services for rural and remote communities. Diversity is a great strength of Australian general practice, and we must not lose it in the rush to reform.

  12. Diabetes Control among Vietnamese Patients in Ho Chi Minh City: An Observational Cross-Sectional Study

    ERIC Educational Resources Information Center

    Yokokawa, Hirohide; Khue, Nguyen Thy; Goto, Aya; Nam, Tran Quang; Trung, Tran The; Khoa, Vo Tuan; Ngoc, Nguyen Thi Boi; Minh, Pham Nghiem; Vinh, Nguyen Quang; Okayama, Akira; Yasumura, Seiji

    2010-01-01

    The objective of this study was to assess the extent of diabetic control and its associated factors among Vietnamese patients with diabetes mellitus (DM). The study was conducted among 652 outpatients who were recruited at a public general hospital (People Hospital 115) and a private clinic (Medic Center) in Ho Chi Minh City, Vietnam. Median age…

  13. Use of biological based therapy in patients with cardiovascular diseases in a university-hospital in New York City

    PubMed Central

    Chagan, Larisa; Bernstein, Diane; Cheng, Judy WM; Kirschenbaum, Harold L; Rozenfeld, Vitalina; Caliendo, Gina C; Meyer, Joanne; Mehl, Bernard

    2005-01-01

    Background The use of complementary and alternative products including Biological Based Therapy (BBT) has increased among patients with various medical illnesses and conditions. The studies assessing the prevalence of BBT use among patients with cardiovascular diseases are limited. Therefore, an evaluation of BBT in this patient population would be beneficial. This was a survey designed to determine the effects of demographics on the use of Biological Based Therapy (BBT) in patients with cardiovascular diseases. The objective of this study was to determine the effect of the education level on the use of BBT in cardiovascular patients. This survey also assessed the perceptions of users regarding the safety/efficacy of BBT, types of BBT used and potential BBT-drug interactions. Method The survey instrument was designed to assess the findings. Patients were interviewed from February 2001 to December 2002. 198 inpatients with cardiovascular diseases (94 BBT users and 104 non-users) in a university hospital were included in the study. Results Users had a significantly higher level of education than non-users (college graduate: 28 [30%] versus 12 [12%], p = 0.003). Top 10 BBT products used were vitamin E [41(43.6%)], vitamin C [30(31.9%)], multivitamins [24(25.5%)], calcium [19(20.2%)], vitamin B complex [17(18.1%)], fish oil [12(12.8%)], coenzyme Q10 [11(11.7%)], glucosamine [10(10.6%)], magnesium [8(8.5%)] and vitamin D [6(6.4%)]. Sixty percent of users' physicians knew of the BBT use. Compared to non-users, users believed BBT to be safer (p < 0.001) and more effective (p < 0.001) than prescription drugs. Forty-two potential drug-BBT interactions were identified. Conclusion Incidence of use of BBT in cardiovascular patients is high (47.5%), as is the risk of potential drug interaction. Health care providers need to monitor BBT use in patients with cardiovascular diseases. PMID:15745441

  14. Cost of hospital care for HIV/AIDS infected patients in three general reference hospitals in Lubumbashi, DR Congo: prospective cohort study

    PubMed Central

    Tshamba, Henri Mundongo; a Kaut, Clarence Mukeng; Kyalubile, Nono Mulubwa; Kakambal, Alphonse Kaij; Yav, Grevisse Ditend; Kaj, Françoise Malonga; Vancaillie, Didier

    2013-01-01

    Introduction This article analyses the composition of healthcare costs for HIV/AIDS infected patients in a country with limited resources and attempts to identify the factors that influence these costs. The aims are to calculate medical care costs, analysing how they vary depending on patients’ income, and to evaluate the factors explaining healthcare consumption. Methods This is a prospective cohort study focusing on patients who were admitted to hospital for a short stay between January 2010 and June 2011, before their integration into a specialised program. The patients were selected randomly. Free consent was obtained from all participants. Data were analysed using the SPSS 19.0 software. The significance threshold was set at 5% and the CI (Confidence Interval) at 95%. We used Kruskal-Wallis tests, Fisher's exact test and multiple linear regression. Results We monitored 209 patients. Their average age was 36.37 years (SD: 8.72). The sex ratio was 0.58 and the women patients were generally younger than the male ones (p=0.011). The overall cost of healthcare amounted to $US 41,922. The cost of Antiretroviral Therapy represented 21.6% ($US 9,045). The price of para-clinical examinations represented 46% ($US 19,136) of the overall cost. The patient's average monthly income was $US 157.40 whereas the average direct cost per patient was$US 201.45. Both monthly income (t=4.385; p=0.0000) and education level (t=3.703 p=0.0003) were statistically significant predictive factors for healthcare consumption. The medical care costs for patients with opportunistic infections were nine times higher than those for patients who presented none. The presence of opportunistic infections increased healthcare consumption by approximately 31$ US (CI 95%: 15-46.9). Conclusion The average direct cost for patients on each short-term stay was higher than the average monthly income. To be able to access the necessary services, the patients need additional resources, which are derived

  15. Support for compassionate care: Quantitative and qualitative evaluation of Schwartz Center Rounds in an acute general hospital

    PubMed Central

    Muncer, Steven J; Hannon, Bronagh C; Goodrich, Joanna; Cornwell, Jocelyn

    2016-01-01

    Objective To evaluate the impact of Schwartz Center Rounds, a multi-disciplinary forum to reflect on the emotional consequences of working in healthcare, on the staff of a large acute general hospital over a three-year period. Design Evaluation data following each Round were collected routinely from all staff attending over this period and analysed quantitatively and qualitatively. Setting An integrated university teaching trust with both acute hospital and community services in the North East of England. Participants Over the three-year period of the study, 795 participant evaluation forms were returned by staff attending the Rounds. Main outcome measures A standard evaluation form completed at the end of each Round by those present, including ratings on a five-point scale against each of eight statements and an opportunity to offer additional free text comments. Results The findings show a very positive response to all aspects of the Rounds by staff who attended. The most highly rated statement was: ‘I have gained insight into how others think/feel in caring for patients’. This was reinforced by the qualitative analysis in which the primary theme was found to be Insight. There were no significant differences between disciplines/staff groups, indicating that all staff whether clinical or non-clinical responded to the Rounds equally positively. Conclusions Schwartz Rounds are highly valued by staff from all disciplines, and by managers and other non-clinicians as well as clinicians. They appear to have the potential to increase understanding between different staff, and so to reduce isolation and provide support. PMID:28050259

  16. [SIM and SINASC: social representation of nurses and professional in administrative sectors who work in hospitals in the city of São Paulo].

    PubMed

    Schoeps, Daniela; Almeida, Marcia Furquim de; Raspantini, Priscila Ribeiro; Novaes, Hillegonda Maria Dutilh; Silva, Zilda Pereira da; Lefevre, Fernando

    2013-05-01

    Few studies have analyzed the SINASC (Live Birth Information System) and MIS (Mortality Information System) applying qualitative methodology seeking to understand data production processes and contexts. This article aims to study the social representation of health professionals about Live Birth Certificates (LBC) and perinatal Death Certificates (DC). A total of 24 interviews were conducted with nurses and other professionals of 16 Unified Health System (SUS) and non-SUS hospitals of the city of São Paulo in 2009. Qualitative methodology was adopted along with the Collective Subject Discourse technique. Professionals acknowledged that they are an integral part of the information production process of SINASC and their reports indicate that they incorporate it in their work routine. They also perceive that training activities are a tool to understand the information produced by them and are aware of the utility of LBC information. Although physicians are legally responsible for the DC, other professionals frequently provide some of the information to complete it. The professionals see themselves as participants of the SINASC. Despite providing information to complete the DC, they do not see themselves as participants of the MIS operation.

  17. Pattern of Skin Diseases at University of Benin Teaching Hospital, Benin City, Edo State, South-South Nigeria: A 12 Month Prospective Study

    PubMed Central

    Ukonu, B. A.; Eze, E. U

    2012-01-01

    Background and Objective: This study aims to look at the pattern and incidence of skin diseases seen in Dermatology/Venereology clinic at the University of Benin Teaching Hospital, Benin City, Edo State, South-South Zone, Nigeria and compare it with other zones of Nigeria. Materials and Methods: This was a prospective study on pattern and incidence of skin diseases in new patients presenting at the Dermatology/Venereology outpatient clinic of the University of Benin Teaching Hospital, Benin City, Edo State, South-South, Nigeria, from September 2006 to August 2007. All patients were seen by the researchers. Diagnosis were made clinically and sometimes with the support of histopathology. Results: A total number of 4786 patients were seen during the study period and these comprised 2647 HIV/AIDS patients and 2112 pure Dermatological patients. Out of 4786 patients, 755 (15.8%) were new patients. The new patients comprised 96 (12.7%) children patients (< 15 years) and 659 (83.7%) adult patients (>15years). The ages of the patients ranged from 2 weeks to 80 years and more than two-third were < 40 years. There were 354 males (46.9%) and 401 females (53.1%). This represents female: male ratio of 1.1: 1. Eczematous dermatitis accounted for 20.9% of the skin diseases and was the most common of the skin diseases observed. This is consistent with observation from other zones in Nigeria. Other skin diseases observed in order of frequencies include: Papulosqamous disorder (9.0%), Infectious skin diseases like fungal, viral, bacterial and parasitic infestation, at 7.9%, 7.7%, 2.3% and 2.1% respectively. Pigmentary disorders (5.0%), hair disorders (4.2%) and Benign neoplastic skin disease (6.5%). All the patients that had neurofibromatosis were females (1.9%). HIV-related skin diseases were observed to have increased remarkably (7.9%) with Kaposi’s sarcoma, papular pruritic eruptions and drug eruptions being the commonest mode of presentation. Conclusion: The current pattern of

  18. Acute Interventions and Referral of Patients With Bipolar Disorder by the Psychiatric Consultation Liaison Service in a General Hospital in Germany: A Retrospective Analysis

    PubMed Central

    Anderson, Christina

    2014-01-01

    Objective: To investigate the population of bipolar patients in a general hospital in Germany who required treatment by a consultant psychiatrist. Method: A retrospective analysis was conducted of the clinical records of 47 patients diagnosed with bipolar disorder (DSM-IV-TR criteria) who were treated by a consultant psychiatrist between 2009 and 2012 in one of the general hospitals of Charité Berlin, Campus Benjamin Franklin, Berlin, Germany. We investigated the sections of the hospital that requested psychiatric consultations for bipolar patients, the status of these patients, and their primary cause of treatment, as well as the intervention (including pharmacotherapy) recommended by the consultant psychiatrist. Results: For more than half of the patients, their psychiatric illness was either directly or indirectly the reason they presented to the hospital. The remaining bipolar patients were treated for various somatic illnesses unrelated to their bipolar disorder throughout the hospital, with a relative overrepresentation of patients in the neurology department. More than half of the patients were referred to a psychiatric hospital by the consultant psychiatrist. Benzodiazepines were the most commonly administered drugs for acute pharmacologic intervention. Conclusions: Psychiatric consultations are not frequently requested for bipolar patients compared to those with other psychiatric disorders. However, more than half of the bipolar patients needed further psychiatric treatment in a psychiatric hospital. This finding emphasizes the importance of psychiatric consultations in a general hospital for bipolar patients. The administration of benzodiazepines as an acute treatment seems to be the standard pharmacologic procedure, not a specific pharmacotherapy like mood stabilizers. PMID:25133062

  19. Secondary stroke in patients with polytrauma and traumatic brain injury treated in an Intensive Care Unit, Karlovac General Hospital, Croatia.

    PubMed

    Belavić, M; Jančić, E; Mišković, P; Brozović-Krijan, A; Bakota, B; Žunić, J

    2015-11-01

    Traumatic brain injury (TBI) is divided into primary and secondary brain injury. Primary brain injury occurs at the time of injury and is the direct consequence of kinetic energy acting on the brain tissue. Secondary brain injury occurs several hours or days after primary brain injury and is the result of factors including shock, systemic hypotension, hypoxia, hypothermia or hyperthermia, intracranial hypertension, cerebral oedema, intracranial bleeding or inflammation. The aim of this retrospective analysis of a prospective database was to determine the prevalence of secondary stroke and stroke-related mortality, causes of secondary stroke, treatment and length of stay in the ICU and hospital. This study included patients with TBI with or without other injuries who were hospitalised in a general ICU over a five-year period. The following parameters were assessed: demographics (age, sex), scores (Glasgow Coma Score, APACHE II, SOFA), secondary stroke (prevalence, time of occurrence after primary brain injury, causes of stroke and associated mortality), length of stay in the ICU and hospital, vital parameters (state of consciousness, cardiac function, respiration, circulation, thermoregulation, diuresis) and laboratory values (leukocytes, C-reactive protein [CRP], blood glucose, blood gas analysis, urea, creatinine). Medical data were analysed for 306 patients with TBI (median age 56 years, range 18-93 years) who were treated in the general ICU. Secondary stroke occurred in 23 patients (7.5%), 10 of whom died, which gives a mortality rate of 43.4%. Three patients were excluded as the cause of the injury was missile trauma. The study data indicate that inflammation is the most important cause of secondary insults. Levels of CRP were elevated in 65% of patients with secondary brain injury; leukocytosis was present in 87% of these patients, and blood glucose was elevated in 73%. The lungs and urinary tract were the most common sites of infection. In conclusion

  20. Entrance surface dose and image quality: comparison of adult chest and abdominal X-ray examinations in general practitioner clinics, public and private hospitals in Malaysia.

    PubMed

    Hambali, Ahmad Shariff; Ng, Kwan-Hoong; Abdullah, Basri Johan Jeet; Wang, Hwee-Beng; Jamal, Noriah; Spelic, David C; Suleiman, Orhan H

    2009-01-01

    This study was undertaken to compare the entrance surface dose (ESD) and image quality of adult chest and abdominal X-ray examinations conducted at general practitioner (GP) clinics, and public and private hospitals in Malaysia. The surveyed facilities were randomly selected within a given category (28 GP clinics, 20 public hospitals and 15 private hospitals). Only departmental X-ray units were involved in the survey. Chest examinations were done at all facilities, while only hospitals performed abdominal examinations. This study used the x-ray attenuation phantoms and protocols developed for the Nationwide Evaluation of X-ray Trends (NEXT) survey program in the United States. The ESD was calculated from measurements of exposure and clinical geometry. An image quality test tool was used to evaluate the low-contrast detectability and high-contrast detail performance under typical clinical conditions. The median ESD value for the adult chest X-ray examination was the highest (0.25 mGy) at GP clinics, followed by private hospitals (0.22 mGy) and public hospitals (0.17 mGy). The median ESD for the adult abdominal X-ray examination at public hospitals (3.35 mGy) was higher than that for private hospitals (2.81 mGy). Results of image quality assessment for the chest X-ray examination show that all facility types have a similar median spatial resolution and low-contrast detectability. For the abdominal X-ray examination, public hospitals have a similar median spatial resolution but larger low-contrast detectability compared with private hospitals. The results of this survey clearly show that there is room for further improvement in performing chest and abdominal X-ray examinations in Malaysia.

  1. Perceptions of Receiving Bad News about Cancer among Bone Cancer Patients in Sarawak General Hospital - A Descriptive Study

    PubMed Central

    Cheah, Whye Lian; Dollah, Nurul Bahariah; Chang, Ching Thon

    2012-01-01

    Background: This study aimed to determine the perceptions and expectations of bone cancer patients with respect to their doctors and the breaking of bad news as well as the environment in which the news was delivered. Methods: A cross-sectional study using a pretested 41-item questionnaire was conducted using convenience sampling among bone cancer patients in Sarawak General Hospital. Face-to-face interviews were conducted after consent was obtained. Data were analysed using SPSS version 16 (SPSS Inc., IL, US). Results: A total of 30 patients were interviewed. The majority of the respondents were younger than 40-years-old, Malays, and female. All of the respondents perceived that they received news in a comfortable place, agreed that the doctor used simple language and appropriate words during the interaction, and believed that the way the doctor delivered the news might influence their life. The majority of the respondents reported that their news was received without interruption, that the doctor was sitting close but without making physical contact, and time was given for patient to ask questions and they were informed accordingly. Conclusion: Delivering bad news regarding cancer is an important communication skill and a complex task that can be learned and acquired. Specially tailored training is proposed to improve medical practice in this area. PMID:23610548

  2. Use of a Hospital-Wide Screening Program for Early Detection of Sepsis in General Surgery Patients.

    PubMed

    MacQueen, Ian T; Dawes, Aaron J; Hadnott, Tracy; Strength, Kristen; Moran, Gregory J; Holschneider, Christine; Russell, Marcia M; Maggard-Gibbons, Melinda

    2015-10-01

    Sepsis remains a significant source of mortality among hospitalized patients. This study examines the usage of a vital sign-based screening protocol in identifying postoperative patients at risk for sepsis at an academic-affiliated medical center. We identified all general surgery inpatients undergoing abdominopelvic surgery from January to June 2014, and compared those with positive screening tests to a sample of screen-negative controls. Multivariate logistic regression was used to identify predictors of positive screening tests and progression to severe sepsis. In total, 478 patients underwent abdominopelvic operations, 59 had positive screening tests, 33 qualified for sepsis, and six progressed to severe sepsis. Predictors of a positive screening test were presence of cancer [odds ratio (OR) 30.7, 95% confidence interval (CI) 2.2-420], emergency operation (OR 6.5, 95% CI 1.7-24), longer operative time (OR 2.2/h, 95% CI 1.2-4.1), and presence of postoperative infection (OR 6.4, 95% CI 1.5-27). The screening protocol had sensitivity 100 per cent and specificity 88 per cent for severe sepsis. We identified no predictors of severe sepsis. In conclusion, vital sign-based screening provides value by drawing early attention to patients with potential to develop sepsis, but escalation of care for these patients should be based on clinical judgment.

  3. [Professional absenteeism in the pediatric service of the general hospital of Loandjili in Pointe-Noire (Congo)].

    PubMed

    Tsiba, J B; Mabiala Babela, J R; Ngoulou, M N; Niambi Poaty, G; Moukouyou Ndombo, M; Moukassa, D

    2013-10-01

    The supply and the quality of care dispensed in a service depend on the quality of the technical and human tray, but also from effective presence of the staff during the work time. The purpose of this study is to determine the absenteeism level of the paramedical staff in General Pediatric and Neonatology of Loandjili General Hospital (Pointe Noire) and identifying causes. A cross-sectional study has been conducted from January 1(st) to June 30(th) 2011 on 21 nurses in General Pediatric and 20 in Neonatology. The absenteeism level was obtained by the link of the number of missing days out of the number of the work days x 100. The absence was justified when it relieved from a reason informed by the administrative texts of the firm; and authorized when it requested the authorization of the administration of the firm. In total, 370 absences have been unregistered, the average absenteeism level was of 8.4%. The absence was justified in 242 cases (65.4%) and authorized in 178 cases (48.1%) which 84 times in writing and 94 times verbally. When the absence was justified, it was the fact of the disease of a member of the family in 82 cases, of the death or the burial of a member of the family in 81 cases, of the agent disease, 84 cases, or other reasons in the remains of cases. The absence occurred between 7 a.m. and 14 p.m. in 57.3%, 14 p.m. and 7 p.m.in, 25.7% and between 7 p.m. and 7 a.m. in 17.0%. The absenteeism was mainly observed (85.7%) for the nurses of about 30 years old and those (59.5%) whom the seniority in the service was inferior or equal 5 years. The absences justified were more observed (p< 10(-4)) for nurses of about 30 years old and those whom the seniority did not pass 5 years. The absenteeism of nurses constitutes a real social and administrative problem that deserves a particular attention considering its impact on the supply and the quality of cares.

  4. Medicare program; reissuance of the wage index in the 1981 schedule of limits on hospital per diem inpatient general routine operating costs--HCFA. Final notice.

    PubMed

    1984-11-26

    This notice affirms the use of the wage index that was used to calculate the 1981 schedule of limits on hospital per diem inpatient general routine operating costs, which was issued on June 30, 1981 [46 FR 33637], and September 30, 1981 [46 FR 48010]. The 1981 wage index was reissued for public comment on February 17, 1984 [49 FR 6175].

  5. The impact of 9/11 on the association of ambient air pollution with daily respiratory hospital admissions in a Canada-US border city, Windsor, Ontario

    PubMed Central

    LUGINAAH, ISAAC; FUNG, KAREN Y.; GOREY, KEVIN M.; KHAN, SHAHEDUL

    2010-01-01

    The 11 September 2001 (9/11) terrorist attacks in the United States resulted in long lines of trucks at the border crossing in Windsor, Ontario. Public concern about the potential impact of these trucks spewing toxic pollutants into the air drew attention to the need to investigate the impact of 9/11 on the daily levels of air pollutants and respiratory hospitalization. In this study, significant increases in respiratory admissions were found one month and 6 months post-9/11. Mean daily respiratory admission was also significantly higher than the same period one year earlier and one year later. SO2 and CO concentration levels were found to be generally higher after 9/11 than one year before and immediately before. Relative risk estimates of respiratory hospitalization after 9/11 showed that SO2 (RR̂ = 1.15 for two-day, RR̂ = 1.18 for three-day, and RR̂ = 1.21 for five-day averages), NO2 (RR̂ = 1.10 for current day), and COH (RR̂ = 1.09 for current day, RR̂ = 1.10 for two-day average) had the most significant effects after 9/11. These results suggest the need for more stringent regulatory efforts in air quality in the region in response to the changing transportation dynamics at this Canada-US border crossing. PMID:21234298

  6. The impact of 9/11 on the association of ambient air pollution with daily respiratory hospital admissions in a Canada-US border city, Windsor, Ontario.

    PubMed

    Luginaah, Isaac; Fung, Karen Y; Gorey, Kevin M; Khan, Shahedul

    2006-08-01

    The 11 September 2001 (9/11) terrorist attacks in the United States resulted in long lines of trucks at the border crossing in Windsor, Ontario. Public concern about the potential impact of these trucks spewing toxic pollutants into the air drew attention to the need to investigate the impact of 9/11 on the daily levels of air pollutants and respiratory hospitalization. In this study, significant increases in respiratory admissions were found one month and 6 months post-9/11. Mean daily respiratory admission was also significantly higher than the same period one year earlier and one year later. SO(2) and CO concentration levels were found to be generally higher after 9/11 than one year before and immediately before. Relative risk estimates of respiratory hospitalization after 9/11 showed that SO(2) (RR̂ = 1.15 for two-day, RR̂ = 1.18 for three-day, and RR̂ = 1.21 for five-day averages), NO(2) (RR̂ = 1.10 for current day), and COH (RR̂ = 1.09 for current day, RR̂ = 1.10 for two-day average) had the most significant effects after 9/11. These results suggest the need for more stringent regulatory efforts in air quality in the region in response to the changing transportation dynamics at this Canada-US border crossing.

  7. Investigation on the Lung Function of General Population in Ilam, West of Iran, as a City Exposed to Dust Storm

    PubMed Central

    Amarloei, Ali; Jafari, Ahmad Jonidi; Mahabadi, Hassan Asilian; Asadollahi, Kheirollah; Nourmoradi, Heshmatollah

    2015-01-01

    Background: Dust storm is one of the most important natural sources of air pollution in the Middle East that has caused a major concern in recent years. The aim of this study was to evaluate the respiratory tract function of people living in Ilam city (Iran) during dust storm. Methods: A sample size of 250 people was selected and the cluster sampling was randomly used from 13 health centers in Ilam city. Pulmonary function test (PFT) was determined via a standard spirometry apparatus. Vital capacity (VC), Forced Vital capacity (FVC), FVC in first second (FEV1), FEV1/VC, FEV1/FVC, peek expiratory flow (PEF), forced expiratory flow (FEF25-75%), forced expiratory flow (FEF25–75%), forced expiratory flow (FEF75–85%), forced mid flow time (FMFT) and maximum voluntary ventilation (MVV) were measured. Results: Mean values of respiratory capacities measured in all participants excluding FEV1/VC and FMFT were less than predicted mean values by ECCS reference. 21.6% of the population suffered from obstructive lesions. This value among males (24.1%) was more than females (19.6%). This could be related to more exposure (outdoor jobs) of males with dust storms. Conclusion: The results also showed a negative significant relationship between duration of inhabitance in Ilam city and all respiratory capacities. Further studies are needed for confident confirmation of whether reduction of respiratory capacities among Ilamian people is only related to dust storms. PMID:25948466

  8. The spectrum of HIV infection in patients seen at a private hospital in Mexico City: 115 patients seen from 1984 to 1990.

    PubMed

    del Río-Chiriboga, C; Tellez-Gómez, I; Orzechowski-Rallo, A; Alanis-Ortega, A

    1996-01-01

    The objective of this study was to describe the epidemiology and clinical presentation of HIV infection among upper middle class patients in Mexico City. A retrospective review of outpatient and hospital records of all HIV-infected patients was accomplished by one of the authors between 1984 and 1990. A total of 115 patients were seen during the study period, 109 men and 6 women. One hundred and seven patients acquired HIV infection through sexual contact, six patients had HIV infection associated with blood transfusion and two were homosexual men who also had a history of intravenous drug use. The mean age of the patients was 36.2 years (range 13 - 65 years). CDC classification at presentation was predominantly stage IV (65%) with the most common AIDS associated diseases at presentation being wasting syndrome in 30 (42.2%), P. carinii pneumonia in 22 (30.9%), cytomegalovirus infection in 11 (15.5%), Cryptosporidium parvum diarrhea in 7 (9.8%), and Kaposi's sarcoma in 6 (8.4%). CD4+ T-lymphocyte cell counts at the time of HIV diagnosis were available in 87 patients (median = 150 cells/microliters; mean = 224 cells/microliters, SD +/- 219). Zidovudine was used in 37 patients after 1988 when it first became available in Mexico, in six patients the drug had to be discontinued because of serious hematologic toxicity. The average follow-up on zidovudine was 8.5 months. Similar age, gender, age distribution, risk categories and CDC classification at presentation was seen compared to other series reported from Mexico. However, the spectrum of opportunistic infections found were similar to that seen in the United States.

  9. Extraintestinal salmonellosis in a general hospital (1991 to 1996): relationships between Salmonella genomic groups and clinical presentations.

    PubMed

    Rodríguez, M; de Diego, I; Mendoza, M C

    1998-11-01

    Episodes of extraintestinal salmonellosis treated at a general hospital (1,522 beds) over a 6-year period (1991 to 1996) were characterized by the analysis of phenotypic and genotypic traits of Salmonella organisms and clinical data from medical reports. Extraintestinal salmonellosis accounted for 8% of all salmonellosis episodes. Fifty-two medical reports, dealing with 6 cases of typhoid fever, 32 cases of bacteremia, and 14 focal infections, were reviewed. All cases of typhoid fever except 1, 7 cases of bacteremia, and 5 focal infections were not related to any underlying disease or predisposing factors, while 25 cases of bacteremia and 9 focal infections were associated with some of these risk factors. All typhoid isolates and 65.4% of the nontyphoid isolates were susceptible to antimicrobials. Fifty-one nontyphoid strains were analyzed and assigned to 21 genomic groups, which were defined by serotype, combined ribotype, and combined randomly amplified polymorphic DNA type (each genomic group could include organisms differing in some phenotypic traits). The relationships between genomic groups and clinical presentations were traced. Organisms causing 22 episodes (17 episodes of bacteremia, 2 of pneumonia, 1 of peritonitis, 1 of pyelonephritis, and 1 of cystitis) belonged to a prevalent Salmonella enterica serotype Enteritidis genomic group, which included organisms assigned to four phage types, five biotypes, and four resistance patterns, causing infections in patients with and without risk factors. Seven other genomic groups, 4 Enteritidis groups (associated with both bacteremia and focal infections), 2 Typhimurium groups (one associated with bacteremia and the other with focal infections) and 1 Brandenburg group (associated with bacteremia) included two or more strains, and the remaining 13 genomic groups consisted of only one strain each.

  10. Antimicrobial use and microbiological testing in district general hospital ICUs of the Veneto region of north-east Italy.

    PubMed

    Benedetti, P; Sefton, A M; Menegozzo, M; Guerriero, C; Bordignon, G; Da Rin, G; Romualdi, C; Pellizzer, G; Livermore, D M

    2016-10-01

    International - predominantly American - studies undertaken in the ICUs of teaching centres show that inadequate antibiotic therapy increases mortality and length of stay. We sought to ascertain whether this also pertains to smaller ICUs in the Veneto region of north-east Italy. To the best of our knowledge, this is the first such survey in the Veneto area or in Italy as a whole. A retrospective, observational study was performed across five general-hospital ICUs to examine appropriateness of microbiological sampling, empirical antibiotic adequacy, and outcomes. Among 911 patients (mean age, 65.8 years ± 16.2 SD; median ICU stay, 17.0 days [IQR, 8.0-29.0]), 757 (83.1 %) were given empirical antibiotics. Treatment adequacy could be fully assessed in only 212 patients (28.0 %), who received empirical treatment and who had a relevant clinical sample collected at the initiation of this antibiotic (T0). Many other patients only had delayed microbiological investigation of their infections between day 1 and day 10 of therapy. Mortality was significantly higher among the 34.9 % of patients receiving inadequate treatment (48.6 % vs 18.80 %; p < 0.001). Only 32.5 % of combination regimens comprised a broad-spectrum Gram-negative β-lactam plus an anti-MRSA agent, and many combinations were irrational. Inadequate treatment was frequent and was strongly associated with mortality; moreover, there was delayed microbiological investigation of many infections, precluding appropriate treatment modification and de-escalation. Improvements in these aspects and in antibiotic stewardship are being sought.

  11. Incidence of tuberculous and non-tuberculous mycobacteria, differentiated by multiplex PCR, in clinical specimens of a large general hospital

    PubMed Central

    Bensi, Eliane Picoli Alves; Panunto, Patricia Costa; de Carvalho Ramos, Marcelo

    2013-01-01

    OBJECTIVE: To determine the incidence of Mycobacterium tuberculosis complex and non-tuberculous mycobacterial isolates in the routine setting of a large general hospital using an "in-house" multiplex polymerase chain reaction method and to establish a paradigm for the definitive identification of mycobacteria isolated using semi-automated equipment. METHODS: Established tests, including polymerase chain reaction restriction enzyme analysis, PNB, and NAP inhibition tests as the gold standard, showed 100% agreement with an IS6110/hsp65 multiplex polymerase chain reaction when used to identify stock strains (n = 117). RESULTS: In a subsequent study, 8,790 clinical specimens producing 476 isolates were evaluated with multiplex PCR and also showed 100% agreement in identification using PRA-polymerase chain reaction as the gold standard. The application of this technique to routine analysis was demonstrated in this study. A method was established with the initial application of multiplex PCR for all positive liquid cultures and the subsequent identification of non-tuberculous mycobacteria by polymerase chain reaction restriction enzyme analysis. In total, 77% of isolates belonged to the Mycobacterium tuberculosis complex, and 23% were non-tuberculous mycobacteria. CONCLUSIONS: Several non-tuberculous mycobacterial species were identified, primarily M. avium, but other potentially pathogenic species were also frequently observed, including M. fortuitum, M. abscessus, and M. kansasii. The expeditious communication of these data to the clinical staff was fundamental for the diagnosis of clinical cases. Even in settings where tuberculosis is of major importance, the incidence of non-tuberculous mycobacteria infection is substantial. PMID:23525313

  12. Time and Cost Analysis: Pediatric Dental Rehabilitation with General Anesthesia in the Office and the Hospital Settings

    PubMed Central

    Rashewsky, Stephanie; Parameswaran, Ashish; Sloane, Carole; Ferguson, Fred; Epstein, Ralph

    2012-01-01

    Pediatric dental patients who cannot receive dental care in the clinic due to uncooperative behavior are often referred to receive dental care under general anesthesia (GA). At Stony Brook Medicine, dental patients requiring treatment with GA receive dental care in our outpatient facility at the Stony Brook School of Dental Medicine (SDM) or in the Stony Brook University Hospital ambulatory setting (SBUH). This study investigates the time and cost for ambulatory American Society of Anesthesiologists (ASA) Class I pediatric patients receiving full-mouth dental rehabilitation using GA in these 2 locations, along with a descriptive analysis of the patients and dental services provided. In this institutional review board–approved cross-sectional retrospective study, ICD-9 codes for dental caries (521.00) were used to collect patient records between July 2009 and May 2011. Participants were limited to ASA I patients aged 36–60 months. Complete records from 96 patients were reviewed. There were significant differences in cost, total anesthesia time, and recovery room time (P < .001). The average total time (anesthesia end time minus anesthesia start time) to treat a child at SBUH under GA was 222 ± 62.7 minutes, and recovery time (time of discharge minus anesthesia end time) was 157 ± 97.2 minutes; the average total cost was $7,303. At the SDM, the average total time was 175 ± 36.8 minutes, and recovery time was 25 ± 12.7 minutes; the average total cost was $414. After controlling for anesthesia time and procedures, we found that SBUH cost 13.2 times more than SDM. This study provides evidence that ASA I pediatric patients can receive full-mouth dental rehabilitation utilizing GA under the direction of dentist anesthesiologists in an office-based dental setting more quickly and at a lower cost. This is very promising for patients with the least access to care, including patients with special needs and lack of insurance. PMID:23241037

  13. Time and cost analysis: pediatric dental rehabilitation with general anesthesia in the office and the hospital settings.

    PubMed

    Rashewsky, Stephanie; Parameswaran, Ashish; Sloane, Carole; Ferguson, Fred; Epstein, Ralph

    2012-01-01

    Pediatric dental patients who cannot receive dental care in the clinic due to uncooperative behavior are often referred to receive dental care under general anesthesia (GA). At Stony Brook Medicine, dental patients requiring treatment with GA receive dental care in our outpatient facility at the Stony Brook School of Dental Medicine (SDM) or in the Stony Brook University Hospital ambulatory setting (SBUH). This study investigates the time and cost for ambulatory American Society of Anesthesiologists (ASA) Class I pediatric patients receiving full-mouth dental rehabilitation using GA in these 2 locations, along with a descriptive analysis of the patients and dental services provided. In this institutional review board-approved cross-sectional retrospective study, ICD-9 codes for dental caries (521.00) were used to collect patient records between July 2009 and May 2011. Participants were limited to ASA I patients aged 36-60 months. Complete records from 96 patients were reviewed. There were significant differences in cost, total anesthesia time, and recovery room time (P < .001). The average total time (anesthesia end time minus anesthesia start time) to treat a child at SBUH under GA was 222 ± 62.7 minutes, and recovery time (time of discharge minus anesthesia end time) was 157 ± 97.2 minutes; the average total cost was $7,303. At the SDM, the average total time was 175 ± 36.8 minutes, and recovery time was 25 ± 12.7 minutes; the average total cost was $414. After controlling for anesthesia time and procedures, we found that SBUH cost 13.2 times more than SDM. This study provides evidence that ASA I pediatric patients can receive full-mouth dental rehabilitation utilizing GA under the direction of dentist anesthesiologists in an office-based dental setting more quickly and at a lower cost. This is very promising for patients with the least access to care, including patients with special needs and lack of insurance.

  14. Epidemiology of Suicide and Associated Socio-Demographic Factors in Emergency Department Patients in 7 General Hospitals in Northwestern China

    PubMed Central

    Zhao, Cheng-jin; Dang, Xing-bo; Su, Xiao-li; Bai, Jia; Ma, Long-yang

    2015-01-01

    Background This study aimed to illustrate the characteristics of suicide attempters treated in the Emergency Departments of 7 general hospitals in Xi’an and to provide relevant data for early psychological treatment. Material/Methods Between October 2010 and September 2014, 155 suicide attempters were treated in the Emergency Departments. Data were collected using a semi-structured questionnaire. Descriptive statistics, chi-square tests, and multivariate analyses were used to identify the factors associated with suicidal behaviors. Results Females outnumbered males at a ratio of 3.7 to 1. The greatest proportion of cases was in the age group of 21 to 30 years (52.9%). Patients who finished middle school or high school accounted for most of the suicide attempters (50.3%). The most common method used for attempted suicide was drug ingestion (86.5%). The majority of cases attempted suicide at home (74.8%) during the night. Marriage frustration, work and study problems, family fanaticism and conflict, somatic disease, and history of mental disorders were all significantly associated with suicide attempts. The ratio of patients to be discharged or to die were similar in occupation, marital status, and the place of suicide attempt; however, the results were different in gender, age, educational level, methods used for suicide, time of day, and reason. Conclusions Suicide is an important public health problem and is multidimensional in nature. Future studies with larger samples are expected to provide more specific knowledge of the effect of each social factor on the suicide risk in Chinese in order to improve the prevention of suicides. PMID:26369363

  15. Evaluation of efficacy of restorative dental treatment provided under general anesthesia at hospitalized pediatric dental patients of Isfahan

    PubMed Central

    Eshghi, Alireza; Samani, Mahdi Jafarzadeh; Najafi, Naghme Feyzi; Hajiahmadi, Maryam

    2012-01-01

    Background: General anesthesia (GA) allows dental treatment to be rendered under optimal conditions, theoretically ensuring ideal outcomes. The aim of this study was to determine the efficacy of restorative dental procedures performed under GA. Materials and Methods: In this cross-sectional retrospective study, 305 pediatric patients who had been treated under GA 6 to 24 months before our survey at Isfahan's hospitalized dentistry center were examined. The examination was performed on dental chair with oral mirror and dental probe. The results were recorded in a special form for each patient for statistical analysis and evaluation of restorations to be successful or failed. Statistical analysis was performed by chi-square and fisher exact tests for comparison between success rates of restorations and Kendall's tau-b test for evaluating the effect of time on success rates of them (P < 0.05). Results: Stainless steel crown restorations had significantly better results vs class I and class II amalgam and class I and class II tooth color restorations. All types of posterior tooth color restorations had statistically same results with amalgam restorations. Anterior composite resin build-up represented significantly low success rates. The failure rates of stainless steel crown and anterior composite resin build-up restorations did not correlate with the time of follow-up (P = 0.344 and P = 0.091, respectively). Conclusion: Stainless steel crown restorations had significantly better results vs other posterior restorations. The failure rates of stainless steel crown and anterior composite resin build-up restorations did not correlate with the time of follow-up in comparison of other restorations. PMID:23162592

  16. Hypokalaemia: Improving the investigation, management and therapeutic monitoring of hypokalaemic medical inpatients at a district general hospital.

    PubMed

    Jordan, Mark; Caesar, Jenny

    2015-01-01

    Hypokalaemia is prevalent in 20% of hospitalised patients. Furthermore, inadequate management of hypokalemia was identified in 24% of these patients. Associated with significant patient morbidity and mortality, the identification, investigation, and treatment of hypokalaemia was identified as an area for improvement in the management of medical inpatients. The project aims to measure the assessment, management, and therapeutic monitoring of medical inpatients with hypokalaemia in a district general hospital. All medical inpatients over a one week period who met the criteria for hypokalaemia (serum potassium <3.5 mmol/L on standard biochemical sample) were included in the audit. Patient's notes were located and evaluated to identify if they had mild, moderate, or severe hypokalaemia. Further data on ECG requests, repeat U&Es, serum magnesium analysis, treatment prescribed, and medication review dates was collated. A re-audit was completed after the introduction of a set of interventions which included a hypokalaemia treatment algorithm. Pre-intervention analysis of all medical inpatients, who met our inclusion criteria for hypokalaemia, identified 32 patients. 25 of these patients met the criteria for mild hypokalaemia (3.1-3.4 mmol/L) and 7 met the criteria for moderate hypokalaemia (2.5-3.0 mmol/L). Only 7/32 (22 %) patients were receiving adequate treatment based on trust guidelines. Post intervention results showed marked improvement in the management of patients with hypokalaemia. A total of 30 patients were identified in this post-intervention group. There were 16/30 patients who qualified as mild hypokalaemia (3.1-3.4 mmol/L) and 14/30 with moderate hypokalaemia (2.5-3.0 mmol/L). 19/30 (63%) patients in the post-intervention group were correctly prescribed appropriate medication doses consistent with the treatment algorithm. Following the initial success of the project, analysis at 3 months showed a positive trend for sustained improvement when compared to

  17. The role of the Director Zmago Slokan in the development of Maribor General Hospital in the first period after the Second World War (1953-1970).

    PubMed

    Pivec, Gregor

    2015-12-01

    The author explores and explains the role of the director of Maribor General Hospital in the first period after Second World War. The period was problematic on account of the difficult economic situation and changes in the political system. On one hand the hospital suffered relatively large damage due to bombing attacks during the war and on the other it had to face numerous staffing problems, especially with a lack of physicians and trained nursing staff (from 1948 an executive order entered into force forbidding the nursing nuns from performing nursing care in hospitals). The change in the political system required the management of the hospital to be taken over by an individual who enjoyed the political, professional and economic trust of the then authorities. Based on his engagement during the Second World War, the director, Zmago Slokan, represented a form of guarantee for the political system of that time, which nevertheless wanted the quality-based, professional and economic progress of the hospital. Using his personal characteristics, professional medical and economic knowledge as well as political experience, he was able to manage different tendencies to continue the quality-based progress of the institution. Thus, he set a proper foundation for its development in the periods that followed, in the Socialist Federative Republic of Yugoslavia as well as in the independent Republic of Slovenia (after 1991). The author discusses the role of the director in the hospital's progress chronologically.

  18. Improving the quality of discharge summaries: implementing updated Academy of Medical Royal Colleges standards at a district general hospital.

    PubMed

    May-Miller, Hannah; Hayter, Joanne; Loewenthal, Lola; Hall, Louis; Hilbert, Rebecca; Quinn, Michael; Pearson, Nicola; Patel, Alisha; Law, Rebekah

    2015-01-01

    Quality of documentation is harder to quantify and incentivise, but it has a significant impact on patient care. Good discharge summaries facilitate continuity between secondary and primary care. The junior doctors' forum led this project to improve the quality of electronic discharge summaries (eDS). Baseline measurement revealed significant room for improvement. We measured the quality of 10 summaries per month (across all inpatient specialties), against 23 indicators from the revised Academy of Medical Royal Colleges (AoMRC) standards (2013) that were prioritised by GPs as a "minimum dataset". Junior doctors felt that the Trust's dual eDS systems were responsible for great variation in quality. This was confirmed by the results of a comparison audit of the systems in April 2014: one system greatly outperformed the other (57% mean compliance with iSoft clinical management (iCM) based system vs. 77% with InfoPath-based system). We recommended that the Trust move to a single eDS system, decommissioning the iCM-based system, and this proposal was approved by several Trust committees. We worked with information services, junior doctors, general practitioners and hospital physicians to develop and implement a generic template to further improve compliance with AoMRC standards. In August 2014, the iCM-based system was withdrawn, the new template went live, and training was delivered, coinciding with the changeover of junior doctors to minimise disruption. Median compliance increased from 66.7% to 77.8%. Quality of discharge summaries had improved across the specialties. There was a reduction in the number of complaints and positive qualitative feedback from general practitioners and junior doctors. Completion of discharge summaries within 24 hours was not affected by this change. There is still more to be done to improve quality; average compliance with the full AoMRC standards (39 indicators) is 59.5%. With the approval of the Trust executive committee further plan

  19. Improving the quality of discharge summaries: implementing updated Academy of Medical Royal Colleges standards at a district general hospital

    PubMed Central

    May-Miller, Hannah; Hayter, Joanne; Loewenthal, Lola; Hall, Louis; Hilbert, Rebecca; Quinn, Michael; Pearson, Nicola; Patel, Alisha; Law, Rebekah

    2015-01-01

    Quality of documentation is harder to quantify and incentivise, but it has a significant impact on patient care. Good discharge summaries facilitate continuity between secondary and primary care. The junior doctors’ forum led this project to improve the quality of electronic discharge summaries (eDS). Baseline measurement revealed significant room for improvement. We measured the quality of 10 summaries per month (across all inpatient specialties), against 23 indicators from the revised Academy of Medical Royal Colleges (AoMRC) standards (2013) that were prioritised by GPs as a “minimum dataset”. Junior doctors felt that the Trust's dual eDS systems were responsible for great variation in quality. This was confirmed by the results of a comparison audit of the systems in April 2014: one system greatly outperformed the other (57% mean compliance with iSoft clinical management (iCM) based system vs. 77% with InfoPath-based system). We recommended that the Trust move to a single eDS system, decommissioning the iCM-based system, and this proposal was approved by several Trust committees. We worked with information services, junior doctors, general practitioners and hospital physicians to develop and implement a generic template to further improve compliance with AoMRC standards. In August 2014, the iCM-based system was withdrawn, the new template went live, and training was delivered, coinciding with the changeover of junior doctors to minimise disruption. Median compliance increased from 66.7% to 77.8%. Quality of discharge summaries had improved across the specialties. There was a reduction in the number of complaints and positive qualitative feedback from general practitioners and junior doctors. Completion of discharge summaries within 24 hours was not affected by this change. There is still more to be done to improve quality; average compliance with the full AoMRC standards (39 indicators) is 59.5%. With the approval of the Trust executive committee further

  20. A flexible system for vital signs monitoring in hospital general care wards based on the integration of UNIX-based workstations, standard networks and portable vital signs monitors.

    PubMed

    Welch, J P; Sims, N; Ford-Carlton, P; Moon, J B; West, K; Honore, G; Colquitt, N

    1991-01-01

    The article describes a study conducted on general surgical and thoracic surgical floors of a 1000-bed hospital to assess the impact of a new network for portable patient care devices. This network was developed to address the needs of hospital patients who need constant, multi-parameter, vital signs surveillance, but do not require intensive nursing care. Bedside wall jacks were linked to UNIX-based workstations using standard digital network hardware, creating a flexible system (for general care floors of the hospital) that allowed the number of monitored locations to increase and decrease as patient census and acuity levels varied. It also allowed the general care floors to provide immediate, centralized vital signs monitoring for patients who unexpectedly became unstable, and permitted portable monitors to travel with patients as they were transferred between hospital departments. A disk-based log within the workstation automatically collected performance data, including patient demographics, monitor alarms, and network status for analysis. The log has allowed the developers to evaluate the use and performance of the system.

  1. Percutaneous endoscopic gastrostomy in a general hospital: prospective evaluation of indications, outcome, and randomised comparison of two tube designs.

    PubMed Central

    Panos, M Z; Reilly, H; Moran, A; Reilly, T; Wallis, P J; Wears, R; Chesner, I M

    1994-01-01

    The indications for percutaneous endoscopic gastrostomy (PEG) and patient outcome, were examined prospectively in the setting of a general hospital. In the course of 26 months, 76 patients underwent PEG (median age 62 years (range 18-99)) and were followed up for 6887 patient days. The median (range) duration of PEG feeding was 93 (3-785) days. The procedure was carried out for neurological indications in 76% of cases (stroke 51%) and 53% of patients were severely malnourished (body mass index < 17 kg/m2) at the time of referral. In 12 (16%) patients swallowing recovered and the PEG was removed after a median (range) of 55 days (20-150). Three (4%) deaths were related to PEG (one oesophageal perforation, one haemorrhage, and one aspiration pneumonia). One patient developed peritonism and ileus, which resolved with conservative treatment. Minor complications included local sepsis 3%, tube blockage 12%, and tube connector leak 5%. During seven days of observation, demands on nursing time for routine care of the PEG were the same as for nasogastric tube feeding, median (range) 21 (4-42) v 16 (4-40) min/day respectively, but in about half the latter cases the tube had to be replaced at least once. Over 15 months, 29 patients were randomised to receive a 1.9 mm inner, 2.9 mm (9F) outer diameter Fresenius and 27 a 3.0 mm inner, 4.0 mm (12F) outer diameter Bower polyurethane tube and were followed for 2920 and 2388 patient days respectively. There was no difference in the insertion time (median (range) 20 (10-45) v 24 (10-45) min respectively) or number of patients with complications (three v eight patients NS), although there were more minor mechanical problems (three v 12, p < 0.01) with the 12F tube. The internal anchoring device of the 12F tube allowed its non-endoscopic removal, a method applicable too 16% of cases. No tubes were removed because of blockage. PMID:7828971

  2. Nutritional Practices and Taboos Among Pregnant Women Attending Antenatal Care at General Hospital in Kano, Northwest Nigeria

    PubMed Central

    Ugwa, EA

    2016-01-01

    Background: Food taboos among rural women have been identified as one of the factors contributing to maternal undernutrition in pregnancy. Aim: The aim of this study was to explore some of the taboos and nutritional practices among pregnant women attending antenatal care at a General Hospital in Dawakin Kudu LGA, Kano, Nigeria. Subjects and Methods: This was a cross-sectional study involving 220 pregnant women. Interviewer-administered structured questionnaire was used to interview the respondents, which showed various sociodemographic information, cultural nutritional processes, taboos of the community, and a 24 h food recall. The ages, parities, and gestational ages of the women were collated. Descriptive statistics was used. Data were analyzed using SPSS statistical software Version 17.0 (SPSS Inc., Chicago, IL, USA). Association between sociodemographic factors and nutritional practices and taboos was determined using Chi-square test and P < 0.05 was considered statistically significant. Results: At the end of the study, 200 participants (91%) gave complete information. Most of the women, 70% (140/200) were in the 20–39 years age range with mean (standard deviation [SD]) age of 23.7 (6.1) years, mostly uneducated, 70% (140/200), and unemployed, 51% (102/200). Most of the women did a child spacing of 12–24 months, 62% (124/200) with mean (SD) child spacing interval of 26.32 (10.19) months. Gestational age at booking was mostly 13–26 weeks, 48% (96/200) with an average of 26.60 (8.01). Most of the women had 1–4 children, 54.5% (109/200) with mean (SD) of 2.47 (2.50). Most of the women agreed that they had adequate intake of oil, 86% (172/200), meat/fish, 92% (194/200), fruit/vegetables 56% (112/200), and had 3 meals/day 80% (152/200), and did not practice pica 83% (166/200). All of the women, 100% (200/200) believe that women should eat more during pregnancy in order to have healthy babies. They were mostly supported by their husbands, 53% (106/200) and

  3. Satisfaction survey in general hospital personnel involved in blood transfusion: implementation of the ISO 9001: 2000 standard.

    PubMed

    Chord-Auger, S; Tron de Bouchony, E; Moll, M C; Boudart, D; Folléa, G

    2004-10-01

    As part of its policy of constant quality improvement, Etablissement francais du sang (EFS) des pays de la Loire (Pays de la Loire Regional Blood Transfusion Centre) carried out a satisfaction survey among the hospital personnel involved in prescribing and using immunohaematological tests and labile blood products (LBP). The polling tool selected by agreement between the Saint Nazaire's hospital management and Quality Assurance (QA) Department was a questionnaire that permitted item rating and free commentary. It addressed the personnel's perception of the quality of erythrocyte immunohaematological (EIH) testing and of the products administered, as well as their perception of the quality of communications with the local EFS. The questionnaire was sent to 26 physicians and 32 senior nurses in 15 hospital departments. The reply rate was 60% and expressed an 85% overall satisfaction level. Dissatisfaction causes were more specifically analysed, the main one involving LBP distribution in emergency situations. A joint undertaking by the EFS and the hospital led to the implementation of corrective measures, including the writing and implementation of a common standard operating procedure for emergency transfusion management. The results obtained demonstrated the feasibility of this type of survey and the interest, to a blood transfusion centre and the hospital personnel involved in transfusion, of assessing their very own perception of service quality.

  4. [Satisfaction survey in general hospital personnel involved in blood transfusion: implementation of the ISO 9001: 2000 standard].

    PubMed

    Chord-Auger, S; de Bouchony, E Tron; Moll, M-C; Boudart, D; Folléa, G

    2004-07-01

    As part of its policy of constant quality improvement, Etablissement Français du Sang (EFS) des Pays de la Loire (Pays de la Loire Regional blood transfusion institution) carried out a satisfaction survey among the hospital personnel involved in prescribing and using immuno-hematological tests and labile blood products. The polling tool selected by agreement between the hospital management and quality assurance department was a questionnaire that permitted item rating and free commentary. It addressed the personnel's perception of the quality of erythrocyte immuno-hematological (EIH) testing and of the products administered, as well as their perception of the quality of communications with the local EFS. The questionnaire was sent to 26 physicians and 32 senior nurses in 15 hospital departments. The reply rate was 60% and expressed a 85% overall satisfaction level. Dissatisfaction causes were more specifically analysed, the main one involving labile blood product distribution in emergency situations. A joint undertaking by the EFS and the hospital led to the implementation of corrective measures, including the writing and implementation of a common standard operating procedure for emergency transfusion management. The results obtained demonstrated the feasibility of this type of survey and the interest, to a blood transfusion centre and the hospital personnel involved in transfusion, of assessing their very own perception of service quality.

  5. Barriers and Challenges in Seeking Psychiatric Intervention in a General Hospital, by the Collaborative Child Response Unit, (A Multidisciplinary Team Approach to Handling Child Abuse) A Qualitative Analysis.

    PubMed

    Subramaniyan, Vyjayanthi Kanugodu Srinivasa; Mital, Anukant; Rao, Chandrika; Chandra, Girish

    2017-01-01

    Child abuse is a serious criminal act against children in our country and punishable according to protection of children from sexual offenses act 2012. No one agency has the ability to respond completely to the abuse. Hence a multidisciplinary team approach was developed in India. Aim is to narrate the collaborative effort among the multiple disciplines in a general hospital to deliver child protection services and explore the barriers to integrate psychiatric services.

  6. Assessment of Health Behaviors, Health Education Interests, and Injuries among Employees at the General Leonard Wood Army Community Hospital, October 2014 - December 2014

    DTIC Science & Technology

    2016-05-06

    Behaviors , Health Education Interests, and Injuries among Employees at the General Leonard Wood Army Community Hospital, October 2014 – December 2014...2016 2. REPORT TYPE FINAL 3. DATES COVERED (From – To) October 2014-December 2014 4. TITLE AND SUBTITLE Assessment of Health Behaviors , Health...military as well as civilian populations. Purpose: To assess health behaviors , health education interests, perceived barriers to participation in health

  7. Assessment of urban sustainability efficiency based on general data envelopment analysis: a case study of two cities in western and eastern China.

    PubMed

    Yan, Yan; Shan, Peng; Wang, Chenxing; Quan, Yuan; Wu, Di; Zhao, Chunli; Wu, Gang; Deng, Hongbing

    2017-04-01

    Sustainable urban development focuses on enhancing urban well-being, while also balancing the demands of urban social and economic development, natural resource consumption, and environmental pollution. This work used general data envelopment analysis to assess the urban sustainability efficiency (USE) and sustainability potential (SP) in Lanzhou and Xiamen, two cities that are characteristic of urban areas in western and eastern China. The assessment indicator system included important natural and urban welfare factors as input and output indices, respectively. The results showed that overall urban sustainability efficiency increased in Lanzhou and Xiamen from 1985 to 2010, but that the sustainability of natural resources clearly decreased. The urban sustainability efficiency of Xiamen was higher than that of Lanzhou, and the sustainability potential of Xiamen was lower than that of Lanzhou; this indicates that Xiamen performed better in terms of urban sustainable development. The urban sustainability efficiency in Xiamen has increased with increasing urban population, and the rate and scale of economic development have been higher than in Lanzhou. The assessment and analysis performed in this study show that cities with different natural resources and development characteristics have different forms, patterns, and trajectories of sustainable development.

  8. Impact of betablockers on general and local outcome in patients hospitalized for lower extremity peripheral artery disease

    PubMed Central

    Mirault, Tristan; Galloula, Alexandre; Cambou, Jean-Pierre; Lacroix, Philippe; Aboyans, Victor; Boulon, Carine; Constans, Joel; Bura-Riviere, Alessandra; Messas, Emmanuel

    2017-01-01

    Abstract Lower extremity peripheral artery disease (PAD) is one manifestation of atherosclerosis. Patients with PAD have an increased rate of mortality due to concurrent coronary artery disease and hypertension. Betablockers (BB) may, therefore, be prescribed, especially in case of heart failure. However, BB safety in PAD is controversial, because of presumed peripheral hemodynamic consequences of BB that could lead to worsening of symptoms in patients with PAD. In this context, we aimed to determine the impact of BB on all-cause and cardiovascular mortality and amputation rate at 1 year after hospitalization for PAD from the COPART Registry population. This is a prospective multicenter observational study collecting data from consecutive patients hospitalized for PAD in vascular medicine departments of 4 academic hospitals in France. Patients with, either claudication, critical limb ischemia or acute lower limb ischemia related to a documented PAD were included. We compared the outcomes of patients with BB versus those without BB in their prescription list at hospital discharge. The mean age of the study population was 70.9 years, predominantly composed of males (71%). Among the 1267 patients at admission, 28% were treated by BB for hypertension, prior myocardial infarction or heart failure. During their hospital stay, 40% underwent revascularization (including bypass surgery 29% and angioplasty 74%), 17% required an amputation, and 5% died. In a multivariate analysis, only prior myocardial infarction was found associated with BB prescription with an odds ratio (OR) of 3.11, P < 0.001. Conversely, chronic obstructive pulmonary disease or PAD with ulcer impeded BB prescription (OR: 0.57 and 0.64, P = 0.007; P = 0.001, respectively). One-year overall mortality of patients with BB did not differ from those without (23% vs. 23%, P = 0.95). The 1-year amputation rate did not differ either (4% vs. 6%, P = 0.14). Patients hospitalized for PAD with a

  9. Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study

    PubMed Central

    Carrière, Isabelle; Fourrier-Reglat, Annie; Dartigues, Jean-François; Rouaud, Olivier; Pasquier, Florence; Ritchie, Karen; Ancelin, Marie-Laure

    2009-01-01

    Objective To examine the association between use of medications with anticholinergic properties, cognitive decline and incident dementia in a large community-based sample of subjects aged 65 years and over. Methods Participants were 4128 women and 2784 men from a population-based cohort recruited from three French cities. Cognitive performance, clinical diagnosis of dementia and anticholinergic use were evaluated at base-line, 2 and 4 year later. Results 7.5% of subjects reported anticholinergic drug use at base-line. Multivariate adjusted logistic regression indicated that women reporting anticholinergic drugs at base-line showed greater decline over four years in verbal fluency scores (OR=1.41, CI=1.11–1.79) and in global cognitive functioning (OR=1.22, CI=0.96–1.55) than women not using anticholinergic drugs. In men, an association was found with decline in visual memory (OR=1.63, CI=1.08–2.47) and to a lesser extent in executive function (OR=1.47, CI=0.89–2.44). Significant interactions were observed in women between anticholinergic use and age, apolipoprotein E, or hormone replacement therapy. A significantly 1.4–2 fold higher risk of cognitive decline was observed for continuous anticholinergic users but not for those having discontinued. The risk of incident dementia over the four-year followup was also increased in continuous users (HR=1.65, CI=1.00–2.73) but not in those having discontinued anticholinergic drugs (HR=1.28, CI=0.59–2.76). Conclusions Elderly people taking anticholinergic drugs were at increased risk for cognitive decline and dementia. Discontinuing anticholinergic treatment was associated with a decreased risk. Physicians should carefully consider prescription of anticholinergic drugs in elderly people especially in the oldest old and persons at high genetic risk of cognitive disorder. PMID:19636034

  10. Medicare program; reissuance of the wage index in the 1981 schedule of limits on hospital per diem inpatient general routine operating costs--HCFA. Proposed notice.

    PubMed

    1984-02-17

    We are reissuing for public comment the change in the types of data that were used to calculate the wage index that was contained in the schedules of limits on hospital per diem inpatient general routine operating costs reimbursable under Medicare that were applicable to cost reporting periods beginning on or after July 1, 1981 and for cost reporting periods ending after September 30, 1981. The cost limits for cost reporting periods beginning on or after October 1, 1982 are governed by the notice published in the Federal Register on September 30, 1982 (47 FR 43296) and August 30, 1983 (48 FR 39426) and are not affected by this reissuance. The wage index was originally issued as part of the schedule of limits published on June 30, 1981 (46 FR 33637) and September 30, 1981 (46 FR 48010) and is being reissued as the result of the April 29, 1983 decision of the United States District Court for the District of Columbia in the case of District of Columbia Hospital Association, et al. v Heckler, et al. (No. 82-2520 DDC). The District Court held that the 1981 schedule of hospital cost limits was invalid for failure to comply with the Administrative Procedure Act insofar as the schedule incorporated or was formulated by using a wage index that was calculated by excluding Federal government hospital wage data.

  11. [Access, use and preferences of Information and Communication Technologies by physicians in a general hospital in Peru].

    PubMed

    Vásquez-Silva, Luis; Ticse, Ray; Alfaro-Carballido, Luz; Guerra-Castañon, Felix

    2015-01-01

    We assessed the access, use and preferences of information and communication technology (ICT) by physicians who practice at Cayetano Heredia National Hospital. The questionnaire explored the availability and skills of ICT, time, educational activities, search engines and technological applications most used as well as ICT preferences in education.211 physicians were surveyed; laptop use was 93%, tablet and smartphone use was 66% and 88%.68% have mobile Internet. Differences were evident in the frequency of use of ICT in 25-34 year old age group as well as a higher level of skills (p<0.05). 86% use PubMed, Facebook and WhatsApp as a means of exchanging images and data related to health, 50% participated in medical blogs, online courses or videoconferences. The use and access of ICT is common among doctors in this hospital and there is positive interest in its use in education.

  12. Application of ATC/DDD methodology to eveluate of antibiotic use in a general hospital in Turkey

    PubMed Central

    2013-01-01

    Background The aim of this study is to evaluate in-house antibiotic use in a state hospital in Turkey with its cost, using the ATC/DDD index, which is an accepted standard method. Methods This study was performed as a point prevalence study in a state hospital with 372 beds. All in-house patients using antibiotics on July 19, 2011 were included in the study. Indications for antibiotic use and information about the patients were recorded on special forms. Antibiotic use and cost analysis were evaluated using the ATC/DDD index, which is also suggested by the WHO to be used in similar studies. Findings 147 patients out of 308 patients who were in-house were identified to use antibiotics with appropriate indications for prophylaxis or treatment in 61% of the patients. The rate of appropriate antibiotic use was identified to be in 78%, while this rate was 38.9% in surgical clinics. The daily cost of the antibiotics consumed on the date of the study was calculated as 4104.79 TL (=2476.80 USD). Discussion The rate of inappropriate use of antibiotics seems to be high in our hospital. This will result in both increased costs and also increased nosocomial infection rates with resistant species. Infectious disease specialists should take more active roles in the in-house antibiotic use, hospitals should prepare and implement their own principles of antibiotic use, and microbiology laboratories should be used more effectively. These measures would decrease the conspicuous shortcomings in the antibiotic use. PMID:24004538

  13. HIV-related risk behaviors among the general population: a survey using Audio Computer-Assisted Self-Interview in 3 cities in Vietnam.

    PubMed

    Vu, Lan T H; Nadol, Patrick; Le, Linh Cu

    2015-03-01

    This study used a confidential survey method-namely, Audio Computer-Assisted Self-Interview (ACASI)-to gather data about HIV-related risk knowledge/behaviors among the general population in Vietnam. The study sample included 1371 people aged 15 to 49 years in 3 cities-Hanoi, Da nang, and Can Tho. Results indicated that 7% of participants had ever had nonconsensual sex, and 3.6% of them had ever had a one-night stand. The percentage of male participants reported to ever have sex with sex workers was 9.6% and to ever inject drugs was 4.3%. The proportion of respondents who had ever tested for HIV was 17.6%. The risk factors and attitudes reported in the survey indicate the importance of analyzing risk behaviors related to HIV infection among the general population. Young people, especially men in more urbanized settings, are engaging in risky behaviors and may act as a "bridge" for the transmission of HIV from high-risk groups to the general population in Vietnam.

  14. Transport accidents among children and adolescents at the emergency service of a teaching hospital in the southern zone of the city of São Paulo☆☆☆

    PubMed Central

    Gorios, Carlos; de Souza, Renata Maia; Gerolla, Viviane; Maso, Bruno; Rodrigues, Cintia Leci; Armond, Jane de Eston

    2014-01-01

    Objective to describe the victim profile and circumstances of transport accidents involving children and adolescents who were attended at a teaching hospital in the southern zone of the city of São Paulo. Methods this was an individual observational case series study among patients up to the age of 19 years who were attended at a hospital in the southern zone of the city of São Paulo, state of São Paulo, Brazil, due to traffic accidents. The files notifying suspected or confirmed cases of violence and accidents (SIVVA files) covering January to December 2012 were analyzed. Results among the 149 cases notified, 64.4% related to males and 35.6% to females. The transport accidents were predominantly among males, irrespective of age. The main injury diagnoses were superficial head trauma (24.8%) followed by multiple non-specified trauma (36.4%), in both sexes. Conclusion transport accidents among children and adolescents occurred more often among males. The main transport accidents among the children and adolescents attended as emergency cases were caused by motor vehicles and motorcycles. Among the accident victims, the largest proportion was attended because of being run over. PMID:26229833

  15. Assessing knowledge, performance, and efficiency for hospital waste management-a comparison of government and private hospitals in Pakistan.

    PubMed

    Ali, Mustafa; Wang, Wenping; Chaudhry, Nawaz; Geng, Yong; Ashraf, Uzma

    2017-04-01

    Proper management of healthcare waste is a critical concern in many countries of the world. Rapid urbanization and population growth rates pose serious challenges to healthcare waste management infrastructure in such countries. This study was aimed at assessing the situation of hospital waste management in a major city of Pakistan. Simple random sampling was used to select 12 government and private hospitals in the city. Field visits, physical measurements, and questionnaire survey method were used for data collection. Information was obtained regarding hospital waste generation, segregation, collection, storage, transportation, and disposal. Data envelopment analysis (DEA) was used to classify the hospitals on the basis of their relative waste management efficiencies. The weighted average total waste generation at the surveyed hospitals was discovered to be 1.53 kg/patient/day of which 75.15% consisted of general waste and the remaining consisted of biomedical waste. Of the total waste, 24.54% came from the public hospital and the remaining came from the private hospitals. DEA showed that seven of the surveyed hospitals had scale or pure technical inefficiencies in their waste management activities. The public hospital was relatively less efficient than most of the private hospitals in these activities. Results of the questionnaire survey showed that none of the surveyed hospitals was carrying out waste management in strict compliance with government regulations. Moreover, hospital staff at all the surveyed hospitals had low level of knowledge regarding safe hospital waste management practices. The current situation should be rectified in order to avoid environmental and epidemiological risks.

  16. Genetic hemochromatosis is a rare disease entity among French Basques: a center-based study from the general hospital of Basque County.

    PubMed

    Bauduer, F; Scribans, C; Renoux, M; Borot, N

    2001-08-01

    A center-based study from the general hospital of Basque country has been performed to evaluate the importance of genetic hemochromatosis among French Basques. A sample of 37 patients from 34 families fulfilling the diagnosis criteria of hemochromatosis was obtained. Only four of them were of Basque origin: two homozygotes for C282Y, one homozygote for H63D, and one heterozygote for C282Y. These results suggest a significant lower prevalence of genetic hemochromatosis in Basques than in people from other French regions (P=0.001). They underline further the biological specificity of this population.

  17. A Cross-Sectional Study of Prisoners in Mexico City Comparing Prevalence of Transmissible Infections and Chronic Diseases with That in the General Population

    PubMed Central

    Bautista-Arredondo, Sergio; González, Andrea; Servan-Mori, Edson; Beynon, Fenella; Juarez-Figueroa, Luis; Conde-Glez, Carlos J.; Gras, Nathalie; Sierra-Madero, Juan; Lopez-Ridaura, Ruy; Volkow, Patricia; Bertozzi, Stefano M.

    2015-01-01

    Objectives To describe patterns of transmissible infections, chronic illnesses, socio-demographic characteristics and risk behaviors in Mexico City prisons, including in comparison to the general population, to identify those currently needing healthcare and inform policy. Materials and Methods A cross-sectional study among 17,000 prisoners at 4 Mexico City prisons (June to December 2010). Participation was voluntary, confidential and based on informed consent. Participants were tested for HIV, Hepatitis B & C, syphilis, hypertension, obesity, and, if at risk, glucose and cholesterol. A subset completed a questionnaire on socio-demographic characteristics and risk behaviors. Positive results were delivered with counseling and treatment or referral. Results 76.8% (15,517/20,196) of men and 92.9% (1,779/1,914) of women participated. Complete data sets were available for 98.8%. The following prevalence data were established for transmissible infections: HIV 0.7%; syphilis: Anti-TP+/VDRL+ 2.0%; Hepatitis B: HBcAb 2.8%, HBsAg 0.15%; Anti-HCV 3.2%. Obesity: 9.5% men, 33.8% women. Compared with national age- and sex-matched data, the relative prevalence was greater for HIV and syphilis among women, HIV and Hepatitis C in men, and all infections in younger participants. Obesity prevalence was similar for women and lower among male participants. The prevalence of previously diagnosed diabetes and hypertension was lower. Questionnaire data (1,934 men, 520 women) demonstrated lower educational levels, increased smoking and substance use compared to national data. High levels of non-sterile tattooing, physical abuse and histories of sexual violence were found. Conclusion The study identified that health screening is acceptable to Mexico City prisoners and feasible on a large-scale. It demonstrated higher prevalence of HIV and other infections compared to national data, though low rates compared to international data. Individual participants benefited from earlier diagnosis

  18. Estimating PM2.5 Concentrations in Xi'an City Using a Generalized Additive Model with Multi-Source Monitoring Data

    PubMed Central

    Song, Yong-Ze; Yang, Hong-Lei; Peng, Jun-Huan; Song, Yi-Rong; Sun, Qian; Li, Yuan

    2015-01-01

    Particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) represents a severe environmental problem and is of negative impact on human health. Xi'an City, with a population of 6.5 million, is among the highest concentrations of PM2.5 in China. In 2013, in total, there were 191 days in Xi’an City on which PM2.5 concentrations were greater than 100 μg/m3. Recently, a few studies have explored the potential causes of high PM2.5 concentration using remote sensing data such as the MODIS aerosol optical thickness (AOT) product. Linear regression is a commonly used method to find statistical relationships among PM2.5 concentrations and other pollutants, including CO, NO2, SO2, and O3, which can be indicative of emission sources. The relationships of these variables, however, are usually complicated and non-linear. Therefore, a generalized additive model (GAM) is used to estimate the statistical relationships between potential variables and PM2.5 concentrations. This model contains linear functions of SO2 and CO, univariate smoothing non-linear functions of NO2, O3, AOT and temperature, and bivariate smoothing non-linear functions of location and wind variables. The model can explain 69.50% of PM2.5 concentrations, with R2 = 0.691, which improves the result of a stepwise linear regression (R2 = 0.582) by 18.73%. The two most significant variables, CO concentration and AOT, represent 20.65% and 19.54% of the deviance, respectively, while the three other gas-phase concentrations, SO2, NO2, and O3 account for 10.88% of the total deviance. These results show that in Xi'an City, the traffic and other industrial emissions are the primary source of PM2.5. Temperature, location, and wind variables also non-linearly related with PM2.5. PMID:26540446

  19. Estimating PM2.5 Concentrations in Xi'an City Using a Generalized Additive Model with Multi-Source Monitoring Data.

    PubMed

    Song, Yong-Ze; Yang, Hong-Lei; Peng, Jun-Huan; Song, Yi-Rong; Sun, Qian; Li, Yuan

    2015-01-01

    Particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) represents a severe environmental problem and is of negative impact on human health. Xi'an City, with a population of 6.5 million, is among the highest concentrations of PM2.5 in China. In 2013, in total, there were 191 days in Xi'an City on which PM2.5 concentrations were greater than 100 μg/m3. Recently, a few studies have explored the potential causes of high PM2.5 concentration using remote sensing data such as the MODIS aerosol optical thickness (AOT) product. Linear regression is a commonly used method to find statistical relationships among PM2.5 concentrations and other pollutants, including CO, NO2, SO2, and O3, which can be indicative of emission sources. The relationships of these variables, however, are usually complicated and non-linear. Therefore, a generalized additive model (GAM) is used to estimate the statistical relationships between potential variables and PM2.5 concentrations. This model contains linear functions of SO2 and CO, univariate smoothing non-linear functions of NO2, O3, AOT and temperature, and bivariate smoothing non-linear functions of location and wind variables. The model can explain 69.50% of PM2.5 concentrations, with R2 = 0.691, which improves the result of a stepwise linear regression (R2 = 0.582) by 18.73%. The two most significant variables, CO concentration and AOT, represent 20.65% and 19.54% of the deviance, respectively, while the three other gas-phase concentrations, SO2, NO2, and O3 account for 10.88% of the total deviance. These results show that in Xi'an City, the traffic and other industrial emissions are the primary source of PM2.5. Temperature, location, and wind variables also non-linearly related with PM2.5.

  20. Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England

    PubMed Central

    Bouras, George; Burns, Elaine Marie; Howell, Ann-Marie; Bottle, Alex; Athanasiou, Thanos; Darzi, Ara

    2015-01-01

    Background Trends towards day case surgery and enhanced recovery mean that postoperative venous thromboembolism (VTE) may increasingly arise after hospital discharge. However, hospital data alone are unable to capture adverse events that occur outside of the hospital setting. The National Institute for Health and Care Excellence has suggested the use of primary care data to quantify hospital care-related VTE. Data in surgical patients using these resources is lacking. The aim of this study was to measure VTE risk and associated mortality in general surgery using linked primary care and hospital databases, to improve our understanding of harm from VTE that arises beyond hospital stay. Methods This was a longitudinal cohort study using nationally linked primary care (Clinical Practice Research Datalink, CPRD), hospital administrative (Hospital Episodes Statistics, HES), population statistics (Office of National Statistics, ONS) and National Cancer Intelligence Network databases. Routinely collected information was used to quantify 90-day in-hospital VTE, 90-day post-discharge VTE and 90-day mortality in adults undergoing one of twelve general surgical procedures between 1st April 1997 and 31st March 2012. The earliest postoperative recording of deep vein thrombosis or pulmonary embolism in CPRD, HES and ONS was counted in each patient. Covariates from multiple datasets were combined to derive detailed prediction models for VTE and mortality. Limitation included the capture of VTE presenting to healthcare only and the lack of information on adherence to pharmacological thromboprophylaxis as there was no data linkage to hospital pharmacy records. Results There were 981 VTE events captured within 90 days of surgery in 168005 procedures (23.7/1000 patient-years). Overall, primary care data increased the detection of postoperative VTE by a factor of 1.38 (981/710) when compared with using HES and ONS only. Total VTE rates ranged between 3.2/1000 patient-years in

  1. [Factors influencing uptake of influenza vaccination in healthcare workers. Findings from a study in a general hospital].

    PubMed

    Castella, A; Argentero, P A; Lanszweert, A

    2009-01-01

    Despite recommendations, influenza vaccination coverage in health professionals remains low throughout the world. In order to identify reasons for adherence or refusal we conducted a study within our hospital by means of interview questionnaires which were distributed to health care workers to reveal factors influencing acceptance or refusal of vaccination and to get suggestions to improve vaccination coverage. There is good overlap between our results and data obtainable from international literature: the main motivating factor for vaccination is personal protection against influenza, while only a significantly smaller part gave protection of patients as a reason. The main factors for not adhering to vaccination are belief the vaccine is not effective, influenza-related sick leave, fear of adverse effects and lack of availability. These data point out the need for more information concerning the importance of influenza infection within risk groups, the safety and effectiveness of the vaccine. Further, it is suitable to increase availability of the vaccine free of charge.

  2. Improving the effectiveness of the emergency management of renal colic in a district general hospital: a completed audit cycle

    PubMed Central

    Kastner, C; Tagg, A

    2003-01-01

    Methods: Data were collected about the use of analgesia, waiting time for intravenous urography (IVU), and admission status of patients presenting to the hospital with symptoms of renal colic over the period of three months. A literature search into the use of analgesia, imaging, and treatment was performed. Members of the involved departments were consulted and new guidelines developed and implemented. This was followed by further data collection over three months. Results: Seven of 14 patients were admitted. Five to wait for their IVU. Their average waiting time was 12.3 (SD 2.2) hours. Mainly intramuscular opioid analgesia was used. Literature recommended the use of diclofenac. Although computed tomography was favoured it was decided to continue to use IVU because of circumstances within the hospital. The literature recommended a cut off between conservative and surgical treatment at a calculus size of >4 mm. Existing policies of the relevant departments were obeyed and a training system for the junior doctors was introduced. Emergency department staff were encouraged to perform 3-film IVUs. After this, of 5 of 19 patients were admitted, only one of those to wait for an IVU. The average waiting time for an IVU was 4.1 (SD 0.96) hours. Rectal diclofenac was noted to be the drug of choice. Conclusion: Coordination of efforts, interdepartmental communication, and a practical application of available literature has resulted in a significant improvement of effectiveness without affecting medical standards, workload, or resources. Accident and emergency senior house officers felt highly satisfied at being able to complete management from presentation to diagnosis and treatment. Interdisciplinary communication has to be continued to maintain smooth operation of the guidelines. PMID:12954686

  3. Rate of Pressure Ulcers in Intensive Units and General Wards of Iranian Hospitals and Methods for Their Detection

    PubMed Central

    AKBARI SARI, Ali; DOSHMANGHIR, Leila; NEGHAHBAN, Zahra; GHIASIPOUR, Maryam; BEHESHTIZAVAREH, Zeinab

    2014-01-01

    Abstract Background This study aimed to estimate the rate of pressure ulcers in intensive care units (ICUs) and medical and surgical wards of Iranian hospitals and compare the performance of methods of medical record review as well as direct observation for their detection. Methods The research team visited 308 patients in medical and surgical wards of hospitals affiliated with Tehran University of Medical Sciences and a further 90 patients in their ICUs between March 2009 and April 2010. In addition 310 patient records were randomly selected from patients discharged from the ICUs between March 2009 and April 2010. And a further 600 patient records were randomly selected from the patients that were discharged from medical and surgical wards between March 2010 and April 2011. These 910 selected records were retrospectively reviewed to identify pressure ulcers. Data were collected by a structured checklist. Results In ICUs 24 of 90 patients (26.7%, 95% CI: 17.56 to 35.84) that were directly observed and 59 of 310 patients (19.0%, 95% CI: 14.63 to 23.37) that were studied by retrospective review of medical records had pressure ulcers. In medical and surgical wards, 5 of 308 patients (1.6%, 95% CI: 0.20 to 3.00) that were directly observed had pressure ulcers, but no pressure ulcer was detected by review of 600 medical records. Conclusion Pressure ulcers are significantly more frequent in ICUs than in medical and surgical wards and a significant proportion of pressure ulcers are not reported. PMID:26110149

  4. Short-Term Effects of Gaseous Pollutants and Particulate Matter on Daily Hospital Admissions for Cardio-Cerebrovascular Disease in Lanzhou: Evidence from a Heavily Polluted City in China

    PubMed Central

    Zheng, Shan; Wang, Minzhen; Wang, Shigong; Tao, Yan; Shang, Kezheng

    2013-01-01

    Panel studies show a consistent association between increase in the cardiovascular hospitalizations with air pollutants in economically developed regions, but little evidence in less developed inland areas. In this study, a time-series analysis was used to examine the specific effects of major air pollutants [particulate matter less than 10 microns in diameter (PM10), sulfur dioxide (SO2), and nitrogen dioxides (NO2)] on daily hospital admissions for cardio-cerebrovascular diseases in Lanzhou, a heavily polluted city in China. We examined the effects of air pollutants for stratified groups by age and gender, and conducted the modifying effect of seasons on air pollutants to test the possible interaction. The significant associations were found between PM10, SO2 and NO2 and cardiac disease admissions, SO2 and NO2 were found to be associated with the cerebrovascular disease admissions. The elderly was associated more strongly with gaseous pollutants than younger. The modifying effect of seasons on air pollutants also existed. The significant effect of gaseous pollutants (SO2 and NO2) was found on daily hospital admissions even after adjustment for other pollutants except for SO2 on cardiac diseases. In a word, this study provides the evidence for the detrimental short-term health effects of urban gaseous pollutants on cardio-cerebrovascular diseases in Lanzhou. PMID:23358231

  5. Audit of 149 consecutive carotid endarterectomies performed by a single surgeon in a district general hospital over a 12-year period.

    PubMed Central

    Tan, L. C.; Sutton, G. L.; Taffinder, N. J.; Perry, M.; Fail, T.

    1996-01-01

    Carotid endarterectomy has been established by two large randomised controlled trials (European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET)) as an important surgical procedure for the prevention of ischaemic strokes in patients presenting with transient cerebral ischaemia or non-disabling strokes attributable to severe ipsilateral carotid artery stenosis. The operation carries significant risk of death and stroke and it has been advocated by some that carotid endarterectomy should only be performed in a small number of designated regional centres in order to achieve good surgical results. It is doubtful that the regional centres alone can cope with the increasing numbers of patients requiring carotid endarterectomy and there is therefore a requirement for the procedure to be carried out by vascular surgeons in district general hospitals. It is important that surgical results are audited to ensure that comparable outcomes are achieved. We present an audit of our experience of carotid endarterectomy since 1981. A total of 149 consecutive carotid endarterectomies were performed by a single surgeon with a special interest in carotid surgery. The results are comparable to ECST with a 30-day mortality of 0% and an overall 30-day stroke rate of 5.7% (major strokes) for patients with severe, ie 70-99%, ipsilateral carotid artery stenoses. We have shown that carotid endarterectomy is an operation that can be performed safely and with good results by suitably trained surgeons in district general hospitals. PMID:8712647

  6. International Classification of Primary Care-2 coding of primary care data at the general out-patients’ clinic of General Hospital, Lagos, Nigeria

    PubMed Central

    Olagundoye, Olawunmi Abimbola; van Boven, Kees; van Weel, Chris

    2016-01-01

    Background: Primary care serves as an integral part of the health systems of nations especially the African continent. It is the portal of entry for nearly all patients into the health care system. Paucity of accurate data for health statistics remains a challenge in the most parts of Africa because of inadequate technical manpower and infrastructure. Inadequate quality of data systems contributes to inaccurate data. A simple-to-use classification system such as the International Classification of Primary Care (ICPC) may be a solution to this problem at the primary care level. Objectives: To apply ICPC-2 for secondary coding of reasons for encounter (RfE), problems managed and processes of care in a Nigerian primary care setting. Furthermore, to analyze the value of selected presented symptoms as predictors of the most common diagnoses encountered in the study setting. Materials and Methods: Content analysis of randomly selected patients’ paper records for data collection at the end of clinic sessions conducted by family physicians at the general out-patients’ clinics. Contents of clinical consultations were secondarily coded with the ICPC-2 and recorded into excel spreadsheets with fields for sociodemographic data such as age, sex, occupation, religion, and ICPC elements of an encounter: RfE/complaints, diagnoses/problems, and interventions/processes of care. Results: Four hundred and one encounters considered in this study yielded 915 RfEs, 546 diagnoses, and 1221 processes. This implies an average of 2.3 RfE, 1.4 diagnoses, and 3.0 processes per encounter. The top 10 RfE, diagnoses/common illnesses, and processes were determined. Through the determination of the probability of the occurrence of certain diseases beginning with a RfE/complaint, the top five diagnoses that resulted from each of the top five RfE were also obtained. The top five RfE were: headache, fever, pain general/multiple sites, visual disturbance other and abdominal pain/cramps general. The

  7. [Education for chronic cardiologic diseases in a transversal multidisciplinary unit: the experience of a general hospital center].

    PubMed

    Dujardin, J J; Joly, P; Jaboureck, O; Madoun, S; Bresson, R; Averous, V; Prévost, G; Maetz, E; Racoussot, S; Dervaux, D

    2005-11-01

    Treatments for congestive heart failure, hypertension and cardiovascular risk have significantly changed and have become more complex. The have also become more and more effective thanks to the results of great clinical studies that have enabled European and North-American societies to issues recommendations. The observance of the pharmacological and non-pharmacological treatments requires the education of patients and their family following guidelines that have been clearly defined by the European Society of Cardiology. This education, in which the technic of communication is very important, is common to a lot of chronic diseases and requires adequate material and human resources in order to have an optimal quality of treatment. In a society in which spending is on rise, getting such resources is not easy. However, putting in common resources of several departments can be a good solution. The experience of the Hospital Center of Douai (France) lead to the creation of a Transversal Education Unit at the end of the year 2003. This unit centralizes the efforts of several departments of care like pneumology, pediatrics, diabetology, nutrition and cardiology and allows patients suffering from co-morbidities to have access to various programs of this unit.

  8. Evaluation of extremity pain in children using technetium-99m MDP bone scan: A general hospital experience

    SciTech Connect

    Park, H.M.; Rothschild, P.A.; Kernek, C.B.

    1984-01-01

    This study was undertaken to evaluate the efficacy of three-phase bone scan in detection of significant pathology i.e., osteomyelitis (OM), septic joint, cellulitis, etc., in children with symptoms of extremity pain. A total of 100 consecutive patients (age 9 days - 16 yrs, 63 boys and 37 girls) were studied. The authors reviewed their scans, x-rays and hospital records. The final diagnoses were based on the findings of needle aspiration, surgical drainage, biopsy, culture, and on the therapeutic response. In 87%, sufficiently long clinical follow-up was available to confirm the final diagnoses. In the remaining 13%, the symptoms resolved quickly and follow-up was not felt necessary. The scan was essential in pinpointing the lesions in pts with referred or nonlocalizing extremity pain. The +ve and -ve predictive values of the scan and OM were 89% and 96% respectively. One spiral fracture was misinterpreted as diffuse OM. One ''Subacute epiphyseal OM'' was not detected. In two cases, cellulitis and septic joint obscured underlying OM. Prior antibotic therapy resulted in one equivocal scan. Although less sensitive (29%) in early OM, radiographs play an important complimentary role. Bone scans detected underlying pathology for extremity pain in 61% of all pts studied.

  9. [Reasons for the construction of Bispebjerg Hospital--a hospital with light, air and freedom of nature].

    PubMed

    Permin, Henrik; Wagner, Peter

    2009-01-01

    Since the 1850ies the city of Copenhagen changed, ramparts were removed or remodelled as parks, industries were established. The new factories and wharfs expanded, labourers were needed; many country people moved into the city to find work and thus the population increased immensely. In Copenhagen a few hospitals only were present around 1850; The Royal Frederik Hospital (now the Museum of applied Arts) was the only hospital in the modern sense of the word. Other institutions with "hospital" as part of their name as e.g. General Hospital (Almindelig Hospital) or Ladegaarden were a mixture of hospital and workhouse and The Royal Maternity Hospital founded in 1750. The wealthy and the upper middle class citizens were nursed or cured at home. At the end of the nineteenth century medical doctors could successfully cure some diseases, and surgeons could after the introduction of the anesthetic and aseptic treatment carry out operations with diminished risks of complications. Copenhagen's first modern hospital, Municipal Hospital (Kommunehospitalet) opened 1863, but in a very short time it was permanently overcrowded. Although two small hospitals Blegdam Hospital (isolation hospital) and the Oresund Hospital (quarantine station) were established a large new hospital was needed. Although the financial situation of the city of Copenhagen was strained due to the expenditures caused by the rapidly growing population within the city itself and the villages incorporated into it, the first social democratic mayor Jens Jensen wanted to secure his voters the same care and treatment as citizens of better means. As this view was accepted by the majority of the city council a hospital in the then modern and functional pavilion system (ascribed to Florence Nightingale) with buildings surrounded by gardens was planned. The architect Martin Nyrop (1849-1921) who had just completed the monumental and beautiful Copenhagen City Hall along with the engineer AC Karsten (1857-1931) and

  10. The Organization of Hospital Services for Casualties due to the Bombing of Cities, Based on Experience Gained in Barcelona—with Special Reference to the Classification of Casualties

    PubMed Central

    Trueta, J.

    1939-01-01

    (1) Difference between modern “total population” war and old-fashioned war. Difference between bombing of (a) military objectives and (b) civilian population. (a) The heavy bomb, e.g. 750 lb., with large fragments, upward throw, great destruction of buildings. (b) The light bomb with finger nail fragments, horizontal throw, great velocity.There is in addition the incendiary bomb, little used in Barcelona because the buildings are built of stone and concrete. (2) Aerial bombing of a town produces injuries needing more immediate hospitalization than most front-line wounds. At the same time it is possible in a town to organize rapid collection of patients and their immediate transfer to hospital. (3) Experience shows that it is most desirable to make this transfer of patients to hospital a primary consideration. On arrival they are “sorted” and minor injuries are given First Aid treatment and sent home, others are fully examined, classified, and dispatched to the theatres on a priority list, to nearby wards for resuscitation, to wards for rest, or sent on to plaster rooms for splintage, or to a neurosurgical centre. (4) First-aid posts in a town should be in hospitals and treat superficial injuries, &c., after primary sorting in the hospital reception room. (5) First-aid posts in outlying areas should carry out the same function for the same type of cases; all the more seriously wounded, including those with tiny penetrating wounds, should be dispatched without first aid treatment direct to hospital. (6) Hospital arrangements, for circulation of ambulances, for sorting, undressing of patients, docketing of valuables, &c. (7) Classification must be carried out by surgeons of experience and judgment. They must regard not only a standard priority list but the particular clinical picture and prognosis in each case. (8) The surgeon will furthermore draft the cases with regard to the special abilities of the surgical units available, e.g. chest, abdomen, or limbs

  11. Short-Term Effects of Coarse Particulate Matter on Hospital Admissions for Cardiovascular Diseases: A Case-Crossover Study in a Tropical City.

    PubMed

    Chen, Ying-Chen; Weng, Yi-Hao; Chiu, Ya-Wen; Yang, Chun-Yuh

    2015-01-01

    This study was undertaken to determine whether there was an association between coarse particles (PM2.5-10) levels and frequency of hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions for CVD, including ischemic heart disease (IHD), stroke, congestive heart failure (CHF), and arrhythmias, and ambient air pollution data levels for Kaohsiung were obtained for the period 2006-2010. The relative risk of hospital admissions for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased rates of admissions for CVD were significantly associated with higher coarse PM levels only on cool days (< 25°C), with a 10-μg/m(3) elevation in PM2.5-10 concentrations associated with a 3% (95% CI = 2-4%) rise in IHD admissions, 5% (95% CI = 4-6%) increase in stroke admissions, 3% (95% CI = 1-6%) elevation in CHF admissions, and 3% (95% CI = 0-6%) rise in arrhythmias admissions. No significant associations were found between coarse particle levels and number of hospital admissions for CVD on warm days. In the two-pollutant models, PM2.5-10 levels remained significantly correlated with higher rate of CVD admissions even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. Compared to the effect estimate associated with a 10-μg/m(3) increase in PM2.5 levels, effect estimates of frequency of CVD-related admissions associated with a 10-μg/m(3) rise in coarse PM levels were weaker. This study provides evidence that higher levels of PM2.5-10 enhance the risk of hospital admissions for CVD.

  12. India's Cities in Crisis.

    ERIC Educational Resources Information Center

    Bryjak, George J.

    1984-01-01

    Indian cities are growing rapidly due to natural increase and migration from rural areas. This has caused huge pollution problems and has resulted in overcrowded schools and hospitals. Conflict between religious groups has increased; so has crime. India is modernizing, but not fast enough. (CS)

  13. Workload due to Aspergillus fumigatus and significance of the organism in the microbiology laboratory of a general hospital.

    PubMed

    Bouza, E; Guinea, J; Peláez, T; Pérez-Molina, J; Alcalá, L; Muñoz, P

    2005-05-01

    The increase in the immunocompromised population and the incidence of invasive aspergillosis (IA) are leading to an overinterpretation of the potential clinical significance of many isolates of Aspergillus fumigatus. Our work prospectively assesses the workload of the isolation of A. fumigatus and its clinical significance in the microbiology laboratory of a large teaching hospital. During a 3-year period, all patients from whom A. fumigatus was isolated were prospectively monitored and classified as having IA or "nonsignificant" disease. A point score based on the prediction of five easily obtained laboratory and clinical parameters was applied. We found 404 A. fumigatus isolates in 260 patients (1/1,000 microbiology laboratory samples; 2.1 patients/10,000 admissions). A total of 90 isolates (22.3%) were from patients with IA. Of the 260 patients, 31 (12%) had invasive disease (IA), and the remaining 229 had "nonsignificant" disease. A score based on points for five parameters was applied to our population. It was constructed as follows: "sample obtained by invasive procedures" (1 point), "presence of two or more positive samples from the same patient" (1 point), "leukemia" (2 points), "neutropenia" (5 points), and "corticosteroid treatment" (2 points). Patients with a score of 0 had only a 2.5% probability of IA. Those with a score of 1 or 2 had an increased probability of 10.3%. The probabilities rose to 40% and 70%, respectively, for patients with a score of 3 or 4 or a score of > or = 5. A simple score based on five easily available parameters may be of help to microbiologists and clinicians to predict the risk of IA.

  14. Prevalence of Escherichia coli and Salmonella spp. in street-vended food of open markets (tianguis) and general hygienic and trading practices in Mexico City.

    PubMed

    Estrada-Garcia, T; Lopez-Saucedo, C; Zamarripa-Ayala, B; Thompson, M R; Gutierrez-Cogco, L; Mancera-Martinez, A; Escobar-Gutierrez, A

    2004-12-01

    Street-vendors in Mexico City provide ready-to-eat food to a high proportion of the inhabitants. Nevertheless, their microbiological status, general hygienic and trading practices are not well known. During spring and summer 2000, five tianguis (open markets) were visited and 48 vendors in 48 stalls interviewed. A total of 103 taco dressings were sampled for E. coli and Salmonella spp.: 44 (43%) contained E. coli and 5 (5%) Salmonella (2 S. Enteritidis phage type 8, 1 S. Agona, 2 S. B group). Both E. coli and salmonellas were isolated from three samples. Of Salmonella-positive stalls 80% (4/5) had three or more food-vendors and 80% of vendors were males, compared with 37.3% (16/43) and 46.4% (20/43) in the Salmonella-negative stalls respectively. Food-vendors kept water in buckets (reusing it all day), lacked toilet facilities, and prepared taco dressings the day before which remained at the tianguis without protection for 7.8 h on average. Consumption of street-vended food by local and tourist populations poses a health risk.

  15. Prevalence of Escherichia coli and Salmonella spp. in street-vended food of open markets (tianguis) and general hygienic and trading practices in Mexico City.

    PubMed Central

    Estrada-Garcia, T.; Lopez-Saucedo, C.; Zamarripa-Ayala, B.; Thompson, M. R.; Gutierrez-Cogco, L.; Mancera-Martinez, A.; Escobar-Gutierrez, A.

    2004-01-01

    Street-vendors in Mexico City provide ready-to-eat food to a high proportion of the inhabitants. Nevertheless, their microbiological status, general hygienic and trading practices are not well known. During spring and summer 2000, five tianguis (open markets) were visited and 48 vendors in 48 stalls interviewed. A total of 103 taco dressings were sampled for E. coli and Salmonella spp.: 44 (43%) contained E. coli and 5 (5%) Salmonella (2 S. Enteritidis phage type 8, 1 S. Agona, 2 S. B group). Both E. coli and salmonellas were isolated from three samples. Of Salmonella-positive stalls 80% (4/5) had three or more food-vendors and 80% of vendors were males, compared with 37.3% (16/43) and 46.4% (20/43) in the Salmonella-negative stalls respectively. Food-vendors kept water in buckets (reusing it all day), lacked toilet facilities, and prepared taco dressings the day before which remained at the tianguis without protection for 7.8 h on average. Consumption of street-vended food by local and tourist populations poses a health risk. PMID:15635978

  16. A Protocolised Once a Day Modified Early Warning Score (MEWS) Measurement Is an Appropriate Screening Tool for Major Adverse Events in a General Hospital Population

    PubMed Central

    Ludikhuize, Jeroen; Kramer, Mark H. H.

    2016-01-01

    Background The Modified Early Warning Score (MEWS) was developed to timely recognise clinically deteriorating hospitalised patients. However, the ability of the MEWS in predicting serious adverse events (SAEs) in a general hospital population has not been examined prospectively. The aims were to (1) analyse protocol adherence to a MEWS protocol in a real-life setting and (2) to determine the predictive value of protocolised daily MEWS measurement on SAEs: death, cardiac arrests, ICU-admissions and readmissions. Methods All adult patients admitted to 6 hospital wards in October and November 2015 were included. MEWS were checked each morning by the research team. For each critical score (MEWS ≥ 3), the clinical staff was inquired about the actions performed. 30-day follow-up for SAEs was performed to compare between patients with and without a critical score. Results 1053 patients with 3673 vital parameter measurements were included, 200 (19.0%) had a critical score. The protocol adherence was 89.0%. 18.2% of MEWS were calculated wrongly. Patients with critical scores had significant higher rates of unplanned ICU admissions [7.0% vs 1.3%, p < 0.001], in-hospital mortality [6.0% vs 0.8%, p < 0.001], 30-day readmission rates [18.6% vs 10.8%, p < 0.05], and a longer length of stay [15.65 (SD: 15.7 days) vs 6.09 (SD: 6.9), p < 0.001]. Specificity of MEWS related to composite adverse events was 83% with a negative predicting value of 98.1%. Conclusions Protocol adherence was high, even though one-third of the critical scores were calculated wrongly. Patients with a MEWS ≥ 3 experienced significantly more adverse events. The negative predictive value of early morning MEWS < 3 was 98.1%, indicating the reliability of this score as a screening tool. PMID:27494719

  17. Education Cities

    ERIC Educational Resources Information Center

    Shaked, Haim

    2014-01-01

    In recent years, several cities in Israel have labeled themselves "Education Cities," concentrating on education as their central theme. Employing qualitative techniques, this article aims to describe, define, and conceptualize this phenomenon as it is being realized in three such cities. Findings show that Education Cities differ from…

  18. Qualitative Inquiry into Challenges Experienced by Registered General Nurses in the Emergency Department: A Study of Selected Hospitals in the Volta Region of Ghana

    PubMed Central

    Adatara, Peter

    2016-01-01

    Registered General Nurses (RGNs) play crucial roles in emergency departments (EDs). EDs in Ghana are primarily staffed by RGNs who have had no additional formal education in emergency care. Additionally, basic, master's, or doctoral level nursing education programs provide limited content on the complexities of emergency nursing. Nurses in EDs are affected by many challenges such as growing patient population, financial pressures, physical violence, verbal abuse, operational inefficiencies, overcrowding, and work overload. There is a paucity of research on challenges experienced by RGNs in EDs in the Volta Region of Ghana. In this qualitative study, twenty RGNs in EDs from three selected hospitals in the Volta Region of Ghana were interviewed. All recorded interviews were transcribed, reviewed several times by researchers and supervisors, and analyzed using content analysis. Five thematic categories were identified. These thematic categories of challenges were lack of preparation for ED role, verbal abuse from patients relatives, lack of resources in ED, stressful and time consuming nature of ED, and overcrowding in ED. Formal education of RGNs in the advanced role of emergency care, adequate supply of resources, increased hospital management support, and motivations for RGNs working in ED are necessary to improve the practice of emergency care. PMID:27885343

  19. [Development of antibiotherapy at the General Hospital Center R Ballanger of Aulnay-sous-Bois between 1978 and 1986: comparison of 2 prevalence surveys].

    PubMed

    Rozenbaum, L; Elhadad, A; Fabreguettes, A; Giacomini, T; Le Pennec, M P; Barberot, N

    1989-04-01

    Two investigations of the prevalence of antibiotherapy and pathology due to infections have been conducted in 1978 and 1986 in a General Hospital (650 beds). In the first investigation, 29%, and, in the second one, 20% of hospitalized patients received a curative antibiotherapy. Among these patients, microbiology tests scored positive in 44% of cases in the first investigation and in 36% of cases in the second one. In the last inquiry, it was found that: the prescription was adapted to the infection in 95% of cases; the choice of antibiotic was adequate in 78% of curative treatments. Preventive antibiotherapy accounts for 30% of treatments in both investigations. In the second investigation, the prescription was adequate in 97% of cases and the length of treatment was less than 72 hours in 53% of cases. The frequency of Gram-positive cocci infections was increased while Gram-negative bacilli infections were reduced. Between the two investigations, antibiotic treatments have changed. Most noticeably, there is an increase in the number of prescriptions of macrolides, cephalosporins, nitro-imidazole derivatives and a reduction of tetracyclines, urinary antiseptics, quinolones of the 1st generation, sulfamides and penicillins. However, penicillins remain the most commonly used antibiotics family.

  20. "Gentlemen! This Is No Humbug": Did John Collins Warren, M.D., Proclaim These Words on October 16, 1846, at Massachusetts General Hospital, Boston?

    PubMed

    Haridas, Rajesh P

    2016-03-01

    The proclamation, "Gentlemen! this is no humbug," attributed to John Collins Warren, M.D., was not identified in any contemporaneous eyewitness report of William T. G. Morton's October 16, 1846, demonstration of ether at Massachusetts General Hospital. The earliest known documentation of the proclamation is in Nathan P. Rice's biography of Morton, first published in 1859. Only three eyewitnesses, Washington Ayer, M.D., Robert Thompson Davis, M.D., and Isaac Francis Galloupe, M.D., reported Warren's alleged proclamation. However, their accounts first appeared in 1896, 50 yr after Morton's demonstration of etherization. Although Warren's alleged proclamation appears plausible, the overall impression from eyewitness statements and publications relating to the October 16, 1846, demonstration of etherization is that it may not have been made.

  1. Restructuring within an academic health center to support quality and safety: the development of the Center for Quality and Safety at the Massachusetts General Hospital.

    PubMed

    Bohmer, Richard M J; Bloom, Jonathan D; Mort, Elizabeth A; Demehin, Akinluwa A; Meyer, Gregg S

    2009-12-01

    Recent focus on the need to improve the quality and safety of health care has created new challenges for academic health centers (AHCs). Whereas previously quality was largely assumed, today it is increasingly quantifiable and requires organized systems for improvement. Traditional structures and cultures within AHCs, although well suited to the tripartite missions of teaching, research, and clinical care, are not easily adaptable to the tasks of measuring, reporting, and improving quality. Here, the authors use a case study of Massachusetts General Hospital's efforts to restructure quality and safety to illustrate the value of beginning with a focus on organizational culture, using a systematic process of engaging clinical leadership, developing an organizational framework dependent on proven business principles, leveraging focus events, and maintaining executive dedication to execution of the initiative. The case provides a generalizable example for AHCs of how applying explicit management design can foster robust organizational change with relatively modest incremental financial resources.

  2. Prevalence of osteonecrosis of the jaw and oral characteristics of oncologic patients treated with bisphosphonates at the General Hospital of Mexico

    PubMed Central

    2016-01-01

    Objectives To determine the prevalence and oral characteristics of cancer patients treated with bisphosphonates in the oncology and maxillofacial prosthesis departments of the General Hospital of Mexico between 2011 and 2013. Materials and Methods This cross-sectional study included patients who received prior treatment with bisphosphonates; an intraoral examination was performed by 2 standardized examiners. Results The prevalence of bisphosphonate-related necrosis in 75 patients was 2.6%; the most common malignancy was breast cancer (84.0%), followed by prostate cancer (16.0%). Exostosis was present in 9.3% of patients and the mean Decayed, Missing, Filled Teeth index was 4.64; 44.0% of the study group had a Community Periodontal Index value between 2 and 2.9 (mean, 0.60). Conclusion A detailed intraoral assessment must be performed before initiating treatment with bisphosphonates to identify risk factors for osteonecrosis. PMID:28053907

  3. A prospective study of incidence of medication-related problems in general medicine ward of a tertiary care hospital

    PubMed Central

    Movva, Ramya; Jampani, Anusha; Nathani, Jyothsna; Pinnamaneni, Sri Harsha; Challa, Siva Reddy

    2015-01-01

    The study is aimed to assess the incidence of drug-related problems (DRPs) and provide pharmacist interventions for identified DRPs. A prospective, observational study was conducted among 189 patients with cardiovascular disease who were aged 18 years or older and admitted to the general medicine in-patient ward. During the 6 months study period, the incidence of DRPs was identified using Pharmaceutical Care Network Europe Foundation classification system version 6.2. A total of 189 patients were screened for DRPs. Among them, 130 patients have at least one DRP. A total of 416 DRPs were identified (on average, 2.2 DRPs per each patient). Of the 416 DRPs, 125 (30.04%) interventions were accepted, 7 (1.68%) interventions were not accepted, while remaining (68.26%) accepted but no action taken. The results of the study indicate that incidence of DRPs is substantial and pharmacist-led interventions resulted in resolution of DRPs. This represents the need for the active role of the clinical pharmacist in the developing countries like India. PMID:26605161

  4. Improving door-to-needle times for patients presenting with ST-elevation myocardial infarction at a rural district general hospital

    PubMed Central

    Jordan, Mark; Caesar, Jenny

    2016-01-01

    Acute coronary syndrome is a common condition with a major global impact on healthcare resources and expenditure. International guidelines are clear in specifying that patients with acute ST-elevation myocardial infarction (STEMI) should receive urgent coronary reperfusion with either primary percutaneous coronary intervention (PCI) or thrombolysis. Although PCI is the gold standard in the treatment of STEMI, this is not always achievable in a rural hospital with no cardiac catheterization service. Consequently, local recommendations on STEMI management exist to promote timely administration of thrombolysis within 30 minutes of patient arrival. However, translating updated clinical policy into practice is a challenging and complex task that requires a multi-faceted approach with sustained engagement from local stakeholders. Whilst working at a district general hospital in New Zealand, we noted a high incidence of patients presenting with STEMI receiving thrombolytic therapy outside the recommended 30 minutes door-to-needle time. Although final treatment was often only delayed by 5-10 minutes, we were concerned by the seemingly inconsistent management of these patients, often leading to unnecessary delays in the initiation of rapid reperfusion therapy. We therefore championed a newly updated clinical guideline and promoted an early STEMI recognition and treatment algorithm in our hospital to raise awareness amongst staff and improve door-to-needle times. We introduced a number of simple low-cost interventions that included educational sessions for junior doctors and cardiac nursing staff, as well as posters and training on the use of a remote electronic ECG interpretation system to streamline out-of-hours management. Overall, we found there to a be a steady improvement in door-to-needle times at our hospital, with 74% of patients receiving appropriate care within 30 minutes, compared to 43% prior to our interventions. This also translated to better patient outcomes

  5. The Impact of Healthcare Workers Job Environment on Their Mental-emotional Health. Coping Strategies: The Case of a Local General Hospital.

    PubMed

    Koinis, Aristotelis; Giannou, Vasiliki; Drantaki, Vasiliki; Angelaina, Sophia; Stratou, Elpida; Saridi, Maria

    2015-04-13

    Workplace stress can influence healthcare professionals' physical and emotional well-being by curbing their efficiency and having a negative impact on their overall quality of life. The aim of the present study was to investigate the impact that work environment in a local public general hospital can have on the health workers' mental-emotional health and find strategies in order to cope with negative consequences. The study took place from July 2010 to October 2010. Our sample consisted of 200 healthcare professionals aged 21-58 years working in a 240-bed general hospital and the response rate was 91.36%). Our research protocol was first approved by the hospital's review board. A standardized questionnaire that investigates strategies for coping with stressful conditions was used. A standardized questionnaire was used in the present study Coping Strategies for Stressful Events, evaluating the strategies that persons employ in order to overcome a stressful situation or event. The questionnaire was first tested for validity and reliability which were found satisfactory (Cronbach's α=0.862). Strict anonymity of the participants was guaranteed. The SPSS 16.0 software was used for the statistical analysis. Regression analysis showed that health professionals' emotional health can be influenced by strategies for dealing with stressful events, since positive re-assessment, quitting and seeking social support are predisposing factors regarding the three first quality of life factors of the World Health Organization Quality of Life - BREF. More specifically, for the physical health factor, positive re-assessment (t=3.370, P=0.001) and quitting (t=-2.564, P=0.011) are predisposing factors. For the 'mental health and spirituality' regression model, positive re-assessment (t=5.528, P=0.000) and seeking social support (t=-1.991, P=0.048) are also predisposing factors, while regarding social relationships positive re-assessment (t=4.289, P=0.000) is a predisposing factor

  6. Development of the 24/7 Nurse Practitioner Model on the Inpatient Pediatric General Surgery Service at a Large Tertiary Care Children's Hospital and Associated Outcomes.

    PubMed

    Rejtar, Marketa; Ranstrom, Lee; Allcox, Christina

    Nurse practitioners (NPs) have been providing high-quality and safe patient care for a few decades, and evidence showing the extent of their impact is emerging. This article describes the implementation of a 24/7 NP patient care model on an inpatient pediatric general surgery service in a tertiary free-standing Children's Hospital in the Northeastern United States. The literature shows that there is limited evidence regarding NP models of care and their effect on patient outcomes. In response to policy changes leading to reduction of resident work hours and a more acute and complex inpatient pediatric general surgery patient population, our existing NP model evolved into a 24/7 NP Model in June 2011. The results from two quality improvement projects showed positive registered nurse and attending surgeon staff satisfaction with the 24/7 NP Model of care and a decreased trend of unplanned intensive care unit patient transfers after the 24/7 NP Model implementation. These findings further support the evidence in the literature that NPs provide safe and quality patient care.

  7. Help-seeking Behaviors Among Caregivers of Schizophrenia and other Psychotic Patients: A Hospital-based Study in Two Geographically and Culturally Distinct Indian Cities

    PubMed Central

    Naik, Sujit Kumar; Pattanayak, Sanjay; Gupta, Chandra Shekhar; Pattanayak, Raman Deep

    2012-01-01

    Background: India is a country of several diversities and cultures, which may influence the help-seeking behavior of mentally ill patients and families. Only a few Indian studies have focused on help seeking, especially for severe mental disorders. Objective: The study aimed to describe and compare the help-seeking behaviors among caregivers of psychotic patients visiting psychiatric clinics at two distinct cities of India. Materials and Methods: This was a cross-sectional exploratory study of key caregivers (N=50) of patients with a DSM-IV TR diagnosis of schizophrenia and other psychotic disorders, visiting psychiatric out-patient departments of VIMHANS, New Delhi, and CIMS, Bilaspur, Chhattisgarh. After due informed consent was taken, a semi-structured proforma was administered for socio-demographic profile, illness details, causative beliefs, and information on help seeking. Results: Supernatural forces were held responsible by 40% of the Bilaspur sample in contrast to 8% in New Delhi sample. Faith-healers were initial contacts for 56% and 64% of sample, respectively, at New Delhi and Bilaspur. Faith-healers followed by a psychiatrist formed the commonest pathway of care at both centers (32% and 36%, respectively). The sample at New Delhi spent significantly more money (median: $4000 vs. $10) and traveled greater distances (median: 35 km vs. 10 km) for faith-healers during the course of illness. Two-thirds of sample in New Delhi and one-third at Bilaspur were aware of the nearby psychiatrist at the time of initial help seeking; however, only 28% and 12%, respectively, chose psychiatrist as an initial contact. The New Delhi sample reported a fear of medication adverse effects and stigma as perceived disadvantages of psychiatric help. The median time lost at both the centers was 1 month, with a maximum of 8.4 years in New Delhi and 4.9 years in Bilaspur. Of the total, 16% caregivers at New Delhi and 32% at Bilaspur center reported an intention to continue with

  8. [Changes in the structure of pathogens of calculous pyelonephritis complicated with diabetes mellitus type ii, in the hospital urology of the city of Volgograd].

    PubMed

    Petrov, V I; Vinarov, A Z; Vekilyan, M A; Kulchenko, N G

    2016-08-01

    Among the diseases complicating the course of calculous pyelonephritis, are among the leaders of diabetes mellitus, which is associated with reduced immune response, deterioration of renal hemodynamics, the reduced sensitivity to antibacterial drugs. The purpose of the study is to improve the results of treatment of patients with calculous pyelonephritis and diabetes mellitus type 2. The materials and methods of research. We studied 179 people. This was a retrospective pharmaco-epidemiological analysis of medical records of patients who were treated in 2009 and 2013, in hospital of Volgograd. Women in the study was greater than 99(by 55.4%), males - 80 (44,6%). All patients underwent standard clinical examination, with mandatory bacteriological urine analysis, ultrasound study of kidneys.

  9. [Drug monitoring in hospitals of Cordoba City (Argentina). 2-year-experience of the Pharmacological Department as a peripheric effect of ANMAT].

    PubMed

    Segura, Aída E del V; Mutal, Víctor; Lizzio, Salvador; Montrull, Hilda L

    2005-01-01

    There were designed Monitorings study (FVG), centred on three Public Hospitals of C6rdoba, seeking to detect Adverse Reactions for medicines. To such purpose there were realized forming courses of human resources in FVG. FVG's cards were distributed, of own design, recovered then. For statistical calculation there was applied the INFO 4. 84 informed cards were recovered. The groups of involved medicines: they were: Antibiotics (22%), cardiovascular (16%), antiulcerous (10%), anxiolytics (8.75%), nonsteroidal anti-inflammatory (8%), onchologics (6%), anticonvulsants (3.75%), hypolypemics (3.5%), sexual hormones (2.5%), hypoglycemics (2.5%), plasmatic expansors (2.5%). The organs affected by RAM were: Central Nervous System (25%), skin (25%), gastrointestinal (17.5%), Bleeds (7.5%), cardiovascular (7.5%), respiratory (7%), immune (6%), renal (4%). The analysis of imputability indicated: Definite RAM: 10 % Probable RAM: 90%.

  10. [A retrospective study on the incidence of chronic renal failure in the Department of Internal Medicine and Nephrology at University Hospital of Antananarivo (the capital city of Madagascar)].

    PubMed

    Ramilitiana, Benja; Ranivoharisoa, Eliane Mikkelsen; Dodo, Mihary; Razafimandimby, Evanirina; Randriamarotia, Willy Franck

    2016-01-01

    Chronic renal failure is a global public health problem. In developed countries, this disease occurs mainly in the elderly, but in Africa it rather affects active young subjects. This disease need for expensive treatments in a low income country, because of its costs. Our aim is to describe the epidemiology of new cases of chronic renal failure in Madagascar. This is a retrospective, descriptive study of 239 patients with chronic renal failure over a 3 year period, starting from 1 January 2007 to 31 December 2009, in the Department of Internal Medicine and Nephrology at University Hospital of Antananarivo. The incidence was 8.51% among patients hospitalized in the Department. The average age of patients was 45.4 years with extremes of 16 and 82 years and a sex ratio 1,46. The main antecedent was arterial hypertension (59.8%). Chronic renal failure was terminal in 75.31% of the cases (n=180). The causes of chronic renal failure were dominated by chronic glomerulonephritis (40.1%), nephroangiosclerosis (35.5%). Hemodialysis was performed in 3 patients (1.26%), no patient was scheduled for a renal transplantation. Mortality rate in the Department was 28.87%. Chronic renal failure is a debilitating disease with a dreadful prognosis which affects young patients in Madagascar. Its treatment remains inaccessible to the majority of patients. The focus must be mainly on prevention, especially on early effective management of infections, arterial hypertension and diabetes to reduce its negative impacts on the community and public health. The project on renal transplantation: living donor, effective and less expensive treatment compared to hemodialysis could also be a good solution for these Malagasy young subjects.

  11. Demographics, Clinical Characteristics, and Treatment of Aggressive Patients Admitted to the Acute Behavioral Unit of a Community General Hospital: A Prospective Observational Study

    PubMed Central

    Reade, Cynthia; Stoltzfus, Jill; Mittal, Vikrant

    2014-01-01

    Objective: Aggressive patients are not uncommon in acute inpatient behavioral health units of general hospitals. Prior research identifies various predictors associated with aggressive inpatient behavior. This prospective observational study examines the demographic and clinical characteristics of aggressive inpatients and the routine medications these patients were receiving at discharge. Method: Thirty-six adults diagnosed with a DSM-IV mental disorder who met 2 of 6 established inclusion criteria for high violence risk and a Clinical Global Impressions–Severity of Illness (CGI-S) scale score ≥ 4 were observed for a maximum of 28 days on the 23-bed case mix acute behavioral health unit of St Luke’s University Hospital, Bethlehem, Pennsylvania, from January 2012 to May 2013. Primary outcome measures were the Modified Overt Aggression Scale (MOAS) and CGI-S; secondary measures were symptom outcome measures and demographic and clinical characteristics data. Analysis was conducted using repeated measures methodology. Results: Younger males with a history of previous violence, psychiatric admissions, and symptoms of severe agitation were more at risk for aggressive behavior. Positive psychotic symptoms, a diagnosis of bipolar disorder, substance use, and comorbid personality disorders also increased risk. Significant improvements from baseline to last visit were observed for the CGI-S and MOAS (P < .001 for both), with a significant correlation between the MOAS and CGI-S at last visit (P < .001). Only the symptom of agitation was significantly correlated to MOAS scores at both baseline and last visit (P < .001). Conclusion: Patients significantly improved over time in both severity of illness and level of aggression. PMID:25317364

  12. Suicide attempts and related factors in patients admitted to a general hospital: a ten-year cross-sectional study (1997-2007)

    PubMed Central

    2011-01-01

    Background Suicide and suicide attempts represent a severe problem for public health services. The aim of this study is to determine the socio-demographic and psychopathological variables associated with suicide attempts in the population admitted to a General Hospital. Methods An observational-descriptive study of patients admitted to the A Coruña University Hospital (Spain) during the period 1997-2007, assessed by the Consultation and Liaison Psychiatric Unit. We include n = 5,234 admissions from 4,509 patients. Among these admissions, n = 361 (6.9%) were subsequent to a suicide attempt. Admissions arising from a suicide attempt were compared with admissions occurring due to other reasons. Multivariate generalised estimating equation logistic regression models were used to examine factors associated with suicide attempts. Results Adjusting by age, gender, educational level, cohabitation status, being employed or unemployed, the psychiatric diagnosis at the time of the interview and the information on previous suicide attempts, we found that the variables associated with the risk of a suicide attempt were: age, psychiatric diagnosis and previous suicide attempts. The risk of suicide attempts decreases with age (OR = 0.969). Psychiatric diagnosis was associated with a higher risk of suicide attempts, with the highest risk being found for Mood or Affective Disorders (OR = 7.49), followed by Personality Disorders (OR = 7.31), and Schizophrenia and Other Psychotic Disorders (OR = 5.03). The strongest single predictive factor for suicide attempts was a prior history of attempts (OR = 23.63). Conclusions Age, psychopathological diagnosis and previous suicide attempts are determinants of suicide attempts. PMID:21453478

  13. Understanding and reducing the prescription of hypnotics and sedatives at the interface of hospital care and general practice: a protocol for a mixed-methods study

    PubMed Central

    Heinemann, Stephanie; Weiß, Vivien; Straube, Kati; Nau, Roland; Grimmsmann, Thomas; Himmel, Wolfgang; Hummers-Pradier, Eva

    2016-01-01

    Introduction Hypnotics and sedatives, especially benzodiazepines and Z-drugs, are frequently prescribed for longer periods than recommended—in spite of potential risks for patients. Any intervention to improve this situation has to take into account the interplay between different actors, interests and needs. The ultimate goal of this study is to develop—together with the professionals involved—ideas for reducing the use of hypnotics and sedatives and then to implement and evaluate adequate interventions in the hospital and at the primary and secondary care interface. Methods and analysis The study will take place in a regional hospital in northern Germany and in some general practices in this region. We will collect data from doctors, nurses, patients and a major social health insurer to define the problem from multiple perspectives. These data will be explored and discussed with relevant stakeholders to develop interventions. The interventions will be implemented and, in a final step, evaluated. Both quantitative and qualitative data, including surveys, interviews, chart reviews and secondary analysis of social health insurance data, will be collected to obtain a full understanding of the frequency and the reasons for using hypnotics and sedatives. Ethics and dissemination Approval has been granted from the ethics review committee of the University Medical Center Göttingen, Germany. Results will be disseminated to researchers, clinicians and policy makers in peer-reviewed journal articles and conference publications. One or more dissemination events will be held locally during continuous professional development events for local professionals, including (but not confined to) the study participants. PMID:27496238

  14. Adherence to Treatment and Factors Affecting Adherence of Epileptic Patients at Yirgalem General Hospital, Southern Ethiopia: A Prospective Cross-Sectional Study

    PubMed Central

    Hasiso, Temesgen Yohannes; Desse, Tigestu Alemu

    2016-01-01

    Background Non adherence of epileptic patients to antiepileptic medication often leads to an increased risk of seizures and worsening of disease, death and increased health care costs. Objective to assess adherence to treatment and factors affecting adherence of epileptic patients at Yirgalem General Hospital, Southern Ethiopia. Methods and Materials We conducted a cross-sectional study on epileptic patients from February 9 to 22, 2015. Data were collected from patients ≥18 years old. Adherence was measured using the eight-item Morisky’s medication adherence scale. All consecutive patients coming to epilepsy clinic during the study period were interviewed until the calculated sample size (210) was obtained. We collected patient demographics, perception about epilepsy and adherence to medication(s). We used chi-square tests and a binary logistic regression model for statistical analysis. Statistical significance was considered at P<0.05. Results out of a total of 210 participants, 194 were willing to participate and were studied. Of the 194 participants, 109 (56.2%) were males. The mean age of the participants was 33.62±11.44 years; range 18 to 66 years. The majority, 123(63.41%), of the participants were taking two antiepileptic medications. Sixty two (32%) of the participants were adherent to their treatment. The most common reported reasons for non-adherence were forgetfulness 49(75.4%) and run out of pills 7(10.8%). Factors that affect medication adherence are epilepsy treatment for <1 year (P = 0.011), epilepsy treatment for 1–3 years (P = 0.002), epilepsy treatment for 3–5 years (P = 0.007), being married (P = 0.006), grade 9–12 education (P = 0.028), college or university education (P = 0.002) and absence of co-morbidity (P = 0.008). Conclusions The rate of adherence observed in this study was low. The most common reason for non- adherence was forgetfulness. Therefore, the hospital should devise strategies to improve adherence of epileptic patients

  15. Assessment of periodontal health status in postmenopausal women visiting dental hospital from in and around Meerut city: Cross-sectional observational study

    PubMed Central

    Deepa, D.; Jain, Gazal

    2016-01-01

    Background: Puberty, menses, pregnancy, and menopause are the different phases of a woman's life which have a varied influence on oral health. During the menopause, women go through biological and endocrine changes, particularly in their sex steroid hormone production which affects their health. Because the oral mucosa contains estrogen receptors, variations in hormone levels can be seen directly in the oral cavity leading to a few oral conditions and diseases seen more frequently during postmenopausal years. Objective: The objective of this study is to assess periodontal health status in postmenopausal women in and around Meerut city. Materials and Methods: The study sample comprised ninety postmenopausal women. History of menopause was recorded, and the dental examinations were done by measuring the following parameters of periodontal health: plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket probing depth, and Russell's periodontal index. The collected data were subjected to statistical analyses. Results and Conclusion: In the study group, mean age was 55 years, mean missing teeth were 10.3, mean duration of menopause was 9.23. Eleven percent females were completely edentulous, and 5 females had never brushed. Mean PI-s was 1.99, mean GI-s was 1.74, mean BOP was 52.85, and mean Russell's periodontal index was 4.34. Eleven patients were at the initial stages of destructive periodontal disease, 34 had established destructive periodontal disease while thirty patients had the terminal periodontal disease. These findings suggest that females after menopause are at a risk of developing destructive periodontal disease if proper oral hygiene practices are not followed. PMID:28096641

  16. [Yesterdays and happenings at hospitals of Tehuacán, Puebla, México].

    PubMed

    Fajardo-Ortiz, Guillermo

    2004-01-01

    The history of the hospital of Tehuacán, the second city importance in Puebla State, began in 1744, when the Hospital de San Juan de Dios (Hospital of St. John) was founded; in 1820, it was converted into the Municipal of Civil Hospital. The medical establishement continues to provide services to the poor to this day annual also covers health public workers of services for the municipality. The Hospital de la Cruz Roja Mexicana (The Mexican Red Cross Hospital) was created in 1934 provide medical services for accident victims: The hospital services of the Mexican Institute of Social Security (IMSS) began in 1953; an earthquake destroyed the building in 1973, and a new hospital was inaugurated in 1979; at present, it readers services to 98,000 persons. The Sanatorio del Sagrado Corazón (Sacred Heart Sanatorium) is a private religious institution founded at the beginning of the second half the 20th century. In 1996, the Hospital General (General Hospital) began to provide services, takes care of the poor of the geographical region, and is financed with federal funds. The Instituto de Seguridad y Servicios Sociales para Trabajadores del Estado (Institute of Securtiy and Social Services for the Workers of the State, ISSSTE) has a small hospital with 10 beds, it was founded in 1995.

  17. Analysis of molecular epidemiologic characteristics of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli colonizing feces in hospital patients and community dwellers in a Japanese city.

    PubMed

    Nakamura, Akihiro; Komatsu, Masaru; Noguchi, Nobuyoshi; Ohno, Yuki; Hashimoto, Eriko; Matsutani, Hiroko; Abe, Noriyuki; Fukuda, Saori; Kohno, Hisashi; Nakamura, Fumihiko; Matsuo, Shuji; Kawano, Seiji

    2016-02-01

    Infectious diseases caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli are prevalent because of nosocomial infection. In addition, colonization of ESBL-producing E. coli in the intestinal tract of community dwellers due to the contamination of meat or environmental water is assumed to be one of the sources, but the causes have not been clarified. To analyze these factors, we investigated the difference in clonal groups using a combination of phylogenetic groups and multilocus sequence typing of ESBL-producing E. coli, which were obtained from the feces of an inpatient group in our hospital and a community-dwelling group living in a Japanese city. The carriage rate of ESBL-producing E. coli in the inpatient group was 12.5% (32/257), similar to that of 8.5% (42/496) in the community dwellers (P = 0.082). Of the ESBL clonal groups detected from the community dwellers, 52% (22/42) were clonal groups, including D-ST1485, D-ST70, D-ST2847, B2-ST550, B2-ST3510, A-ST93, A-ST580, A-ST716 and B1-ST2787, that have not been detected from human pathogens, meat, companion animals and environmental water, whereas all clonal groups detected from the inpatients were those that had already been reported. The rate of fluoroquinolone-resistant ESBL clonal groups colonizing the intestinal tract of the inpatient group rose as the number of hospital days increased. These results indicated that different factors were related to colonization of ESBL-producing E. coli in the feces of the inpatient group and the community-dwelling group.

  18. [Cultural adaptation and Argentine validation of the Northwick Park Neck Pain Questionnaire in the hospitals of the Autonomous City of Buenos Aires].

    PubMed

    Aguirre, Mariana V; Rodríguez, Matias G; Clarett, Martín; Iribarne, Juan I; Martínez, Marianela; Battistotti, Romina; López de Arcaute, Ana S; Adarves, Romina; Orsini, Esteban

    2013-01-01

    Objetivo: realizar la adaptación cultural y validación del Cuestionario Northwick Park (NPQ) en Argentina, determinando sus propiedades psicométricas, en pacientes con dolor cervical de origen mecánico derivados al Servicio de Kinesiología del Hospital D. F. Santojanni. Materiales y Métodos: Se solicitó la autorización del autor original del NPQ, luego se realizó la adaptación lingüística y prueba piloto. Las propiedades psicométricas incluyeron: confiabilidad test-retest (coeficiente de correlación intraclase, CCI), validez (coeficiente de correlación de Pearson NPQ-Escala Análoga Visual, EVA), consistencia interna (alfa de Cronbach) y sensibilidad al cambio (prueba T para pruebas pareadas NPQ-EVA). Se incluyeron consecutivamente 60 pacientes de septiembre de 2007 a febrero de 2009 con dolor cervical mecánico. Se midieron las variables porcentaje de discapacidad (NPQ) y dolor (EVA) al día del ingreso, a las 24 horas y al alta. Resultados: Veintiséis pacientes completaron el estudio, 4 fueron eliminados y 30 no completaron la 3° medición. Se obtuvo una buena confiabilidad test-retest (ICC 0.8979) y una alta consistencia interna (alfa de Cronbach 0.86). La validez mostró una buena correlación (r= 0,678). La sensibilidad al cambio fue buena (r=0.661). Conclusión: El NPQ es un instrumento válido, confiable y sensible para evaluar la discapacidad asociada al dolor cervical de origen mecánico en pacientes atendidos en el ámbito hospitalario de la Ciudad Autónoma de Buenos Aires.

  19. Parasuicide and drug self-poisoning: analysis of the epidemiological and clinical variables of the patients admitted to the Poisoning Treatment Centre (CAV), Niguarda General Hospital, Milan

    PubMed Central

    2005-01-01

    Epidemiological knowledge of parasuicides and drug self-poisoning is still limited by a lack of data. A number of preliminary studies, which require further analysis, evidenced that parasuicidal acts occur more often among females, that the peak rate is generally recorded between the ages of 15 and 34 years and psychotropic medications seems to be the most frequently used. The aim of this study was to describe the demographic and clinical variables of a sample of subjects admitted to the Posisoning Treatment Centre (CAV), Niguarda General Hospital, Milan, following drug self-poisoning. Furthermore, this study is aimed to identify the risk factors associated to parasuicidal gestures, with special care for the used drugs, the presence of psychiatric or organic disorders, alcoholism and drug addiction. The study included the 201 patients attending the CAV in 1999 and 2000 who satisfied the criteria of self-poisoning attempts: 106 cases in 1999 and 95 in 2000. The sample had a prevalence of females (64%). The peak rates of parasuicides from drug self-poisoning were reached between 21 and 30 years among the females, and 31 and 40 years among the males. 81.6% of the patients used one or more psychoactive drugs, the most frequent being the benzodiazepines (58.7%), classic neuroleptics (16.9%) and new-generation antidepressants (SSRIs, SNRIs, NARIs) (12.9%). The prevalence of mood disorders was higher among females (64% vs 42%), whereas schizophrenia was more frequently diagnosed in males (22% vs 10%). 61% (33%) had a history of previous attempted suicides. The presence of clinically relevant organic diseases was observed in 24.9% of the sample. PMID:15967050

  20. Awareness and Practices of Oral Hygiene and its Relation to Sociodemographic Factors among Patients attending the General Outpatient Department in a Tertiary Care Hospital of Kolkata, India

    PubMed Central

    Paul, Bobby; Basu, Mausumi; Dutta, Sinjita; Chattopadhyay, Sita; Sinha, Debasis; Misra, Raghunath

    2014-01-01

    Background: Periodontal diseases, dental caries, malocclusion, and oral cancer are the most prevalent dental diseases affecting people in the Indian community. Objective: The study was conducted to assess the awareness and practices on oral hygiene and its association with the sociodemographic factors among patients attending the general Outpatient Department (OPD). Materials and Methods: A cross-sectional study was conducted among 224 patients attending the general OPD of the SSKM Hospital, Kolkata, India, from 1 April to 30 April, 2013. The study tool was a pre-designed and pre-tested semi-structured schedule. Results: About 69.20% of the participants used a toothbrush with toothpaste as a method of cleaning their teeth; 35.71% brushed twice in a day; 33.03% brushed both in the morning and at bedtime; and 8.93% used mouthwash. About 40.62% visited the dentist during the last six months; among them 61.18% attended because of pain. Almost three-fourth of the participants knew that tooth decay and bad breath were the effects of not cleaning the teeth. It was known to 71.42, 63.39, 70.53, and 73.21% of the respondents, respectively, that excess sweet, cold drink, alcohol, and smoking/pan chewing were bad for dental health. Television was the source of knowledge to 57.14% of the participants and 35.71% acquired their knowledge from a dentist. Females, literates, urban residents, users of mouthwash, and regular visitors to the dentist had good oral hygiene practices. Conclusion: Oral health awareness and practices among the study population are poor and need to improve. PMID:25161965

  1. Management of hospitals solid waste in Khartoum State.

    PubMed

    Saad, Suhair A Gayoum

    2013-10-01

    This research had been conducted during year 2012 to review existing data on hospital waste management for some of Khartoum town hospitals and to try to produce appropriate proposals acceptable for waste management and final treatment methods. The overall status of hospital waste management in Khartoum has been assessed through direct visits and designated questionnaires. Eight main hospitals were covered in the study with an overall bed capacity of 2,978. The current waste management practice observed at all studied hospitals was that most of waste, office, general, food, construction debris, and hazardous chemical materials were all mixed together as they are generated, collected, and finally disposed of. Only a small portion of waste in some hospitals (part of potentially infectious, body parts, and sharps) are collected separately and treated in a central incinerator. The estimated value of per bed generation rate in the studied hospitals was found to be 0.87 kg/day, which lies within the range for the low-income countries. In all studied hospitals, it was found that workers were working under very poor unsafe conditions with very low salaries ($35 to $45 per month on average). About 90 % were completely illiterate or had very low education levels. At the national level, no laws considering hospital waste, or even hazardous waste, were found; only some federal general environmental regulations and some procedures from town and city localities for controlling general municipal waste exist. At the hospital level, no policies or rules were found, except in the radiotherapy center, where they manage radioactive wastes under the laws of the Sudanese Atomic Agency. Urgent actions are needed for the remediation and prevention of hazards associated with this type of waste.

  2. Comparison of the use of liquid crystal thermometers with glass mercury thermometers in febrile children in a children's ward at Port Moresby General Hospital, Papua New Guinea.

    PubMed

    Mauta, L; Vince, J; Ripa, P

    2009-12-01

    We compared the temperatures recorded, in febrile children admitted to a children's ward at Port Moresby General Hospital, by a doctor and by a group of nurses using glass mercury thermometers (GMT) and liquid crystal thermometers (LCT, Nextemp and Traxit. The mean difference (with 95% confidence intervals) in temperatures between GMT and Nextemp were -0.12 degrees C (-0.16 degrees C to -0.08 degrees C) for the doctor and 0.12 degrees C (0.04-0.20 degrees C) for nurses. The mean difference in temperatures between GMT and Traxit were -0.05 degrees C (-0.09 degrees C to -0.01 degrees C) for the doctor and 0.19 degrees C (0.10-0.28 degrees C) for the nurses. A similar result was obtained when one of the Nextemp thermometers used in the initial study was compared with GMT on a small sample of patients by the doctor 8 months later. Limited evaluation showed nursing staff were in favour of using the LCTs. Nextemp and Traxit thermometers can be used interchangeably with GMT in this setting.

  3. [Institutional support as a method of analysis-intervention in the context of public health policies: the experience in a general hospital].

    PubMed

    Barros, Maria Elizabeth Barros de; Guedes, Carla Ribeiro; Roza, Monica Maria Raphael

    2011-12-01

    The article addresses the elaboration of a method for analysis/intervention in the sphere of public health policies. It describes the introduction of the National Humanization Policy of the Unified Health System (SUS) in a general hospital. It proposes institutional support expressed as a method for doing things that seeks the creation of group action, work process analysis and involves examining work management methods. It relies on promotion of health, which implies the production of subjects. The promotion of health is a networking process that involves individuals, work processes, knowledge and power. The challenge of supporting this network is to foster the exercise of the role of individuals and summon the inherent creative potential of life for the construction of new ways of work management that are not new forms of subjection. The study aims to show that by means of institutional support it is possible to bring to the fore the forces involved in the promotion of health and thereby summon the groups for an analysis of its implications. The effects produced indicate that this is a powerful strategy for the intervention of work processes within the scope of public health policies.

  4. Lack of knowledge about mother-to-child HIV transmission prevention in pregnant women at Tijuana General Hospital, Baja California, Mexico.

    PubMed

    Becka, Chandra M; Chacón-Cruz, Enrique; Araneta, Maria Rosario; Viani, Rolando M

    2015-01-01

    The objective of this study was to identify determinants of human immunodeficiency virus (HIV) knowledge regarding mother-to-child transmission (MTCT) among pregnant women at Tijuana General Hospital, Baja California, Mexico. Between March and November 2003, patients from the prenatal care (n = 1294) and labor and delivery (L&D) units (n = 495) participated in a cross-sectional study to measure HIV knowledge. Less than one-third (30%) knew that HIV could be transmitted to a child during delivery, and 36% knew that HIV could be transmitted by breast-feeding. Only 27% knew that an MTCT could be prevented. Prenatal patients were more likely to know that MTCT was preventable (prenatal: 31% versus L&D 25%; P = .02). Logistic regression indicated that prenatal patients (odds ratio = 1.49, confidence interval 1.07-2.07) were more likely to know that HIV could be transmitted through breast-feeding. Overall, both groups had poor knowledge regarding MTCT of HIV.

  5. Barriers and Challenges in Seeking Psychiatric Intervention in a General Hospital, by the Collaborative Child Response Unit, (A Multidisciplinary Team Approach to Handling Child Abuse) A Qualitative Analysis

    PubMed Central

    Subramaniyan, Vyjayanthi Kanugodu Srinivasa; Mital, Anukant; Rao, Chandrika; Chandra, Girish

    2017-01-01

    Child abuse is a serious criminal act against children in our country and punishable according to protection of children from sexual offenses act 2012. No one agency has the ability to respond completely to the abuse. Hence a multidisciplinary team approach was developed in India. Aim is to narrate the collaborative effort among the multiple disciplines in a general hospital to deliver child protection services and explore the barriers to integrate psychiatric services. Methodology: Members of the team were recruited from different disciplines and trained by experts. A mission statement, protocol to assess the victims and provide treatment was formulated as an algorithm. The barriers to psychiatric treatment among the stakeholders were analyzed using framework method of qualitative analysis. Results (After 20 months) the unit received 27 referrals in 20 months, 24 females, and 3 males. Age of the victims was between 8 months and 17 years. Two cases found to be physically abused. Penetrative sexual abuse was found in 23 cases, pregnant victims were 4. Most referrals were by police, trafficking found in 6 cases. Discussion: It was possible to provide multidisciplinary care to the victims and families. Recurrent themes of barriers to psychiatric treatment were stigma, victim blaming; focus on termination of pregnancy, minimization of abuse in males by stakeholders. Conclusion is collaboration needs more effort to integrate psychiatric services but can minimize the reduplication of services. PMID:28250553

  6. Female sexual dysfunction: A comparative study in drug naive 1st episode of depression in a general hospital of South Asia

    PubMed Central

    Roy, Payel; Manohar, Shivananda; Raman, Rajesh; Sathyanarayana Rao, T. S.; Darshan, M. S.

    2015-01-01

    Background: Women's sexual dysfunction is found to be highly prevalent in western and Indian literature. Limited studies are available on drug naive depression in western literature and in Indian population. Aim: To determine the prevalence rate and symptom profile of female sexual dysfunctions in patients with untreated depression. Design: A cross-sectional study in the psychiatry out-patient department of general hospital in South India. Materials and Methods: Following written informed consent female sexual functioning index (FSFI) and Arizona Sexual Experience Scale (ASEX) – female version and Hamilton Depression Rating Scale (HAMD - 17 item) on 30 cases and 30 controls was administered. Sociodemographic data, pattern and type of sexual dysfunctions were enquired. Data were analyzed using descriptive statistics, contingency co-efficient analysis and stepwise multiple regression. Results: The mean score of HAMD 17 item in study group was 19.13. The study showed that female sexual dysfunction was 70.3% in study group compared to 43.3% in control FSFI scores above 16 in HAMD had dysfunction of 76% with FSFI in study group. With ASEX-F sexual dysfunction was 73.3% in study compared to 20% in control. Scores above 16 in HAMD had 80% of sexual dysfunction with ASEX-F in study group. Conclusion: The study found that ASEX-F co-related better with HAMD 17 item. Following the onset of depression, the incidence of sexual dysfunction started at an early age in women. PMID:26600576

  7. Female Genital Mutilation in Infants and Young Girls: Report of Sixty Cases Observed at the General Hospital of Abobo (Abidjan, Cote D'Ivoire, West Africa)

    PubMed Central

    Plo, Kouie; Asse, Kouadio; Seï, Dohagneron; Yenan, John

    2014-01-01

    The practice of female genital mutilations continues to be recurrent in African communities despite the campaigns, fights, and laws to ban it. A survey was carried out in infants and young girls at the General Hospital of Abobo in Cote D'Ivoire. The purpose of the study was to describe the epidemiological aspects and clinical findings related to FGM in young patients. Four hundred nine (409) females aged from 1 to 12 years and their mothers entered the study after their consent. The results were that 60/409 patients (15%) were cut. The majority of the young females came from Muslim families (97%); the earlier age at FGM procedure in patients is less than 5 years: 87%. Amongst 409 mothers, 250 women underwent FGM which had other daughters cut. Women were mainly involved in the FGM and their motivations were virginity, chastity, body cleanliness, and fear of clitoris similar to penis. Only WHO types I and II were met. If there were no incidental events occurred at the time of the procedure, the obstetrical future of these young females would be compromised. With FGM being a harmful practice, health professionals and NGOs must unite their efforts in people education to abandon the procedure. PMID:24729789

  8. Prevalence and associated factors of anxiety and depression among patients with chronic respiratory diseases in eight general hospitals in Jiangsu Province of China: A cross-sectional study.

    PubMed

    Zhou, Xianmei; Li, Jiashu; Gu, Wei; Wang, Jian; Zhu, Yimin; Zhang, Guicai; Ding, Yuanhua; Tang, Yanfen

    2017-05-01

    Anxiety and depression are two common psychological disorders with high morbidity worldwide. Understanding of their prevalence of patients with chronic respiratory diseases is becoming more and more important for clinicians. The current study aims at investigation of the prevalence and potential risk factors of anxiety and depression among patients with chronic respiratory diseases. The psychological status, anxiety and depression, and the relevant risk factors of 1713 patients with chronic respiratory diseases from 8 general hospitals in Jiangsu Province of China were evaluated. The results showed that the patients with chronic respiratory diseases experiencing depression and anxiety accounted for 46.00% and 25.34%, respectively. Multivariate logistic regression analysis revealed that lower body mass index (BMI), sleep disorders, limitation of physical activity, and negative life events were significantly associated with an increased risk of both depressive and anxiety symptoms. Poor marital status including divorce, separation and widowerhood was markedly correlated with an increased risk of depression, and chronic pain was with anxiety symptoms, respectively. Collectively, the data demonstrated that depression and anxiety were highly prevalent among the patients with chronic respiratory diseases. It is greatly significant to take specific psychological measures to lower the incidence of depression and anxiety in these patients.

  9. Female genital mutilation in infants and young girls: report of sixty cases observed at the general hospital of abobo (abidjan, cote d'ivoire, west Africa).

    PubMed

    Plo, Kouie; Asse, Kouadio; Seï, Dohagneron; Yenan, John

    2014-01-01

    The practice of female genital mutilations continues to be recurrent in African communities despite the campaigns, fights, and laws to ban it. A survey was carried out in infants and young girls at the General Hospital of Abobo in Cote D'Ivoire. The purpose of the study was to describe the epidemiological aspects and clinical findings related to FGM in young patients. Four hundred nine (409) females aged from 1 to 12 years and their mothers entered the study after their consent. The results were that 60/409 patients (15%) were cut. The majority of the young females came from Muslim families (97%); the earlier age at FGM procedure in patients is less than 5 years: 87%. Amongst 409 mothers, 250 women underwent FGM which had other daughters cut. Women were mainly involved in the FGM and their motivations were virginity, chastity, body cleanliness, and fear of clitoris similar to penis. Only WHO types I and II were met. If there were no incidental events occurred at the time of the procedure, the obstetrical future of these young females would be compromised. With FGM being a harmful practice, health professionals and NGOs must unite their efforts in people education to abandon the procedure.

  10. [Symptomatic and asymptomatic Plasmodium falciparum infection in children from 6 months to 6 years old in the Abobo general hospital (Abidjan, Côte d'Ivoire)].

    PubMed

    Assoumou, A; Adoubryn, K D; Aboum, K S; Kouadio-Yapo, C G; Ouhon, J

    2008-02-01

    It is commonly admitted that people living in malarial zone are carrying asymptomatic Plasmodium. Côte d'Ivoire is one of these zones. The studies carried out on malaria in these areas have focused mainly on the clinical forms of the disease and effectiveness of the antimalarial drugs. The purpose of this study was to determine the prevalence of the symptomatic and asymptomatic carriage of Plasmodium falciparum in children of 6 months to 180 months old in the Abidjan area. Over a period of twelve months, 902 feverish subjects and 681 non-feverish subjects were selected among the 7,017 people admitted in the paediatrics service of the Abobo general hospital for detection of malaria parasite. Among 1,583 selected subjects, 358 were carrying Plasmodium falciparum implying a total prevalence rate of 22.6%. The prevalence rate was 13.5% and 29.5% respectively in the asymptomatic subjects and symptomatic subjects. The highest proportions of positive thick smears were observed during the long rainy and dry seasons but, parasitaemia was the highest during the short dry season. In 31.5% of the cases, the asymptomatic carriers had a parasitic density higher or equal to 10,000 trophozoites/microl of blood and fever was not related to parasitic load. The prevalence rates of Plasmodium carriage and malaria were higher during the long rainy season. This study highlighted a considerable proportion of asymptomatic Plasmodium falciparum carriers. Improving environmental conditions should help to reduce this rate of carriage.

  11. Statement of Mark R. Disler, Deputy Assistant Attorney General, Civil Rights Division, before the Committee on Labor and Human Resources, United States Senate, Concerning Grove City Legislation.

    ERIC Educational Resources Information Center

    Disler, Mark R.

    Testimony concerning the Supreme Court decisions in the case of Grove City College v. Bell (1984) is presented in this document. The Courts ruling that Federal aid to a student constitutes funding only of the college's student air program, nor the entire institution, reflected the more persuasive reading of the Title IX Education Amendments,…

  12. A Modified General Location Model for Noncompliance with Missing Data: Revisiting the New York City School Choice Scholarship Program Using Principal Stratification

    ERIC Educational Resources Information Center

    Jin, Hui; Barnard, John; Rubin, Donald B.

    2010-01-01

    Missing data, especially when coupled with noncompliance, are a challenge even in the setting of randomized experiments. Although some existing methods can address each complication, it can be difficult to handle both of them simultaneously. This is true in the example of the New York City School Choice Scholarship Program, where both the…

  13. The postindustrial decentralization of the hospital and the urban analogy.

    PubMed

    Hurley, R E

    1987-01-01

    The hospital in the United States as an institution, a community, an organizational form, and a social phenomenon shares many striking commonalities with the city. It has highly important technical functions which are accompanied, and at times overshadowed, by broader social purposes and roles. The hospital also has undergone a number of transformations over time and has experienced a distinct, if idealized, golden age fostered by key technological advances. It has been the site of significant political and social tensions and conflicts. And in recent years, it has begun to evidence a decline in social significance and standing, and a general deconcentration which further underscores the usefulness of the urban analogy. The application of an ecological perspective aids in framing this intrigui